WorldWideScience

Sample records for bypasses

  1. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  2. Coronary Artery Bypass

    Science.gov (United States)

    ... to 3 days in the Intensive Care Unit (ICU). Life After Bypass After bypass surgery, your doctor will recommend that you join a cardiac rehabilitation program. These programs help you make lifestyle changes ...

  3. Gastric bypass surgery

    Science.gov (United States)

    ... Roux-en-Y; Weight-loss surgery - gastric bypass; Obesity surgery - gastric bypass ... bypass surgery is not a quick fix for obesity. It will greatly change your lifestyle. After this surgery, you must eat healthy foods, control portion sizes of ...

  4. Flood Bypass Capacity Optimization

    Science.gov (United States)

    Siclari, A.; Hui, R.; Lund, J. R.

    2015-12-01

    Large river flows can damage adjacent flood-prone areas, by exceeding river channel and levee capacities. Particularly large floods are difficult to contain in leveed river banks alone. Flood bypasses often can efficiently reduce flood risks, where excess river flow is diverted over a weir to bypasses, that incur much less damage and cost. Additional benefits of bypasses include ecosystem protection, agriculture, groundwater recharge and recreation. Constructing or expanding an existing bypass costs in land purchase easements, and levee setbacks. Accounting for such benefits and costs, this study develops a simple mathematical model for optimizing flood bypass capacity using benefit-cost and risk analysis. Application to the Yolo Bypass, an existing bypass along the Sacramento River in California, estimates optimal capacity that economically reduces flood damage and increases various benefits, especially for agriculture. Land availability is likely to limit bypass expansion. Compensation for landowners could relax such limitations. Other economic values could affect the optimal results, which are shown by sensitivity analysis on major parameters. By including land geography into the model, location of promising capacity expansions can be identified.

  5. Bypassing damaged nervous tissue

    CERN Document Server

    Shneider, M N

    2016-01-01

    We show the principal ability of bypassing damaged demyelinated portions of nervous tissue, thereby restoring its normal function for the passage of action potentials. We carry out a theoretical analysis on the basis of the synchronization mechanism of action potential propagation along a bundle of neurons, proposed recently in [1]. And we discuss the feasibility of implement a bypass to restore damaged nervous tissue and creating an artificial neuron network.

  6. Your diet after gastric bypass surgery

    Science.gov (United States)

    Gastric bypass surgery - your diet; Obesity - diet after bypass; Weight loss - diet after bypass ... You had gastric bypass surgery. This surgery made your stomach smaller by closing off most of your stomach with staples. It changed the way your ...

  7. Bypass Flow Study

    Energy Technology Data Exchange (ETDEWEB)

    Richard Schultz

    2011-09-01

    The purpose of the fluid dynamics experiments in the MIR (Matched Index of-Refraction) flow system at Idaho National Laboratory (INL) is to develop benchmark databases for the assessment of Computational Fluid Dynamics (CFD) solutions of the momentum equations, scalar mixing, and turbulence models for the flow ratios between coolant channels and bypass gaps in the interstitial regions of typical prismatic standard fuel element (SFE) or upper reflector block geometries of typical Modular High-temperature Gas-cooled Reactors (MHTGR) in the limiting case of negligible buoyancy and constant fluid properties. The experiments use Particle Image Velocimetry (PIV) to measure the velocity fields that will populate the bypass flow study database.

  8. Heart bypass surgery - minimally invasive

    Science.gov (United States)

    ... Names Minimally invasive direct coronary artery bypass; MIDCAB; Robot-assisted coronary artery bypass; RACAB; Keyhole heart surgery; ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  9. The Best Bypass Surgery Trial

    DEFF Research Database (Denmark)

    Møller, Christian H; Jensen, Birte Østergaard; Gluud, Christian

    2007-01-01

    Recent trials suggest that off-pump coronary artery bypass grafting (OPCAB) reduces the risk of mortality and morbidity compared with conventional coronary artery bypass grafting (CCAB) using cardiopulmonary bypass. Patients with a moderate- to high-risk of complications after CCAB may have addit...

  10. Partial Ileal Bypass Undone

    NARCIS (Netherlands)

    Beynen, A.C.; Schouten, J.A.; Hoitsma, H.F.W.

    1984-01-01

    Partial ileal bypass (PIB) for the treatment of hypercholesterolaemia was introduced 20 years ago. About 110 cases have been described. We know of only 1 case of restoration of intestinal continuity; no details were given. We report here the second case of PIB in the Netherlands; the operation was r

  11. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik;

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI...

  12. Experimental laparoscopic aortobifemoral bypass.

    Science.gov (United States)

    Dion, Y M; Chin, A K; Thompson, T A

    1995-08-01

    The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass. Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor. Using this approach, we performed four aorto-bifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.

  13. Relationship of femorodistal bypass patency to clinical outcome. Iloprost Bypass International Study Group

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H;

    1999-01-01

    To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures.......To investigate the relationship between bypass patency, limb survival and clinical symptoms after femorodistal bypass procedures....

  14. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  15. Spiritual Bypass: A Preliminary Investigation

    Science.gov (United States)

    Cashwell, Craig S.; Glosoff, Harriet L.; Hammond, Cheree

    2010-01-01

    The phenomenon of spiritual bypass has received limited attention in the transpersonal psychology and counseling literature and has not been subjected to empirical inquiry. This study examines the phenomenon of spiritual bypass by considering how spirituality, mindfulness, alexithymia (emotional restrictiveness), and narcissism work together to…

  16. Cardiopulmonary bypass in pregnancy

    Directory of Open Access Journals (Sweden)

    Mukul Chandra Kapoor

    2014-01-01

    Full Text Available Cardiac surgery carried out on cardiopulmonary bypass (CPB in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women. Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB. The CPB is associated with utero-placental hypoperfusion due to a number of factors, which may translate into low fetal cardiac output, hypoxia and even death. Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status, use of perioperative fetal monitoring, optimization of CPB, delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

  17. Bypass rewiring and robustness of complex networks

    Science.gov (United States)

    Park, Junsang; Hahn, Sang Geun

    2016-08-01

    A concept of bypass rewiring is introduced, and random bypass rewiring is analytically and numerically investigated with simulations. Our results show that bypass rewiring makes networks robust against removal of nodes including random failures and attacks. In particular, random bypass rewiring connects all nodes except the removed nodes on an even degree infinite network and makes the percolation threshold 0 for arbitrary occupation probabilities. In our example, the even degree network is more robust than the original network with random bypass rewiring, while the original network is more robust than the even degree networks without random bypass. We propose a greedy bypass rewiring algorithm which guarantees the maximum size of the largest component at each step, assuming which node will be removed next is unknown. The simulation result shows that the greedy bypass rewiring algorithm improves the robustness of the autonomous system of the Internet under attacks more than random bypass rewiring.

  18. Bypass Rewiring and Robustness of Complex Networks

    CERN Document Server

    Park, Junsang

    2016-01-01

    A concept of bypass rewiring is introduced and random bypass rewiring is analytically and numerically investigated with simulations. Our results show that bypass rewiring makes networks robust against removal of nodes including random failures and attacks. Especially, random bypass rewiring connects all nodes except the removed nodes on an even degree infinite network and makes the percolation threshold $0$ for arbitrary occupation probabilities. In our example, the even degree network is more robust than the original network with random bypass rewiring while the original network is more robust than the even degree networks without random bypass. We propose a greedy bypass rewiring algorithm which guarantees the maximum size of the largest component at each step, assuming which node will be removed next is unknown. The simulation result shows that the greedy bypass rewiring algorithm improves the robustness of the autonomous system of the Internet under attacks more than random bypass rewiring.

  19. Heart bypass surgery - minimally invasive - discharge

    Science.gov (United States)

    ... invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  20. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary per

  1. Technology Solutions Case Study: Preventing Thermal Bypass

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2012-10-01

    This project highlights the importance of continuous air barriers in full alignment with insulation to prevent thermal bypasses and achieve high energy performance, and recommends use of ENERGY STAR's Thermal Bypass Inspection Checklist.

  2. Perforation in the bypassed stomach following laparoscopic Roux-en-Y gastric bypass.

    Science.gov (United States)

    Papasavas, Pavlos K; Yeaney, Woodrow W; Caushaj, Philip F; Keenan, Robert J; Landreneau, Rodney J; Gagné, Daniel J

    2003-10-01

    Access to the bypassed stomach is difficult following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The bypassed stomach is not readily available for endoscopic or radiographic evaluation. Diagnosis and treatment of peptic ulcer disease and its complications in the excluded stomach becomes difficult. We present a case of perforation in the bypassed stomach following LRYGBP secondary to peptic ulcer disease.

  3. 40 CFR 403.17 - Bypass.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true Bypass. 403.17 Section 403.17... GENERAL PRE-TREAT-MENT REGULATIONS FOR EXIST-ING AND NEW SOURCES OF POLLUTION § 403.17 Bypass. (a) Definitions. (1) Bypass means the intentional diversion of wastestreams from any portion of an Industrial...

  4. Undiagnosed phaeochromocytoma following infrainguinal bypass surgery

    DEFF Research Database (Denmark)

    Levi, N; Schroeder, T V

    1998-01-01

    We present a rare case of undiagnosed phaeochromocytoma following infrainguinal bypass surgery. The patient, a 59-year-old lady, had a one year history of hypertension following a first femoro-tibial bypass and presented as a cardiorespiratory emergency in the admission room following her...... contralateral femoro-tibial bypass. The patient recovered after some days in intensive care despite a delayed diagnosis....

  5. In situ bypass og diabetes

    DEFF Research Database (Denmark)

    Jensen, Leif Panduro; Schroeder, T V; Lorentzen, J E

    1993-01-01

    From 1986 through to 1990 a total of 483 in situ bypass procedures were performed in 444 patients. Preoperative risk-factors were equally distributed among diabetic (DM) and non-diabetic (NDM) patients, except for smoking habits (DM:48%, NDM:64%, p = 0.002) and cardiac disease (DM:45%, NDM:29%, p...

  6. Deep-water sediment bypass

    NARCIS (Netherlands)

    Stevenson, Christopher J.; Jackson, Christopher A L; Hodgson, David M.; Hubbard, Stephen M.; Eggenhuisen, Joris T.

    2015-01-01

    Submarine gravity flows are a key process for transporting large volumes of sediment from the continents to the deep sea. The location, volume, and character of the sediment bypassed by these flows dictates the areal extent and thickness of the associated deposits. Despite its importance, sediment b

  7. Bypass materials in vascular surgery

    Science.gov (United States)

    Eidt, Daniela; Roll, Stephanie; Kulp, Werner; Müller-Nordhorn, Jaqueline; Vauth, Christoph; Greiner, Wolfgang; Willich, Stefan N.; von der Schulenburg, Johann-Matthias

    2006-01-01

    Introduction Arteriosclerotic changes can lead to circulatory disturbances in various areas of the human vascular system. In addition to pharmacological therapy and the management of risk factors (e. g. hypertension, diabetes, lipid metabolism disorders, and lifestyle), surgical interventions also play an important role in the treatment of arteriosclerosis. Long-segment arterial occlusions, in particular, can be treated successfully with bypass sur-gery. A number of different materials are available for this type of operation, such as autologous vein or pros-thetic grafts comprised of polytetrafluoroethylene (PTFE) or Dacron®. Prosthetic materials are used especially in the treatment of peripheral artery disease, such as in aortoiliac or femoropopliteal bypass surgery. The present report will thus focus on this area in order to examine the effectiveness of different bypass materials. Among the efforts being made to refine the newly introduced DRG system in Germany, analysing the different bypass materials used in vascular surgery is particularly important. Indeed, in its current version the German DRG system does not distinguish between bypass materials in terms of reimbursement rates. Differences in cost structures are thus of especial interest to hospitals in their budget calculations, whereas both private and statutory health insurance funds are primarily interested in long-term results and their costs. Objectives The goal of this HTA is to compare the different bypass materials used in vascular surgery in terms of their medical efficiency and cost-effectiveness, as well as with regard to their ethical, social and legal implications. In addition, this report aims to point out the areas in which further medical, epidemiological and health economic research is still needed. Methods Relevant publications were identified by means of a structured search of databases accessed through the German Institute of Medical Documentation and Information (DIMDI), as well as by

  8. Bypass Gástrico BII.

    OpenAIRE

    Himpens, Jaques

    2014-01-01

    Hay varias técnicas de bypass gástrico para la reducción del peso, la cual se decide dependiendo de la historia, hábitos dietéticos, evaluación psicológica, estado médico, reflujo gastroesofágico, diabetes. El bypass gástrico Roux-en-Y es la única opción en 50% de los pacientes debido a reflujo, diabetes o ambas. Estos pacientes tienen ciertas características como el IMC, síndrome metabólico y diabetes. Los pacientes obesos presentan mayor resistencia a la insulina, que se encuentra regulada ...

  9. Reconnaissance Report Yolo Bypass, California

    Science.gov (United States)

    1992-03-01

    proximity of these plans, a plan for one area could not be constructed separately without creating major hydraulic impacts to the other area. In essence ...native woody species which may be commonly found include eucalyptus , acacia, giant reed, and honey locust. Yolo Bypass. In the project area, vegetation...forbs form an often dense ground cover. Non- native woody species which may be commonly found include eucalyptus , acacia, giant reed and honey locust

  10. History of cardiopulmonary bypass (CPB).

    Science.gov (United States)

    Hessel, Eugene A

    2015-06-01

    The development of cardiopulmonary bypass (CPB), thereby permitting open-heart surgery, is one of the most important advances in medicine in the 20th century. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how recently it came into use (60 years) and how much the practice of CPB has changed during its short existence. In this paper, the development of CPB and the many changes and progress that has taken place over this brief period of time, making it a remarkably safe endeavor, are reviewed. The many as yet unresolved questions are also identified, which sets the stage for the other papers in this issue of this journal.

  11. Gut hormones and gastric bypass

    DEFF Research Database (Denmark)

    Holst, Jens J.

    2016-01-01

    , oxyntomodulin, neurotensin and peptide YY (PYY). However, some proximal hormones also show changes probably reflecting that the distribution of these hormones is not restricted to the bypassed segments of the gut. Thus, cholecystokinin responses are increased, whereas gastric inhibitory polypeptide responses......%. The increased insulin responses after the operation, one of the important mechanisms whereby these operations cause diabetes remission, is clearly due to a combination of the increased glucose absorption rates and the exaggerated GLP-1 secretion. The hormonal changes are therefore very important...

  12. Epicardial ultrasound in coronary artery bypass surgery

    NARCIS (Netherlands)

    Budde, R.P.J.

    2005-01-01

    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeo

  13. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after c

  14. 30 CFR 57.19018 - Overtravel by-pass switches.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Overtravel by-pass switches. 57.19018 Section... Hoisting Hoists § 57.19018 Overtravel by-pass switches. When an overtravel by-pass switch is installed, the... switch is held in the closed position by the hoistman. The overtravel by-pass switch shall...

  15. 30 CFR 56.19018 - Overtravel by-pass switches.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Overtravel by-pass switches. 56.19018 Section... Hoisting Hoists § 56.19018 Overtravel by-pass switches. When an overtravel by-pass switch is installed, the... switch is held in the closed position by the hoistman. The overtravel by-pass switch shall...

  16. 34 CFR 76.677 - Continuation of a bypass.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Continuation of a bypass. 76.677 Section 76.677... Be Met by the State and Its Subgrantees? Procedures for Bypass § 76.677 Continuation of a bypass. The Secretary continues a bypass until the Secretary determines that the grantee or subgrantee will meet...

  17. Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Temucin Noyan Ogus

    2010-01-01

    Full Text Available Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

  18. Exhaust gas bypass valve control for thermoelectric generator

    Science.gov (United States)

    Reynolds, Michael G; Yang, Jihui; Meisner, Greogry P.; Stabler, Francis R.; De Bock, Hendrik Pieter Jacobus; Anderson, Todd Alan

    2012-09-04

    A method of controlling engine exhaust flow through at least one of an exhaust bypass and a thermoelectric device via a bypass valve is provided. The method includes: determining a mass flow of exhaust exiting an engine; determining a desired exhaust pressure based on the mass flow of exhaust; comparing the desired exhaust pressure to a determined exhaust pressure; and determining a bypass valve control value based on the comparing, wherein the bypass valve control value is used to control the bypass valve.

  19. MHD Energy Bypass Scramjet Engine

    Science.gov (United States)

    Mehta, Unmeel B.; Bogdanoff, David W.; Park, Chul; Arnold, Jim (Technical Monitor)

    2001-01-01

    Revolutionary rather than evolutionary changes in propulsion systems are most likely to decrease cost of space transportation and to provide a global range capability. Hypersonic air-breathing propulsion is a revolutionary propulsion system. The performance of scramjet engines can be improved by the AJAX energy management concept. A magneto-hydro-dynamics (MHD) generator controls the flow and extracts flow energy in the engine inlet and a MHD accelerator downstream of the combustor accelerates the nozzle flow. A progress report toward developing the MHD technology is presented herein. Recent theoretical efforts are reviewed and ongoing experimental efforts are discussed. The latter efforts also include an ongoing collaboration between NASA, the US Air Force Research Laboratory, US industry, and Russian scientific organizations. Two of the critical technologies, the ionization of the air and the MHD accelerator, are briefly discussed. Examples of limiting the combustor entrance Mach number to a low supersonic value with a MHD energy bypass scheme are presented, demonstrating an improvement in scramjet performance. The results for a simplified design of an aerospace plane show that the specific impulse of the MHD-bypass system is better than the non-MHD system and typical rocket over a narrow region of flight speeds and design parameters. Equilibrium ionization and non-equilibrium ionization are discussed. The thermodynamic condition of air at the entrance of the engine inlet determines the method of ionization. The required external power for non-equilibrium ionization is computed. There have been many experiments in which electrical power generation has successfully been achieved by magneto-hydrodynamic (MHD) means. However, relatively few experiments have been made to date for the reverse case of achieving gas acceleration by the MHD means. An experiment in a shock tunnel is described in which MHD acceleration is investigated experimentally. MHD has several

  20. Prophylactic digitalization for coronary artery bypass surgery.

    Science.gov (United States)

    Johnson, L W; Dickstein, R A; Fruehan, C T; Kane, P; Potts, J L; Smulyan, H; Webb, W R; Eich, R H

    1976-05-01

    One hundred and twenty patients undergoing aortocoronary bypass procedures were randomly placed into control and digitalized groups. All were initially in normal sinus rhythm and without evidence of congestive heart failure. Supraventricular arrhythmias occurred in 17 of 66 controls and in only three of 54 digitalized patients (P less than 0.01). There was no evidence of digitals toxicity. Based on this evidence we recommend prophylactic digitalization for patients having aortocoronary bypass operations.

  1. Monsanto may bypass NIH in microbe test.

    Science.gov (United States)

    Sun, Marjorie

    1985-01-11

    The Monsanto Company is planning to ask the Environmental Protection Agency for clearance to field test a genetically engineered microbial pesticide, bypassing the traditional approval process of the National Institutes of Health. Although only federally funded institutions are required to obtain NIH approval for genetic engineering tests, Monsanto is the first company to bypass the NIH regulatory process, which has become mired in a lawsuit brought by Jeremy Rifkin.

  2. Bypass diode for a solar cell

    Science.gov (United States)

    Rim, Seung Bum; Kim, Taeseok; Smith, David D.; Cousins, Peter J.

    2012-03-13

    Bypass diodes for solar cells are described. In one embodiment, a bypass diode for a solar cell includes a substrate of the solar cell. A first conductive region is disposed above the substrate, the first conductive region of a first conductivity type. A second conductive region is disposed on the first conductive region, the second conductive region of a second conductivity type opposite the first conductivity type.

  3. An experimental study of nerve bypass graft

    Institute of Scientific and Technical Information of China (English)

    XU Jie; LI Xue-shi

    2008-01-01

    Objective: To study the use of a nerve "bypass" graft as a possible alternative to neurolysis or segmental resection with interposition grafting in the treatment of neuroma-in-continuity. Methods: A sciatic nerve crush injury model was established in the Sprague-Dawley rat by compression with a straight hemostatic forceps. Epineurial windows were created proximal and distal to the injury site. An 8-mm segment of radial nerve was harvested and coaptated to the sciatic nerve at the epineurial window sites proximal and distal to the compressed segment (bypass group). A sciatic nerve crush injury without bypass served as a control. Nerve conduction studies were performed over an 8-week period. Sciatic nerves were then harvested and studied under transmission electron microscopy. Myelinated axon counts were obtained. Results: Nerve conduction velocity was significantly faster in the bypass group than in the control group at 8 weeks (63.57 m/s±5.83 m/s vs. 54.88 m/s±4.79m/s, P<0.01). Myelinated axon counts in distal segments were found more in the experimental sciatic nerve than in the control sciatic nerve. Significant axonal growth was noted in the bypass nerve segment itself. Conclusion: Nerve bypass may serve to augment peripheral axonal growth while avoiding further loss of the native nerve.

  4. [Simplified laparoscopic gastric bypass. Initial experience].

    Science.gov (United States)

    Hernández-Miguelena, Luis; Maldonado-Vázquez, Angélica; Cortes-Romano, Pablo; Ríos-Cruz, Daniel; Marín-Domínguez, Raúl; Castillo-González, Armando

    2014-01-01

    Antecedentes: la cirugía de la obesidad comprende diversos procedimientos gastrointestinales. El bypass gástrico en Y de Roux es el prototipo de los procedimientos mixtos y el más practicado en el mundo en sus diversas variedades. Una técnica similar y novedosa es la adoptada por Cardoso-Ramos y Galvao denominada "bypass simplificado" que rápidamente se aceptó por la mayor facilidad y resultados muy parecidos a la técnica convencional. Objetivo: describir los resultados a un año del bypass gástrico simplificado para el tratamiento de la obesidad mórbida. Material y métodos: estudio retrospectivo y descriptivo de todos los pacientes a quienes se realizó bypass gástrico de enero de 2008 a julio de 2012, en la clínica de obesidad de un hospital privado de la Ciudad de México. Resultados: se estudiaron 90 pacientes con diagnóstico de obesidad mórbida, con límites de edad de 18 y 65 años, operados para bypass gástrico simplificado. En 10% de los pacientes hubo complicaciones, las más frecuentes fueron: hemorragia y hernia interna. Durante el periodo de estudio la mortalidad fue de 0%. La pérdida de peso promedio a los 12 meses fue de 72.7%. Conclusión: el bypass gástrico simplificado laparoscópico es una cirugía segura, con buenos resultados a mediano plazo, y con una pérdida del exceso de peso adecuada en 71% de los casos.

  5. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The litera......This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines...

  6. Doppler spectral characteristics of infrainguinal vein bypasses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; von Jessen, F; Sillesen, H;

    1993-01-01

    With the aim of assessing the velocity profile of femoropopliteal and femorocrural vein bypasses, 128 patients undergoing infrainguinal vein bypass surgery entered a postoperative Duplex surveillance protocol, which included clinical assessment and Duplex scanning, using Doppler spectral analysis...... of arteriovenous fistulas the initially antegrade diastolic velocity was replaced by a retrograde flow within 3 months, whereas a forward flow in diastole was sustained in grafts with patent fistulas. Abnormal Duplex findings in 31 patients led to angiography and revision in 13 cases. Four revised grafts failed...

  7. Variable volume combustor with an air bypass system

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Thomas Edward; Ziminsky, Willy Steve; Ostebee, Heath Michael; Keener, Christopher Paul

    2017-02-07

    The present application provides a combustor for use with flow of fuel and a flow of air in a gas turbine engine. The combustor may include a number of micro-mixer fuel nozzles positioned within a liner and an air bypass system position about the liner. The air bypass system variably allows a bypass portion of the flow of air to bypass the micro-mixer fuel nozzles.

  8. 46 CFR 154.550 - Excess flow valve: Bypass.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Excess flow valve: Bypass. 154.550 Section 154.550... and Process Piping Systems § 154.550 Excess flow valve: Bypass. If the excess flow valve allowed under § 154.532(b) has a bypass, the bypass must be of 1.0 mm (0.0394 in.) or less in diameter. Cargo Hose...

  9. 21 CFR 870.4240 - Cardiopulmonary bypass heat exchanger.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass heat exchanger. 870.4240... bypass heat exchanger. (a) Identification. A cardiopulmonary bypass heat exchanger is a device, consisting of a heat exchange system used in extracorporeal circulation to warm or cool the blood...

  10. Obstructive and enteropathic syndromes after jejunoileal bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Karasick, D.; Karasick, S.

    1981-05-15

    Small bowel bypass procedures for morbid obesity have been associated with many postoperative complications. With the use of the Scott procedure, the bypassed or excluded small bowel segment has recently been the focus of 2 syndromes - 'bypass enteritis' and 'defunctioned bowel syndrome'. We describe these postoperative complications and present their significant radiologic features.

  11. 21 CFR 870.3545 - Ventricular bypass (assist) device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ventricular bypass (assist) device. 870.3545... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3545 Ventricular bypass (assist) device. (a) Identification. A ventricular bypass (assist) device is a device that...

  12. 20 CFR 631.18 - Federal by-pass authority.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Federal by-pass authority. 631.18 Section 631... Procedures § 631.18 Federal by-pass authority. (a) In the event that a State fails to submit a biennial State... Secretary's intent to exercise by-pass authority and an opportunity to request and to receive a...

  13. Bypassing BDD Construction for Reliability Analysis

    DEFF Research Database (Denmark)

    Williams, Poul Frederick; Nikolskaia, Macha; Rauzy, Antoine

    2000-01-01

    In this note, we propose a Boolean Expression Diagram (BED)-based algorithm to compute the minimal p-cuts of boolean reliability models such as fault trees. BEDs make it possible to bypass the Binary Decision Diagram (BDD) construction, which is the main cost of fault tree assessment....

  14. Robotically-Assisted Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Thierry A. Folliguet

    2010-01-01

    Full Text Available Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB, and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB grafting. Nine patients (16% were converted to open techniques. The mean total operating time for TECAB was 372±104 minutes and for MIDCAB was 220±69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50% in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.

  15. Gastric infarction following gastric bypass surgery

    Science.gov (United States)

    Do, Patrick H; Kang, Young S; Cahill, Peter

    2016-01-01

    Gastric infarction is an extremely rare occurrence owing to the stomach’s extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition. PMID:27200168

  16. Cephalic veins in coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Licht, P; Jakobsen, Erik; Lerbjerg, G;

    1996-01-01

    Various alternative conduits for aortocoronary bypass grafting have been suggested when the saphenous vein quality is inadequate. During a 10-year period we have used the cephalic vein in 39 patients. Eighteen entered an angiographic follow-up study. A total of 31 arm vein grafts were used with 4...

  17. Post-Bypass Extensive Ascites due to Splanchnic Bypass and the Effectiveness of Hyperalimentation Treatment

    Directory of Open Access Journals (Sweden)

    Veysel Temizkan

    2013-04-01

    Full Text Available Reperfusion edema may develop in the early periods of chronic ischemic tissue reperfusion. Reperfusion edema may be represented after the splanchnic bypass with ascites, abdominal distension, and liver and kidney function impairment. In this article, we are reporting the hyperalimentation treatment and its results for the common ascites and hepatorenal syndrome, after a coeliac and superior mesenteric artery bypass. [Arch Clin Exp Surg 2013; 2(2.000: 124-128

  18. Audiometric changes after coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Khorsandi M T

    2007-09-01

    Full Text Available Background: Hearing is one of the most significant senses; There fore, any defect can be frightening. The incidence of sever hearing loss following coronary artery bypass surgery has been estimated as one per thousand. This Prospective study carried out to determine hearing effects of coronary artery bypass surgery."nMethods: age, audiometric changes before and after surgery (hearing levels at multiple frequencies, speech reception threshold and speech discrimination score, minimum blood pressure during the operation, and the time on bypass, measured on One hundred consecutive patients who candidate for coronary artery bypass surgery and the results analysed."nResults: One hundred patients completed the tests. Based on hearing changes found on pre- and post-operative tests, the patients were divided into 3 groups: Those with no change (47 patients according to their audiometric results; those with slight changes ≤10 db (43 patients; and those having average deficits of more than 10 db (10 patients. All the patients were male. None of the patients had complete or severe sensorineural hearing loss. The third group had more prolonged pumping duration when compared with the others groups (p=0.002. Furthermore, 90 percent of patients with a sensorineural hearing loss more than 10 db had diabetes mellitus and hyperlipidemia as risk factors."nConclusion: Sudden sensorineural hearing loss is a sequela in patients who undergoing coronary artery bypass surgery; however, it was usually mild and asymptomatic. Pumping time during the operation is a significant factor in occurring of this complication. With proper treatment of underlying diseases and eliminating the risk factors with improvement of our cardiopulmonary pumps we probably can get better hearing results.

  19. Power turbine bypass for improved compression braking

    Energy Technology Data Exchange (ETDEWEB)

    Brooks, R.M.; Lutz, T.P.; Stang, J.

    1992-06-09

    This patent describes a turbocompound engine having a power turbine bypass control. It comprises an internal combustion engine having a crankshaft, an intake manifold and an exhaust manifold; turbocharger means connected with the intake and exhaust manifolds for converting exhaust gas energy into mechanical energy for boosting intake air pressure; power turbine means for producing mechanical energy from energy remaining in the exhaust gases exiting the first turbine.

  20. Coronary artery bypass grafting for Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

    GUO Hong-wei; CHANG Qian; XU Jian-ping; SONG Yun-hu; SUN Han-song; HU Sheng-shou

    2010-01-01

    Background Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5±0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months),clincal angina disappeared or improved. Cardiac function was in Class Ⅰ-Ⅱ (NYHA).Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

  1. Bypass systems for shared outlets. Bypass-systemen voor gemeenschappelijke afvoersystemen

    Energy Technology Data Exchange (ETDEWEB)

    Dijkhof, W.; Huijzer, E.L.; Beltman, H.A.

    1993-05-01

    In stacked buildings large pressure differences can occur when appliances with individual air supply pipes are connected to a communal outlet. This can be prevented by using a so-called bypass system, which couples the air supply pipe directly to the combustion gases outlet. In case of overpressure on the air supply of an appliance, air will be transported to the combustion gases outlet around the appliance. Descriptions are given of two GASTEC-developed indoor systems: a mechanical bypass system and an aerodynamic bypass system. The aerodynamic system has been optimized for a retrofitting boiler project in Assen, Netherlands. In this project a communal heating system has been replaced by individual central heating boilers. The appliance used was a high-efficiency boiler, the NEFIT Turbo 21. The disadvantage of the mechanical bypass system is one of the moving parts: the valve, which is too sensitive for pollution and failures. Large pressure difference reductions are possible by means of the aerodynamic bypass system. Recirculation can be prevented by high-speed injection of the combustion gases in the combustion gases outlet. 13 figs., 26 tabs., 2 appendices, 2 refs.

  2. Patient's Perception About Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Kelminda Maria Bulhões Mendonça

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: The diagnosis of coronary artery disease referred for heart surgery has an important psychological component. The purpose of this study was to access the difficulties experienced by individuals awaiting coronary artery bypass grafting and to determine strategies that facilitate adaptation to a new lifestyle, modified by the disease. METHODS: A qualitative, exploratory study involving patients admitted to a university teaching hospital in the city of Salvador, Bahia, Brazil, awaiting coronary artery bypass grafting. Semi-structured interviews were performed in accordance with a previously defined script based on the study objective. Each transcription was read in its entirety to verify the representativeness, homogeneity and pertinence of the data obtained (pre-analysis, followed by separation of categories of analysis. RESULTS: The descriptions of this study show that patients admitted to the completion of coronary artery bypass grafting experience a wide range of psychological difficulties, considering that surgery acquires interpretations that vary according to individuals' subjectivity. The patients recognized the benefit of being able to discuss their feelings as a means of diminishing their fear and anxiety. CONCLUSION: Helping patients find resources to confront more positively the daily hospitalization is an important aspect for the health care professionals who assist them. This goal can be achieved through modification of the biomedical model of care for a biopsychosocial view. The investment of time and attention is of fundamental importance and aims to overcome existing deficiencies that interfere with the outcome of patients after cardiac surgery.

  3. Atypical complications of gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, Myrosia T. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States)]. E-mail: mmitchell@radiology.bsd.uchicago.edu; Pizzitola, Victor J. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Knuttinen, M-Grace [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Robinson, Tiffany [University of Chicago, Department of Internal Medicine, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States); Gasparaitis, Arunas E. [University of Chicago, Department of Radiology, 5841 S. Maryland Avenue, MC 2026, Chicago, IL 60637 (United States)

    2005-03-01

    Although gastric bypass surgery continues to grow in popularity for weight loss and weight maintenance in the morbidly obese, there has been little attention given to the imaging of complications associated with these surgeries. The purpose of our study is to demonstrate the variety of gastric bypass surgery complications that can be identified radiographically, with attention to the more unusual complications. This study was performed with institutional Internal Review Board approval. We performed a 5-year retrospective review of all patients who had undergone gastric bypass surgery, had complications of the surgery, and had studies performed in our department to image these complications. These studies consisted of contrast fluoroscopy and CT. We identified the more common complications of anastomotic stenoses and anastomotic leaks. We also identified six unusual complications as follow: (1) internal herniation through the small bowel mesentery, (2) internal herniation through the transverse mesocolon, (3) external herniation through the abdominal wall incision, (4) enterocutaneous fistulas, (5) antiperistaltic construction of the Roux-en-Y, and (6) incorrect anstomoses of the Roux limbs resulting in a Roux-en-O configuration. Our findings show that a thorough understanding of expected postoperative bowel configuration is essential in the evaluation of these patients. In addition, fluoroscopic evaluation should assess not only anatomy, but also motility.

  4. Dynamic Experimental Study of a Multi—bypass Pulse Tube Refrigerator with Two—bypass Tubes

    Institute of Scientific and Technical Information of China (English)

    YonglinJu; ChaoWang; 等

    1998-01-01

    A dynamic experimental apparatus to measure the instantaneous velocity and pressure in the multibypass pulse tube refrigerator(MPTR) was designed and constructed.Some important experimental results of the instantaneous measurements of the velocity and the pressure in the MPTR with twobypass tubes during actual operation are prsented.The effects of the middle-bypass version on the dynamic pressure and mass flow rate at the cold end of the pulse tube are ev aluated from experimental measurements.DC-flow phenomena are observed in this MPTR.The reasons of the multi-bypass version improved the performance of pulse tube refrigertor are given.

  5. A marked increase in gastric fluid volume during cardiopulmonary bypass

    OpenAIRE

    2011-01-01

    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patie...

  6. Extra-intracranial standard bypass in the elderly

    DEFF Research Database (Denmark)

    Sandow, Nora; von Weitzel-Mudersbach, Paul; Rosenbaum, Sverre;

    2013-01-01

    Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. Due to demographic changes, an increasing number of elderly patients presents with cerebrovascular hemodynamic insufficiency. So far......, little data for EC-IC bypass surgery in elderly patients suffering occlusive cerebrovascular disease are available. We therefore designed a retrospective study to address the question whether EC-IC bypass is a safe and efficient treatment in a patient cohort ≥70 years....

  7. Endovascular exclusion of aortoesophageal fistula after coarctation extraanatomical bypass.

    Science.gov (United States)

    Myers, Patrick O; Gemayel, Gino; Mugnai, Damiano; Murith, Nicolas; Kalangos, Afksendiyos

    2014-07-01

    Extraanatomical bypass has been advocated as the primary technique in adolescents or adults presenting with aortic coarctation. This approach carries significant morbidity, and graft-related complications may be more important in the young patient population. A 52-year-old man who had previously undergone extraanatomical bypass of aortic coarctation was diagnosed with a distal anastomotic pseudoaneurysm and aortoesophageal fistula. This was managed by proximal bypass plugging with an occluder, endovascular exclusion with a stent-graft in the thoracic descending aorta covering the pseudoaneurysm, and coarctation balloon dilation. Aortoesophageal fistula is a late complication observed after extraanatomical bypass for coarctation. This case illustrates this rare complication.

  8. Hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass

    Institute of Scientific and Technical Information of China (English)

    苏肇伉; 周成斌; 张海波; 祝忠群

    2003-01-01

    Objective To study the hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass.Methods Six pregnant ewes underwent fetal cardiopulmonary bypasses with artificial oxygenators and roller pumps for 30 minutes, which maintained the blood gas value at the fetal physiological level. The fetal blood pressure, heart rate, pH value and blood lactate levels were monitored. The levels of catecholamine, cortisol and insulin were measured pre-bypass and then again 30 minutes later. The blood glucose and free fatty acid levels were monitored continuously during the bypass. Fetal hepatic PAS staining was also carried out.Results There were no changes before and during the bypass in fetal blood pressure, heart rate and blood gas. However, pH values decreased and blood lactate levels increased (P<0.05). The fetal catecholamine and cortisol levels increased significantly (P<0.01), while the levels of insulin did not change. The blood glucose and free fatty acid levels increased at the beginning of the bypass (P<0.01), and then gradually slowed down during the bypass. The fetal hepatic PAS staining showed that hepatic glycogen was consumed in large amounts. After 30 minutes of bypass, the fetal lamb would not survive more than 1 hour.Conclusion The fetal lamb has a strong negative reaction to cardiopulmonary bypass.

  9. On streak breakdown in bypass transition

    Science.gov (United States)

    Schlatter, Philipp; Brandt, Luca; de Lange, H. C.; Henningson, Dan S.

    2008-10-01

    Recent theoretical, numerical, and experimental investigations performed at the Department of Mechanics, KTH Stockholm, and the Department of Mechanical Engineering, Eindhoven University of Technology, are reviewed, and new material is presented to clarify the role of the boundary-layer streaks and their instability with respect to turbulent breakdown in bypass transition in a boundary layer subject to free-stream turbulence. The importance of the streak secondary-instability process for the generation of turbulent spots is clearly shown. The secondary instability manifests itself as a growing wave packet located on the low-speed streak, increasing in amplitude as it is dispersing in the streamwise direction. In particular, qualitative and quantitative data pertaining to temporal sinuous secondary instability of a steady streak, impulse responses both on a parallel and a spatially developing streak, a model problem of bypass transition, and full simulations and experiments of bypass transition itself are collected and compared. In all the flow cases considered, similar characteristics in terms of not only growth rates, group velocity, and wavelengths but also three-dimensional visualizations of the streak breakdown have been found. The wavelength of the instability is about an order of magnitude larger than the local boundary-layer displacement thickness δ∗, the group velocity about 0.8 of the free-stream velocity U∞, and the growth rate on the order of a few percent of U∞/δ∗. The characteristic structures at the breakdown are quasistreamwise vortices, located on the flanks of the low-speed region arranged in a staggered pattern.

  10. Work on the Geneva motorway bypass

    CERN Multimedia

    État de Genève, DCTI, Direction du génie civil

    2006-01-01

    Work on the airport section of the Geneva motorway bypass is continuing and will require the temporary closure of two sliproads allowing traffic to make a U-turn near the airport and the Palexpo exhibition centre. The sliproads on the French and Lausanne sides will be closed until autumn 2006. U-turns will still be possible via clearly marked deviations. For further information: www.autoroute-aeroport.ch We would like to thank you in advance for your understanding. Civil Engineering Department, DCTI, State of Geneva

  11. Bypass variants of Zgornji Hotič

    OpenAIRE

    Vozelj, Nejc

    2014-01-01

    In my Graduation Thesis we presented the solution of road through Zgornji Hotič. This road si daily very busy, because the road is the main connection between the capital of Slovenia and the region Zasavje. The discussed road through Zgornji Hotič is problematic because of dangerous sections of the road and nearby buildings, which lower the transportability and safety of the road. As a solution we have decided to make a bypass between the south-end of Zgornji Hotič and the river Sava. We have...

  12. Hemodynamics Simulation of Stenosed Coronary Bypass Graft

    Institute of Scientific and Technical Information of China (English)

    LIU You-jun; QIAO Aike; DU Jian-jun

    2005-01-01

    By means of FEM, the physiological blood flow in coronary bypass graft is simulated. The stenosis in coronary artery is involved in the graft model,and the deformation of graft end to allow the surgical suture with a smaller diameter coronary is taken into consideration. The flow pattern, secondary flow and wall shear stress in the vicinity of anastomosis are analyzed. It is shown that a zone of low wall stress and high wall stress gradient exists downstream the toe. The floor opposed to the anastomosis is an area of high wall stress and high wall stress gradient. Both the toe downstream and the anastomosis bottom floor are prone to intimal hyperplasia.

  13. TRAS principles blight arterial bypass and plasty.

    Directory of Open Access Journals (Sweden)

    Kothari M

    1997-04-01

    Full Text Available A new concept--Tissue Requisitions (Principle I/Relinquishes (Principle II Arterial Supply--of TRAS principles is introduced to help appreciate the failures/successes of modern medicine′s attempts at restoring arterial flow in luminally compromised coronary/carotid fields, an invasive branch rightly called vascular ReRheology, which comprises diagnosing/treating arterial blocks. The technical wizardry of arterial reconstruction (bypass or lumen--restoration (plasty has to reckon with the TRAS principles all the time.

  14. Flow characteristics in narrowed coronary bypass graft

    Science.gov (United States)

    Bernad, S. I.; Bosioc, A.; Bernad, E. S.; Petre, I.; Totorean, A. F.

    2016-06-01

    Tortuous saphenous vein graft (SVG) hemodynamics was investigated using computational fluid dynamics (CFD) techniques. Computed tomography (CT) technology is used for non-invasive bypass graft assessment 7 days after surgery. CT investigation shown two regions with severe shape remodelling first is an elbow type contortion and second is a severe curvature with tortuous area reduction. In conclusion, the helical flow induced by vessel torsion may stabilize the blood flow in the distal part of the SVG, reducing the flow disturbance and suppressing the flow separation, but in the distal end of the graft, promote the inflammatory processes in the vessels.

  15. Indications and Outcomes of Prophylactic and Therapeutic Extracranial-to-intracranial Arterial Bypass for Cerebral Revascularization

    Directory of Open Access Journals (Sweden)

    Emre Gazyakan, MD, MSc

    2015-04-01

    Conclusions: The collaboration of neurosurgeons and plastic surgeons in performing EC-IC bypass can result in excellent outcomes with a high bypass patency rate and few complications, particularly for prophylactic EC-IC bypass.

  16. Efficiency Biliopancreatic bypass surgery in bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Yu I Yashkov

    2008-06-01

    Full Text Available A clinical significance in the treatment of bulimia nervosa patients with morbid obesity had already been raised [10, 13], but we did not find publications on the effectiveness of bariatric surgery in these cases. There is also information about the possibility of applying the operation bilio-pancreatic bypass, effective in patients with morbid obesity with uncontrolled eating behavior for the treatment of patients with anorexia BILIM not suffering from morbid obesity. In this article the data of clinical observation of a small sample of patients. As a result, the treatment of these patients found that severe nervous BILIM can be seen as a latent form of morbid obesity. The choice of treatment should depend not only on the initial body weight of the patient, but also on the severity of the nervous BILIM. Unsuccessful attempts at organized-balanced, conservative treatment of patients with severe bulimia nervosa may be considered a variant of surgical treatment, while bilio-pancreatic bypass surgery is considered as the most preferred operation, compared with the installation of the gastric balloon and others. All candidates for surgical treatment of obesity must identify clinical signs of bulimia nervosa, as this may influence the choice of method of operation. Further study of the role of hyperinsulinemia, secretion of ghrelin, leptin, intestinal peptide may contribute to the elucidation of the true causes of bulimia nervosa, probably has a similar origin with morbid obesity.

  17. Previous gastric bypass surgery complicating total thyroidectomy.

    Science.gov (United States)

    Alfonso, Bianca; Jacobson, Adam S; Alon, Eran E; Via, Michael A

    2015-03-01

    Hypocalcemia is a well-known complication of total thyroidectomy. Patients who have previously undergone gastric bypass surgery may be at increased risk of hypocalcemia due to gastrointestinal malabsorption, secondary hyperparathyroidism, and an underlying vitamin D deficiency. We present the case of a 58-year-old woman who underwent a total thyroidectomy for the follicular variant of papillary thyroid carcinoma. Her history included Roux-en-Y gastric bypass surgery. Following the thyroid surgery, she developed postoperative hypocalcemia that required large doses of oral calcium carbonate (7.5 g/day), oral calcitriol (up to 4 μg/day), intravenous calcium gluconate (2.0 g/day), calcium citrate (2.0 g/day), and ergocalciferol (50,000 IU/day). Her serum calcium levels remained normal on this regimen after hospital discharge despite persistent hypoparathyroidism. Bariatric surgery patients who undergo thyroid surgery require aggressive supplementation to maintain normal serum calcium levels. Preoperative supplementation with calcium and vitamin D is strongly recommended.

  18. Haemodynamics during maximal exercise after coronary bypass surgery

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M.F. Rousseau (Francois); J. Cosyns; R. Ponlot; L.A. Brasseur; J-M.R. Detry (Jean-Marie)

    1978-01-01

    textabstractFifty patients underwent an objective measurement of physical working capacity by means of a multistage test of maximally tolerated exertion before and after coronary bypass surgery; 29 patients also had haemodynamic measurements during maximal exercise before and after coronary bypass s

  19. Renal tubular acidosis secondary to jejunoileal bypass for morbid obesity

    DEFF Research Database (Denmark)

    Schaffalitzky de Muckadell, O B; Ladefoged, Jens; Thorup, Jørgen Mogens

    1985-01-01

    Renal handling of acid and base was studied in patients with persistent metabolic acidosis 3-9 years after jejunoileal bypass for morbid obesity. Excretion of acid was studied before and after intravenous infusion of NH4Cl and excretion of bicarbonate after infusion of NaHCO3. Bypass patients...

  20. 20 CFR 631.38 - State by-pass authority.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false State by-pass authority. 631.38 Section 631.38 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE III OF THE JOB TRAINING PARTNERSHIP ACT State Administration § 631.38 State by-pass authority....

  1. Computed tomography perfusion evaluation after extracranial-intracranial bypass surgery

    NARCIS (Netherlands)

    Vos, P.C.; Riordan, A.J.; Smit, E.J.; Jong, H.W. de; Zwan, A. van der; Velthuis, B.K.; Viergever, M.A.; Dankbaar, J.W.

    2015-01-01

    OBJECTIVE: Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obt

  2. Computed tomography perfusion evaluation after extracranial-intracranial bypass surgery

    NARCIS (Netherlands)

    Vos, Pieter C.; Riordan, Alan J.; Smit, Ewoud J.; de Jong, Hugo W. A. M.; van der Zwan, Albert; Velthuis, BK; Viergever, Max A.; Dankbaar, Jan Willem

    2015-01-01

    Objective: Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obt

  3. Lower leg electrical impedance after distal bypass surgery

    DEFF Research Database (Denmark)

    Belanger, G K; Bolbjerg, M L; Heegaard, N H;

    1998-01-01

    Electrical impedance was determined in 13 patients following distal bypass surgery to evaluate lower leg oedema as reflected by its circumference. Tissue injury was assessed by the plasma concentration of muscle enzymes. After surgery, the volume of the control lower leg increased from 1250 (816...... to be a useful method for the evaluation of lower leg oedema after distal bypass surgery....

  4. Diagnostic tools for post-gastric bypass hypoglycaemia

    NARCIS (Netherlands)

    Emous, M.; Ubels, F. L.; van Beek, A. P.

    2015-01-01

    In spite of its evident success, several late complications can occur after gastric bypass surgery. One of these is post-gastric bypass hypoglycaemia. No evidence-based guidelines exist in the literature on how to confirm the presence of this syndrome. This study aims to describe and compare the tes

  5. Sen perforation af tyndtarm efter laparoskopisk gastrisk bypass

    DEFF Research Database (Denmark)

    Spanager, Lene; Sigild, Ulf Henrik; Neuenschwander, Anders Ulrich

    2010-01-01

    We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case...... bypass but as our two cases illustrate they are important to keep in mind....

  6. The in situ saphenous vein bypass graft: radiologic aspects.

    Science.gov (United States)

    Schwarz, W; Nozick, J; Richmand, D; Rodgers, B; Simpson, A; Argila, C; Honickman, S

    1986-03-01

    The use of the in situ saphenous vein for bypassing arterial occlusions in the lower extremities appears to have a higher patency rate than other bypass procedures but presents unique technical problems, such as lysing valves and occluding venous tributaries. Forty-four patients undergoing in situ bypasses had preoperative arteriograms. Special attention was paid to the small runoff vessels around the ankle, which are not suitable for reversed bypass procedures but may be adequate for in situ bypasses. Eight patients also had preoperative saphenous venograms, which revealed surgically important abnormalities in six cases. Postoperative arteriograms obtained within 2 weeks in 10 patients and within 2-12 months in 15 patients revealed persistent arteriovenous fistulas in four patients, stenoses in nine, occlusions in five, and progressive disease in the nonbypassed arteries in five patients. Early recognition of these problems led to 11 surgical repairs; nine repairs used the interventional radiologic procedures of balloon angioplasty, transcatheter embolization, and catheter thrombolysis. In this group of 44 patients, five patients died with patent bypasses and three patients required amputation despite functioning bypasses. Only four amputations were attributed to bypass failure. This low figure may be due to the close cooperation of the vascular surgeons and the vascular radiologists in dealing with these complicated cases.

  7. Dacron or PTFE for above-knee femoropopliteal bypass. a multicenter randomised study

    DEFF Research Database (Denmark)

    Jensen, L P; Lepäntalo, M; Fossdal, J E

    2007-01-01

    To compare polytetrafluorethylene (PTFE) and polyester grafts (Dacron) for above knee femoropopliteal bypass.......To compare polytetrafluorethylene (PTFE) and polyester grafts (Dacron) for above knee femoropopliteal bypass....

  8. Complement activation in coronary artery bypass grafting patients without cardiopulmonary bypass - The role of tissue injury by surgical incision

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; Boonstra, PW; Grandjean, JG; van Oeveren, W

    1999-01-01

    Study objectives: Complement activation is a trigger in inducing inflammation in patients who undergo coronary artery bypass grafting (CABG) and is usually thought to be induced by the use of cardiopulmonary bypass (CPB), In this study, we examined whether tissue injury caused by chest surgical inci

  9. A marked increase in gastric fluid volume during cardiopulmonary bypass

    Science.gov (United States)

    Hirota, Kazuyoshi; Kudo, Mihoko; Hashimoto, Hiroshi; Kushikata, Tetsuya

    2011-01-01

    Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H2 antagonist (roxatidine, cardiopulmonary bypass-H2 group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patients undergoing cardiac surgery with cardiopulmonary bypass, and also compared in patients undergoing a off-pump coronary artery bypass graft surgery (off-pump cardiopulmonary bypass-H2 group, n = 15). Gastric pH (5.14 ± 0.61) and gastric fluid volume (13.2 ± 2.4 mL) at the end of surgery in off-pump cardiopulmonary bypass-H2 groups was significantly lower and higher than those in both cardiopulmonary bypass-H2 (6.25 ± 0.54, 51.3 ± 8.0 mL) and cardiopulmonary bypass-PPI (7.29 ± 0.13, 63.5 ± 14.8 mL) groups, respectively although those variables did not differ between groups after the induction of anesthesia. Plasma gastrin (142 ± 7 pg/mL) at the end of surgery and maximal blood lactate levels (1.50 ± 0.61 mM) in off-pump cardiopulmonary bypass-H2 group were also significantly lower than those in both cardiopulmonary bypass-H2 (455 ± 96 pg/mL, 3.97 ± 0.80 mM) and cardiopulmonary bypass-PPI (525 ± 27 pg/mL, 3.15 ± 0.44 mM) groups, respectively. In addition, there was a significant correlation between gastric fluid volume and maximal blood lactate (r = 0.596). In conclusion, cardiopulmonary bypass may cause an increase in gastric fluid volume which neither H2 antagonist nor PPI suppresses. A significant correlation between gastric fluid volume and maximal blood lactate suggests that gastric fluid volume may predict degree of gastrointestinal tract hypoperfusion. PMID:21765601

  10. Bypass technology enhances the efficiency of wind power plants; Bypass-Technologie erhoeht WEA-Effizienz

    Energy Technology Data Exchange (ETDEWEB)

    Ebach, Thorsten [EKS Engel GmbH und Co. KG, Wenden (Germany)

    2013-04-01

    A reliable operation of wind power parks significantly depends on a trouble-free data communication. If one or more network participants break down, then it depends on the topology whether the complete power distribution system is available or not. An optical bypass such as it is supplied by EKS Engel GmbH and Co. KG (Wenden, Federal Republic of Germany) offers a remedial action.

  11. Emergent cardiopulmonary bypass during pectus excavatum repair

    Directory of Open Access Journals (Sweden)

    Ryan Craner

    2013-01-01

    Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

  12. Transient Diabetes Insipidus Following Cardiopulmonary Bypass.

    Science.gov (United States)

    Ekim, Meral; Ekim, Hasan; Yilmaz, Yunus Keser; Bolat, Ali

    2015-04-01

    Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

  13. Current status of coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin

    2009-01-01

    @@ Surgical revascularization for atherosclerotic heart disease, also called coronary artery bypass grafting (CABG), was first performed in 1962, and is one of the great achievements in medicine. Relief of angina, improvement of exercise tolerance, and the realization of survival benefit have been documented.1 CABG has been used in multi-vessel disease and left main stenosis for over 40 years.2 In the last two decades the mortality of CABG has decreased to less than 2% despite an aging population with increased risk factors. However, percutaneous coronary intervention (PCI), especially with drug-eluting stents, has been challenging CABG, While PCI has improved, CABG has also progressed with better peri-operative management, a higher use of arterial grafting, off-pump surgery, and improved techniques with minimally invasive surgical options.3,4

  14. CFD Analysis of Core Bypass Phenomena

    Energy Technology Data Exchange (ETDEWEB)

    Richard W. Johnson; Hiroyuki Sato; Richard R. Schultz

    2009-11-01

    The U.S. Department of Energy is exploring the potential for the VHTR which will be either of a prismatic or a pebble-bed type. One important design consideration for the reactor core of a prismatic VHTR is coolant bypass flow which occurs in the interstitial regions between fuel blocks. Such gaps are an inherent presence in the reactor core because of tolerances in manufacturing the blocks and the inexact nature of their installation. Furthermore, the geometry of the graphite blocks changes over the lifetime of the reactor because of thermal expansion and irradiation damage. The existence of the gaps induces a flow bias in the fuel blocks and results in unexpected increase of maximum fuel temperature. Traditionally, simplified methods such as flow network calculations employing experimental correlations are used to estimate flow and temperature distributions in the core design. However, the distribution of temperature in the fuel pins and graphite blocks as well as coolant outlet temperatures are strongly coupled with the local heat generation rate within fuel blocks which is not uniformly distributed in the core. Hence, it is crucial to establish mechanistic based methods which can be applied to the reactor core thermal hydraulic design and safety analysis. Computational Fluid Dynamics (CFD) codes, which have a capability of local physics based simulation, are widely used in various industrial fields. This study investigates core bypass flow phenomena with the assistance of commercial CFD codes and establishes a baseline for evaluation methods. A one-twelfth sector of the hexagonal block surface is modeled and extruded down to whole core length of 10.704m. The computational domain is divided vertically with an upper reflector, a fuel section and a lower reflector. Each side of the one-twelfth grid can be set as a symmetry boundary

  15. CFD Analysis of Core Bypass Phenomena

    Energy Technology Data Exchange (ETDEWEB)

    Richard W. Johnson; Hiroyuki Sato; Richard R. Schultz

    2010-03-01

    The U.S. Department of Energy is exploring the potential for the VHTR which will be either of a prismatic or a pebble-bed type. One important design consideration for the reactor core of a prismatic VHTR is coolant bypass flow which occurs in the interstitial regions between fuel blocks. Such gaps are an inherent presence in the reactor core because of tolerances in manufacturing the blocks and the inexact nature of their installation. Furthermore, the geometry of the graphite blocks changes over the lifetime of the reactor because of thermal expansion and irradiation damage. The existence of the gaps induces a flow bias in the fuel blocks and results in unexpected increase of maximum fuel temperature. Traditionally, simplified methods such as flow network calculations employing experimental correlations are used to estimate flow and temperature distributions in the core design. However, the distribution of temperature in the fuel pins and graphite blocks as well as coolant outlet temperatures are strongly coupled with the local heat generation rate within fuel blocks which is not uniformly distributed in the core. Hence, it is crucial to establish mechanistic based methods which can be applied to the reactor core thermal hydraulic design and safety analysis. Computational Fluid Dynamics (CFD) codes, which have a capability of local physics based simulation, are widely used in various industrial fields. This study investigates core bypass flow phenomena with the assistance of commercial CFD codes and establishes a baseline for evaluation methods. A one-twelfth sector of the hexagonal block surface is modeled and extruded down to whole core length of 10.704m. The computational domain is divided vertically with an upper reflector, a fuel section and a lower reflector. Each side of the sector grid can be set as a symmetry boundary

  16. Alongshore sediment bypassing as a control on river mouth morphodynamics

    Science.gov (United States)

    Nienhuis, Jaap H.; Ashton, Andrew D.; Nardin, William; Fagherazzi, Sergio; Giosan, Liviu

    2016-04-01

    River mouths, shoreline locations where fluvial and coastal sediments are partitioned via erosion, trapping, and redistribution, are responsible for the ultimate sedimentary architecture of deltas and, because of their dynamic nature, also pose great management and engineering challenges. To investigate the interaction between fluvial and littoral processes at wave-dominated river mouths, we modeled their morphologic evolution using the coupled hydrodynamic and morphodynamic model Delft3D-SWAN. Model experiments replicate alongshore migration of river mouths, river mouth spit development, and eventual spit breaching, suggesting that these are emergent phenomena that can develop even under constant fluvial and wave conditions. Furthermore, we find that sediment bypassing of a river mouth develops though feedbacks between waves and river mouth morphology, resulting in either continuous bypassing pathways or episodic bar bypassing pathways. Model results demonstrate that waves refracting into the river mouth bar create a zone of low alongshore sediment transport updrift of the river mouth, which reduces sediment bypassing. Sediment bypassing, in turn, controls the river mouth migration rate and the size of the river mouth spit. As a result, an intermediate amount of river discharge maximizes river mouth migration. The fraction of alongshore sediment bypassing can be predicted from the balance between the jet and the wave momentum flux. Quantitative comparisons show a match between our modeled predictions of river mouth bypassing and migration rates observed in natural settings.

  17. Seasonal Variation of Climatological Bypassing Flows around the Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    LI Qiang; ZHANG Renhe

    2012-01-01

    The present study investigated diagnostically the seasonal variation of the bypassing flows caused by the splitting effect of the Tibetan Plateau (TP).The relationships among the splitting bypassing flows around the TP to precipitation in China,the westerly jet stream,and the thermal status over the TP are revealed.The bypassing flows occur from the 1st to the 22nd pentad and from the 59th to the 73rd pentad,respectively,and they disappear from the 29th to the 58th pentad.They are strongest in winter from the 1st to the 22nd pentad and from the 59th to the 73rd pentad,respectively.During the rebuilding of the bypassing flows from mid-October to mid-February,they are the main cause of precipitation over southeastern China.The enhancement of the bypassing flow intensity in March cau cause the precipitation to increase in the early stage of the persistent spring rain over southeastern China.From winter to summer,the seasonal transition of the bypassing flows in the lower troposphere precedes that of the westerly jet stream axis in the upper troposphere to the west of the TP by ~4 pentads,while from summer to winter lags by ~4 pentads.The seasonal variation of the thermal status over the TP plays an important role in the bypassing flows around the TP.The strengthening of the heating over the TP weakens the bypassing flows,and the increase in cooling over the TP is related to the rebuilding and strengthening of the bypassing flows.

  18. Asendan Desendan Aortic Bypass: Atan Kalpte Mediyan Sternotomi Yoluyla Onarim

    Directory of Open Access Journals (Sweden)

    Muhammet Akyuz

    2013-10-01

    Full Text Available We report the case of a 9-month-old patient presenting for redo aortic arch surgery because of recoarctation. In present case, ascending-to-descending aortic bypass via median sternotomy was performed without cardiopulmonary bypass with good result. In spite of the fact that the different surgical and intervention treatment options of aortic coarctation are quite satisfactory, a certain group of patients need reoperation because of recoarctation. The recoarctation repair of the aorta with the extra-anatomic aortic bypass is considered a low-risk procedure with high success rate.

  19. 34 CFR 300.198 - Continuation of a by-pass.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Continuation of a by-pass. 300.198 Section 300.198... CHILDREN WITH DISABILITIES State Eligibility By-Pass for Children in Private Schools § 300.198 Continuation of a by-pass. The Secretary continues a by-pass until the Secretary determines that the SEA, LEA...

  20. 34 CFR 300.192 - Notice of intent to implement a by-pass.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Notice of intent to implement a by-pass. 300.192... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility By-Pass for Children in Private Schools § 300.192 Notice of intent to implement a by-pass. (a) Before taking any final action to implement a by-pass,...

  1. 34 CFR 300.191 - Provisions for services under a by-pass.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Provisions for services under a by-pass. 300.191... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility By-Pass for Children in Private Schools § 300.191 Provisions for services under a by-pass. (a) Before implementing a by-pass, the Secretary consults...

  2. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy

    DEFF Research Database (Denmark)

    Patti, M E; McMahon, G; Mun, E C;

    2005-01-01

    was assessed in all three patients. RESULTS: All three patients had evidence of severe postprandial hyperinsulinaemia and hypoglycaemia. In one patient, reversal of gastric bypass was ineffective in reversing hypoglycaemia. All three patients ultimately required partial pancreatectomy for control...

  3. [Psychoprophylaxis in patients after coronary artery bypass graft operations].

    Science.gov (United States)

    Rymaszewska, Joanna; Chładzińska-Kiejna, Sylwia; Górna, Renata; Kustrzycki, Wojciech

    2004-05-01

    The paper presented problems of quality of life and psychosocial functioning of patients following coronary artery bypass grafting operations. Possibilities of psychoprophylactic effects towards these patients and its efficacy were described.

  4. Value of Optical Bypass in Packet Ring Networks

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    This paper firstly examines the value of optical bypass scheme in packet ring networks. An Integer Linear Program (ILP) formulation is presented and analytical results under different traffic patterns are given.

  5. Oil Bypass Filter Technology Performance Evaluation - January 2003 Quarterly Report

    Energy Technology Data Exchange (ETDEWEB)

    Laurence R. Zirker; James E. Francfort

    2003-01-01

    This report details the initial activities to evaluate the performance of the oil bypass filter technology being tested by the Idaho National Engineering and Environmental Laboratory (INEEL) for the U.S. Department of Energy's FreedomCAR & Vehicle Technologies Program. Eight full-size, four-cycle diesel-engine buses used to transport INEEL employees on various routes have been equipped with oil bypass systems from the puraDYN Corporation. Each bus averages about 60,000 miles a year. The evaluation includes an oil analysis regime to monitor the presence of necessary additives in the oil and to detect undesirable contaminants. Very preliminary economic analysis suggests that the oil bypass system can reduce life-cycle costs. As the evaluation continues and oil avoidance costs are quantified, it is estimated that the bypass system economics may prove increasingly favorable, given the anticipated savings in operational costs and in reduced use of oil and waste oil avoidance.

  6. Oil Bypass Filter Technology Performance Evaluation - First Quarterly Report

    Energy Technology Data Exchange (ETDEWEB)

    Zirker, L.R.; Francfort, J.E.

    2003-01-31

    This report details the initial activities to evaluate the performance of the oil bypass filter technology being tested by the Idaho National Engineering and Environmental Laboratory (INEEL) for the U.S. Department of Energy's FreedomCAR & Vehicle Technologies Program. Eight full-size, four-cycle diesel-engine buses used to transport INEEL employees on various routes have been equipped with oil bypass systems from the puraDYN Corporation. Each bus averages about 60,000 miles a year. The evaluation includes an oil analysis regime to monitor the presence of necessary additives in the oil and to detect undesirable contaminants. Very preliminary economic analysis suggests that the oil bypass system can reduce life-cycle costs. As the evaluation continues and oil avoidance costs are quantified, it is estimated that the bypass system economics may prove increasingly favorable, given the anticipated savings in operational costs and in reduced use of oil and waste oil avoidance.

  7. Prolonged successful therapy for hyperinsulinaemic hypoglycaemia after gastric bypass

    DEFF Research Database (Denmark)

    Myint, K S; Greenfield, J R; Farooqi, I S;

    2012-01-01

    Spontaneous hyperinsulinaemic hypoglycaemia following gastric bypass surgery (GBS) is increasingly recognised. However, its pathophysiology remains unclear. Some patients require pancreatectomy. Medical therapy with calcium channel blockers, acarbose and diazoxide has been reported to be beneficial...

  8. Antiplatelet therapy at the time of coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Kremke, Michael; Tang, Mariann; Bak, Mikkel;

    2013-01-01

    OBJECTIVES: The purpose of this multicentre cohort study was to examine the relationship between antiplatelet therapy (APT) at the time of coronary artery bypass grafting (CABG) and postoperative bleeding complications, transfusion requirements and adverse cardiovascular events. METHODS: A matched...

  9. Canals, Bypass Canal, Published in 2002, Duchesne County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Canals dataset, was produced all or in part from Other information as of 2002. It is described as 'Bypass Canal'. Data by this publisher are often provided in...

  10. Palliative surgical bypass for unresectable periampullar y carcinoma

    Institute of Scientific and Technical Information of China (English)

    Shivendra Singh; Ajay Kumar Sachdev; Adarsh Chaudhary; Anil Kumar Agarwal

    2008-01-01

    BACKGROUND:Around 60% to 80% of patients with periampullary carcinoma are unresectable either due to distant metastasis or local vascular invasion. With the advancement of endoscopic interventional procedures, the role of surgical bypass has diminished. However, surgical bypass is still appropriate in patients with unresectable disease discovered at the time of surgery. This study was conducted to assess the results of palliative surgical bypass for patients with unresectable periampullary carcinoma at our hospital, a tertiary referral center of Northern India. METHOD:The study group comprised 204 patients who had undergone surgical bypass for advanced periampullary carcinoma over the last 15 years. RESULTS:Between January 1990 and December 2004, 204 patients (128 males, 76 females) consisting of 179 patients with carcinoma of head of the pancreas, 14 patients with ampullary carcinoma, 8 patients with lower end cholangiocarcinoma and 3 patients with duodenal carcinoma underwent surgical bypass. Their average age was 51 years (range 20-78 years). Both biliary and gastric bypasses were done in 158 (77.45%), biliary bypass alone in 37 (18.13%), and gastric bypass alone in 9 (4.32%). Biliary bypass was done by Roux-en-Y hepaticojejunostomy, and gastric bypass by retrocolic gastrojejunostomy. The overall postoperative mortality and morbidity were 0.98%and 26.9%, respectively. The patients who died had undergone previously endoscopic intervention. Complications included wound infection in 12.25% of the patients, bile leak in 5.12%, delayed gastric emptying in 5.38%, ascitic leak from drains in 8.8%, and upper gastrointestinal bleeding in 1.96%. The incidences of wound infection and bile leak both were signiifcantly higher in patients who had had preoperative biliary stenting. None of the patients who had undergone Roux-en-Y hepati-cojejunostomy+retrocolic gastrojejunostomy required any intervention later in their life. CONCLUSIONS:Surgical bypass is a safe procedure with

  11. Night Blindness and Vitamin A Deficiency following Jejunoilieal Bypass Surgery

    OpenAIRE

    Adams, Paul C; Canny, Christopher L.

    1989-01-01

    A 42-year-old man who developed severe night blindness 15 years following jejunoileal bypass surgery for morbid obesity is described. Ophthamological testing, including dark adaptation, electroretinography and serum vitamin A levels, confirmed a diagnosis of vitamin A deficiency. Oral vitamin A 25,000 iu/day for two months resulted in a full recovery of visual deficits. Nutritional vitamin A deficiency is discussed in the context of intestinal bypass surgery.

  12. Severe peripheral neuropathy following gastric bypass surgery for morbid obesity.

    OpenAIRE

    Maryniak, O.

    1984-01-01

    Severe weakness in the limbs developed in a young woman 3 1/2 months after successful gastric bypass surgery for morbid obesity. Electromyography confirmed the clinical impression of generalized axonal polyneuropathy. Vitamin B replacement therapy was started. The gastric bypass was not reversed, and the patient continued to lose weight while undergoing rehabilitation. After 10 months she had almost fully recovered. Her total weight loss was 76 kg. Neuropathy is an uncommon but serious compli...

  13. Association of sex with patency of femorodistal bypass grafts

    DEFF Research Database (Denmark)

    Watson, H R; Schroeder, T V; Simms, M H;

    2000-01-01

    There is evidence for superior patency in infra-inguinal bypass procedures in men compared to women. A large, prospectively planned series was investigated in order to confirm this finding and to determine the origin of this difference in outcome.......There is evidence for superior patency in infra-inguinal bypass procedures in men compared to women. A large, prospectively planned series was investigated in order to confirm this finding and to determine the origin of this difference in outcome....

  14. Bypass Selection for Control of Heat Exchanger Network

    Institute of Scientific and Technical Information of China (English)

    SUN Lin; LUO Xionglin; HOU Benquan; BAI Yujie

    2013-01-01

    Considering the flexibility and controllability of heat exchanger networks (HENs),bypasses are widely used for effective control of process stream target temperatures.However,the optimal location for the bypass is generally difficult to design with the trade-off between controllability and capital investments.In this paper,based on the steady-state model of heat exchanger networks the optimal bypass location was firstly selected by iteratively calculating the non-square Relative Gain Array (ns-RGA).To simplify the calculation process,rules of bypass selection were also proposed.In order to evaluate this method,then,the structural controllability of heat exchanger networks was analyzed.With both the consideration of the controllability and capital investments,the bypasses locations were finally selected.A case study on the HEN in Crude Distillation Unit was presented in which the ns-RGA and structural controllability were used to select bypasses and also to evaluate the results.

  15. One-dimensional Arterial Network Model for Bypass Grafts Assessment

    CERN Document Server

    Ghigo, Arthur; Wang, Xiaofei; Lagrée, Pierre-Yves; Fullana, Jose-Maria

    2016-01-01

    We propose an arterial network model based on 1D blood hemodynamic equations to study the behavior of different vascular surgical bypass grafts in case of an arterial occlusive pathology: an obliteration or stenosis of the iliac artery. We investigate the performances of three different bypass grafts (Aorto-Femoral, Axillo-Femoral and cross-over Femoral) depending on the degree of obliteration of the stenosis. Numerical simulations show that all bypass grafts are efficient since we retrieve in all cases the normal hemodynamics in the stenosed region while ensuring at the same time a global healthy circulation. We analyze in particular the Axillo-Femoral bypass graft by performing hundreds of simulations by varying the values of the Young's modulus [0.1--50 MPa] and the radius [0.01--5 cm] of the bypass graft. We show that the Young's modulus and radius of commercial bypass grafts are optimal in terms of hemodynamic considerations. The numerical findings prove that this approach could be used to optimize or pl...

  16. Progress on Complications of Direct Bypass for Moyamoya Disease

    Science.gov (United States)

    Yu, Jinlu; Shi, Lei; Guo, Yunbao; Xu, Baofeng; Xu, Kan

    2016-01-01

    Moyamoya disease (MMD) involves progressive occlusion of the intracranial internal carotid artery resulting in formation of moyamoya-like vessels at the base of the brain. It can be characterized by hemorrhage or ischemia. Direct vascular bypass is the main and most effective treatment of MMD. However, patients with MMD differ from those with normal cerebral vessels. MMD patients have unstable intracranial artery hemodynamics and a poor blood flow reserve; therefore, during the direct bypass of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, perioperative risk factors and anesthesia can affect the hemodynamics of these patients. When brain tissue cannot tolerate a high blood flow rate, it becomes prone to hyperperfusion syndrome, which leads to neurological function defects and can even cause intracranial hemorrhage in severe cases. The brain tissue is prone to infarction when hemodynamic equilibrium is affected. In addition, bypass vessels become susceptible to occlusion or atrophy when blood resistance increases. Even compression of the temporalis affects bypass vessels. Because the STA is used in MMD surgery, the scalp becomes ischemic and is likely to develop necrosis and infection. These complications of MMD surgery are difficult to manage and are not well understood. To date, no systematic studies of the complications that occur after direct bypass in MMD have been performed, and reported complications are hidden among various case studies; therefore, this paper presents a review and summary of the literature in PubMed on the complications of direct bypass in MMD. PMID:27499690

  17. Progress on Complications of Direct Bypass for Moyamoya Disease.

    Science.gov (United States)

    Yu, Jinlu; Shi, Lei; Guo, Yunbao; Xu, Baofeng; Xu, Kan

    2016-01-01

    Moyamoya disease (MMD) involves progressive occlusion of the intracranial internal carotid artery resulting in formation of moyamoya-like vessels at the base of the brain. It can be characterized by hemorrhage or ischemia. Direct vascular bypass is the main and most effective treatment of MMD. However, patients with MMD differ from those with normal cerebral vessels. MMD patients have unstable intracranial artery hemodynamics and a poor blood flow reserve; therefore, during the direct bypass of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, perioperative risk factors and anesthesia can affect the hemodynamics of these patients. When brain tissue cannot tolerate a high blood flow rate, it becomes prone to hyperperfusion syndrome, which leads to neurological function defects and can even cause intracranial hemorrhage in severe cases. The brain tissue is prone to infarction when hemodynamic equilibrium is affected. In addition, bypass vessels become susceptible to occlusion or atrophy when blood resistance increases. Even compression of the temporalis affects bypass vessels. Because the STA is used in MMD surgery, the scalp becomes ischemic and is likely to develop necrosis and infection. These complications of MMD surgery are difficult to manage and are not well understood. To date, no systematic studies of the complications that occur after direct bypass in MMD have been performed, and reported complications are hidden among various case studies; therefore, this paper presents a review and summary of the literature in PubMed on the complications of direct bypass in MMD.

  18. Post-gastric bypass hypoglycaemia: a review.

    Science.gov (United States)

    Shantavasinkul, Prapimporn C; Torquati, Alfonso; Corsino, Leonor

    2016-07-01

    Bariatric surgery is a highly effective treatment for severe obesity, resulting in substantial weight loss and normalizing obesity-related comorbidities. However, long-term consequences can occur, such as postbariatric surgery hypoglycaemia. This is a challenging medical problem, and the number of patients presenting with it has been increasing. Roux-en-Y gastric bypass (RYGB) is the most popular bariatric procedure, and it is the surgery most commonly associated with the development of postbariatric surgery hypoglycaemia. To date, the pathogenesis of this condition has not been completely established. However, various factors - particularly increased postprandial glucagon-like peptide (GLP)-1 secretion - have been considered as crucial mediator. The mechanisms responsible for diabetic remission after bariatric surgery may be responsible for the development of hypoglycaemia, which typically occurs 1-3 h after a meal and is concurrent with inappropriate hyperinsulinaemia. Carbohydrate-rich foods usually provoke hypoglycaemic symptoms, which can typically be alleviated by strict dietary modifications, including carbohydrate restriction and avoidance of high glycaemic index foods and simple sugars. Few patients require further medical intervention, such as medications, but some patients have required a pancreatectomy. Because this option is not always successful, it is no longer routinely recommended. Clinical trials are needed to further determine the pathophysiology of this condition as well as the best diagnostic and treatment approaches for these patients.

  19. Current status of mini-gastric bypass

    Science.gov (United States)

    Mahawar, Kamal K.; Kumar, Parveen; Carr, William RJ; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K.

    2016-01-01

    Mini-gastric bypass (MGP) is a promising bariatric procedure. Tens of thousands of this procedure have been performed throughout the world since Rutledge performed the first procedure in the United States of America in 1997. Several thousands of these have even been documented in the published scientific literature. Despite a proven track record over nearly two decades, this operation continues to polarise the bariatric community. A large number of surgeons across the world have strong objections to this procedure and do not perform it. The risk of symptomatic (bile) reflux, marginal ulceration, severe malnutrition, and long-term risk of gastric and oesophageal cancers are some of the commonly voiced concerns. Despite these expressed fears, several advantages such as technical simplicity, shorter learning curve, ease of revision and reversal, non-inferior weight loss and comorbidity resolution outcomes have prompted some surgeons to advocate a wider adoption of this procedure. This review examines the current status of these controversial aspects in the light of the published academic literature in English. PMID:27251826

  20. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  1. Current status of mini-gastric bypass

    Directory of Open Access Journals (Sweden)

    Kamal K Mahawar

    2016-01-01

    Full Text Available Mini-gastric bypass (MGP is a promising bariatric procedure. Tens of thousands of this procedure have been performed throughout the world since Rutledge performed the first procedure in the United States of America in 1997. Several thousands of these have even been documented in the published scientific literature. Despite a proven track record over nearly two decades, this operation continues to polarise the bariatric community. A large number of surgeons across the world have strong objections to this procedure and do not perform it. The risk of symptomatic (bile reflux, marginal ulceration, severe malnutrition, and long-term risk of gastric and oesophageal cancers are some of the commonly voiced concerns. Despite these expressed fears, several advantages such as technical simplicity, shorter learning curve, ease of revision and reversal, non-inferior weight loss and comorbidity resolution outcomes have prompted some surgeons to advocate a wider adoption of this procedure. This review examines the current status of these controversial aspects in the light of the published academic literature in English.

  2. SUrgical versus PERcutaneous Bypass: SUPERB-trial; Heparin-bonded endoluminal versus surgical femoro-popliteal bypass: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Lensvelt, M.M.A.; Holewijn, S.; Fritschy, W.M.; Wikkeling, O.R.; Walraven, L.A. van; Wallis de Vries, B.M.; Zeebregts, C.J.A.; Reijnen, M.M.P.J.

    2011-01-01

    BACKGROUND: Endovascular treatment options for the superficial femoral artery are evolving rapidly. For long lesions, the venous femoropopliteal bypass considered to be superior above the prosthetic bypass. An endoluminal bypass, however, may provide equal patency rates compared to the prosthetic ab

  3. SUrgical versus PERcutaneous Bypass : SUPERB-trial; Heparin-bonded endoluminal versus surgical femoro-popliteal bypass: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Lensvelt, Mare M. A.; Holewijn, Suzanne; Fritschy, Wilbert M.; Wikkeling, Otmar R. M.; van Walraven, Laurens A.; de Vries, Bas M. Wallis; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    2011-01-01

    Background: Endovascular treatment options for the superficial femoral artery are evolving rapidly. For long lesions, the venous femoropopliteal bypass considered to be superior above the prosthetic bypass. An endoluminal bypass, however, may provide equal patency rates compared to the prosthetic ab

  4. Annular MHD Physics for Turbojet Energy Bypass

    Science.gov (United States)

    Schneider, Steven J.

    2011-01-01

    The use of annular Hall type MHD generator/accelerator ducts for turbojet energy bypass is evaluated assuming weakly ionized flows obtained from pulsed nanosecond discharges. The equations for a 1-D, axisymmetric MHD generator/accelerator are derived and numerically integrated to determine the generator/accelerator performance characteristics. The concept offers a shockless means of interacting with high speed inlet flows and potentially offers variable inlet geometry performance without the complexity of moving parts simply by varying the generator loading parameter. The cycle analysis conducted iteratively with a spike inlet and turbojet flying at M = 7 at 30 km altitude is estimated to have a positive thrust per unit mass flow of 185 N-s/kg. The turbojet allowable combustor temperature is set at an aggressive 2200 deg K. The annular MHD Hall generator/accelerator is L = 3 m in length with a B(sub r) = 5 Tesla magnetic field and a conductivity of sigma = 5 mho/m for the generator and sigma= 1.0 mho/m for the accelerator. The calculated isentropic efficiency for the generator is eta(sub sg) = 84 percent at an enthalpy extraction ratio, eta(sub Ng) = 0.63. The calculated isentropic efficiency for the accelerator is eta(sub sa) = 81 percent at an enthalpy addition ratio, eta(sub Na) = 0.62. An assessment of the ionization fraction necessary to achieve a conductivity of sigma = 1.0 mho/m is n(sub e)/n = 1.90 X 10(exp -6), and for sigma = 5.0 mho/m is n(sub e)/n = 9.52 X 10(exp -6).

  5. Photovoltaic-module bypass-diode encapsulation. Annual report

    Energy Technology Data Exchange (ETDEWEB)

    1983-06-20

    The design and processing techniques necessary to incorporate bypass diodes within the module encapsulant are presented in this annual report. A comprehensive survey of available pad-mounted PN junction and Schottky diodes led to the selection of Semicon PN junction diode cells for this application. Diode junction-to-heat spreader thermal resistance measurements, performed on a variety of mounted diode chip types and sizes, have yielded values which are consistently below 1/sup 0/C per watt, but show some instability when thermally cycled over the temperature range from -40 to 150/sup 0/C. Based on the results of a detailed thermal analysis, which covered the range of bypass currents from 2 to 20 amperes, three representative experimental modules, each incorporating integral bypass diode/heat spreader assemblies of various sizes, were designed and fabricated. Thermal testing of these modules has enabled the formation of a recommended heat spreader plate sizing relationship. The production cost of three encapsulated bypass diode/heat spreader assemblies were compared with similarly rated externally-mounted packaged diodes. An assessment of bypass diode reliability, which relies heavily on rectifying diode failure rate data, leads to the general conclusion that, when proper designed and installed, these devices will improve the overall reliability of a terrestrial array over a 20 year design lifetime.

  6. Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass

    Science.gov (United States)

    Salameh, Aida; Dhein, Stefan; Dähnert, Ingo; Klein, Norbert

    2016-01-01

    Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain. PMID:27879647

  7. Vitamin deficiency after gastric bypass surgery: a review.

    Science.gov (United States)

    Matrana, Marc R; Davis, William E

    2009-10-01

    More than 60% of the adult US population now meets the criteria for being overweight or obese. Gastric bypass surgery has become a popular and effective way to combat this medical problem. Despite the success of these procedures, they are associated with many complications, including malnutrition, neurological compromise, and vitamin deficiency. Research has determined that even with multivitamin supplementation for life, a large percentage of bypass patients develop vitamin deficiencies. We present a case of beriberi after Roux-en-Y bypass that illustrates the importance of close follow up. A thorough review of vitamin deficiencies in this unique patient population is explored. Vitamin supplementation and treatment recommendations are compiled from the most up-to-date sources. Even patients on regular supplements should be closely monitored for vitamin deficiencies. Patient education regarding vitamin supplementation is vital; it should begin prior to surgery and continue throughout the postoperative period and beyond.

  8. A Comparative Performance Analysis of Low Power Bypassing Array Multipliers

    Directory of Open Access Journals (Sweden)

    Nirlakalla Ravi

    2013-07-01

    Full Text Available Low power design of VLSI circuits has been identified as vital technology in battery powered portable electronic devices and signal processing applications such as Digital Signal Processors (DSP. Multiplier has an important role in the DSPs. Without degrading the performance of the processor, low power parallel multipliers are needed to be design. Bypassing is the widely used technique in the DSPs when the input operand of the multiplier is zero. A Row based Bypassing Multiplier with compressor at the final addition of the ripple carry adder (RCA is designed to focus on low power and high speed. The proposed bypassing multiplier with compressor shows high performance and energy efficiency than Kuo multiplier with Carry Save Adder (CSA at the final RCA.

  9. Rankine cycle load limiting through use of a recuperator bypass

    Science.gov (United States)

    Ernst, Timothy C.

    2011-08-16

    A system for converting heat from an engine into work includes a boiler coupled to a heat source for transferring heat to a working fluid, a turbine that transforms the heat into work, a condenser that transforms the working fluid into liquid, a recuperator with one flow path that routes working fluid from the turbine to the condenser, and another flow path that routes liquid working fluid from the condenser to the boiler, the recuperator being configured to transfer heat to the liquid working fluid, and a bypass valve in parallel with the second flow path. The bypass valve is movable between a closed position, permitting flow through the second flow path and an opened position, under high engine load conditions, bypassing the second flow path.

  10. Proposal of bypass in heat recovery system with sucking air

    Science.gov (United States)

    Siažik, Ján; Malcho, Milan; Rezničák, Štefan

    2016-06-01

    Waste heat is utilized in a wide variety of technologies for a number of reasons. But the significant one such reason is use of the energy contained for example in waste water or waste heat that would otherwise left unused. Other considerable reason it is also reduces primary costs to operate the technology. The article deals with the arrangement section of the unit in heat recovery systems where the entry of waste gases into defluorinastion device. The technologies re-use heat often use the bypass. Bypass fulfill their duty in equipment failures, for example heat exchanger where it is not possible to stop the operationimmediately and the hot combustion gases can flow bypass without interrupting operation.

  11. Fibrin Adhesive: Clinical Application in Coronary Artery Bypass Graft Surgery

    Science.gov (United States)

    Fundaró, Pino; Velardi, Antonio R.; Santoli, Carmine

    1985-01-01

    Fibrin adhesive was used 72 times in a group of 67 patients undergoing elective coronary artery bypass graft surgery. The indications were prophylactic sealing of potential sources of bleeding, topical hemostasis (control of bleeding sites dangerous or difficult to suture), and fixation of the graft in the optimal position. The method of glue application under varying circumstances is described and the results are reported. This experience suggests that in some cases the glue expedites the operation and makes it safer. We conclude that the fibrin sealing represents a valid aid in coronary artery bypass graft surgery. PMID:15227018

  12. Obstetrical and neonatal outcomes in women following gastric bypass

    DEFF Research Database (Denmark)

    Berlac, Janne Foss; Skovlund, Charlotte Wessel; Lidegaard, Ojvind

    2014-01-01

    more admissions to neonatal intensive care unit compared with newborn of normal weight mothers; RR = 1.5 (1.1-2.0). CONCLUSIONS: Gastric bypass may reduce the risk of preeclampsia, emergency cesarean section, and perinatal asphyxia, compared with adipose women without surgery. Compared with normal...... weight controls women who had had a gastric bypass had a higher risk of hypertension, gestational diabetes, and acute abdominal pain during pregnancy and their children a lower birthweight and higher incidence of admittance to neonatal intensive care....

  13. [Prevalence of early and late dumping after gastric bypass].

    Science.gov (United States)

    Héraïef, R; Giusti, V

    2014-03-26

    Gastric bypass surgery is an effective treatment of obesity, bringing a significant weight loss and a major improvement of carbohydrate profile. However, in some patients, a deregulation in carbohydrate metabolism between insulin secretion and sensitivity is observed, whereupon early and late dumping happen. Their prevalence isn't well studied, although it seems that 10 to 20% of patients are affected. We've studied a cohort of 70 patients who undergone gastric bypass surgery at the CHUV. 18 (25.7%) patients have a positive anamnesis for early dumping and 10 (14.3%) for late dumping, being it superior as what is described in the literature.

  14. Dextrocardia with situs inversus totalis: coronary artery bypass grafting.

    Science.gov (United States)

    Hashmi, Salila; Anis, Mariam; Darr, Umer

    2012-01-01

    Dextrocardia with situs inversus is a rare congenital abnormality involving a left-handed mal rotation of the visceral organs. The incidence of coronary artery disease is the same as that in the general population. Performing coronary artery bypass surgery on patients with dextrocardia poses a more challenging task. It is recommended that the right internal mammary artery be the first choice of graft for the anterior descending artery for a "situs inversus" situation. We report 2 cases of patients with Dextrocardia who developed coronary artery disease and underwent coronary artery bypass grafting. Also mentioned is the slight difference in our technique.

  15. Tidlige erfaringer med duplexovervågning af femoropopliteale og -krurale vene-bypass

    DEFF Research Database (Denmark)

    Nielsen, Tina G; von Jessen, Frants; Schroeder, T V

    1993-01-01

    Identification and correction of graft stenoses in femoropopliteal and -crural vein bypasses can prevent reconstruction failure. Sixty six consecutive vein bypasses entered a postoperative surveillance protocol, which implied clinical assessment, measurement of ankle blood pressure and duplex-sca...

  16. Managing the Inflammatory Response after Cardiopulmonary Bypass : Review of the Studies in Animal Models

    NARCIS (Netherlands)

    Liguori, Gabriel Romero; Kanas, Alexandre Fligelman; Moreira, Luiz Felipe Pinho

    2014-01-01

    OBJECTIVE: To review studies performed in animal models that evaluated therapeutic interventions to inflammatory response and microcirculatory changes after cardiopulmonary bypass. METHODS: It was used the search strategy ("Cardiopulmonary Bypass" (MeSH)) and ("Microcirculation" (MeSH) or "Inflammat

  17. Off-pump coronary artery bypass grafting in patients with mirror-imaging dextrocardia.

    Science.gov (United States)

    Yuan, Xin; Sun, Hansong; Wang, Xianqiang

    2015-08-01

    Dextrocardia requires alterations in techniques during coronary artery bypass graft (CABG) surgery. We report two cases undergoing off-pump coronary artery bypass graft (OPCAB) surgery and discuss techniques for the operative management of these patients.

  18. Hereditary spherocytosis in a patient undergoing coronary artery bypass grafting with cardiopulmonary bypass--a case report.

    Science.gov (United States)

    Spegar, J; Riha, H; Kotulak, T; Vanek, T

    2015-01-01

    Hereditary spherocytosis is a genetically determined abnormality of red blood cells. It is the most common cause of inherited haemolysis in Europe and North America within the Caucasian population. We document a patient who underwent an aortocoronary bypass procedure on cardiopulmonary bypass. In view of the uncertain tolerance of the abnormal red cells in hereditary spherocytosis to cardiopulmonary bypass, we reviewed the patient's chart and analyzed recorded values of these parameters: free plasma haemoglobin, renal parameters, cystatin C, bilirubin, liver tests, urine samples. From the results, we can see that slight haemolysis-elevated bilirubin in the blood sample and elevated bilirubin and urobilinogen in the urine sample occurred on the first postoperative day. The levels of these parameters slowly decreased during the next postoperative days. There was no real clinical effect of this haemolysis on renal functions.

  19. 21 CFR 870.4410 - Cardiopulmonary bypass in-line blood gas sensor.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass in-line blood gas sensor... Cardiopulmonary bypass in-line blood gas sensor. (a) Identification. A cardiopulmonary bypass in-line blood gas sensor is a transducer that measures the level of gases in the blood. (b) Classification. Class...

  20. Fabrication of nanofiber non-wovens on the melt blowing die with air by-passes

    Directory of Open Access Journals (Sweden)

    Chen Ting

    2016-01-01

    Full Text Available The air flow field of the melt blowing die with air by-passes is simulated. The results show that fibers fabricated on the die with air by-passes are much finer than those without air by-passes, which indicates an energy-saving approach to fabricating nanofibers on the melt blowing equipment.

  1. Fabrication of nanofiber non-wovens on the melt blowing die with air by-passes

    OpenAIRE

    Chen Ting; Yang Kang; Wu Li-Li

    2016-01-01

    The air flow field of the melt blowing die with air by-passes is simulated. The results show that fibers fabricated on the die with air by-passes are much finer than those without air by-passes, which indicates an energy-saving approach to fabricating nanofibers on the melt blowing equipment.

  2. On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in Elderly Patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Houlind, Kim; Kjeldsen, Bo Juul;

    2012-01-01

    Conventional coronary artery bypass grafting performed with the use of cardiopulmonary bypass is a well-validated treatment for patients with ischemic heart disease. Off-pump coronary artery bypass grafting (OPCAB) has been suggested to reduce the number of perioperative complications, especially...... in elderly patients....

  3. Natural headland sand bypassing; towards identifying and modelling the mechanisms and processes

    NARCIS (Netherlands)

    Bin Ab Razak, M.S.

    2015-01-01

    Natural headland sand bypassing: Towards identifying and modelling the mechanisms and processes contributes to the understanding of the mechanisms and processes of sand bypassing in artificial and non-artificial coastal environments through a numerical modelling study. Sand bypassing processes in ge

  4. On-pump versus off-pump coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    2013-01-01

    Off pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized controlled trials . Co...

  5. 21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

    Science.gov (United States)

    2010-04-01

    ... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass vascular catheter,...

  6. Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention

    Science.gov (United States)

    Liu, Jiexin (Jason); Bellamy, Gail R.; McCormick, Melissa

    2007-01-01

    Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally. Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to…

  7. Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke.

    Science.gov (United States)

    Horiuchi, Tetsuyoshi; Nitta, Junpei; Ishizaka, Shigetoshi; Kanaya, Kohei; Yanagawa, Takao; Hongo, Kazuhiro

    2013-10-01

    Previous studies have shown that extracranial-intracranial (EC-IC) bypass surgery has no preventive effect on subsequent ipsilateral ischemic stroke in patients with symptomatic atherosclerotic internal carotid occlusion and hemodynamic cerebral ischemia. A few studies have assessed whether an urgent EC-IC bypass surgery is an effective treatment for main trunk stenosis or occlusion in acute stage. The authors retrospectively reviewed 58 consecutive patients who underwent urgent EC-IC bypass for symptomatic internal carotid artery or the middle cerebral artery stenosis or occlusion between January 2003 and December 2011. Clinical characteristics and neuroimagings were evaluated and analyzed. Based on preoperative angiogram, responsible lesions were the internal carotid artery in 19 (32.8%) patients and the middle cerebral artery in 39 (67.2%). No hemorrhagic complication occurred. Sixty-nine percent of patients showed improvement of neurological function after surgery, and 74.1% of patients had favorable outcome. Unfavorable outcome was associated with insufficient collateral flow and new infarction after bypass surgery.

  8. Emergency bypass post percutaneous atrial ablation: a case report.

    LENUS (Irish Health Repository)

    Hargrove, M

    2010-11-01

    A 34-year-old male undergoing percutaneous atrial ablation procedure for paroxysmal fibrillation required emergency sternotomy for cardiac tamponade. The patient had been anticoagulated and had received plavix and aspirin prior to and during the ablation procedure. Seven units of red cell concentrate had been transfused in the cardiac catherisation laboratory. On arrival in theatre, the patient was hypotensive, but was awake on induction of anaesthesia. No recordable blood pressure with non-invasive monitoring was observed. A sternotomy was immediately performed and, on evacuation of the pericardium, a bleeding site was not visible. The patient was commenced on cardiopulmonary bypass. Bleeding site was identified and the defect closed. The patient was weaned from cardiopulmonary bypass with minimal inotropic support and made an uneventful recovery. Bypass time was 38 minutes. A literature review showed a 1% incidence of post-ablation bleeding(1). The incidence of reverting to bypass for such an event has not been reported previously. During these procedures, it might be wise to have the cardiothoracic team notified while atrial ablation procedures are being performed in the cardiac catheterization laboratory.

  9. 21 CFR 870.4350 - Cardiopulmonary bypass oxygenator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass oxygenator. 870.4350 Section 870.4350 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... gases between blood and a gaseous environment to satisfy the gas exchange needs of a patient during...

  10. Bypassing of a barrier by dissociated and superlattice dislocations

    DEFF Research Database (Denmark)

    Bhushan, Karihaloo

    1975-01-01

    Very simple procedures are used to calculate the upper and lower bounds for the applied stress required for the leading extended (superlattice) dislocation in a group of n coplanar screw dislocations of like sign with Burgers vector b to bypass a noncoplanar perfect screw dislocation with Burgers...... vector mb (m...

  11. Polarization for the by-pass SLAC/PEP collider

    Energy Technology Data Exchange (ETDEWEB)

    Chao, A.W.

    1980-06-01

    It was suggested that one can collide the store e/sup +/ beam in PEP with the e/sup /minus// beam from SLAC to reach a center-of-mass energy higher than that achieved by the PEP colliding beams. Although the future of this PEP/SLAC collider is not yet certain, it is useful to first explore its physics possibilities. One possible version of the SLAC/PEP collider utilizes a by-pass at the interaction point; the stored beam is displaced vertically by a set of vertical bending magnets every time the linac beam arrives. One feature of this by-pass scheme that makes it attractive is that the amount of the vertical displacement of the by-pass can be chosen so that the spin polarization of the stored beam is made longitudinal at the point of interaction. In this note, we have studied the various depolarization effects of the stored e/sup +/ beam due to the perturbation of the by-pass magnets. 1 fig.

  12. Prediction of bypass transition with differential Reynolds stress models

    NARCIS (Netherlands)

    Westin, K.J.A.; Henkes, R.A.W.M.

    1998-01-01

    Boundary layer transition induced by high levels of free stream turbulence (FSl), so called bypass transition, can not be predicted with conventional stability calculations (e.g. the en-method). The use of turbulence models for transition prediction has shown some success for this type of flows, and

  13. Blood concentrations of cefuroxime in cardiopulmonary bypass surgery

    NARCIS (Netherlands)

    Bertholee, Daphne; ter Horst, Peter G. J.; Hijmering, Michel L.; Spanjersberg, Alexander J.; Hospes, Wobbe; Wilffert, Bob

    2013-01-01

    Objectives Patients with coronary artery bypass graft (CABG) surgery are at risk for severe postoperative infections. Prophylactic cefuroxime may help to reduce this risk, however sufficient concentrations, i.e. above the breakpoint (32 mg/L), are mandatory. The aim of this study is to evaluate the

  14. The influence of biomaterials on inflammatory responses to cardiopulmonary bypass.

    Science.gov (United States)

    Courtney, J M; Matata, B M; Yin, H Q; Esposito, A; Mahiout, A; Taggart, D P; Lowe, G D

    1996-05-01

    The nature of cardiopulmonary bypass and the complexity of the inflammatory response make the detection and interpretation of a biomaterial influence difficult. However, if mediation of the inflammatory response is considered to be an appropriate clinical goal, alteration to the biomaterial influence merits further investigation.

  15. Gastrointestinal motility during cardiopulmonary bypass : A sonomicrometric study

    NARCIS (Netherlands)

    Gu, YJ; de Kroon, TL; Elstrodt, JM; Rakhorst, G

    2006-01-01

    Cardiopulmonary bypass (CPB) is known to impair the integrity of the gastrointestinal tract. However, little is known about the movement behavior of the gastrointestinal tract during CPB. This study was aimed to assess the gastrointestinal motility with sonomicrometry, a distance measurement using u

  16. Fabric heart retractor for coronary artery bypass operations.

    Science.gov (United States)

    Kazama, S; Ishihara, A

    1993-06-01

    A new device for heart retraction during coronary artery bypass operations has been developed. It provides safe and steady support and an unobstructed view of the lateral, posterior, and inferior surfaces of the heart; in addition, it is easy to handle.

  17. Pathophysiology and treatment of edema following femoropopliteal bypass surgery

    NARCIS (Netherlands)

    te Slaa, A.; Dolmans, D. E. J. G. J.; Ho, G. H.; Moll, F. L.; van der Laan, L.

    2012-01-01

    Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this e

  18. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Whitlock, Richard P; Chan, Simon; Devereaux, P J;

    2008-01-01

    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality...

  19. Computer-assisted LAD bypass grafting at the open heart

    Science.gov (United States)

    Hartung, Christine; Gnahm, Claudia; Friedl, Reinhard; Hoffmann, Martin; Dietmayer, Klaus

    2009-02-01

    Open heart bypass surgery is the standard treatment in advanced coronary heart diseases. For an effective revascularization procedure, optimal placement of the bypass is very important. To accelerate the intraoperative localization of the anastomosis site and to increase the precision of the procedure, a concept for computer assistance in open heart bypass surgery has been developed comprising the following steps: 1. Preprocedural planning: A patient-specific coronary map with information on vessel paths and wall plaque formations is extracted from a multi-slice computed tomography (MSCT). On this basis, the heart surgeon and the cardiac radiologist define the optimal anastomosis site prior to surgery. 2. Intraoperative navigation: During surgery, data are recorded at the beating heart using a stereo camera system. After registering the pre- and intraoperative data sets, preprocedural information can be transferred to the surgical site by overlaying the coronary map and the planned anastomosis site on the live video stream. With this visual guidance system, the surgeon can navigate to the planned anastomosis site. In this work, the proposed surgical assistance system has been validated for the left anterior descending coronary artery (LAD). The accuracy of the registration mechanism has been evaluated in retrospective on patient data sets and the effects of breathing motion were quantified. The promising results of the retrospective evaluation led to the in-vivo application of the computer assistance system during several bypass grafting procedures. Intraoperative navigation has been performed successfully and postoperative evaluation confirms that the bypass grafts were accurately positioned to the preoperatively planned anastomosis sites.

  20. Reoperations for occluded arterial bypasses in the lower limbs

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background We reviewed the outcomes of reoperations for 29 patients (30 limbs) who had undergone occluded arterial bypass in the lower limbs from May 1996 to September 2005. Methods The 30 lower limbs of the 29 patients with arteriosclerotic obstruction received 44 reoperations, including thrombectomy alone (group T, 27) and inflow or outflow reconstruction plus thrombectomy (group C, 17). Among the 17 operations in group C, 17.6% (3/17) were inflow reconstructions involving the axillary-femoral (1), aorta-iliac (1) and aorta-femoral (1) arteries, and 76.4% (13/17) outflow reconstructions involving the femoral-popliteal bypass-tibial (8), femoral-tibial (1), femoral-popliteal bypass-popliteal arteries below the knee (2), and the femoral-popliteal bypass-tibial-peroneal trunk (2). One patient (1 limb) underwent both inflow and outflow reconstructions with an iliac arterial stent and a graft-popliteal anastomosis patch. Polytetrafluoroethylene (PTFE) grafts were used in the inflow or outflow reconstructions abve the knee. Autovenous grafts or autovenously combined PTFE grafts were used in the outflow reconstructions below the knee. Results The percentages of Fontaine stage III and IV before primary operation and reoperation were 60% (18/30) and 86.7% (26/30), respectively (P0.05). Among 42 reoperations, 19 failed within 1 month in groups T (16) and C (3) (P0.05). The rate of limb salvage was 64.29% (18/28). Conclusions The percentages of Fontaine stage III and IV before reoperation may be much higher than those before primary operation. Thrombectomy plus inflow/outflow reconstruction creates patency better than thrombectomy alone for re-occluded bypass.

  1. PV modules without bypass diodes; PV-Module ohne Bypass-Dioden? - Untersuchungen an einer PV-Fassade

    Energy Technology Data Exchange (ETDEWEB)

    Laukamp, H.; Kresse, A.; Leithold, W. [Fraunhofer-Institut fuer Solare Energiesysteme (ISE), Freiburg im Breisgau (Germany)]|[Ingenieurbuero A. Kresse, Karlsruhe (Germany)]|[Solare Systemtechnik GmbH, Freiburg (Germany)

    1998-12-01

    In order to protect solar modules against high output losses with non-homogeneous irradiation, bypass diodes which are mostly accommodated in the module connection socket are used. One would often gladly dispense with these connection sockets for integration of customer-specific large modules in facades. The question: ``Where will the diodes go?`` must then be satisfactorily answered. Both laminating the diodes in the module and their external accommodation cause extra expense elsewhere. It would be ideal if one could dispense with the bypass diodes altogether. This article tries to answer the question, in what conditions this is possible. Starting from the PV facade `Freiburg solar centre`, where one dispensed with the protective diodes, investigations are carried out experimentally and by means of simulation calculations. [Deutsch] Um Solarmodule bei inhomogener Bestrahlung vor hohen Verlustleistungen zu schuetzen, werden ueblicherweise Bypass-Dioden eingesetzt, die zumeist in der Modulanschlussdose untergebracht sind. Zur Fassadenintegration von kundenspezifischen Grossmodulen wuerde man manchmal gerne auf die Anschlussdosen verzichten. Hierfuer muesste zunaechst die Frage `wohin mit den Dioden?` befriedigend beantwortet werden. Sowohl die Einlaminierung der Dioden in das Modul, als auch deren externe Unterbringung versursachen an anderer Stelle einen erhoehten Aufwand. Ideal waere es, wenn man auf die Bypass-Dioden ganz verzichten koennte. Die vorliegende Arbeit versucht die Frage zu beantworten, unter welchen Bedingungen dies moeglich ist. Ausgehend von der PV-Fassade `Solarzentrum Freiburg` - hier wurde auf den Einsatz von Schutzdioden verzichtet - werden experimentell und mittels Simulationsrechnungen Untersuchungen durchgefuehrt. (orig./RHM)

  2. Long-term patency of superficial temporal artery to middle cerebral artery bypass for cerebral atherosclerotic disease: factors determining the bypass patent.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Tateyama, Kojiro; Tamaki, Tomonori; Mizunari, Takayuki; Matsukawa, Hideoshi; Teramoto, Akira; Morita, Akio

    2016-10-01

    Long-term patency of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery for atherosclerotic disease and associated risk factors for loss of patency have rarely been discussed. We retrospectively analyzed long-term patency following STA-MCA bypass and evaluated various demographic and clinical factors to identify the ones predictive of postsurgical loss of patency using records of 84 revascularization procedures (58 patients, 45 males; mean age at surgery 63.6 years, range 31-78 years). Bypass patency was diagnosed based on magnetic resonance angiography or three-dimensional computed tomography. The mean follow-up period was 24.7 months (range 6-63 months). Decreased bypass patency was observed in 4 of 58 patients (6.9 %) who collectively underwent 6 bypasses (7.1 %) of 84. All cases of decreased bypass patency were first detected within 6 months of surgery. Bypass patency was not correlated with age, sex, number of anastomoses, postoperative cerebral infarction, or control of postoperative diabetes mellitus. We found a significant association of bypass patency with hyperperfusion (p = 0.01) and postoperative smoking (p = 0.0036). Furthermore, we found a significant association of hyperperfusion with STA diameter (p bypass patency in cerebral atherosclerotic disease patients. Careful monitoring of patency to prevent hyperperfusion and cessation of smoking are recommended, particularly within 6 months of the surgery.

  3. Numerical analysis for the matching of the core driven compression system in a double bypass engine

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xin; LIU Bao-jie

    2011-01-01

    The numerical analysis for the matching of the core driven compression system in a double bypass variable cycle engine was presented in this paper. The system consists of a one-stage-core driven fan stage (CDFS), an inner bypass duet and a five-stage high pressure compressor (HPC), providing two basic operating modes: the single bypass mode and the double bypass mode. Variable vanes are necessary to realize the mode switch of the system. The correct matching in the double bypass mode requires a proper combination of the mass flow, total pressure ratio and blade speed. The work capacity of the system decreases in the double bypass mode and the pressure ratio tends to decrease more for the CDFS and the front stages of the HPC. The overall system efficiency is higher in the double bypass mode. The radial distributions of aerodynamic parameters are similar in different modes. The notable redistribution of mass flow downstream the CDFS in the single bypass mode leads to strong radial flows and additional mixing losses. The absolute flow angles into the inner bypass increase for the inner span and decrease for the outer span when the system is switched from the single bypass mode to the double bypass mode.

  4. Arterial pressure and deltoid muscle gas tensions during cardiopulmonary bypass in man.

    Science.gov (United States)

    Stanley, T H

    1978-07-01

    The results of this study demonstrate that standard techniques of conducting cardiopulmonary bypass produce low muscle oxygen and high muscle carbon dioxide tensions and, thus, little perfusion of skeletal muscle. Our findings also show that PmO2 and PmCO2 do not return to pre-bypass levels until the mean arterial blood pressure exceeds 12 kPa (90 torr) during bypass and that utilization of vasopressor drugs during bypass maintains the pressure; but at the expense of muscle blood flow. The data indicate that both high mean blood pressure and high flow are necessary during bypass to ensure skeletal muscle perfusion and suggest, when combined with preliminary animal findings, that this type of bypass perfusion may prove to be superior to standard techniques in hastening recovery after cardio-pulmonary bypass.

  5. Totally laparoscopic bypass surgery for aortoiliac occlusive disease in China

    Institute of Scientific and Technical Information of China (English)

    GUO Lian-rui; GU Yong-quan; QI Li-xing; TONG Zhu; WU Xin; GUO Jian-ming; ZHANG Jian

    2013-01-01

    Background Totally laparoscopic aortic surgery is still in its infancy in China.One of the factors preventing adoption of this technique is its steep learning curve.The objective of this study was to evaluate the feasibility and safety of laparoscopic surgery for aortoiliac occlusive disease (AIOD).Methods From November 2008 to November 2012,12 patients were treated for severe AIOD with a totally laparoscopic bypass surgery at our university hospital.The demographic data,operative data,postoperative recovery data,morbidity and mortality were analyzed and compared with those of conventional open approach.Results Twelve totally laparoscopic aortic surgery procedures,including two iliofemoral bypasses (IFB),three unilateral aortofemoral bypasses (UAFB),and seven aortobifemoral bypasses (ABFB),were performed.Conversion to open procedures was required in three patients.The mean operation time was 518 (range,325-840) minutes,mean blood loss was 962 (range,400-2500) ml,and mean aortic anastomosis time was 75 (range,40-150) minutes.Compared with conventional open approach for aortofemoral bypasses performed concomitantly during this period,laparoscopic patients required fewer narcotics and a shorter in-hospital stay and earlier recovery.Postoperative complications developed in four patients,including a single patient with transient left hydronephrosis,ischemic colonic fistula and pneumonia,residual aortic stenosis proximal to the anastomotic site,and asymptomatic partial left renal infarction.All patients recovered and were discharged on postoperative Days 7-14 except one patient that died of respiratory failure on Day 46.All grafts were patent with follow-up imaging performed by Duplex examination,with a mean follow-up time of 10.7 (range,2-61) months.Conclusion Totally laparoscopic bypass surgery is a feasible and safe procedure forAIOD,but attention needs to be paid to improve laparoscopic skills of vascular surgery in order to minimize morbidity during the learning

  6. Jugular-axillary vein bypass for salvage of arteriovenous access.

    Science.gov (United States)

    Fulks, K D; Hyde, G L

    1989-01-01

    Stenosis or occlusion of the subclavian vein can cause incapacitating upper extremity swelling and venous hypertension in the patient with an arteriovenous (AV) access. A case of subclavian vein occlusion is reported that was treated with internal jugular-axillary vein bypass. This procedure resulted in salvage of the access and rapid resolution of the associated upper extremity swelling. It was concluded that jugular-axillary vein bypass should be considered in patients who have massive upper extremity edema resulting from a functioning AV access and ipsilateral subclavian vein occlusion. Patients undergoing creation of an AV access who have had previous temporary subclavian catheters or previous early failure of an AV access should have phlebography before surgery.

  7. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    DEFF Research Database (Denmark)

    Nielsen, T G; Djurhuus, C; Pedersen, Erik Morre;

    1996-01-01

    PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...... 10 cm upstream of a fistula with low outflow resistance. Flow and intraluminal pressure were measured proximal to the stenosis and downstream of the fistula. The waveform parameters peak systolic velocity, end-diastolic velocity, pulsatility index, and pulse rise time were determined from midstream...... Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters...

  8. Axillobifemoral bypass: a brief surgical and historical review

    Science.gov (United States)

    Mishall, Priti L.; Matakas, Jason D.; English, Keara; Allyn, Katherine; Algava, Diane; Howe, Ruth A.; Downie, Sherry A.

    2017-01-01

    Peripheral artery disease (PAD) occurs when plaque accumulates in the arterial system and obstructs blood flow. Narrowing of the abdominal aorta and the common iliac arteries due to atherosclerotic plaques restricts blood supply to the lower limbs. Clinically, the lower limb symptoms of PAD are intermittent claudication, discoloration of the toes, and skin ulcers, all due to arterial insufficiency. Surgical revascularization is the primary mode of treatment for patients with severe limb ischemia. The objective of the surgical procedure is to bypass a blockage in an occluded major vessel by constructing an alternate route for blood flow using an artificial graft. This article presents information on aortoiliac reconstruction, with an emphasis on axillobifemoral bypass grafting.

  9. Dobutamine for inotropic support during emergence from cardiopulmonary bypass.

    Science.gov (United States)

    Tinker, J H; Tarhan, S; White, R D; Pluth, J R; Barnhorst, D A

    1976-04-01

    Dobutamine, a recently introduced derivative of dopamine, is reported to retain inotropic properties with less pronounced chronotropic and arrhythmogenic effects than isoproterenol. The drug was evaluated in two doses, 5 mug/kg/min and 10 mug/kg/min, in two groups of ten patients each, during emergence from cardiopulmonary bypass. A third group of five patients was studied similarly with isoproterenol, 0.02 mug/kg/min. Cardiac index increased 16 and 28 per cent eith the two doses of dobutamine, respectively, and 9 per cent with isoproterenol. Heart rate, in contrast, increased 6 and 15 per cent with dobutamine (not significant) and 44 per cent with isoproterenol (significant). Dobutamine seemed to associated with fewer arrhythmias than isoproterenol. It is concluded that dobutamine, 5-10 mug/kg/min, is suitable for use during emergence from cardiopulmonary bypass and may possess advantages over isoproterenol.

  10. Coronary artery bypass grafting in a patient with organophosphate poisoning.

    Science.gov (United States)

    Pieris, Rajeeva R; Fernando, Ravindra

    2015-08-30

    A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

  11. In situ saphenous vein bypass surgery in diabetic patients

    DEFF Research Database (Denmark)

    Jensen, L P; Schroeder, T V; Lorentzen, J E

    1992-01-01

    .005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic......From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry...... this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0...

  12. Dacron or PTFE for above-knee femoropopliteal bypass

    DEFF Research Database (Denmark)

    Jensen, Leif P.; Lepäntalo, M.; Fossdal, J.E.

    2007-01-01

    OBJECTIVES: To compare polytetrafluorethylene (PTFE) and polyester grafts (Dacron) for above knee femoropopliteal bypass. DESIGN: Multicenter randomised clinical trial. MATERIAL AND METHODS: 427 patients were randomised between 6mm Dacron (Uni-Graft, B. Braun Melsungen AG, 34212 Melsungen, Germany......) and PTFE (Goretex, W. L. Gore & Ass. Inc., Newark DE 19711, USA) above-knee femoropopliteal bypass grafts within 13 centres in Denmark (n=261), Norway (n=113) & Finland (n=53) between 1993 and 1998. Fourteen (3%) patients were excluded, leaving 413 patients with 208 Dacron and 205 PTFE grafts for analysis......-brachial pressures or imaging in case of doubt. RESULTS: The two-year primary patency rates for Dacron and PTFE were 70% and 57% (p=0.02), whereas the secondary patency rates were 76% and 65% (p=0.04), respectively. Primary patency at two years was significantly influenced by the number of patent crural vessels (two...

  13. ANALYSIS OF 312 CASES OF REPEAT CORONARY ARTERY BYPASS GRAFTING

    Institute of Scientific and Technical Information of China (English)

    陈长志; 陆佩中

    2003-01-01

    Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients.Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyzed. The mean duration follow up after the first CABG was 11.8±4.5 years. A total of 1069 bypass grafts were performed. Among them, 386 were arterial grafts such as internal mammary artery, radial artery and gastroepiploic artery; 682 were venous grafts and 1 Gore-Tex graft. Results The operative mortality was 4. 5%. Fifteen patients (4. 8%) had peri-operative myocardial infarction and 46 patients (15%) had low cardiac output syndrome. Intra-aortic balloon pump (IABP) was used in 131 patients before, during and after operation. One hundred and nineteen patients weaned off IABP and recovered. ConclusionAlthough the difficulties and risk factors were increased, the results of redo CABG were still good.

  14. The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)

    DEFF Research Database (Denmark)

    Houlind, Kim; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard;

    2009-01-01

    BACKGROUND: Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross-clampin...

  15. secondary Prevention of Coronary Events by Coronary Artery Bypass Surgery

    OpenAIRE

    2003-01-01

    Coronary artery bypass surgery has shown its superiority on other therapeutic options in specific but frequent indications such as left main lesions, multivessel disease with alteration of ventricular function, proximal lesions of the LAD, and multivessel diseases in diabetic patients. After reviewing the epidemiology of coronary artherosclerosis, we emphasize the efficacy of the surgical treatment compared to medical or interventional therapy for preventing ischemic events. The results deriv...

  16. Human gut microbiota in obesity and after gastric bypass.

    Science.gov (United States)

    Zhang, Husen; DiBaise, John K; Zuccolo, Andrea; Kudrna, Dave; Braidotti, Michele; Yu, Yeisoo; Parameswaran, Prathap; Crowell, Michael D; Wing, Rod; Rittmann, Bruce E; Krajmalnik-Brown, Rosa

    2009-02-17

    Recent evidence suggests that the microbial community in the human intestine may play an important role in the pathogenesis of obesity. We examined 184,094 sequences of microbial 16S rRNA genes from PCR amplicons by using the 454 pyrosequencing technology to compare the microbial community structures of 9 individuals, 3 in each of the categories of normal weight, morbidly obese, and post-gastric-bypass surgery. Phylogenetic analysis demonstrated that although the Bacteria in the human intestinal community were highly diverse, they fell mainly into 6 bacterial divisions that had distinct differences in the 3 study groups. Specifically, Firmicutes were dominant in normal-weight and obese individuals but significantly decreased in post-gastric-bypass individuals, who had a proportional increase of Gammaproteobacteria. Numbers of the H(2)-producing Prevotellaceae were highly enriched in the obese individuals. Unlike the highly diverse Bacteria, the Archaea comprised mainly members of the order Methanobacteriales, which are H(2)-oxidizing methanogens. Using real-time PCR, we detected significantly higher numbers of H(2)-utilizing methanogenic Archaea in obese individuals than in normal-weight or post-gastric-bypass individuals. The coexistence of H(2)-producing bacteria with relatively high numbers of H(2)-utilizing methanogenic Archaea in the gastrointestinal tract of obese individuals leads to the hypothesis that interspecies H(2) transfer between bacterial and archaeal species is an important mechanism for increasing energy uptake by the human large intestine in obese persons. The large bacterial population shift seen in the post-gastric-bypass individuals may reflect the double impact of the gut alteration caused by the surgical procedure and the consequent changes in food ingestion and digestion.

  17. Interventions in infrainguinal bypass grafts; Interventionen an infrainguinalen Bypaessen

    Energy Technology Data Exchange (ETDEWEB)

    Schoder, M.; Cejna, M.; Lammer, J. [Univ. Klinik fuer Radiodiagnostik, Wien (Austria). Abt. fuer Angiographie und Interventionelle Radiologie

    2001-12-01

    The long-term success of infrainguinal bypass grafts depends on meticulous surgical technique and a periodic program of postoperative surveillance. Duplex scanning is the method of choice for the detection of stenotic lesions that threaten graft patency. As an alternative to surgery, PTA is gaining increasing acceptance for the treatment of non-recurrent, short, and single stenotic lesions, despite somewhat controversial opinions. The initial technical success rates for PTA were reported to be up to 100%, and a 5-year primary assisted patency rate of up to 65% has been achieved. Some authors favorize intra-arterial infusion of fibrinolytic agents for the treatment of bypass graft occlusion with technical success rates of up to 92%. In addition to a reduced trauma compared to surgical thrombectomy, of the venous wall the advantage of thrombolytic therapy is clot lysis in run-off vessels, and uncovering of the stenotic lesions. This stenosis may then be treated by an endovascular or surgical approach. (orig.) [German] Der Langzeiterfolg infrainguinaler Bypaesse wird vor allem durch Anastomosenstenosen, seltener durch Stenosen im Bypass selbst, bestimmt. Neben exakten Operationstechniken ist deshalb eine regelmaessige postoperative Ueberwachung des Bypasses zur Verbesserung der Langzeitdurchgaengigkeit allgemein akzeptiert. Zur Identifizierung von bypassgefaehrdenden Stenosen hat die Duplexsonographie als Untersuchungsmodalitaet der Wahl einen fixen Stellenwert erlangt. Die perkutane transluminale Angioplastie (PTA) ist eine sinnvolle, minimal invasive Alternative zur offenen chirurgischen Revision von erstmalig aufgetretenen kurzstreckigen und singulaeren Bypassstenosen respektive Anastomosenstenosen. Primaer technische Erfolgsraten nach PTA werden bis zu 100%, primaer assistierte 5-Jahres-Offenheitsraten bis zu 65% angegeben. Die intraarterielle Thrombolyse bei Bypassthrombosen ist mit bis zu 92%iger technischer Erfolgsrate von manchen Arbeitsgruppen als primaere

  18. Assessing Patient bypass Behavior Using Taxi Trip Origin–Destination (OD Data

    Directory of Open Access Journals (Sweden)

    Gege Yang

    2016-09-01

    Full Text Available Many patients prefer to use the best hospitals even if there are one or more other hospitals closer to their homes; this behavior is called “hospital bypass behavior”. Because this behavior can be problematic in urban areas, it is important that it be reduced. In this paper, the taxi GPS data of Beijing and Suzhou were used to measure hospital bypass behavior. The “bypass behavior index” (BBI represents the bypass behavior for each hospital. The results indicated that the mean hospital bypass trip distance value ranges from 5.988 km to 9.754 km in Beijing and from 4.168 km to 10.283 km in Suzhou. In general, the bypass shares of both areas show a gradually increasing trend. The following hospitals exhibited significant patient bypass behavior: the 301 Hospital, Beijing Children’s Hospital, the Second Affiliated Hospital of Soochow University and the Suzhou Hospital of Traditional Chinese Medicine. The hospitals’ reputation, transport accessibility and spatial distribution were found to be the main factors affecting patient bypass behavior. Although the hospital bypass phenomena generally appeared to be more pronounced in Beijing, the bypass trip distances between hospitals were found to be more significant in Suzhou.

  19. Distal wound complications following pedal bypass: analysis of risk factors.

    Science.gov (United States)

    Robison, J G; Ross, J P; Brothers, T E; Elliott, B M

    1995-01-01

    Wound complications of the pedal incision continue to compromise successful limb salvage following aggressive revascularization. Significant distal wound disruption occurred in 14 of 142 (9.8%) patients undergoing pedal bypass with autogenous vein for limb salvage between 1986 and 1993. One hundred forty-two pedal bypass procedures were performed for rest pain in 66 patients and tissue necrosis in 76. Among the 86 men and 56 women, 76% were diabetic and 73% were black. All but eight patients had a history of diabetes and/or tobacco use. Eight wounds were successfully managed with maintenance of patent grafts from 5 to 57 months. Exposure of a patent graft precipitated amputation in three patients, as did graft occlusion in an additional patient. One graft was salvaged by revision to the peroneal artery and one was covered by a local bipedicled flap. Multiple regression analysis identified three factors associated with wound complications at the pedal incision site: diabetes mellitus (p = 0.03), age > 70 years (p = 0.03), and rest pain (p = 0.05). Ancillary techniques ("pie-crusting") to reduce skin tension resulted in no distal wound problems among 15 patients considered to be at greatest risk for wound breakdown. Attention to technique of distal graft tunneling, a wound closure that reduces tension, and control of swelling by avoiding dependency on and use of gentle elastic compression assume crucial importance in minimizing pedal wound complications following pedal bypass.

  20. Percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion

    Directory of Open Access Journals (Sweden)

    Lichtenberg M

    2012-05-01

    Full Text Available Michael Lichtenberg1, Matthias Käunicke1, Birgit Hailer1,21Cardiovascular Clinic, Vascular Center, Katholisches Klinikum Essen, Germany; 2University of Witten/Herdecke, GermanyAbstract: Acute and subacute ischemia of the legs in acute and subacute femoropopliteal bypass occlusion is a dramatic situation that endangers the survival of the limbs, depending on the severity of the ischemia. Different therapy options like percutaneous mechanical thrombectomy procedures, which include rotational thrombectomy, have become available in recent years, in addition to local lysis and surgical thrombectomy. Surgical thrombectomy using the Fogarty catheter technique, in particular, shows an increased incidence of perioperative complications but only small technical success rates in randomized trials. On the other hand, local lysis is associated with increased costs due to resource-consuming measures, such as intensive monitoring and repeat angiographies, in addition to bleeding complications. In the past, further development of the Straub Rotarex® system as an endovascular therapy option has demonstrated good success leading to amputation-free survival in multiple studies. At the same time, a low rate of complications with use has been documented. Most examinations have been conducted in the thigh. To date, there are little investigational data on its use in acutely and subacutely occluded femoropopliteal bypasses. In this paper, the current study-based significance of the Rotarex system for this indication is analyzed based on the existing literature and the authors' own experiences with 22 patients.Keywords: acute limb ischemia, femoropopliteal bypass, local lysis, rotational thrombectomy

  1. Pipelining and bypassing in a RISC/DSP processor

    Science.gov (United States)

    Yu, Guojun; Yao, Qingdong; Liu, Peng; Jiang, Zhidi; Li, Fuping

    2005-03-01

    This paper proposes pipelining and bypassing unit (BPU) design method in our 32-bit RISC/DSP processor: MediaDsp3201 (briefly, MD32). MD32 is realized in 0.18μm technology, 1.8v, 200MHz working clock and can achieve 200 million/s Multiply-Accumulate (MAC) operations. It merges RISC architecture and DSP computation capability thoroughly, achieves fundamental RISC, extended DSP and single instruction multiple data (SIMD) instruction set with various addressing modes in a unified and customized DSP pipeline stage architecture. We will first describe the pipeline structure of MD32, comparing it to typical RISC-style pipeline structure. And then we will study the validity of two bypassing schemes in terms of their effectiveness in resolving pipeline data hazards: Centralized and Distributed BPU design strategy (CBPU and DBPU). A bypassing circuit chain model is given for DBPU, which register read is only placed at ID pipe stage. Considering the processor"s working clock which is decided by the pipeline time delay, the optimization of circuit that serial select with priority is also analyzed in detail since the BPU consists of a long serial path for combination logic. Finally, the performance improvement is analyzed.

  2. Ileal loop interposition:an alternative biliar y bypass technique

    Institute of Scientific and Technical Information of China (English)

    Felipe JF Coimbra; Alessandro L Diniz; Heber SC Ribeiro; Wilson L Costa Jr.; Eduardo NP Lima; André L Montagnini

    2010-01-01

    BACKGROUND: Obstructive jaundice is a common condition in advanced digestive cancer. Palliative procedures can improve quality of life and allow patients to attempt a systemic treatment. Bilioenteric anastomosis is still the procedure of choice for patients in many centers. When a surgical bypass is not possible, biliary drainage can be done by placing endoscopic or transparietal stents, which are less durable methods even when an expandable stent is employed. METHODS: A 47-year-old male with an excellent clinical status and a previous cholecystectomy and an exploratory laparotomy for advanced gastric cancer was referred with obstructive jaundice. A preoperative CT scan showed a dilated bile duct and a small mass at the distal hepatic hilum. No other signs of metastasis were found. A surgical bilioenteric anastomosis was indicated. At surgery, a distal choledochal obstruction and a mesenteric retraction by a lymph node mass prevented the jejunum to ascend for a bilioenteric anastomosis. Surgically, an alternative bilioenteric bypass was performed by means of an ileal loop interposition between the bile duct and the jejunum. RESULT: The recovery of the patient was uneventful and his bilirubin levels normalized after one week. The patient was then referred for systemic chemotherapy. CONCLUSIONS: This alternative biliary bypass can be safely and easily performed, and may be a good alternative for patients already referred for surgery because of a better life expectancy and when the jejunum is not an alternative.

  3. Breast cancer biomarkers predict weight loss after gastric bypass surgery

    Directory of Open Access Journals (Sweden)

    Sauter Edward R

    2012-01-01

    Full Text Available Abstract Background Obesity has long been associated with postmenopausal breast cancer risk and more recently with premenopausal breast cancer risk. We previously observed that nipple aspirate fluid (n levels of prostate specific antigen (PSA were associated with obesity. Serum (s levels of adiponectin are lower in women with higher body mass index (BMI and with breast cancer. We conducted a prospective study of obese women who underwent gastric bypass surgery to determine: 1 change in n- and s-adiponectin and nPSA after surgery and 2 if biomarker change is related to change in BMI. Samples (30-s, 28-n and BMI were obtained from women 0, 3, 6 and 12 months after surgery. Findings There was a significant increase after surgery in pre- but not postmenopausal women at all time points in s-adiponectin and at 3 and 6 months in n-adiponectin. Low n-PSA and high s-adiponectin values were highly correlated with decrease in BMI from baseline. Conclusions Adiponectin increases locally in the breast and systemically in premenopausal women after gastric bypass. s-adiponectin in pre- and nPSA in postmenopausal women correlated with greater weight loss. This study provides preliminary evidence for biologic markers to predict weight loss after gastric bypass surgery.

  4. EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS

    Science.gov (United States)

    STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

  5. COMPLICATIONS RELATED TO GASTRIC BYPASS PERFORMED WITH DIFFERENT GASTROJEJUNAL DIAMETERS

    Science.gov (United States)

    SAMPAIO-NETO, José; BRANCO-FILHO, Alcides José; NASSIF, Luis Sérgio; BROSKA, Anne Caroline; KAMEI, Douglas Jun; NASSIF, André Thá

    2016-01-01

    ABSTRACT Background: Among the options for surgical treatment of obesity, the most widely used has been the Roux-en-Y gastric bypass. The gastrojejunal anastomosis can be accomplished in two ways: handsewn or using circular and linear stapled. The complications can be divided in early and late. Aim: To compare the incidence of early complications related with the handsewn gastrojejunal anastomosis in gastric bypass using Fouchet catheter with different diameters. Method: The records of 732 consecutive patients who had undergone the bypass were retrospectively analyzed and divided in two groups, group 1 with 12 mm anastomosis (n=374), and group 2 with 15 mm (n=358). Results: The groups showed anastomotic stenosis with rates of 11% and 3.1% respectively, with p=0.05. Other variables related to the anastomosis were also analyzed, but without statistical significance (p>0.05). Conclusion: The diameter of the anastomosis of 15 mm was related with lower incidence of stenosis. It was found that these patients had major bleeding postoperatively and lower surgical site infection, and in none was observed presence of anastomotic leak. PMID:27683767

  6. SUrgical versus PERcutaneous Bypass: SUPERB-trial; Heparin-bonded endoluminal versus surgical femoro-popliteal bypass: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Wallis de Vries Bas M

    2011-07-01

    Full Text Available Abstract Background Endovascular treatment options for the superficial femoral artery are evolving rapidly. For long lesions, the venous femoropopliteal bypass considered to be superior above the prosthetic bypass. An endoluminal bypass, however, may provide equal patency rates compared to the prosthetic above knee bypass. The introduction of heparin-bonded endografts may further improve patency rates. The SUrgical versus PERcutaneous Bypass (SuperB study is designed to assess whether a heparin-bonded endoluminal bypass provides equal patency rates compared to the venous bypass and to prove that it is associated with improved quality of life, related to a decreased complication rate, or not. Methods/design Two-hundred-twenty-two patients with peripheral arterial occlusive disease, category 3-6 according to Rutherford, will be randomized in two treatment arms; 1. the surgical femoro-popliteal bypass, venous whenever possible, and 2. the heparin-bonded endoluminal bypass. The power analysis was based on a non-inferiority principle, with an effect size of 90% and 10% margins (alpha 5%, power 80%. Patients will be recruited from 5 teaching hospitals in the Netherlands during a 2-year period. The primary endpoint is primary patency and quality of life evaluated by the RAND-36 questionnaire and the Walking Impairment Questionnaire. Secondary endpoints include secondary patency, freedom-from-TLR and complications. Discussion The SuperB trial is a multicentre randomized controlled trial designed to show non-inferiority in patency rates of the heparin-bonded endograft compared to the surgical bypass for treatment of long SFA lesions, and to prove a better quality of life using the heparin bonded-endograft compared to surgically treatment, related to a reduction in complications. Trial Registration Clinicaltrials: NCT01220245

  7. Laparoscopic gastric bypass to robotic gastric bypass: time and cost commitment involved in training and transitioning an academic surgical practice.

    Science.gov (United States)

    Lyn-Sue, Jerome R; Winder, Josh S; Kotch, Shannon; Colello, Jacob; Docimo, Salvatore

    2016-06-01

    The Roux-en-Y gastric bypass is the gold standard procedure for weight loss. This relatively complex procedure has excellent outcomes when performed via laparoscopy. The advent of the DaVinci robotic platform has been a technological advancement. Our goal is to provide information regarding the cost, time commitment, and advantages of transitioning an LRYGB program to an RRYGB program in an academic setting. We retrospectively reviewed the last 25 laparoscopic gastric bypass procedures and the first 25 robotic gastric bypass procedures performed by a single surgeon. We compared clinical outcomes and focused on time and hospital cost during this transition phase. There was no significant demographic difference between the groups. The mean age was 41.7 (RRYGB) years vs 43.4 (LRYGM) years. The mean BMI were similar between groups, 45.3 vs 46.5 kg/m(2) for RRYGB and LRYGB. No anastomotic leaks or mortalities were noted. There was one anastomotic stricture in both groups. Excess weight loss was similar in both groups at 1 year. There was a significant increase in operative time with RRYGB, mean 241 min vs mean 174 min (p = 0.0005). Operative time fell by 25 min after the first 10 cases. The hospital cost was also increased with RRYGB mean $5922 vs $4395 (p = 0.03). Transitioning from a laparoscopic to a robotic practice can be done safely, however, the initial operative times were longer and the hospital cost was higher for robotic gastric bypass. We hope in the future that these will decrease after overcoming the learning and as the technology becomes widespread.

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

    Science.gov (United States)

    Pokrovskiĭ, A V; Iakhontov, D I

    2014-01-01

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

  9. Passage of downstream migrant American eels through an airlift-assisted deep bypass

    Science.gov (United States)

    Haro, Alexander J.; Watten, Barnaby J.; Noreika, John

    2016-01-01

    Traditional downstream guidance and bypass facilities for anadromous fishes (i.e., surface bypasses, surface guidance structures, and behavioral barriers) have frequently been ineffective for anguillid eels. Because eels typically spend the majority of their time near the bottom in the vicinity of intake structures, deep bypass structures with entrances near the bottom hold promise for increased effectiveness, thereby aiding in the recovery of this important species. A new design of a deep bypass system that uses airlift technology (the Conte Airlift Bypass) to induce flow in a bypass pipe was tested in a simulated intake entrance environment under controlled laboratory conditions. Water velocities of 0.9–1.5 m s−1 could be generated at the bypass entrance (opening with 0.073 m2 area), with corresponding flows through the bypass pipe of 0.07–0.11 m3 s−1. Gas saturation and hydrostatic pressure within the bypass pipe did not vary appreciably from a control (no air) condition under tested airflows. Migratory silver-phase American eels (Anguilla rostrata) tested during dark conditions readily located, entered, and passed through the bypass; initial avoidance rates (eels approaching but not entering the bypass entrance) were lower at higher entrance velocities. Eels that investigated the bypass pipe entrance tended to enter headfirst, but those that then exited the pipe upstream did so more frequently at lower entrance velocities. Eels appeared to swim against the flow while being transported downstream through the pipe; median transit times through the bypass for each test velocity ranged from 5.8 to 12.2 s, with transit time decreasing with increasing entrance velocity. Eels did not show strong avoidance of the vertical section of the pipe which contained injected air. No mortality or injury of bypassed eels was observed, and individual eels repeatedly passed through the bypass at rates of up to 40 passes per hour, suggesting that individuals do not

  10. Operation characteristics of AMS-02 loop heat pipe with bypass valve

    CERN Document Server

    Wang, N H; Xin, G M; Song, J W; Cui, Z; Burger, J; Du, W J; Luo, F; Cheng, L

    2011-01-01

    Loop heat pipes (LHPs) were designed for the alpha magnetic spectrometer (AMS-02) to dissipate heat from the cryocoolers. A bypass valve is applied to the LHP to keep the cryocooler temperature above its limit (-20A degrees C) in cold environment. Extensive experiments were performed on operation characteristics of LHPs with the bypass valve for AMS-02 during thermal vacuum and thermal balance (TVTB) test. We found that the bypass valve can start up successfully in cold environment. With the bypass valve, the evaporator temperature is stable and can meet the requirement of the cryocooler. We analyzed three operating modes of the bypass valve. Set point temperature and regulation temperature shifts were observed and their relations with the bypass valve temperature were given.

  11. Novel blood sampling method of an artificial endocrine pancreas via the cardiopulmonary bypass circuit.

    Science.gov (United States)

    Kawahito, Shinji; Higuchi, Seiichi; Mita, Naoji; Kitagawa, Tetsuya; Kitahata, Hiroshi

    2013-12-01

    We tried to perform continuous blood glucose monitoring during cardiovascular surgery involving cardiopulmonary bypass using an artificial endocrine pancreas (STG-22 or -55; Nikkiso, Tokyo, Japan); however, we often encountered problems during these procedures because insufficient blood was obtained for monitoring. Thus, we started performing the blood sampling via the venous side of the cardiopulmonary bypass circuit. As a result, continuous blood glucose monitoring using an artificial endocrine pancreas was proven to be stable and reliable during cardiovascular surgery involving cardiopulmonary bypass.

  12. The role of bypass diodes in the failure of solar battery charging stations in Thailand

    Energy Technology Data Exchange (ETDEWEB)

    Greacen, C.; Green, D. [Energy and Resources Group, 310 Barrows Hall no. 3050, University of California, 94720-3050 Berkeley, CA (United States)

    2001-12-15

    This paper focuses on the failure of bypass diodes in solar battery charging stations (SBCS) in Thailand. The Thai government has installed over 1000 SBCS in unelectrified villages to be used to charge 12-V batteries for household lights and small appliances. The unnecessary inclusion of bypass diodes in these systems created an unexpected failure mode when villagers misconnected their batteries with reverse polarity. In a survey of 31 stations, 18 stations were disabled by burnt-out bypass diodes. The electrical engineering theory of this failure mode is analyzed. In addition, we discuss how the bypass diode failures have been compounded by lack of end-user feedback to the implementing agencies.

  13. Electroencephalography during surgery with cardiopulmonary bypass and hypothermia.

    Science.gov (United States)

    Bashein, G; Nessly, M L; Bledsoe, S W; Townes, B D; Davis, K B; Coppel, D B; Hornbein, T F

    1992-06-01

    After more than 30 yr of use, electroencephalographic (EEG) monitoring during cardiopulmonary bypass has not gained wide clinical acceptance. To assess its utility to predict central nervous system injury, two-channel recordings were made from 78 patients undergoing cardiopulmonary bypass and anesthetized with fentanyl/diazepam/enflurane. The perfusion regimen included the use of high pump flow, a bubble oxygenator, and no arterial tubing filter. Target values were 28-32 degrees C for the minimum rectal temperature, 60-80 mmHg for mean arterial pressure, and 20-25% for hematocrit. Eight descriptors of the Fourier power spectra of the EEG were calculated off-line, and outcome comparisons were made with the results from neuropsychological tests. Among 58 patients yielding complete data of acceptable quality, a statistically significant reduction in total power was observed from prebypass to postbypass, accompanied by an increase in the fractional power in the theta and beta frequency bands and in the spectral edge frequency. The shifts in total and theta power were weakly associated with short-term but not with long-term changes in neuropsychological scores. Nearly 40% of the patients' EEGs were corrupted with electrical noise at some time during bypass. In 15 patients selected for having high-quality recordings and no neuropsychological deficit, an extensive statistical analysis failed to reveal any consistent variation in the EEG descriptors with hypothermia. Under the conditions studied, it appears that for other than gross signal dropout, the strong background variability in the EEG makes it have little value for detecting harbingers of brain injury.

  14. Hospitalization before and after mini-gastric bypass surgery.

    Science.gov (United States)

    Rutledge, Robert

    2007-02-01

    The mini-gastric bypass (MGB) was developed to address some of the limitations of the Roux-en-Y gastric bypass ("RNY"). The RNY has recently been reported to increase the need for hospitalization for complications after RNY surgery. To determine the rates and indications for inpatient hospital use before and after MGB in comparison to similar rates in RNY. The study is a self reported retrospective study of patients from across the United States receiving MGB in Centers for Excellence in Laparoscopic Obesity Surgery ("CELOS") hospitals from 2000 to 2005. Complications and hospitalization in the year before and in the 1 to 5 years after MGB. 1069 patients who underwent MGB were selected for study. The rate of hospitalization in the year following MGB was 67% of the rate in the year preceding MGB (11% vs. 17%, P<0.001). The most common reasons for admission prior to MGB were general medical problems (38%) obstetric and Gynecological issues (36%), orthopedic problems (16%), gallbladder surgery (9%) and renal stones in 2%. The most common reasons for hospital admission after MGB were complications from surgery (29%), gallbladder surgery (20%), renal stones (14%), plastic surgery procedures (11%), appendectomy (9%), Gynecologic issues (9%) and orthopedic problems (6%). Thus while MGB complications made up a third of hospital readmissions following MGB surgery the over all hospitalization rates declined significantly. Previous studies have demonstrated that hospitalization after RNY gastric bypass increases remarkably (20% per year). The present study shows that hospitalization following MGB instead of rising, as reported with RNY, decreases by a third. The MGB has been shown to be a short, safe successful weight loss surgery in previous work. The present study supports the MGB as a low risk procedure that decreases the need for hospitalization.

  15. Popular Hybrid Congenital Heart Procedures without Cardiopulmonary Bypass

    Science.gov (United States)

    Gupta, Aamisha; Amin, Zahid

    2017-01-01

    As surgical and catheter interventions advance, patients with congenital heart disease are now offered alternative treatment options that cater to their individual needs. Furthermore, collaboration between interventional cardiologists and cardiac surgeons have led to the development of hybrid procedures, using the best techniques of each respective field to treat these complex cardiac entities from initial treatment in the pediatric patient to repeat intervention in the adult. We present a review of the increased popularity and trend in hybrid procedures in congenital heart disease without the use of cardiopulmonary bypass.

  16. Epidemiologic Surveillance for Staphylococcus epidermidis infections related to cardiopulmonary bypass.

    Science.gov (United States)

    Lathrop, G D; Brockett, R M; Blouse, L E

    1978-07-01

    Epidemiologic investigation of 20 Staphylococcus infections among valvular and aortocoronary bypass graft patients indicated a broad spectrum of clinical illness in these two groups. The highest infection rate (9.3%) and case specific mortality rate (54.5%) were noted among those patients undergoing cardiovalvular replacement surgery with protheses. The median onset of infection was 6 days suggesting infection during the intraoperative period. Using the epidemiologic data from this investigation, a transmission pattern was formulated and a series of control measures designed to interdict the routes of transmission were instituted wigh marked success. These measures significantly reduced the incidence of S. epidermidis infections among these high risk patients.

  17. Lower leg electrical impedance after distal bypass surgery

    DEFF Research Database (Denmark)

    Belanger, G K; Bolbjerg, M L; Heegaard, N H

    1998-01-01

    Electrical impedance was determined in 13 patients following distal bypass surgery to evaluate lower leg oedema as reflected by its circumference. Tissue injury was assessed by the plasma concentration of muscle enzymes. After surgery, the volume of the control lower leg increased from 1250 (816...... of troponin I (n = 8). In conclusion, tissue injury was reflected by increases in muscle enzymes in plasma. We found an inverse correlation between lower leg electrical impedance and volume, but the deviation in electrical impedance was approximately twice that of the leg volume. Electrical impedance appears...

  18. Transient cortical blindness and successful recovery after coronary bypass surgery.

    Science.gov (United States)

    Tasdemir, Kutay; Evereklioglu, Cem; Kaya, Mehmet G

    2011-10-01

    Left ventricular injury has a bad prognosis, especially when a coronary artery is involved. After perforation of the left cardiac ventricle by a knife, a 19-year-old male patient presented with: (i) complete bilateral visual loss; (ii) left anterior descending (LAD) artery injury; (iii) severe systemic hypotension. Under emergency conditions and cardiopulmonary bypass, the LAD artery was revascularized by a saphenous vein graft. Bilateral blindness recovered within several days. Cerebral hypoxia as a result of severe systemic hypotension was the most likely underlying mechanism.

  19. Sen perforation af tyndtarm efter laparoskopisk gastrisk bypass

    DEFF Research Database (Denmark)

    Spanager, Lene; Sigild, Ulf Henrik; Neuenschwander, Anders Ulrich

    2010-01-01

    We present two cases in which the patients were admitted to a local hospital with acute abdominal pain four or five months after having undergone laparoscopic gastric bypass. In both cases, operation revealed a perforation of the small bowel close to the distal anastomosis. In the first case......, a massive constipation of the small bowel was most likely a contributing factor. In the second case, the cause was a kink of the entero-entero anastomosis leading to obstruction and finally perforation of the biliary limp. Late perforations are among the rarely reported complications associated with gastric...

  20. Fuel temperature prediction using a variable bypass gap size in the prismatic VHTR

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Nam, E-mail: snlee@kaeri.re.kr; Tak, Nam-il; Kim, Min Hwan

    2016-04-15

    Highlights: • The bypass flow of the prismatic very high temperature reactor is analyzed. • The bypass gap sizes are calculated considering the effect of the neutron fluences and thermal expansion. • The fuel hot spot temperature and temperature profiles are calculated using the variable gap size. • The BOC, MOC and EOC condition at the cycle 07 and 14 are applied. - Abstract: The temperature gradient and hot spot temperatures were calculated in the prismatic very high temperature reactor as a function of the variable bypass gap size. Many previous studies have predicted the temperature of the reactor core based on a fixed bypass gap size. The graphite matrix of the assemblies in the reactor core undergoes a dimensional change during the operation due to thermal expansion and neutron fluence. The expansion and shrinkage of the bypass gaps change the coolant flow fractions into the coolant channels, the control rod holes, and the bypass gaps. Therefore, the temperature of the assemblies may differ compared to those for the fixed bypass gap case. The temperature gradient and the hot spot temperatures are important for the design of reactor structures to ensure their safety and efficiency. In the present study, the temperature variation of the PMR200 is studied at the beginning (BOC), middle (MOC), and end (EOC) of cycles 07 and 14. CORONA code which has been developed in KAERI is applied to solve the thermal-hydraulics of the reactor core of the PMR200. CORONA solves a fluid region using a one-dimensional formulation and a solid region using a three-dimensional formulation to enhance the computational speed and still obtain a reasonable accuracy. The maximum temperatures in the fuel assemblies using the variable bypass gaps did not differ much from the corresponding temperatures using the fixed bypass gaps. However, the maximum temperatures in the reflector assemblies using the variable bypass gaps differ significantly from the corresponding temperatures

  1. Quadratus lumborum block for femoral–femoral bypass graft placement

    Science.gov (United States)

    Watanabe, Kunitaro; Mitsuda, Shingo; Tokumine, Joho; Lefor, Alan Kawarai; Moriyama, Kumi; Yorozu, Tomoko

    2016-01-01

    Abstract Introduction: Atherosclerosis has a complex etiology that leads to arterial obstruction and often results in inadequate perfusion of the distal limbs. Patients with atherosclerosis can have severe complications of this condition, with widespread systemic manifestations, and the operations undertaken are often challenging for anesthesiologists. Case report: A 79-year-old woman with chronic heart failure and respiratory dysfunction presented with bilateral gangrene of the distal lower extremities with obstruction of the left common iliac artery due to atherosclerosis. Femoral–femoral bypass graft and bilateral foot amputations were planned. Spinal anesthesia failed due to severe scoliosis and deformed vertebrae. General anesthesia was induced after performing multiple nerve blocks including quadratus lumborum, sciatic nerve, femoral nerve, lateral femoral cutaneous nerve, and obturator nerve blocks. However, general anesthesia was abandoned because of deterioration in systemic perfusion. The surgery was completed; the patient remained comfortable and awake without the need for further analgesics. Conclusion: Quadratus lumborum block may be a useful anesthetic technique to perform femoral–femoral bypass. PMID:27583851

  2. Myocardial contractile function in survived neonatal piglets after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Popov Aron-Frederik

    2010-11-01

    Full Text Available Abstract Background Hemodynamic function may be depressed in the early postoperative stages after cardiac surgery. The aim of this study was the analysis of the myocardial contractility in neonates after cardiopulmonary bypass (CPB and mild hypothermia. Methods Three indices of left ventricular myocardial contractile function (dP/dt, (dP/dt/P, and wall thickening were studied up to 6 hours after CPB in neonatal piglets (CPB group; n = 4. The contractility data were analysed and then compared to the data of newborn piglets who also underwent median thoracotomy and instrumentation for the same time intervals but without CPB (non-CPB group; n = 3. Results Left ventricular dP/dtmax and (dP/dtmax/P remained stable in CPB group, while dP/dtmax decreased in non-CPB group 5 hours postoperatively (1761 ± 205 mmHg/s at baseline vs. 1170 ± 205 mmHg/s after 5 h; p max and (dP/dtmax/P there were no statistically significant differences between the two groups. Comparably, although myocardial thickening decreased in the non-CPB group the differences between the two groups were not statistically significant. Conclusions The myocardial contractile function in survived neonatal piglets remained stable 6 hours after cardiopulmonary bypass and mild hypothermia probably due to regional hypercontractility.

  3. Anesthesia for off-pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.

  4. Development of techniques for gastrojejunal bypass surgery in obese mice.

    Science.gov (United States)

    Lan, Zhu; Zassoko, Roman; Liu, Weihua; Garcia, Bertha; Sun, Hongtao; Wang, Rennian; Wang, Hao

    2010-05-01

    We have previously described a duodenojejunal bypass (DJB) surgical model in healthy C57BL/6 mice. However, our pilot study showed that the same surgical technique caused a high mortality rate in obese mice. In this study, to significantly improve animal survival rate following bariatric surgery and thereby providing a stable surgical model for the study of glucose homeostasis in obese mice, we have used modified techniques and developed the end-to-side gastrojejunal bypass (GJB) surgery in obese C57BL/6 with impaired glucose tolerance. The modification consisted of using the distal part of the jejunum for biliopancreatic diversion including: 1) ligation of the distal stomach at the level of the pylorus; 2) connection the jejunum to the anterior wall of stomach in an end-to-side fashion; and 3) diverting the biliopancreatic secretions through the blind limb into the distal jejunum through an end-to-side anastomosis. We found that by modifying the proximal end-to-end duodenojejunal anastomosis, described in our original model, to an end-to-side gastrojejunal anastomosis in these obese mice, we were able to significantly improve the postoperative mortality in this study. We have also demonstrated that performing the GJB surgery in obese mice resulted in significant weight loss, normalized blood glucose levels, and prevented acute pancreatitis. This newly developed GJB surgery in the obese mice offers a unique advantage to study the mechanisms of gastrointestinal surgery as treatment for type 2 diabetes.

  5. Nursing care for the patient after femoral popliteal bypass grafting

    Institute of Scientific and Technical Information of China (English)

    Guo Xiaohui

    2003-01-01

    Objective: To share my knowledge, regarding the nursing care for the patients after femoral popliteal bypass grafting, with my Chinese colleagues who have never been abroad. Methods: From August 1998 to September 2002, five patients (including 1 female and 4 male) were summarized retrospectively on postoperative care by assessment, nursing implementation and evaluation. Results: All patients were followed up for 3 to 6 months. The results were evaluated as follows: patient's condition and the function of the operated leg were improved. The leg pain was released. The peripheral pulses were present and strong. The color, temperature and sensation of the skin were normal. None of further complications was noted. Conclusion: For Nursing the patient after femoral popliteal bypass grafting, the nurses should focus their attention on the circulatory status of the operated leg, anticoagulant therapy and signs of bleeding from the graft site. Meanwhile, provide a quiet、comfortable and safety environment for the patient. Asall of these are the main points of the postoperative care. A good nursing careoffer to a patient not only can ease the patient's physical suffering, but alsocan avoid some complications occurring.

  6. MHD Energy Bypass Scramjet Performance with Real Gas Effects

    Science.gov (United States)

    Park, Chul; Mehta, Unmeel B.; Bogdanoff, David W.

    2000-01-01

    The theoretical performance of a scramjet propulsion system incorporating an magneto-hydro-dynamic (MHD) energy bypass scheme is calculated. The one-dimensional analysis developed earlier, in which the theoretical performance is calculated neglecting skin friction and using a sudden-freezing approximation for the nozzle flow, is modified to incorporate the method of Van Driest for turbulent skin friction and a finite-rate chemistry calculation in the nozzle. Unlike in the earlier design, in which four ramp compressions occurred in the pitch plane, in the present design the first two ramp compressions occur in the pitch plane and the next two compressions occur in the yaw plane. The results for the simplified design of a spaceliner show that (1) the present design produces higher specific impulses than the earlier design, (2) skin friction substantially reduces thrust and specific impulse, and (3) the specific impulse of the MHD-bypass system is still better than the non-MHD system and typical rocket over a narrow region of flight speeds and design parameters. Results suggest that the energy management with MHD principles offers the possibility of improving the performance of the scramjet. The technical issues needing further studies are identified.

  7. Lymphaticovenular bypass surgery for lymphedema management in breast cancer patients.

    Science.gov (United States)

    Chang, D W

    2012-12-01

    Historically, the reported incidence of upper extremity lymphedema in breast cancer survivors who have undergone axillary lymph node dissection has ranged from 9% to 41%. In the past 2 decades, sentinel lymph node biopsy has become popular as a way to minimize the morbidity associated with axillary dissection without compromising the cure rate for breast cancer patients. However, even with sentinel node biopsy, the postoperative incidence of upper limb lymphedema in breast cancer patients remains at 4-10%. Lymphedema occasionally emerges immediately after surgery but most often appears after a latent period. Obesity, postoperative seroma, and radiation therapy have been reported as major risk factors for upper extremity lymphedema, but the etiology of lymphedema is still not fully understood. Common symptoms of upper limb lymphedema are increased volume and weight of the affected limb and increased skin tension. The increased volume of the affected limb not only causes physical impairments in wearing clothes and in dexterity but also affects patients' emotional and mental status. Surgical management of lymphedema can be broadly categorized into physiologic methods and reductive techniques. Physiologic methods such as flap interposition, lymph node transfers, and lymphatic bypass procedures aim to decrease lymphedema by restoring lymphatic drainage. In contrast, reductive techniques such as direct excision or liposuction aim to remove fibrofatty tissue generated as a consequence of sustained lymphatic fluid stasis. Currently, microsurgical variations of lymphatic bypass, in which excess lymph trapped within the lymphedematous limb is redirected into other lymphatic basins or into the venous circulation, have gained popularity.

  8. Minimally invasive cardiac surgery-coronary artery bypass graft.

    Science.gov (United States)

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

    Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested endoscopically. A Y-connection is made between the two arteries. The LITA is used to bypass the left anterior descending coronary artery, while the right RA is used on the obtuse marginal branches and/or the posterior descending coronary artery. A special coronary stabilizer and a heart positioner with a shaft for remote thoracic insertion are needed.

  9. Long-term internal thoracic artery bypass graft patency and geometry assessed by multidetector computed tomography

    DEFF Research Database (Denmark)

    Zacho, Mette; Lilleoer, Nikolaj Thomas; Kelbaek, Henning

    2012-01-01

    The left internal thoracic artery (LITA) undergoes vascular remodelling when used for coronary artery bypass grafting. In this study we tested the hypothesis that the extent of the LITA remodelling late after coronary artery bypass grafting assessed by multidetector computed tomography is related...

  10. Haptic Distal Spatial Perception Mediated by Strings: Point of Closest Approach and Bypass Distance

    Science.gov (United States)

    Cabe, Patrick A.; Hofman, L. Leigh

    2012-01-01

    Four experiments examined haptic perception of two distal spatial properties in a bypass event. A hook suspended a string held taut between the participant's finger and a weight. Moving their fingers laterally beneath the hook, participants estimated the finger's point of closest approach (PCA) to the hook and bypass distance (BPD; i.e., hook…

  11. [Serum immune complexes and cardiopulmonary bypass. A review of thirty-four cases (author's transl)].

    Science.gov (United States)

    Herreman, G; Poisson-Lespassailles, C; Puech, H; Vanetti, A; Delaunay, L; Yvart, J; Fermé, I

    1982-05-20

    The immunologic status of patients undergoing cardiopulmonary bypass as investigated. Rheumatoid factor, cryoglobulinemia and serum immune complexes were looked for. Studies were performed before the operation and eight or fifteen days later. From the results, it is concluded that the immunologic changes that occur in the immediate postoperative period cannot be interpreted because of the profound modifications resulting from cardiopulmonary bypass.

  12. The Straight Path to Healing: Using Motivational Interviewing to Address Spiritual Bypass

    Science.gov (United States)

    Clarke, Philip B.; Giordano, Amanda L.; Cashwell, Craig S.; Lewis, Todd F.

    2013-01-01

    Spiritual bypass is the avoidance of underlying emotional issues by focusing solely on spiritual beliefs, practices, and experiences. Motivational interviewing (MI) is a client-centered, compassionate approach to effectively addressing resistance among those who present with spiritual bypass. In this article, the authors provide background…

  13. Coronary artery surgery without cardiopulmonary bypass: usefulness of the surgical blower-humidifier.

    Science.gov (United States)

    Maddaus, M; Ali, I S; Birnbaum, P L; Panos, A L; Salerno, T A

    1992-12-01

    Coronary artery bypass surgery can be performed without cardiopulmonary bypass (CPB). Bleeding obscuring the operative field and hemodilution of shed blood with irrigating saline are some of the drawbacks of this technique. We report the use of a newly developed surgical blower-humidifier (custom made [Research Medical, Inc.]) for improved visualization and facilitation of coronary artery surgery without CPB.

  14. Innovations in Pedriatic Cradiopulmonary Bypass: a continuous process of quality improvement

    NARCIS (Netherlands)

    H.D. Golab (Hanna)

    2011-01-01

    textabstractCardiopulmonary bypass (CPB) is defined as a technique that temporarily replaces the function of the heart and lungs, maintaining an adequate blood circulation and oxygen content of the body during surgery of the heart and great vessels. The current practice of cardiopulmonary bypass was

  15. 40 CFR 63.307 - Standards for bypass/bleeder stacks.

    Science.gov (United States)

    2010-07-01

    ... install a bypass/bleeder stack flare system that is capable of controlling 120 percent of the normal gas... emissions shall not be vented to the atmosphere through bypass/bleeder stacks, except through the flare... operator of a brownfield coke oven battery or a padup rebuild shall install such a flare system...

  16. Early 24-hour blood pressure response to Roux-en-Y gastric bypass in obese patients

    DEFF Research Database (Denmark)

    Pedersen, Julie S; Borup, Christian; Damgaard, Morten

    2017-01-01

    Recently, it has been proposed, that the blood pressure (BP) lowering effect of gastric bypass surgery not only is explained by the obtained weight loss, but that the anatomical rearrangement of the gut after 'malabsorptive' surgical techniques, such as the laparoscopic Roux-en-Y gastric bypass...

  17. Fluoropolymer-coated dacron versus PTFE grafts for femorofemoral crossover bypass: randomised trial

    DEFF Research Database (Denmark)

    Eiberg, J P; Røder, Ole Christian; Stahl-Madsen, Morten

    2006-01-01

    To investigate whether patency of a thin walled 8 mm fluoropassivated Dacron graft was similar to that of a standard 8mm PTFE graft for femorofemoral crossover bypass surgery.......To investigate whether patency of a thin walled 8 mm fluoropassivated Dacron graft was similar to that of a standard 8mm PTFE graft for femorofemoral crossover bypass surgery....

  18. Assessment of coronary artery bypass graft patency by multidetector computed tomography and electron-beam tomography

    NARCIS (Netherlands)

    Piers, LH; Dorgelo, J; Tio, RA; Jessurun, GAJ; Oudkerk, M; Zijlstra, F

    2005-01-01

    This case report describes the use of retrospectively ECG-gated 16-slice multidetector computed tomography (MDCT) and electron-beam tomography (EBT) for assessing bypass graft patency in two patients with recurrent angina after coronary artery bypass graft surgery. The results of each tomographic mo

  19. Does heparin pretreatment affect the haemostatic system during and after cardiopulmonary bypass?

    NARCIS (Netherlands)

    Brinks, H.J.; Weerwind, P.W.; Bogdan, S.; Verbruggen, H.W.; Brouwer, M.H.J.

    2001-01-01

    In this clinical pilot study, the influence of heparin pretreatment on the haemostatic system during and after cardiopulmonary bypass (CPB) was investigated. Thirteen patients scheduled for elective coronary artery bypass grafting (CABG) were divided into two groups: heparin pretreated (HP, n = 6) a

  20. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H. R.; Pol, Robert A.; Hulsebos, Robin G.; van Det, Rob J.; van der Palen, Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    BACKGROUND: To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. METHODS: Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inl

  1. Arterial clamping leads to stenosis at clamp sites after femoropopliteal bypass surgery

    NARCIS (Netherlands)

    Vriens, Bianca H.R.; Pol, Robert A.; Hulsebos, Robin G.; Det, van Rob J.; Palen, van der Job; Zeebregts, Clark J.; Geelkerken, Robert H.

    2015-01-01

    Background To date, the incidence and clinical relevance of arterial stenosis at clamp sites after femoropopliteal bypass surgery is unknown. Methods Ninety-four patients underwent a femoropopliteal bypass in which the arterial inflow and outflow clamp sites were controlled by the Fogarty-Soft-Inla

  2. One sided bypass for bilateral Moyamoya disease, a case report and review of the literatures

    Directory of Open Access Journals (Sweden)

    Xuhui Li

    2016-01-01

    Conclusion: This case provided further evidence that direct bypass surgery is beneficial for patient in terms of blood flow improvement and symptom relieve. Although there is no consensus on whether bilateral surgical intervention is mandatory for patient with bilateral MMD, unilateral bypass might be sufficient enough. Further study is required to evaluate the best approach for such group of patient.

  3. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; van Oeveren, W; Grandjean, JG; Boonstra, PW

    1998-01-01

    Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

  4. The impact of heparin-coated circuits on hemodynamics during and after cardiopulmonary bypass

    NARCIS (Netherlands)

    de Vroege, R; Huybregts, R; van Oeveren, W; van Klarenbosch, J; Linley, G; Mutlu, J; Jansen, E; Hack, E; Eijsman, L; Wildevuur, C

    2005-01-01

    This study was performed to investigate if heparin-coated extracorporeal circuits can reduce the systemic inflammatory reaction with the subsequent release of vasoactive substances during and after cardiopulmonary bypass. Fifty-one patients scheduled for coronary artery bypass grafting were perfused

  5. The Only Way out Is through: The Peril of Spiritual Bypass

    Science.gov (United States)

    Cashwell, Craig S.; Bentley, Paige B.; Yarborough, J. Preston

    2007-01-01

    Given the increased attention to spirituality in the counseling literature, with a primary emphasis on helping clients find their spiritual path, it is important for counselors to be aware of one potential pitfall of the spiritual path, namely spiritual bypass. Spiritual bypass occurs when clients seek to use their spiritual beliefs, practices,…

  6. Effects of Peripheral Neurotensin on Appetite Regulation and Its Role in Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Ratner, Cecilia; Skov, Louise J; Raida, Zindy;

    2016-01-01

    increased proopiomelanocortin mRNA in the arcuate nucleus. We also investigated the importance of NT for the decreased food intake after gastric bypass surgery in a rat model of Roux-en-Y gastric bypass (RYGB). NT was increased in plasma and in the gastrointestinal tract in RYGB rats, and pharmacological...

  7. Temporary diabetes insipidus in 2 men after on-pump coronary artery bypass grafting.

    Science.gov (United States)

    Uyar, Ihsan Sami; Sahin, Veysel; Akpinar, Besir; Yurtman, Volkan; Abacilar, Feyzi; Okur, Faik Fevzi; Ates, Mehmet

    2013-01-01

    Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.

  8. Active bypass flow control for a seal in a gas turbine engine

    Energy Technology Data Exchange (ETDEWEB)

    Ebert, Todd A.; Kimmel, Keith D.

    2017-01-10

    An active bypass flow control system for controlling bypass compressed air based upon leakage flow of compressed air flowing past an outer balance seal between a stator and rotor of a first stage of a gas turbine in a gas turbine engine is disclosed. The active bypass flow control system is an adjustable system in which one or more metering devices may be used to control the flow of bypass compressed air as the flow of compressed air past the outer balance seal changes over time as the outer balance seal between the rim cavity and the cooling cavity wears. In at least one embodiment, the metering device may include a valve formed from one or more pins movable between open and closed positions in which the one pin at least partially bisects the bypass channel to regulate flow.

  9. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery

    OpenAIRE

    Abdul Jabbar AlHassany, Ali

    2014-01-01

    We present an interesting case of combined vitamin A and copper deficiency after a history of gastric bypass surgery where symptoms improved after parenteral copper and vitamin A treatment. Gastric bypass surgery as a cause of fat soluble vitamin deficiency is generally under-reported. Copper deficiency has been reported after gastric bypass surgery. Vitamin A deficiency after gastric bypass surgery has also been reported in the literature, but the reported cases again fall below the actual f...

  10. The experience of totally endoscopic coronary bypass grafting with the robotic system «Da Vinci» in Russia

    Science.gov (United States)

    Efendiev, V. U.; Alsov, S. A.; Ruzmatov, T. M.; Mikheenko, I. L.; Chernyavsky, A. M.; Malakhov, E. S.

    2015-11-01

    A new technology - a thoracoscopic coronary bypass grafting with the use of Da Vinci robotic system in Russia is represented by the experience of NRICP. The technology was introduced in Russia in 2011. Overall, one hundred endoscopic coronary artery bypass procedures were performed. We have compared and analyzed results of coronary artery stenting vs minimally invasive coronary artery bypass grafting. According to the results, totally endoscopic coronary artery bypass grafting has several advantages over alternative treatment strategies.

  11. Bypass system modification at Bonneville Dam on the Columbia River improved the survival of juvenile salmon

    Science.gov (United States)

    Ferguson, J.W.; Sandford, B.P.; Reagan, R.E.; Gilbreath, L.G.; Meyer, E.B.; Ledgerwood, R.D.; Adams, N.S.

    2007-01-01

    From 1987 to 1992, we evaluated a fish bypass system at Bonneville Dam Powerhouse 2 on the Columbia River. The survival of subyearling Chinook salmon Oncorhynchus tshawytscha released into the system ranged from 0.774 to 0.911 and was significantly lower than the survival of test fish released into turbines and the area immediately below the powerhouse where bypass system flow reentered the river. Yearling and subyearling Chinook salmon and yearling coho salmon O. kisutch released into the bypass system were injured or descaled. Also, levels of blood plasma cortisol and lactate were significantly higher in yearling and subyearling Chinook salmon that passed through the bypass system than in fish released directly into a net located over the bypass exit. This original system was then extensively modified using updated design criteria, and the site where juvenile fish reentered the river was relocated 2.8 km further downstream to reduce predation on bypassed fish by northern pikeminnow Ptychocheilus oregonensis. Based on studies conducted from 1999 to 2001, the new bypass system resulted in high fish survival, virtually no injuries to fish, fish passage times that were generally similar to water travel times, and mild stress responses from which fish recovered quickly. The mean estimated survival of subyearling Chinook salmon passing through the new bypass system was 0.946 in 2001, which was an usually low-flow year. Survival, physical condition, passage timing, and blood physiological indicators of stress were all useful metrics for assessing the performance of both bypass systems and are discussed. The engineering and hydraulic criteria used to design the new bypass system that resulted in improved fish passage conditions are described.

  12. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats.

    Science.gov (United States)

    Cavin, Jean-Baptiste; Voitellier, Eglantine; Cluzeaud, Françoise; Kapel, Nathalie; Marmuse, Jean-Pierre; Chevallier, Jean-Marc; Msika, Simon; Bado, André; Le Gall, Maude

    2016-09-01

    The technically easier one-anastomosis (mini) gastric bypass (MGB) is associated with similar metabolic improvements and weight loss as the Roux-en-Y gastric bypass (RYGB). However, MGB is controversial and suspected to result in greater malabsorption than RYGB. In this study, we compared macronutrient absorption and intestinal adaptation after MGB or RYGB in rats. Body weight and food intake were monitored and glucose tolerance tests were performed in rats subjected to MGB, RYGB, or sham surgery. Carbohydrate, protein, and lipid absorption was determined by fecal analyses. Intestinal remodeling was evaluated by histology and immunohistochemistry. Peptide and amino acid transporter mRNA levels were measured in the remodeled intestinal mucosa and those of anorexigenic and orexigenic peptides in the hypothalamus. The MGB and RYGB surgeries both resulted in a reduction of body weight and an improvement of glucose tolerance relative to sham rats. Hypothalamic orexigenic neuropeptide gene expression was higher in MGB rats than in RYGB or sham rats. Fecal losses of calories and proteins were greater after MGB than RYGB or sham surgery. Intestinal hyperplasia occurred after MGB and RYGB with increased jejunum diameter, higher villi, and deeper crypts than in sham rats. Peptidase and peptide or amino acid transporter genes were overexpressed in jejunal mucosa from MGB rats but not RYGB rats. In rats, MGB led to greater protein malabsorption and energy loss than RYGB. This malabsorption was not compensated by intestinal overgrowth and increased expression of peptide transporters in the jejunum.

  13. Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels

    NARCIS (Netherlands)

    Koehestanie, P.; Dogan, K.; Berends, F.; Janssen, I.; Wahab, P.J.; Groenen, M.; Müller, M.R.; Wit, de N.J.W.

    2014-01-01

    Background and study aims: Endoscopic implantation of a duodenal-jejunal bypass liner (DJBL) is a novel bariatric technique to induce weight loss and remission of type 2 diabetes mellitus. Placement of the DJBL mimics the bypass component of the Roux-en-Y gastric bypass (RYGB) procedure. In this obs

  14. 77 FR 43143 - Limitation on Claims for Judicial Review; Re-Evaluation With Respect to the Willits Bypass...

    Science.gov (United States)

    2012-07-23

    ... Willits Bypass Project, Willits, CA AGENCY: Federal Highway Administration (FHWA), DOT. ACTION: Notice of... to the State Route 101 Willits Bypass Project in Willits (Mendocino County), California, two Re... resulting from the new information and proposed changes to the Willits Bypass Project and in order...

  15. Fetal Growth in Pregnancies Conceived after Gastric Bypass Surgery in Relation to Surgery-to-Conception Interval

    DEFF Research Database (Denmark)

    Nørgaard, Lone Nikoline; Gjerris, Anne Cathrine Roslev; Kirkegaard, Ida;

    2014-01-01

    OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton...... and early or late fetal growth in pregnancies conceived after gastric bypass surgery....

  16. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients.

    Science.gov (United States)

    Abla, Adib A; McDougall, Cameron M; Breshears, Jonathan D; Lawton, Michael T

    2016-05-01

    OBJECT Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. METHODS Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. RESULTS During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. CONCLUSIONS PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one

  17. Obturator or "lateral" bypass in the management of infected vascular prostheses at the groin

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2002-01-01

    Full Text Available The infection of the previously implanted vascular graft at the groin, is associated with great mortality and morbidity rate [1]. The authors present a retrospective study in which they analyzed management of infected vascular prostheses at the groin, using obturator bypass in 26 cases, and "lateral" bypass in 15 cases. The indications for obturator bypass reconstructions included: 20 infections of aorto-femoral grafts, two infected pse udoaneurysms in the groin after RTA of the superficial femoral artery, and 4 infections of iliac-femoral grafts. The indications for lateral bypass reconstructions were: infections after aorto-femoral reconstructions - 8 cases; infection after femora-popliteal reconstructions - 4 cases; infection after iliac-femoral reconstruction - 2 patients, and one infected pseudoaneurysm in the groin after RTA of the superficial femoral artery. In 3 subjects obturator bypass was performed using extraperitoneal approach while in other 23 patients transperitoneal approach was done by donor's artery. The obturator bypass was performed using a PTFE graft in 3 cases and Dacron graft in 23. The donor's artery used for obturator bypass was a noninfected proximal part of aortofemoral graft in 20 cases, and iliac artery in 6 patients. The superfical femoral artery was recipient artery for obturator bypass in 3 cases, deep femoral artery in one case, and above the knee popliteal artery in 22 cases (Figure 1. In two patients transperitoenal approach to donors artery for "lateral" bypass has been used, and in 13 cases extraperitoneal. The proximal noninfected part of aorto femoral graft was used as a donor's artery for lateral bypass in 8 patients, while common iliac artery in 7 subjects. In 5 cases recon structions were performed using PTFE grafts, in 3 using autologous saphenous vein grafts, and in 7 using Dacron grafts. The recipient artery for "lateral" bypass was deep femoral in 8 cases, superficial femoral in three patients and

  18. Ex-situ liver surgery without veno-venous bypass

    Institute of Scientific and Technical Information of China (English)

    Ke-Ming Zhang; Xiong-Wei Hu; Jia-Hong Dong; Zhi-Xian Hong; Zhao-Hai Wang; Gao-Hua Li; Rui-Zhao Qi

    2012-01-01

    AIM:To evaluate the results of hepatic resection with ex-situ hypothermic perfusion and without veno-venous bypass.METHODS:In 3 patients with liver tumor,the degree of the inferior vena cava and/or main hepatic vein involvement was verified when the liver was dissociated in the operation.It was impossible to resect the tumors by the routine hepatectomy,so the patients underwent ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.All surgical procedures were carried out or supervised by a senior surgeon.A retrospective analysis was performed for the prospectively collected data from patients with liver tumor undergoing ex-situ liver surgery,vein cava replacement and hepatic autotransplantation without veno-venous bypass.We also compared our data with the 9 cases of Pichlmayr's group.RESULTS:Three patients with liver tumor were analysed.The first case was a 60-year-old female with a huge haemangioma located in S1,S4,S5,S6,S7 and S8 of liver; the second was a 64-year-old man with cholangiocarcinoma in S1,S2,S3 and S4 and the third one was a 55-year-old man with a huge cholangiocarcinoma in S1,S5,S7 and S8.The operation time for the three patients were 6.6,6.4 and 7.3 h,respectively.The anhepatic phases were 3.8,2.8 and 4.0 h.The volume of blood loss during operation were 1200,3100,2000 mL in the three patients,respectively.The survival periods without recurrence were 22 and 17 mo in the first two cases.As for the third case complicated with postoperative hepatic vein outflow obstruction,emergency hepatic vein outflow extending operation and assistant living donor liver transplantation were performed the next day,and finally died of liver and renal failure on the third day.Operation time (6.7 ± 0.47h vs 13.7 ± 2.6 h) and anhepatic phase (3.5 ± 0.64 h vs 5.7 ± 1.7 h) were compared between Pichlmayr's group and our series (P =0.78).CONCLUSION:Ex-situ liver resection and liver autotransplantation has shown a potential

  19. Changes in Hematology and Calcium Metabolism After Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Worm, Dorte; Madsbad, Sten; Kristiansen, Viggo B

    2015-01-01

    BACKGROUND: Concerns regarding nutritional deficiencies have recently emerged after Roux-en-Y gastric bypass (RYGB). METHODS: A total of 835 subjects underwent RYGB, age 43.3 years, body mass index (BMI) 47.2 kg/m(2). Hematological and calcium metabolic variables were measured before, 6, 12, and 24...... decreased from before surgery to month 24 for both men (9.3 ± 0.05 vs. 8.3 ± 0.08 mmol/L, p anemia was present in 25.8 % of women and 22.1 % of men. Predictors of anemia in both sexes were baseline hemoglobin (p ... sexes (p anemia, which especially affected premenopausal women. More attention should...

  20. Photovoltaic power generation system free of bypass diodes

    Science.gov (United States)

    Lentine, Anthony L.; Okandan, Murat; Nielson, Gregory N.

    2015-07-28

    A photovoltaic power generation system that includes a solar panel that is free of bypass diodes is described herein. The solar panel includes a plurality of photovoltaic sub-modules, wherein at least two of photovoltaic sub-modules in the plurality of photovoltaic sub-modules are electrically connected in parallel. A photovoltaic sub-module includes a plurality of groups of electrically connected photovoltaic cells, wherein at least two of the groups are electrically connected in series. A photovoltaic group includes a plurality of strings of photovoltaic cells, wherein a string of photovoltaic cells comprises a plurality of photovoltaic cells electrically connected in series. The strings of photovoltaic cells are electrically connected in parallel, and the photovoltaic cells are microsystem-enabled photovoltaic cells.

  1. [Percutaneous transluminal angioplasty in vascular by-passes].

    Science.gov (United States)

    Rodríguez, J E; Fernández Guinea, O; López, V; Suárez Pereiro, M J; Reimunde, E; Cosío, J M; Barreiro, A

    1993-01-01

    Results from 21 cases of percutaneous transluminal angioplasties as a treatment of stenosed vascular by-pass from 16 patients, are presented. The technique took place in 10 cases at the aorto-femoral area, in others 10 cases at the popliteal-femoral area and, in the last one, at the carotid-subclavian area. Preliminary results were successful in all cases (100%). Follow-up showed a better long-term results at the aorto-femoral level. Considering the satisfactory results and also considering that, in case of negative results or re-stenosis, other surgical techniques could be performed, we conclude that the percutaneous transluminal angioplasty should be the first treatment for such of injuries.

  2. Hiatal hernia causing extrapericardial tamponade after coronary bypass surgery.

    Science.gov (United States)

    Papoulidis, Pavlos; Beatty, Jasmine Winter; Dandekar, Uday

    2014-10-01

    Cardiac tamponade is defined as compression of the heart due to accumulation of fluid in the pericardial sac, leading to raised pericardial pressures with haemodynamic compromise. We describe the case of a 76-year old female patient who underwent a routine off-pump coronary artery bypass graft operation and within 48 h developed classic signs of cardiac tamponade. The perioperative echocardiogram and operative findings at re-exploration revealed no clots or fluid collection. A giant hiatus hernia was found to be responsible for the tamponade through extrinsic compression. After insertion of a nasogastric tube and decompression of the stomach, there was a rapid improvement of the clinical picture. The remaining postoperative course was uneventful and the patient was discharged 5 days later, with referral to the general surgeon for further management. We conclude that, in cases of tamponade post-cardiac surgery, extrapericardial pathologies should be considered.

  3. Plummer-Vinson syndrome following gastric bypass surgery.

    Science.gov (United States)

    Sapthavee, Andrew; Kircher, Matthew L; Akst, Lee M

    2014-09-01

    Plummer-Vinson syndrome (PVS) is the combination of dysphagia, angular cheilitis, atrophic glossitis, and esophageal webbing in the setting of iron deficiency anemia. Although it is relatively uncommon, this condition is important to recognize because it is a source of dysphagia and it confers an increased risk for hypopharyngeal cancer. Cases of PVS associated with gastrointestinal conditions such as celiac disease and gastric cancer have been previously reported in the literature, but as far as we know, no case of PVS associated with bariatric surgery has been previously reported. We describe the case of a 39-year-old woman who developed PVS following gastric bypass surgery, and we briefly discuss the current knowledge of this syndrome.

  4. The Metaphysical Instincts & Spiritual Bypassing in Integral Psychology

    Directory of Open Access Journals (Sweden)

    Bahman A.K. Shirazi

    2013-09-01

    Full Text Available Instincts are innate, unconscious means by which Nature operates in all forms of life including animals and human beings. In humans however, with progressive evolution of consciousness, instincts become increasingly conscious and regulated by egoic functions. Biological instincts associated with the lower-unconscious such as survival, aggressive, and reproductive instincts are well known in general psychology. The higher-unconscious, which is unique to human beings, may be said to have its own instinctual processes referred to here as the ‘metaphysical instincts’. In traditional spiritual practices awakening the metaphysical instincts has often been done at the expense of suppressing the biological instincts—a process referred to as spiritual bypassing. This essay discusses how the metaphysical instincts initially expressed as the religious impulse with associated beliefs and behaviors may be transformed and made fully conscious, and integrated with the biological instincts in integral yoga and psychology in order to achieve wholeness of personality.

  5. Contrast enhanced magnetic resonance angiography for determining patency of coronary bypass grafts. A comparison with coronary angiography; Kontrastmittelverstaerkte Magnetresonanzangiographie zur Ueberpruefung der Durchgaengigkeit koronarer Bypasses. Vergleich zur Koronarangiographie

    Energy Technology Data Exchange (ETDEWEB)

    Wintersperger, B.J.; Smekal, A. von; Penzkofer, H.V.; Reiser, M. [Inst. fuer Radiologische Diagnostik, Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen (Germany); Engelmann, M.G.; Knez, A. [1. Medizinische Klinik und Poliklinik, Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen (Germany); Laub, G. [Siemens AG, Erlangen (Germany). Bereich Medizintechnik

    1997-12-01

    Aim: Assessment of graft patency with current non-invasive MRA techniques is particularly difficult for evaluating internal mammary artery grafts. Our aim is to determine the accuracy of a contrast enhanced MRA technique in assessing graft patency. Methods: We examined 19 patients with a total of 53 grafts (32 venous/21 arterial), using an ultrafast contrast enhanced 3D gradient-echo technique and compared this with the results of selective angiography. Results: Sensitivity of the contrast enhanced method was 95.2% for venous grafts, 94.4% for IMA grafts and 94.8% overall. Specificity was 85.7% overall, 90.9% for venous and 66.7% for IMA grafts. Positive predictive value was 94.4%. Conclusion: Compared with previous studies, visualisation of IMA grafts was improved by using contrast enhanced MRA. In this preliminary study, contrast enhanced MRA proved promising for the assessment of graft patency. (orig.) [Deutsch] Ziel: Die Bestimmung der Durchgaengigkeit koronarer Bypasses mit bisherigen, nichtinvasiven Methoden der Magnetresonanzangiographie (MRA) erwies sich insbesondere beim A.-mammaria-interna-Bypass (IMA) als schwierig. In unseren Untersuchungen soll die Wertigkeit einer kontrastverstaerkten MRA-Technik zur Ueberpruefung der Bypassdurchgaengigkeit bestimmt werden. Methoden: Wir untersuchten 19 Patienten mit insgesamt 53 Bypasses (32 ACVB/21 IMA) mit einer ultraschnellen, kontrastverstaerkten 3D-Gradienten-Echo-Technik im Vergleich zur selektiven Angiographie. Ergebnisse: Die Sensitivitaet der kontrastverstaerkten Methode betrug 95,2% fuer ACVBs, 94,4% fuer IMA-Bypasses und insgesamt 94,8%. Die Spezifitaet lag insgesamt bei 85,7%, fuer ACVB`s 90,9% und fuer IMA-Bypasses 66,7%. Der positive Vorhersagewert betrug 94,9%. Schlussfolgerung: Im Vergleich zu bisherigen Studien ist die Darstellung von IMA-Bypasses deutlich verbessert und zuverlaessiger. In ersten Ergebnissen stellt die kontrastverstaerkte MRA eine relativ einfache und schnelle Methode zur Bestimmung

  6. Hyperparathyroidism and vitamin D deficiency after laparoscopic gastric bypass.

    Science.gov (United States)

    Clements, Ronald H; Yellumahanthi, Kishore; Wesley, Mary; Ballem, Naveen; Bland, Kirby I

    2008-06-01

    Hyperparathyroidism (HPT) can occur after gastric bypass because of the alteration in vitamin D and calcium absorption. Adequate serum vitamin D concentrations have not been clearly defined in this patient population. Vitamin D (Vit D) and parathyroid hormone (PTH) were assessed 1 year after laparoscopic gastric bypass (LGB). The prevalence of HPT and Vit D deficiency were determined and their association was evaluated using Fisher's exact test. Ninety-three patients (aged 44 +/- 1.1 years, 49.6 +/- 0.67 Kg/m2 body mass index, 79.6% female, 69.6% white) were evaluated. The prevalence of Vit D deficiency (less than 20 ng/mL) and HPT (greater than 65 pg/mL) was 23.6 per cent (n = 22) and 25.7 per cent (n = 28), respectively. Among patients with HPT, only eight of 28 (28.6%) had Vit D deficiency, and of those with Vit D deficiency, only eight of 22 (36.4%) had HPT. There was a weak inverse correlation (r = -0.37) between PTH and Vit D. Blacks are at higher risk for Vit D deficiency. There was no significant association between Vit D deficiency and HPT, Vit D deficiency and Roux limb length, or HPT and Roux limb length. After LGB, Vit D deficiency and hyperparathyroidism occur commonly. Body mass index and Roux limb length are not associated with these two conditions, but racial differences do exist. There is a weak inverse correlation between Vit D and PTH. Further research is needed to elucidate the causes, treatments, and significance of HPT after LGB.

  7. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

    Science.gov (United States)

    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; P<0.01). The primary end point did not show significant differences in graft patency between groups. Secondary end points occurred more frequently in the in situ group (P=0.03), with 7-year rates of 34±10% in the in situ and 25±12% in the Y grafting groups, driven largely by a higher incidence of repeat revascularization in the in situ group (14±4.5% versus 7.4±3.2% at 7 years; P=0.009). There were no significant differences in hospital mortality or morbidity or in late survival, myocardial infarction, or stroke between groups. Conclusions— Three-year systematic angiographic follow-up revealed no significant difference in graft patency between the 2 BITA configurations. However, compared with in situ configuration, the use of BITA in a Y grafting configuration results in lower rates of major adverse cardiovascular and cerebrovascular events at 7 years. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  8. Buprenorphine pharmacokinetic parameters during coronary artery bypass graft surgery.

    Science.gov (United States)

    Amani, A; Joseph, T; Balasaraswathi, K

    1997-10-01

    The pharmacokinetic parameters of buprenorphine (BN) after a single bolus dose of 10 microg/kg i.v. was investigated in 6 male patients whose age averaged 59+/-9.8 years and body weight of 65.8+/-5.7 kg undergoing coronary artery bypass graft surgery (CABG). The unbound BN plasma concentrations were detected using ultrafiltration and high performance liquid chromatography/electro-chemical detection (HPLC/ECD) method. During cardiopulmonary bypass (CPB) there was a fall in BN plasma concentrations, observations similar to reports on fentanyl, sufentanil and alfentanil. This is probably due to haemodilution, hypothermia and hydrophobic sequestration of drug on to the CPB tubing. After CPB the concentrations rose to values higher than during CPB, though it did not attain pre CPB concentrations. These variations were not statistically significant indicating that plasma levels were adequately stable during CPB. The plasma concentration time curves were biexponential and the pharmacokinetic parameters obtained were : distribution half-life 37.24+/-6.57 min, elimination half-life 482.69+/-79 min, clearance 1221.97+/-209.42 ml/min, and volume of distribution 736.46+/-71.25 L. BN in the dose used follows the pharmacokinetic pattern of other commonly used narcotics during CABG. The mean +/- SEM plasma BN concentration during CPB was 0.51+/-0.03 ng/ml which was adequate for the maintenance of analgesia and anaesthesia, as none of our patients expressed the signs and symptoms of awareness during surgery. Further, unlike the other narcotics muscle rigidity was absent. Thus BN is a safe and good alternative to other narcotics for patients undergoing CABG.

  9. Antioxidative effect of propofol during cardiopulmonary bypass in adults

    Institute of Scientific and Technical Information of China (English)

    Shi-hai ZHANG; Shou-yong WANG; Shang-long YAO

    2004-01-01

    AIM: To investigate the antioxidative potential of propofol (an intravenous anesthetic with a chemical structure similar to phenol-based free radical scavengers such as vitamin E) during cardiopulmonary bypass (CPB). METHODS:Thirty adult patients referred for elective cardiac procedure with CPB were included and randomly allocated to a nously for anesthesia maintenance, whereas those allocated to the control group received fentanyl 10 μg/kg intravenously and inhaled enflurane (1%-1.5 %). Blood samples were collected at 7 time points: before the start of CPB,at 30 and 60 min of CPB, at the conclusion of CPB, 10 min after the administration of protamine, and 12 and 24 h after the cessation of CPB. Plasma levels of free F2-isoprostanes (sensitive markers of free radicals production)and complement C5a were determined by mass-spectrometric assay and enzyme immunoassay, respectively. Neutrophil adhesion to endothelial cells was observed at x200 magnification under a light microscope. RESULTS:Levels of F2-isoprostanes, complement C5a and neutrophil adhesion rate increased significantly during and after CPB in both groups. There were significantly higher levels of F2-isoprostanes, C5a, and more neutrophils adhering to endothelial cells in the control group than those in the propofol group, respectively. CONCLUSION: Cardiopulmonary bypass is associated with a great production of damaging free radicals. Propofol may be beneficial both as an anesthetic and as a potent free radical scavenger in patients presenting pathologies associated with free radical reactions during CPB.

  10. Pre-test CFD Calculations for a Bypass Flow Standard Problem

    Energy Technology Data Exchange (ETDEWEB)

    Rich Johnson

    2011-11-01

    The bypass flow in a prismatic high temperature gas-cooled reactor (HTGR) is the flow that occurs between adjacent graphite blocks. Gaps exist between blocks due to variances in their manufacture and installation and because of the expansion and shrinkage of the blocks from heating and irradiation. Although the temperature of fuel compacts and graphite is sensitive to the presence of bypass flow, there is great uncertainty in the level and effects of the bypass flow. The Next Generation Nuclear Plant (NGNP) program at the Idaho National Laboratory has undertaken to produce experimental data of isothermal bypass flow between three adjacent graphite blocks. These data are intended to provide validation for computational fluid dynamic (CFD) analyses of the bypass flow. Such validation data sets are called Standard Problems in the nuclear safety analysis field. Details of the experimental apparatus as well as several pre-test calculations of the bypass flow are provided. Pre-test calculations are useful in examining the nature of the flow and to see if there are any problems associated with the flow and its measurement. The apparatus is designed to be able to provide three different gap widths in the vertical direction (the direction of the normal coolant flow) and two gap widths in the horizontal direction. It is expected that the vertical bypass flow will range from laminar to transitional to turbulent flow for the different gap widths that will be available.

  11. Clinical observation of gastric bypass in treatment of type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    PU Yong-dong; YANG Bo; HE Jiao-miao; WU You-jun; WANG Yi; L(U) Gang; ZHANG Bo; WANG Yue; LIU Wei-ping; WENG Jian-feng; LI Jing-quan; CAO Zhi-yu; WANG Li; HU Xiao; DONG Li-guo; LI Yue-min; ZHAO Hua-zhou; QIN Rong

    2012-01-01

    Background Roux-en-Y gastric bypass (GBP) is the main surgical procedure used in type 2 diabetes.The objective of this study was to evaluate the different types of GBP in treatment of type 2 diabetes.Methods Patients with type 2 diabetes were randomly divided into two groups:those who underwent gastrojejunal loop anastomosis bypass and those who underwent gastrojejunal Roux-en-Y bypass.Blood glucose alterations,operation time,and operation complicatiors were observed.Results Gastrojejunal loop anastomosis bypass and gastrojejunal Roux-en-Y bypass were both effective in the treatment of selected patients with type 2 diabetes.Compared with gastrojejunal Roux-en-Y bypass,gastrojejunal loop anastomosis bypass had the advantages of easier implementation,shorter operation time,and fewer operation complications.Conclusions Gastrojejunal loop anastomosis is effective in treatment of type 2 diabetes.It is safe,easy to implement,and worthy of clinical popularization.

  12. [Application of a device for determination of the transplant length during operation of the aorta-coronary bypass].

    Science.gov (United States)

    Volkov, A M; Khubulava, G G; Paĭvin, A A; Liubimov, A I; Kravchuk, V N

    2012-01-01

    Determination of the necessary length of the bypass is one of the principal stages of operation of the aorta-coronary bypass. The greatest difficulty of the determination of the bypass length is the first-priority applying of proximal anastomoses. It requires the surgeon to have great experience, the operation to be longer. It also makes it necessary to prepare a conduit of deliberately excessive length. A device is proposed for the determination of the necessary bypass length during operation of aorta-coronary bypass consisting of a crocodile grip with a fixed to it polymer tube.

  13. By-Pass Diode Temperature Tests of a Solar Array Coupon under Space Thermal Environment Conditions

    Science.gov (United States)

    Wright, Kenneth H.; Schneider, Todd A.; Vaughn, Jason A.; Hoang, Bao; Wong, Frankie; Wu, Gordon

    2016-01-01

    By-Pass diodes are a key design feature of solar arrays and system design must be robust against local heating, especially with implementation of larger solar cells. By-Pass diode testing was performed to aid thermal model development for use in future array designs that utilize larger cell sizes that result in higher string currents. Testing was performed on a 56-cell Advanced Triple Junction solar array coupon provided by SSL. Test conditions were vacuum with cold array backside using discrete by-pass diode current steps of 0.25 A ranging from 0 A to 2.0 A.

  14. Severe scurvy after gastric bypass surgery and a poor postoperative diet

    DEFF Research Database (Denmark)

    Hansen, Esben P K; Metzsche, Carsten; Henningsen, Emil;

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at......-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. KEYWORDS: Scurvy; Gastric bypass surgery; Multiorgan dysfunction....

  15. Experimental Study on Airflow Reversal Within Bypass Branch During Mine Fire

    Institute of Scientific and Technical Information of China (English)

    周福宝; 王德明; 周延

    2001-01-01

    Based on the analysis of conditions for airflow reversal within a bypass branch, the airflow reversal phenomena were successfully simulated in the laboratory experiments. Data obtained indicate that airflow reversal within a bypass branch is mainly caused by fire pressure yielded in the combustion branch. In addition, the maximum reversal quantity of airflow occurs in step with the highest temperature of fire, the highest concentration of CO2 and the lowest concentration of O2. Moreover, the time that fire size reaches the maximum value corresponds to the time airflow reversal in the bypass branch is most possible. The results are of great significance for guiding rescue work to avoid airflow reversal.

  16. Posttraumatic growth in post-surgical coronary artery bypass graft patients

    Directory of Open Access Journals (Sweden)

    Catherine A Waight

    2015-02-01

    Full Text Available Recent research in posttraumatic growth has been applied to people with life-threatening illnesses to optimise recovery. There is a lack of research exploring posttraumatic growth in coronary artery bypass graft patients. This article describes the recovery experience of 14 coronary artery bypass graft patients (13 males and 1 female at their first outpatient review post-surgery. Grounded theory analysis was used to develop a model of distinct and shared pathways to growth depending on whether patients were symptomatic or asymptomatic pre-coronary artery bypass graft. Outcomes of posttraumatic growth in this sample included action-based healthy lifestyle growth and two forms of cognitive growth: appreciation of life and new possibilities. The model of posttraumatic growth developed in this study may be helpful in guiding future research into promoting posttraumatic growth and behaviour change in coronary artery bypass graft patients.

  17. THE BASIC LAWS AND FEATURES OF CYTOKINE DYNAMICS IN PROCESS AND EARLY TERMS AFTER CARDIOPULMONARY BYPASS

    Directory of Open Access Journals (Sweden)

    S. I. Suskov

    2011-01-01

    Full Text Available The basic variants of cytokines reactions defining type of organ dysfunctions are revealed in the course of car- diopulmonary bypass and in the early postoperative period. Their character and expression, depends on gravity preoperative an immunodeficiency and initial degree of heart insufficiency. Diphasic dynamics of development of system inflammatory reaction is confirmed after cardiopulmonary bypass: increase of levels proinflammatory cytokines is in the first phase and anti-inflammatory cytokines with development immunodepression and cellular anergy in is the second phase. Also, key role IL-1Ra is revealed in restraint of hyperactivation of system inflam- matory reaction. Blood whey levels IL-6, IL-8, G-CSF, TNF-α and IL-1Ra should be defined to cardiopulmonary bypass, in 10–12 hours, 24 hours and 3 days after cardiopulmonary bypass and may be used as prognostic criteria of development of postoperative complications. 

  18. Reversible hyperinsulinemic hypoglycemia after gastric bypass: a consequence of altered nutrient delivery

    DEFF Research Database (Denmark)

    McLaughlin, Tracey; Peck, Marcia; Holst, Jens;

    2010-01-01

    Severe hypoglycemia after Roux-en-Y gastric bypass surgery (RYGB) is an increasingly recognized condition, characterized by neuroglycopenia and inappropriately elevated insulin concentrations that occur primarily in the postprandial state. Both pathophysiology and treatment of this disorder remai...

  19. Coronary Artery Bypass Grafting (CABG) Dengan Menggunakan Vena Saphenous, Arteri Mammaria Interna

    OpenAIRE

    Lita Feriyawati

    2006-01-01

    Coronary Artery Bypass Grafting (CABG) merupakan salahsatu penanganan intervensi dari Penyakit Jantung Koroner (PJK), dengan cara membuat saluran baru melewati bagian Arteri Coronaria yang mengalami penyempitan atau penyumbatan, oleh Lita Feriyawati 06001193

  20. GLP1 and glucagon co-secreting pancreatic neuroendocrine tumor presenting as hypoglycemia after gastric bypass

    DEFF Research Database (Denmark)

    Guimarães, Marta; Rodrigues, Pedro; Pereira, Sofia S;

    2015-01-01

    Post-prandial hypoglycemia is frequently found after bariatric surgery. Although rare, pancreatic neuroendocrine tumors (pNET), which occasionally are mixed hormone secreting, can lead to atypical clinical manifestations, including reactive hypoglycemia. Two years after gastric bypass surgery for...

  1. Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery.

    Science.gov (United States)

    Sevuk, Utkan; Kaya, Sedat; Ayaz, Firat; Aktas, Ulas

    2016-01-01

    Paraplegia is an extremely rare complication after coronary artery bypass grafting (CABG) and the underlying mechanisms remain poorly understood. We report a patient who developed paraplegia after CABG and review the literature on spinal cord ischemia following CABG surgery.

  2. Utilising cardiopulmonary bypass for cancer surgery. Malignancy-induced protein C deficiency and thrombophilia.

    LENUS (Irish Health Repository)

    Marshall, C

    2012-02-03

    Cardiopulmonary bypass has evolved over the last 30 years. It is an important tool for the cardiac surgeon today and also has applications in non-cardiac operations such as surgery to extract tumours. Such patients undergoing surgery for cancer may be at an increased risk of a thromboembolic event post surgery, due to disturbances in the normal clotting pathway leading to hypercoagulability. One such disturbance is malignancy-induced Protein C deficiency. A deficiency of Protein C can cause hypercoagulabitity. Recent studies have examined cardiopulmonary bypass and inherited Protein C deficiency. However, surgery for cancer patients with a malignancy-induced Protein C deficiency involving cardiopulmonary bypass has not been reported. Surgery using CPB in these patients may result in increased morbidity and mortality. The objective of this article is to review the literature in order to discuss the occurrence, the aetiology and possible management of cancer patients with malignancy-induced Protein C deficiencies that require cardiopulmonary bypass for their surgery.

  3. Building America Top Innovations 2012: Thermal Bypass Air Barriers in the 2009 International Energy Conservation Code

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-01-01

    This Building America Top Innovations profile describes Building America research supporting Thermal Bypass Air Barrier requirements. Since these were adopted in the 2009 IECC, close to one million homes have been mandated to include this vitally important energy efficiency measure.

  4. Active bypass flow control for a seal in a gas turbine engine

    Energy Technology Data Exchange (ETDEWEB)

    Ebert, Todd A.; Kimmel, Keith D.

    2017-03-14

    An active bypass flow control system for controlling bypass compressed air based upon leakage flow of compressed air flowing past an outer balance seal between a stator and rotor of a first stage of a gas turbine in a gas turbine engine is disclosed. The active bypass flow control system is an adjustable system in which one or more metering devices may be used to control the flow of bypass compressed air as the flow of compressed air past the outer balance seal changes over time as the outer balance seal between the rim cavity and the cooling cavity wears In at least one embodiment, the metering device may include an annular ring having at least one metering orifice extending therethrough, whereby alignment of the metering orifice with the outlet may be adjustable to change a cross-sectional area of an opening of aligned portions of the outlet and the metering orifice.

  5. Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Pär I; Kofoed, Klaus F;

    2016-01-01

    BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 170 patients were...

  6. Extracranial–intracranial bypass for Takayasu’s arteritis: A case report

    Directory of Open Access Journals (Sweden)

    Richard M. Young, M.D.

    2014-12-01

    Conclusion: STA–MCA bypass to enhance cerebral blood flow in the setting of stroke symptoms due to Takayasu’s arteritis can serve as a bridge before definitive cardiothoracic treatment of the great vessels.

  7. Increased neutrophil priming and sensitization before commencing cardiopulmonary bypass in cardiac surgical patients

    NARCIS (Netherlands)

    Gu, YJ; Schoen, P; Tigchelaar, [No Value; Loef, BG; Ebels, T; Rankin, AJ; van Oeveren, W

    2002-01-01

    Background. Neutrophil activation is implicated in postoperative complications in patients having cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to determine the temporal fluctuations in the primability of neutrophils in the preoperative, intraoperative, and postoperative

  8. Coronary artery bypass grafting in Takayasu's disease--importance of the proximal anastomosis: a case report

    NARCIS (Netherlands)

    Kuijer, A.; Oosterhout, M.F. van; Kloppenburg, G.T.; Morshuis, W.J.

    2015-01-01

    INTRODUCTION: Treatment of coronary artery involvement in Takayasu's arteritis is challenging. Coronary artery bypass grafting may be required. The use of saphenous vein grafts is recommended because of possible inflammatory involvement of the internal thoracic arteries. However, inserting the proxi

  9. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass

    NARCIS (Netherlands)

    Severdija, E.E.; Vranken, N.P.; Teerenstra, S.; Ganushchak, Y.M.; Weerwind, P.W.

    2015-01-01

    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A t

  10. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

    DEFF Research Database (Denmark)

    Møller, Christian H; Steinbrüchel, Daniel A

    2014-01-01

    Coronary artery bypass grafting (CABG) remains the preferred treatment in patients with complex coronary artery disease. However, whether the procedure should be performed with or without the use of cardiopulmonary bypass, referred to as off-pump and on-pump CABG, is still up for debate....... Intuitively, avoidance of cardiopulmonary bypass seems beneficial as the systemic inflammatory response from extracorporeal circulation is omitted, but no single randomized trial has been able to prove off-pump CABG superior to on-pump CABG as regards the hard outcomes death, stroke or myocardial infarction....... In contrast, off-pump CABG is technically more challenging and may be associated with increased risk of incomplete revascularization. The purpose of the review is to summarize the current literature comparing outcomes of off-pump versus on-pump coronary artery bypass surgery....

  11. The effect of arteriovenous fistulas on in situ saphenous vein bypasses

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T;

    1991-01-01

    Intraoperative identification and later development of arteriovenous fistulas were investigated prospectively in 70 in situ saphenous vein bypass procedures. Surveillance was performed by completion arteriography and intra- and postoperative continuous wave Doppler examination. The intraoperative...

  12. Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery

    Directory of Open Access Journals (Sweden)

    Ricardo Antonio G. Barbosa

    2009-03-01

    Full Text Available PURPOSE: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. METHODS: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10 or off-pump coronary artery bypass graft (group, n=10 coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 µg/mL. Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant. RESULTS: After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 ± 117 vs. 216 ± 85 min, p = 0.04. Patients undergoing cardiopulmonary bypass had shorter biological (1.82 ± 0.5 vs. 3.67 ± 1.15h, p < 0.01 and terminal elimination (6.27 ± 1.29 vs. 10.5h ± 2.18, p < 0.01 half-life values, as well as higher total plasma clearance (28.36 ± 11.40 vs.18.29 ± 7.67 mL/kg/min, p = 0.03, compared to patients in the off-pump coronary artery bypass graft group. CONCLUSION: Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

  13. Ventilation during cardiopulmonary bypass for prevention of respiratory insufficiency

    Science.gov (United States)

    Chi, Dongmei; Chen, Chan; Shi, Yu; Wang, Wanyu; Ma, Ye; Zhou, Ronghua; Yu, Hai; Liu, Bin

    2017-01-01

    Abstract Background: Cardiopulmonary bypass (CPB) is necessary for most cardiac surgery, which may lead to postoperative lung injury. The objective of this paper is to systematically evaluate whether ventilation during CPB would benefit patients undergoing cardiac surgery. Methods: We searched randomized controlled trials (RCTs) through PubMed, Embase, and Cochrane Library from inception to October 2016. Eligible studies compared clinical outcomes of ventilation versus nonventilation during CPB in patients undergoing cardiac surgery. The primary outcome includes oxygenation index (PaO2/FiO2 ratio) or alveolar to arterial oxygen tension difference (AaDO2) immediately after weaning from bypass. The secondary outcomes include postoperative pulmonary complications (PPCs), shunt fraction (Qs/Qt), hospital stay, and AaDO2 4 hours after CPB. Results: Seventeen trials with 1162 patients were included in this meta-analysis. Ventilation during CPB significantly increased post-CPB PaO2/FiO2 ratio (mean difference [MD] = 21.84; 95% confidence interval [CI] = 1.30 to 42.37; P = 0.04; I2 = 75%) and reduced post-CPB AaDO2 (MD = –50.17; 95% CI = –71.36 to –28.99; P <0.00001; I2 = 74%). Qs/Qt immediately after weaning from CPB showed a significant difference between groups (MD = –3.24; 95% CI = –4.48 to –2.01; P <0.00001; I2 = 0%). Incidence of PPCs (odds ratio [OR] = 0.79; 95% CI = 0.42 to 1.48; P = 0.46; I2 = 37%) and hospital stay (MD = 0.09; 95% CI = –23 to 0.41; P = 0.58; I2 = 37%) did not differ significantly between groups. Conclusion: Ventilation during CPB might improve post-CPB oxygenation and gas exchange in patients who underwent cardiac surgery. However, there is no sufficient evidence to show that ventilation during CPB could influence long-term prognosis of these patients. The beneficial effects of ventilation during CPB are requisite to be evaluated in powerful and well

  14. Evaluation of Acute Ischemic Mitral Regurgitation Following Cardiopulmonary Bypass Assessed by Biplane Transesophageal Echocardiography

    OpenAIRE

    Nakao, Tatsuya; Fujimoto, Keiko; Brodman, Richard F.; Oka, Yasu

    1997-01-01

    The aim of this study was to evaluate pathogenesis and outcome of acute ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) using biplane transesophageal echocardiography (TEE).   Biplane TEE was continuously monitored in a total of 96 patients who were scheduled for elective CABG surgery. Of 96 patients, 10 with no MR at stages 1 (after anesthetic induction but before skin incision) and 2 (after cardiopulmonary bypass [CPBJ and decannulation) ...

  15. Is it necessary to stent renal artery stenosis patients before cardiopulmonary bypass procedures?

    Institute of Scientific and Technical Information of China (English)

    ZHENG Bin; YAN Hong-bing; LIU Rui-fang; CHENG Shu-juan; WANG Jian; ZHAO Han-jun; SONG Li

    2011-01-01

    Background Acute kidney injury (AKI) is associated with poor prognosis after cardiopulmonary bypass. The aim of this retrospective study was to investigate whether stent implantation before cardiopulmonary bypass has beneficial effect on development of AKI in renal artery stenosis (RAS) patients.Methods In this retrospective study, patients with abnormal baseline serum creatinine (SCr, >106 μmol/L) were not included. Included patients (n=69) were divided into two groups. Group 1 included 31 RAS patients receiving no stent implantation before cardiopulmonary bypass. Group 2 included 38 RAS patients having received stent implantation just before cardiopulmonary bypass. To assess AKI after cardiopulmonary bypass, serum urea nitrogen, SCr and creatinine clearance were recorded at baseline, at the end of operation, during the first and second postoperative 24 hours.Results Baseline characteristics were similar between groups. Serum urea nitrogen, SCr, creatinine clearance before and after cardiopulmonary bypass were also similar class groups. Incidence of AKI in group 1 was not significantly different from group 2. In group 1, AKI defined by RIFLE between occurred in 7 (22.6%) patients: 5 (16.1%) with RIFLE-R,2 (6.5%) with RIFLE-I, and no patients with RIFLE-F. In group 2, 10 patients (26.3%) had an episode of AKI during hospitalization: 6 (15.8%) had RIFLE-R, 4 (10.5%) had RIFLE-I, and no patients had RIFLE-F.Conclusions There are no data suggesting that it is necessary to stent RAS patients with normal SCr before cardiopulmonary bypass. However, it cannot be concluded that RAS is not associated with AKI after cardiopulmonary bypass.

  16. Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

    OpenAIRE

    Elif Basagan-Mogo; Suna Goren; Gulsen Korfali; Gurkan Turker; Fatma Nur Kaya

    2010-01-01

    OBJECTIVE: The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery. INTRODUCTION: Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting ...

  17. Temporary bilateral sensorineural hearing loss following cardiopulmonary bypass -A case report-

    OpenAIRE

    Son, Hyo Jung; Joh, Jung Hwa; Kim, Wook Jong; Chin, Ji Hyun; Choi, Dae Kee; Lee, Eun Ho; Sim, Ji Yeon; Choi, In-Cheol

    2011-01-01

    Sudden sensorineural hearing loss has been reported to occur following anesthesia and various non-otologic surgeries, mostly after procedures involving cardiopulmonary bypass. Unilateral sensorineural hearing loss resulting from microembolism is an infrequent complication of cardiopulmonary bypass surgery that has long been acknowledged. Moreover, there are few reports on the occurrence of bilateral sensorineural hearing loss without other neurologic deficits and its etiology has also not bee...

  18. Numerical simulation of an alternative to prevent hydrates formation in a bypass section

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Lucilla Coelho; Oliveira Junior, Joao Americo Aguirre; Fonte, Clarissa Bergman [Engineering Simulation and Scientific Software Ltda. (ESSS), Florianopolis, SC (Brazil); Silva, Fabricio Soares da; Moraes, Carlos Alberto Capela [Petroleo Brasileiro S.A. (PETROBRAS), Rio de Janeiro, RJ (Brazil)

    2012-07-01

    This work presents the use of Computational Fluid Dynamics to evaluate the feasibility of MEG (monoethylene glycol) injection as an alternative to prevent hydrate formation in a bypass section, present in an inlet module of a separation device of a subsea separation system. As the bypass section is open to the main pipeline, MEG will probably be dragged due to secondary flows generated by the main flow stream. The MEG removal rate is estimated, as well as the internal heat transfer between the currents and the heat loss to the external environment in order to estimate the temperature in the equipment. In a first step, the MEG removal was evaluated considering the heat transfer between the liquid phase (composed of water, oil and MEG) and the gas phase as well as the heat transfer by forced convection to the external environment. In a second step, the influence of a thermal insulation layer around the bypass line, reducing the heat loss to the external environment, was studied. Both simulations (with or without thermal insulation) showed the establishment of secondary flows in the open connection between the main line and bypass line, promoting the removal of MEG from the bypass section and enabling other components of the liquid phase and/or gas to enter in the bypass line. This MEG removal is faster when thermal isolation was considered, due to the fact that higher temperatures are established in the bypass, maintaining the liquid phase with lower densities and viscosities. With regard to temperature, the insulation was able to keep higher temperatures at the bypass line than those obtained without insulation, indicating that the combination of MEG injection and thermal insulation may be able to avoid the critical condition for hydrate formation. (author)

  19. CARDIOPULMONARY BYPASS WITH AUTOLOGOUS LUNG AS SUBSTITUTE FOR ARTIFICIAL OXYGENATOR ATTENUATES INFLAMMATORY RESPONSIVE INSPIRATORY DYSFUNCTION

    Institute of Scientific and Technical Information of China (English)

    HUANG Hui-min; KONG Xiang; WANG Wei; ZHU De-ming; ZHANG Hai-bo

    2007-01-01

    Objective To study if using autologous lung as a substitute of oxygenator in cardiopulmonary bypass is better than the conventional cardiopulmonary bypass with artificial oxygenator in pulmonary preservation.Methods Twelve piglets were randomly divided into two groups ( n = 6). The isolated lung perfusion model was established. The experimental animals underwent continuous lung perfusion for about 120 min. While the control animals underwent 90 min lung ischemia followed by 30 min reperfusion. Another 12 piglets were randomly divided into two groups ( n =6). The experimental animals underwent bi-ventricular bypass with autologous lung perfusion.While control animals underwent conventional cardiopulmonary bypass with artificial oxygenator. The bypass time and aortic cross clamping time were 135 min and 60 min respectively for each animal. The lung static compliance ( Cstat), alveolus-artery oxygen difference ( PA-aO2 ), TNF-α, IL-6 and wet to dry lung weight ratio (W/D) were measured. Histological and ultra-structural changes of the lung were also observed after bypass. Results After either isolated lung perfusion or cardiopulmonary bypass, the Cstat decreased, the PA-aO2 increased and the content of TNF-α increased for both groups, but the changes of experimental group were much less than those of control group. The lower W/D ratio and mild pathological changes in experimental group than those in control group were also demonstrated. Conclusion Autologous lung is able to tolerate the nonpalsatile perfusion. It can be used as a substitute to artificial ogygenator in cardiopulmonary bypass to minimize the inflammatory pulmonary injury caused mainly by ischemic reperfusion and interaction of the blood to the non-physiological surface of artificial oxygenator.

  20. Decline in Health-Related Quality of Life 6 Months After Coronary Artery Bypass Graft Surgery

    DEFF Research Database (Denmark)

    El Baz, Noha; Pedersen, Susanne S.; van Dijk, Jitse P;

    2013-01-01

    Although coronary artery bypass graft (CABG) is known to improve health-related quality of life (HRQoL), this improvement does not seem to be realized in all patients who had undergone CABG surgery.......Although coronary artery bypass graft (CABG) is known to improve health-related quality of life (HRQoL), this improvement does not seem to be realized in all patients who had undergone CABG surgery....

  1. Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

    OpenAIRE

    2016-01-01

    Background: Bypassing available facilities for childbirth has important implications for maternal health service delivery and human resources within a health system. The results are the additional expenses imposed on the woman and her family, as well as the inefficient use of health system resources. Bypassing often indicates a lack of confidence in the care provided by the facility nearest to the mother, which implies a level of dysfunctionality that the health system needs to address. Over ...

  2. Timing of adding blood to prime affects inflammatory response to neonatal cardiopulmonary bypass.

    Science.gov (United States)

    Schmidt, Benjamin S; Jordan, James E; Lane, Magan R; DiPasquale, Vanessa M; Graf, Lori P; Ootaki, Yoshio; Ungerleider, Ross M

    2016-07-08

    Complications from systemic inflammation are reported in neonates following exposure to cardiopulmonary bypass. Although the use of asanguinous primes can reduce these complications, in neonates, this can result in significant haemodilution, requiring addition of blood. This study investigates whether the addition of blood after institution of bypass alters the inflammatory response compared with a blood prime. Neonatal swine were randomised into four groups: blood prime, blood after bypass but before cooling, blood after cooling but before low flow, and blood after re-warming. All groups were placed on central bypass, cooled, underwent low flow, and then re-warmed for a total bypass time of 2 hours. Although haematocrit values between groups varied throughout bypass, all groups ended with a similar value. Although they spent time with a lower haematocrit, asanguinous prime groups did not have elevated lactate levels at the end of bypass compared with blood prime. Asanguinous primes released less tumour necrosis factor α than blood primes (p=0.023). Asanguinous primes with blood added on bypass produced less interleukin 10 and tumour necrosis factor α (p=0.006, 0.019). Animals receiving blood while cool also showed less interleukin 10 and tumour necrosis factor α production than those that received blood warm (p=0.026, 0.033). Asanguinous primes exhibited less oedema than blood primes, with the least body weight gain noted in the end cool group (p=0.011). This study suggests that using an asanguinous prime for neonates being cooled to deep hypothermia is practical, and the later addition of blood reduces inflammation.

  3. Diet micronutrient adequacy of women after 1 year of gastric bypass

    OpenAIRE

    LEIRO,Larissa Silveira; Melendez-ARAÚJO,Mariana Silva

    2014-01-01

    BACKGROUND: The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. AIM: To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. METHODS: This was a transverse d...

  4. Severe Scurvy After Gastric Bypass Surgery and a Poor Postoperative Diet

    OpenAIRE

    Hansen, Esben P.K.; Metzsche, Carsten; Henningsen, Emil; Toft, Palle

    2012-01-01

    After bariatric gastric bypass surgery patients are at risk of developing micronutrient deficiencies. If gastric bypass surgery is followed by a vitamin deficient diet the patients have a risk of developing vitamin-C deficiency. When spontaneous ecchymosis is observed in the skin, in at-risk patients, scurvy must be considered. When treated with large doses of vitamin-C the symptoms of scurvy rapidly improve even if the patient has developed multiple organ dysfunction syndrome. Keywords Scurv...

  5. Surgical treatment of 82 patients with diabetic lower limb ischemia by distal arterial bypass

    Institute of Scientific and Technical Information of China (English)

    GU Yong-quan; WANG Zhong-gao; ZHANG Jian; QI Li-xing; YU Heng-xi; LI Jian-xin; LI Xue-feng; GUO Lian-rui; LUO Tao; CUI Shi-jun

    2007-01-01

    Background Diabetic lower limb ischemia is a serious complication of diabetes mellitus.This study was conducted to investigate the effectiveness of distal arterial bypass treatment in diabetic patients with lower limb ischemia. Methods From July 2000 to July 2004, 96 lower limbs of 82 diabetic patients (type 2) with severe lower limb ischemia were treated in Xuan Wu Hospital. Arterial bypass with femoro-popliteal polytetrafluoroethylene (PTFE) and graft-tibial autologous grafts was performed on 311 limbs (32.3%). Popliteal-tibial artery bypass alone was performed on 22 limbs (22.9%). Combined iliac artery stenting, femoro-popliteal artery PTFE graft bypass, and graft-tibial artery autologous graft bypass was performed on 12 limbs (12.5%), and femoro-tibial artery graft bypass was performed on 10 limbs (10.4%). Popliteal-tibial-pedal artery graft bypass was performed on 7 limbs (7.3%). Results Arterial grafts in 92 limbs of 79 patients were patent on discharge. Three patients with 4 ischemic limbs (3.7%)died of respiratory failure 12 hours, 3 days and 7 days after operation respectively. Early operation success rate was 96.3% (79/82). Graft patency rate of patients on discharge was 95.8% (92/96). The short-term total effectiveness rate was 83.3% (80/96). Foot ulcer healing rate was 35.7% (10/28). 97.4% (75/77) patients were followed up for a mean of 13.5 months. The long-term total effective rate was 80.7% (71/88). The total amputation rate was 4.5% (4/88). Mortality was 4.5%. The total graft patency rate was 90.9% (80/88).Conclusion In the treatment of diabetic foot, distal lower limb arterial bypass can help to avoid amputation or lower the amputation level, and may promote foot ulcer healing and improve patient's quality of life.

  6. [Hypoglycaemia and hypocalcaemia in a gastric bypass-operated patient with high alcohol consumption and colectomia].

    Science.gov (United States)

    Worm, Dorte; Naver, Lars S; Hansen, Dorte L

    2015-04-13

    The combination of gastric bypass, colectomia, lack of substitution with minerals and vitamins, and alcohol consumption led to severe complications in a 57-year-old man. He was submitted to different hospitals 25 times and seen in polyclinics 39 times with no improvement in symptoms of postprandial neurohypoglycaemia, ortostatic hypotension and pronounced hypocalcaemia. The importance of frequent controls after gastric bypass in centres with specialists knowing the common complications after the operation and the need for nutritionel supplements is hereby emphasised.

  7. COMBINED INTRAOPERATIVE ILIAC ARTERY STENTSAND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

    Objective. To review our preliminary experience and evaluate our early results of a combined intraopemtive iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angiOplasty and stenting combined with simultaneous femoro-pepliteal bypass were pedormed on 12 lower extremities of 10 patients suffering from multilevel athemsclemtic occlusive disease. There were 8 men and 2 women, average 72 years. The indicationsf or procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stem procedures combined with simultaneous 9 femoro-popliteal by-pass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stem placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femoro-femoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 -10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patencyrate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% (11/11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectivdy. The amputation rate was 8. 3%(1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively pedormed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C ann fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditionalsurgical intervention, and also, any angioplasty and

  8. COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

    Objective. To review our preliminary experience and evaluate our early results of a combined intraoperative iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease.``Methods. From July 1999 to April 2000, intraoperative iliac angioplasty and stenting combined with simultaneous femoro-popliteal bypass were performed on 12 lower extremities of 10 patients suffering from multilevel atherosclerotic occlusive disease. There were 8 men and 2 women, average 72 years. The indications for procedures included disabling claudication in 3 and rest pain in 7 patients.``Results. Eleven iliac angioplasty and stent procedures combined with simultaneous 9 femoro-popliteal bypass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stent placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femorofemoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 ~ 10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patency rate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% ( 11 /11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectively. The amputation rate was 8.3%(1/12).``Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively performed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a prtable C arm fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditional surgical intervention, and also, any

  9. Management of gallstones and gallbladder disease in patients undergoing gastric bypass

    Institute of Scientific and Technical Information of China (English)

    Bernabé; M; Quesada; Gustavo; Kohan; Hernán; E; Roff; Carlos; M; Canullán; Luis; T; Chiappetta; Porras

    2010-01-01

    The appropriate management of gallstones and gallbladder disease in patients undergoing gastric bypass remains unknown.Several therapeutic modalities are used and include performing cholecystectomy on all patients at the time of gastric bypass,performing concomitant cholecystectomy only when patients have gallstones and performing cholecystectomy only in the presence of both symptoms and gallstones.Some groups administer ursodeoxycholic acid for gallstone prevention in the postoperative period.All treatment...

  10. Experimental and Analytic Study on the Core Bypass Flow in a Very High Temperature Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Richard Schultz

    2012-04-01

    Core bypass flow has been one of key issues in the very high temperature reactor (VHTR) design for securing core thermal margins and achieving target temperatures at the core exit. The bypass flow in a prismatic VHTR core occurs through the control element holes and the radial and axial gaps between the graphite blocks for manufacturing and refueling tolerances. These gaps vary with the core life cycles because of the irradiation swelling/shrinkage characteristic of the graphite blocks such as fuel and reflector blocks, which are main components of a core's structure. Thus, the core bypass flow occurs in a complicated multidimensional way. The accurate prediction of this bypass flow and counter-measures to minimize it are thus of major importance in assuring core thermal margins and securing higher core efficiency. Even with this importance, there has not been much effort in quantifying and accurately modeling the effect of the core bypass flow. The main objectives of this project were to generate experimental data for validating the software to be used to calculate the bypass flow in a prismatic VHTR core, validate thermofluid analysis tools and their model improvements, and identify and assess measures for reducing the bypass flow. To achieve these objectives, tasks were defined to (1) design and construct experiments to generate validation data for software analysis tools, (2) determine the experimental conditions and define the measurement requirements and techniques, (3) generate and analyze the experimental data, (4) validate and improve the thermofluid analysis tools, and (5) identify measures to control the bypass flow and assess its performance in the experiment.

  11. Predicting the Glycemic Response to Gastric Bypass Surgery in Patients With Type 2 Diabetes

    OpenAIRE

    John B Dixon; Chuang, Lee-Ming; Chong, Keong; Chen, Shu-Chun; Lambert, Gavin W; Straznicky, Nora E.; Lambert, Elisabeth A.; Lee, Wei-Jei

    2012-01-01

    OBJECTIVE To find clinically meaningful preoperative predictors of diabetes remission and conversely inadequate glycemic control after gastric bypass surgery. Predicting the improvement in glycemic control in those with type 2 diabetes after bariatric surgery may help in patient selection. RESEARCH DESIGN AND METHODS Preoperative details of 154 ethnic Chinese subjects with type 2 diabetes were examined for their influence on glycemic outcomes at 1 year after gastric bypass. Remission was defi...

  12. Anesthetic considerations for the patients with off-pump coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    New surgical techniques for coronary artery bypass graft (CABG) have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expertise can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.

  13. Evaluation of orthotopic liver transplantation with no veno-venous bypass

    Institute of Scientific and Technical Information of China (English)

    黄东胜; 郑树森; 吴健; 梁廷波; 王伟林; 沈岩; 张珉

    2002-01-01

    Objective: To assess the feasibility and o utcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v bypass) in adult patien ts . Methods: Between 1999 and 2001, 43 adult patients underwent OLT with v-v bypa s s, 33 with no v-v bypass. The operation time, anhepatic time, amount of blood l o ss, amount of blood transfusion, ICU stay days of the two groups were compared; renal function and gastrointestinal function in the two groups were examined. R esults: There was no significant difference in mean serum creatinine on day 3 an d gas discharge time in patients with v-v bypass or not. With no v-v bypass , th e average operation time was 5.7±1.3 hours, anhepatic time was 64±13 minutes, median amount of blood loss in operation was 4000±820 mL, median amount of blood trans fused intraoperatively was 4650±910 mL, median ICU stay was 5.7 days; all thos e were lower or shorter than those with v-v bypass; and these differences betw e en the two groups had statistical significances. Conclusion: OLT with no v-v b y pass is safe and can be performed in the majority of adult patients. The practic e of liver transplantation with no v-v bypass is associated with shorter total o peration time, shorter anhepatic time, lower blood product usage, and shorter IC U stay compared with standard technique of OLT with routine use of v-v bypass.

  14. Transesophageal echocardiography-guided thrombectomy of intracardiac renal cell carcinoma without cardiopulmonary bypass

    Science.gov (United States)

    Souki, Fouad Ghazi; Demos, Michael; Fermin, Lilibeth; Ciancio, Gaetano

    2016-01-01

    Advanced renal cell carcinoma (RCC) resection has important anesthetic management implications, particularly when tumor extends, suprahepatic, into the right atrium. Use of transesophageal echocardiogram (TEE) is essential in identifying tumor extension and guiding resection. Latest surgical approach avoids venovenous and cardiopulmonary bypass yet requires special precautions and interventions on the anesthesiologist's part. We present a case of Level IV RCC resected without cardiopulmonary bypass and salvaged by TEE guidance and detection of residual intracardiac tumor. PMID:27716710

  15. Retrograde intussusception seven years after a laparoscopic Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Leon D Boudourakis

    2013-01-01

    Full Text Available Intussusception after Roux-en-Y gastric bypass is more common than previously believed. It usually occurs between one and three years post-operatively, though we present a case that presented with a retrograde intussusception necessitating bowel resection seven years after a laparoscpic Roux-en-Y gastric bypass. The diagnosis and etiological theories are discussed based on findings from the literature.

  16. Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

    Institute of Scientific and Technical Information of China (English)

    胡盛寿; 王小启; 宋云虎; 吕锋

    2003-01-01

    Objective To compare graft patency in off-pump and conventional coronary artery bypass grafting by using the transit time flow meter in the treatment of triple vessel coronary artery disease. Methods Between June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent coronary artery bypass grafting. They were divided into two groups: off-pump and conventional coronary artery bypass. All completed grafts were tested intraoperatively using Transit Time Flow Measurement (TTFM). Preoperative and postoperative variables of the two groups were also compared. Results There were no significant differences in sex, age, weight, acute or remote myocardial infarction, hypertension, diabetes and type of bypass grafts between the two groups. The number of bypass grafts and the assisted respiratory time of the off-pump coronary artery bypass grafting (OPCAB) group were significantly less than those of the conventional coronary artery bypass grafting (CCABG) group. The flow and pulsatile index (PI) of the left anterior descending artery bypass grafts and the right coronary artery bypass grafts were not significantly different between the OPCAB and CCABG groups. The flow of OM in the CCABG group with the multiple anastomosis site of sequential grafts was higher than that in the OPCAB group. Diffused narrow coronary artery bypass grafts in both groups had less flow.Conclusion No signficant differences in graft patency were observed in patients with triple vessel coronary artery disease who had undergone OPCAB or CCABG.

  17. Case study: nutrition challenges of a marathon runner with a gastric bypass.

    Science.gov (United States)

    Clark, Nancy

    2011-12-01

    A new type of athlete is appearing in the offices of sports dietitians: formerly obese people who have undergone gastric bypass surgery and now aspire to be marathoners, triathletes, and other types of endurance athletes. The standard nutrition advice offered to bypass patients is contrary to the standard sports advice given to athletes. Bypass athletes need to limit carbohydrates, fluids, and energy intake and consume a protein-based diet. This case study describes the sport nutrition concerns of a woman who, after having gastric bypass surgery, trained to run a marathon (42 km). Because of her limited ability to consume food and fluids, she experienced difficulty preventing fatigue and dehydration during her long training runs and the marathon itself. She learned through trial and error how to survive the nutritional challenges and complete the marathon. Health professionals need to be aware of the potential medical risks associated with endurance exercise in gastric bypass patients. Research is needed to determine the best sports nutrition practices for bypass patients. Only then can sport dietitians better educate this small but growing contingent of endurance athletes so the athletes can meet their training and performance goals and reduce their risk of experiencing serious health consequences.

  18. Mixed venous-arterial CO2 tension gradient after cardiopulmonary bypass.

    Science.gov (United States)

    Takami, Yoshiyuki; Masumoto, Hiroshi

    2005-09-01

    Significant venous hypercarbia has been reported in septic shock and circulatory failure. Cardiopulmonary bypass also impairs systemic and pulmonary blood perfusion. The objective of this study was to determine the clinical significance of the increased venous-arterial CO2 tension gradient resulting from venous hypercarbia after cardiopulmonary bypass. On arrival in the intensive care unit, venous and arterial CO2 tensions were measured in the radial and pulmonary arteries in 140 consecutive patients who had undergone coronary (n = 79), valve (n = 34), aortic (n = 20), and other (n = 7) surgery under cardiopulmonary bypass. The mean venous-arterial CO2 tension gradient was 5.0 +/- 3.3 mm Hg (range, 7.7 to 15.7 mm Hg). By linear regression analysis, the factors that significantly correlated with venous-arterial CO2 tension gradient were bypass duration, aortic crossclamp time, initial arterial lactate level, transpulmonary arteriovenous lactate difference, arterial bicarbonate level, base excess, cardiac index, mixed venous O2 saturation, O2 delivery, O2 consumption, and the peak value of creatine kinase. The venous-arterial CO2 tension gradient may reflect impaired perfusion and anaerobic metabolism induced by cardiopulmonary bypass and could be a simple and useful indicator for patient management after surgery under cardiopulmonary bypass.

  19. Experimental investigations of the steady flow through an idealized model of a femoral artery bypass

    Directory of Open Access Journals (Sweden)

    Giurgea Corina

    2014-03-01

    Full Text Available The present paper presents the steps taken by the authors in the first stage of an experimental program within a larger national research project whose objective is to characterize the flow through a femoral artery bypass with a view to finding solutions for its optimization. The objective of the stage is to investigate by means of the PIV method the stationary flow through a bypass model with an idealized geometry. A bypass assembly which reunites the idealized geometry models of the proximal and distal anastomoses, and which respects the lengths of a femoral artery bypass was constructed on the basis of data for a real patient provided by medical investigations. With the aim of testing the model and the established experimental set-up with regard to their suitability for the assessment of the velocity field associated to the steady flow through the bypass, three zones that can restore the whole distal anastomosis were PIV investigated. The measurements were taken in the conditions of maintained inflow at the bypass entry of 0.9 l / min (Re = 600. The article presents comparatively the flow spectra and the velocity fields for each zone obtained in two situations: with the femoral artery completely occluded and completely open.

  20. Endogenous ethanol production and hepatic disease following jejunoileal bypass for morbid obesity.

    Science.gov (United States)

    Mezey, E; Imbembo, A L; Potter, J J; Rent, K C; Lombardo, R; Holt, P R

    1975-11-01

    In this study, we sought to determine whether or not elevated levels of ethanol were present in the systemic circulation, resulting from endogenous ethanol production, which might contribute to the hepatic damage following jejunoileal bypass for morbid obesity. Venous serum samples for assay of ethanol by gas-liquid chromatography were obtained in 8 normal subjects, 9 obese patients prior to surgery, 20 obese patients 2 weeks to 40 months after jejunoileal bypass, and in 2 dogs before and after jejunoileal bypass. Ethanol was detected after jejunoileal bypass in only 7 of the 20 patients and in the 2 dogs. Serum ethanol concentrations ranged from 0.15 to 4.12 mg/100 ml with a mean of 1.18 +/- 1.59 (SD)( mg/100 ml in the 7 patients and ranged from 0.20 to 2.23 mg/100 ml in the dogs. Incubation of the contents of the bypassed intestine of a dog with dextrose resulted in the production of significant amounts of ethanol. However, there was no correlation between the presence of ethanol in the serum and liver histology, when liver biopsy was obtained, postoperatively. Since ethanol was detected in the serum in only small concentrations and in only one-third of the patients, it is unlikely that ethanol production by bacteria in the intestine is of significance in the pathogenesis of liver disease following jejunoileal bypass.

  1. Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting.

    Science.gov (United States)

    Tanaka, Akihito; Ishii, Hideki; Oshima, Hideki; Shibata, Yohei; Tatami, Yosuke; Osugi, Naohiro; Ota, Tomoyuki; Kawamura, Yoshihiro; Suzuki, Susumu; Usui, Akihiko; Murohara, Toyoaki

    2016-07-01

    Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.

  2. Coronary artery bypass surgery in the diabetic patient.

    LENUS (Irish Health Repository)

    Maher, M

    2012-02-03

    Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61 +\\/- 1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months--35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.

  3. Novel TPP-riboswitch activators bypass metabolic enzyme dependency

    Directory of Open Access Journals (Sweden)

    Günter eMayer

    2014-07-01

    Full Text Available Riboswitches are conserved regions within mRNA molecules that bind specific metabolites and regulate gene expression. TPP-riboswitches, which respond to thiamine pyrophosphate (TPP, are involved in the regulation of thiamine metabolism in numerous bacteria. As these regulatory RNAs are often modulating essential biosynthesis pathways they have become increasingly interesting as promising antibacterial targets. Here, we describe thiamine analogs containing a central 1,2,3-triazole group to induce repression of thiM-riboswitch dependent gene expression in different E. coli strains. Additionally, we show that compound activation is dependent on proteins involved in the metabolic pathways of thiamine uptake and synthesis. The most promising molecule, triazolethiamine (TT, shows concentration dependent reporter gene repression that is dependent on the presence of thiamine kinase ThiK, whereas the effect of pyrithiamine (PT, a known TPP-riboswitch modulator, is ThiK independent. We further show that this dependence can be bypassed by triazolethiamine-derivatives that bear phosphate-mimicking moieties. As triazolethiamine reveals superior activity compared to pyrithiamine, it represents a very promising starting point for developing novel antibacterial compounds that target TPP-riboswitches. Riboswitch-targeting compounds engage diverse endogenous mechanisms to attain in vivo activity. These findings are of importance for the understanding of compounds that require metabolic activation to achieve effective riboswitch modulation and they enable the design of novel compound generations that are independent of endogenous activation mechanisms.

  4. Novel TPP-riboswitch activators bypass metabolic enzyme dependency

    Science.gov (United States)

    Mayer, Günter; Lünse, Christina; Suckling, Colin; Scott, Fraser

    2014-07-01

    Riboswitches are conserved regions within mRNA molecules that bind specific metabolites and regulate gene expression. TPP-riboswitches, which respond to thiamine pyrophosphate (TPP), are involved in the regulation of thiamine metabolism in numerous bacteria. As these regulatory RNAs are often modulating essential biosynthesis pathways they have become increasingly interesting as promising antibacterial targets. Here, we describe thiamine analogs containing a central 1,2,3-triazole group to induce repression of thiM-riboswitch dependent gene expression in different E. coli strains. Additionally, we show that compound activation is dependent on proteins involved in the metabolic pathways of thiamine uptake and synthesis. The most promising molecule, triazolethiamine (TT), shows concentration dependent reporter gene repression that is dependent on the presence of thiamine kinase ThiK, whereas the effect of pyrithiamine (PT), a known TPP-riboswitch modulator, is ThiK independent. We further show that this dependence can be bypassed by triazolethiamine-derivatives that bear phosphate-mimicking moieties. As triazolethiamine reveals superior activity compared to pyrithiamine, it represents a very promising starting point for developing novel antibacterial compounds that target TPP-riboswitches. Riboswitch-targeting compounds engage diverse endogenous mechanisms to attain in vivo activity. These findings are of importance for the understanding of compounds that require metabolic activation to achieve effective riboswitch modulation and they enable the design of novel compound generations that are independent of endogenous activation mechanisms.

  5. Off-Pump Coronary Bypass Grafting Causing Stunned Myocardium

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

    Full Text Available The term “stunned myocardium” refers to abnormalities in the myocardial function following reperfusion and is common in on-pump coronary artery bypass grafting (CABG and is exceedingly rare in off- pump CABG. A 53-year-old man presented with unstable angina due to the severe stenosis of the left anterior descending coronary artery (LAD and the obtuse marginal. Laboratory findings and Chest X-ray revealed nothing abnormal. The intraoperative course was uneventful. The patient left the operating room without any inotropic support. Six hours later, however, he developed low cardiac output .At exploration, cardiac tamponade was excluded and flowmetry showed that the graft had adequate function. Cardiac enzymes were normal. High-dose adrenalin and Dobutamine were administrated and an intra-aortic balloon pump was used. After hemodynamic stabilization, the patient left the Intensive Care Unit without an intra-aortic balloon pump and inotropic support. On the fifth postoperative day, coronary angiography showed patent grafts and correct anastomotic sites. On the seventh postoperative day, the akinetic lateral wall of the left ventricle changed to dyskinesia. Finally after hospital discharge on the thirtieth postoperative day, an echocardiogram showed normal left ventricular function without regional wall motion abnormalities

  6. Predictors of post coronary artery bypass grafting atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Tongtong Shen; Qijun Shan; Biao Yuan; Bing Yang; Chun Chen; Dongjie Xu; Minglong Chen; Jiangang Zou; Kejiang Cao

    2007-01-01

    Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312(33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement ( ≥40 mm), a history of AF, prolonged p-wave duration ( ≥ 120 ms) and increased number of grafts (≥3). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of β-blockers,hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.

  7. MYCTOIC ANEURYSM OF POPLITEAL ARTERY AND AORTOFEMORAL BYPASS GRAFT

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    A. Sohrabi

    1979-11-01

    Full Text Available Mycotic aneurysm could be divided into three types according to their etiology: septic-embolic, cryptogenic and traumatic type. During the period from 1972 to 1974 two cases of mycotic aneurysms have been seen at the Ohio Valley Medical Center - one following a sub acute bacterial endocarditic and another one was two years following surgery for aortofemoral bypass graft. The clinical course of both patients is discussed. The prognosis of mycotic aneurysm is always fatal without surgical intervention. Mycotic aneurysm is a rare entity which is occasionally reported in the literatures. As far as these case reports go the pathology could be divided into three categories according to their etiology, even though the pathology is essentially the same. 1. The septic-embolic or primary mycotic aneurysm in which the aneurysm is secondary to the sepsis which settles in the wall of the artery and destroys the lamina media and finally developing an aneurysm. This type of mycotic aneurysm is, usually seen in any type of septicemia. 2. The cryptogenic or secondary, mycotic aneurysm in which the sepsis takes place in the pra-existing aneurysm of the arterial wall usually due to arteriosclerosis disease. 3. Traumatic or mixed type mycotic aneurysm in which the sepsis and arterial wall damage takes place at the same time.

  8. Rplp1 bypasses replicative senescence and contributes to transformation

    Energy Technology Data Exchange (ETDEWEB)

    Artero-Castro, A. [Pathology Department, Fundacio Institut de Recerca Hospital Vall d' Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona (Spain); Kondoh, H. [Department of Geriatric Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507 (Japan); Fernandez-Marcos, P.J.; Serrano, M. [Spanish National Cancer Research Center (CNIO), 3 Melchor Fernandez Almagro St, Madrid 28029 (Spain); Ramon y Cajal, S. [Pathology Department, Fundacio Institut de Recerca Hospital Vall d' Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona (Spain); LLeonart, M.E., E-mail: melleona@ir.vhebron.net [Pathology Department, Fundacio Institut de Recerca Hospital Vall d' Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona (Spain)

    2009-05-01

    To determine whether genes expressed by embryonic stem cells have a proliferative effect in primary cells, primary mouse embryonic fibroblasts were infected with an ES cell cDNA library. This led to identification of the ribosomal protein, Rplp1, a member of the P group of ribosomal proteins, whose putative role for bypassing replicative senescence in MEFs was investigated. Our results show that Rplp1 produces a two-fold increase in the expression of an E2F1 promoter and upregulation of cyclin E in MEFs. Therefore, this study is the first to show that overexpression of a single ribosomal protein, Rplp1, is a cause and not a consequence of cell proliferation. In addition, co-expression of Rplp1 with mutant ras{sup Val12} contributed to transformation in NIH3T3 cells, as was evidenced by colony production in soft-agar assays. Moreover, the Rplp1 protein was upregulated in MEFs and NIH3T3 cells upon expression of a p53 dominant negative mutant gene designated p53R175H. Hence, mutation of p53 may facilitate immortalization in vitro by upregulating Rplp1. Lastly, Rplp1 mRNA was found to be upregulated in 16 of 26 human colon cancer biopsy specimens, a finding that may be of relevance to cancer research.

  9. Plasma levels of immunosuppressive mediators during cardiopulmonary bypass

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    E. Borrelli

    1996-01-01

    Full Text Available The aim of this study was to evaluate plasma levels of two mediators with immunosuppressive properties, complement fraction C3a (C3a and transforming growth factor-β1 (TGF-β1, during extracorporeal circulation. The proliferation index after phytohaemagglutinin (PHA stimulation of isolated peripheral blood mononuclear cells was also investigated. Sixteen patients undergoing hypothermic (n = 8, group 1 and normothermic (n = 8, group 2 cardiopulmormry bypass (CPB were enrolled in this study. As a control, we evaluated four patients undergoing thoracovascular operations without CPB. Blood samples were collected before CPB but after anaesthesia, every 30 min during CPB, at the end of CPB and 10 min after protamine administration. Both C3a and TGF-β1 increased significantly during CPB and after protamine administration in the hypothermic as well as the normothermic group. In the latter case the increase of C3a and TGF-β1, although more prominent, was not significantl higher than in the former group. Conversely, the proliferation, index of peripheral mononuclear cells had already decreased 30 min after CPB was started and remained depressed throughout the CPB time. These results suggest a possible role of C3a and TGF-β1 in the immunological changes occurring during extracorporeal circulation.

  10. Blood flow dynamics, atherosclerosis and bypass graft failure.

    Science.gov (United States)

    Langille, B L; Ojha, M

    1997-05-01

    Atherosclerosis occurs at reproducible sites in the arterial tree and intimal proliferation that leads to bypass graft occlusion also show a well-defined focal distribution. These observations have led to the hypothesis that local blood flow conditions, especially low or fluctuating shear stresses, are important in the development of both disorders. Basic research using both cell culture and animal models has revealed that endothelial cell biology is very sensitive to local shear stresses and rapid progress is being made in characterizing how endothelial cells transduce shear stress. Endothelial sensitivity to shear stress affects control of hemostasis, leukocyte adherence and transmigration, growth factor production, vasomotor responses, endothelial repair and arterial wall remodeling, all of which can be expected to influence development of vascular pathologies. Also, substantial progress has been made in characterizing complex local hemodynamics at relevant arterial sites; however, further progress is needed in this area, as well as in the extrapolation of advances in basic vascular biology to human vascular disease. (Trends Cardiovasc Med 1997;7:111-118). © 1997, Elsevier Science Inc.

  11. Inhibition of neutrophil activity improves cardiac function after cardiopulmonary bypass

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    Grünwald Frank

    2007-10-01

    Full Text Available Abstract Background The arterial in line application of the leukocyte inhibition module (LIM in the cardiopulmonary bypass (CPB limits overshooting leukocyte activity during cardiac surgery. We studied in a porcine model whether LIM may have beneficial effects on cardiac function after CPB. Methods German landrace pigs underwent CPB (60 min myocardial ischemia; 30 min reperfusion without (group I; n = 6 or with LIM (group II; n = 6. The cardiac indices (CI and cardiac function were analyzed pre and post CPB with a Swan-Ganz catheter and the cardiac function analyzer. Neutrophil labeling with technetium, scintigraphy, and histological analyses were done to track activated neutrophils within the organs. Results LIM prevented CPB-associated increase of neutrophil counts in peripheral blood. In group I, the CI significantly declined post CPB (post: 3.26 ± 0.31; pre: 4.05 ± 0.45 l/min/m2; p 2; p = 0.23. Post CPB, the intergroup difference showed significantly higher CI values in the LIM group (p Conclusion Our data provides strong evidence that LIM improves perioperative hemodynamics and cardiac function after CPB by limiting neutrophil activity and inducing accelerated sequestration of neutrophils in the spleen.

  12. Bypass transition and subcritical turbulence in plane Poiseuille flow

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    Zammert, Stefan

    2015-01-01

    Plane Poiseuille flow shows turbulence at a Reynolds number that is lower than the critical one for the onset of Tollmien-Schlichting waves. The transition to turbulence follows the same route as the by-pass transition in boundary layers, i.e. finite amplitude perturbations are required and the flow is dominated by downstream vortices and streaks in the transitional regime. In order to relate the phenomenology in plane Poiseuille flow to our previous studies of plane Couette flow (Kreilos & Eckhardt, 2012), we study a symmetric subspace of plane Poiseuille flow in which the bifurcation cascade stands out clearly. By tracing the edge state, which in this system is a travelling wave, and its bifurcations, we can trace the formation of a chaotic attractor, the interior crisis that increase the phase space volume affected by the flow, and the ultimate transition into a chaotic saddle in a crisis bifurcation. After the boundary crisis we can observe transient chaos with exponentially distributed lifetimes.

  13. [Mesenteric traction syndrome during coronary artery bypass graft surgery].

    Science.gov (United States)

    Koyama, K; Kaneko, I; Mori, K

    1997-02-01

    Mesenteric traction syndrome (MTS) consists of decreased systemic vascular resistance, increased cardiac output, facial flushing and palmar erythema. Local production of PGI2 is thought to be the cause. We experienced a rare case of MTS that occurred during coronary artery bypass graft surgery (CABG). A 64-year-old man was scheduled for CABG for the treatment of angina pectoris. Hemodynamic variables were stable until 50 minutes after surgical incision. Blood pressure fell down suddenly from 110/50 to 70/40 mmHg, accompanied by obvious facial flushing and palmar erythema, when the surgeons were preparing the right gastroepiploic artery. Hemodynamic changes and cutaneous hyperemia returned to the baseline level in about 40 minutes. After this episode, the operation was performed uneventfully. The time sequence between the onset of the surgical procedure and the hemodynamic and cutaneous findings strongly suggest the release of PGI2 and MTS. In patients undergoing CABG with the gastroepiploic artery graft, pretreatment with NSAID might avoid sudden circulatory changes of MTS.

  14. Acute mesenteric ischemia after cardio-pulmonary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    Bassam Abboud; Ronald Daher; Joe Boujaoude

    2008-01-01

    Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency.Several pathophysiologic events (arterial obstruction,venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow.Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities,leading to multi-organ failure and death.Early diagnosis is difficult because the clinical presentation is subtle,and the biological and radiological diagnostic tools lack sensitivity and specificity.Therapeutic options vary from conservative resuscitation,medical treatment,endovascular techniques and surgical resection and revascularization.A high index of suspicion is required for diagnosis,and prompt treatment is the only hope of reducing the mortality rate.Studies are in progress to provide more accurate diagnostic tools for early diagnosis.AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB).Several factors contribute to the systemic hypo-perfusion state,which is the most frequent pathophysiologic event.In this particular setting,the clinical presentation of AMI can be misleading,while the laboratory and radiological diagnostic tests often produce inconclusive results.The management strategies are controversial,but early treatment is critical for saving lives.Based on the experience of our team,we consider prompt exploratory laparotomy,irrespective of the results of the diagnostic tests,is the only way to provide objective assessment and adequate treatment,leading to dramatic reduction in the mortality rate.

  15. The amylase-creatinine clearance ratio following cardiopulmonary bypass.

    Science.gov (United States)

    Murray, W R; Mittra, S; Mittra, D; Roberts, L B; Taylor, K M

    1981-08-01

    The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB.

  16. Hypothermia and normothermia effects on mortality rate of cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ali Rahdari

    2015-12-01

    Full Text Available Introduction: Cardiopulmonary bypass is associated with higher risk of mortality and morbidity, thus it should be investigated regarding the major risk factors. Temperature management have a significant role in postoperative cerebral and neurological complications; however the optimum temperature during cardiopulmonary surgery is not certainly detected. This systematic review has investigated the differences between hypothermia and normothermia regarding postoperative mortality. Method: PubMed was searched for the relevant articles. Only English language articles were included with no time limitation. Data regarding in-hospital patient deaths provided in each article mostly within 30 days after the surgery, were extracted and compared based on relative risk reduction (RRR, absolute risk reduction (ARR, and number needed to treat (NNT.Result: Totally, 28 articles were retrieved and extracted. The mortality rate was zero in hypothermic and normotehrmic groups of 8/28 included studies, thus the RRR, ARR, and NNT could not be calculated. There were no significant differences between investigated groups of each included studies regarding the patients’ age, gender, and preoperative conditions.Conclusions: No significant difference was obtained between two studied groups. Similar prevalence of death observed between hypothermic and normothermic groups might be due to the sample size of studies, or the subsequent cares performed in intensive care units that assist to reduce the postoperative mortality rate. According to the obtained results, both of these procedures might be similarly safe regarding mortality rate.

  17. Bypassing the Pentose Phosphate Pathway: Towards Modular Utilization of Xylose.

    Science.gov (United States)

    Chomvong, Kulika; Bauer, Stefan; Benjamin, Daniel I; Li, Xin; Nomura, Daniel K; Cate, Jamie H D

    2016-01-01

    The efficient use of hemicellulose in the plant cell wall is critical for the economic conversion of plant biomass to renewable fuels and chemicals. Previously, the yeast Saccharomyces cerevisiae has been engineered to convert the hemicellulose-derived pentose sugars xylose and arabinose to d-xylulose-5-phosphate for conversion via the pentose phosphate pathway (PPP). However, efficient pentose utilization requires PPP optimization and may interfere with its roles in NADPH and pentose production. Here, we developed an alternative xylose utilization pathway that largely bypasses the PPP. In the new pathway, d-xylulose is converted to d-xylulose-1-phosphate, a novel metabolite to S. cerevisiae, which is then cleaved to glycolaldehyde and dihydroxyacetone phosphate. This synthetic pathway served as a platform for the biosynthesis of ethanol and ethylene glycol. The use of d-xylulose-1-phosphate as an entry point for xylose metabolism opens the way for optimizing chemical conversion of pentose sugars in S. cerevisiae in a modular fashion.

  18. Lower extremity compartment sindrome following coronary artery bypass.

    Science.gov (United States)

    Papas, T T; Mikroulis, D; Papanas, N; Lazarides, M K; Bougioukas, G

    2007-04-01

    Compartment syndrome is a constellation of symptoms and signs associated with abnormally elevated tissue pressure in the skeletal muscle of the extremities. It is manifested in anatomic locations where muscles are enveloped in fasciae. The case of a lower extremity compartment syndrome in a 71-year-old male patient who underwent coronary artery bypass grafting (CABG) and simultaneous aortic valve surgery is reported. Preoperative evaluation revealed severe peripheral vascular disease. The patient underwent triple CABG using the left internal thoracic artery and two vein grafts. The right great saphenous vein was used for these vein grafts. The aortic valve was replaced with a biologic prosthesis. On postoperative day 1, the patient complained of pain and oedema in the right calf. The next day, symptoms worsened, with marked sensory loss, motor weakness and foot drop in the affected limb. Triplex ultrasonography excluded deep vein thrombosis. Compartment syndrome was diagnosed and successfully managed by fasciotomy. This case illustrates that compartment syndrome may, although rarely, be a complication of CABG.

  19. Perforated peptic ulcer following gastric bypass for obesity.

    Science.gov (United States)

    Macgregor, A M; Pickens, N E; Thoburn, E K

    1999-03-01

    Peptic ulcer in the excluded segment of a gastric bypass performed in the management of morbid obesity has only rarely been reported in the literature. The purpose of this study is to review our experience with the condition in a series of 4300 patients who underwent gastric-restrictive surgery between 1978 and 1997. Eleven patients presented with acute perforation of a peptic ulcer in the excluded gastric segment. Nine ulcers were duodenal, one was gastric, and one patient had both gastric and duodenal perforations. The time between primary gastric-restrictive surgery and ulcer perforation varied from 20 days to 12 years. All patients presented with upper abdominal pain. The classical radiological sign of perforated peptic ulcer, free air under the diaphragm, did not occur in any patient. Nine patients were initially treated by primary closure of the perforation with subsequent definitive ulcer therapy by vagotomy, pyloroplasty, or gastrectomy. One case, initially treated elsewhere, was managed by placement of a Malecot catheter through the duodenal perforation, gastrostomy, and peritoneal drainage. One recent case remains symptom-free on H2 blockers after simple closure. There was no mortality. Six cases were previously reported in the literature with a 33 per cent mortality rate.

  20. Mental Health and Depression after Coronary Artery Bypass Graft

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    Hassan Farrashbandi

    2014-08-01

    Full Text Available Background: Mental health of those with ischemic heart disease (IHD has been a focus of attention of researchers since it has always been considered as a psychosomatic disorder. The present study was designed to investigate mental health status of a group of patients before and after coronary artery bypass graft (CABG. Materials and Methods: In this longitudinal descriptive study 63 candidates for CABG, referred by cardiologist and cardiac surgeon in a 6 month period were asked to take part in the study if they didn't have any exclusion criteria. The patients were the out-patients of cardiac clinics in Shiraz, Iran. The patients were assessed by general health questionnaire (GHQ-28 and beck depression inventory (BDI at 3 phases, before surgery, 1 month after surgery and three months after surgery. Results: The analysis did not show significant statistical change in GHQ-28 and BDI measures before and after CABG. There were statistically significant differences in the mentioned measures between male and female participants in initial assessment, i.e., women scores were higher than men in distress scores measured by GHQ-28 and BDI. Conclusion: In our study, we observed no statistically significant differences between pre and post operation in general health and depression scales. However women showed higher degrees of depressed mood at any step of assessment.

  1. Intussusception after Laparoscopic Gastric Bypass Surgery: An Underrecognized Complication

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    Smit Singla

    2012-01-01

    Full Text Available Introduction. Intussusception after bariatric surgery is an uncommon complication that is now being frequently reported. Most people consider dysmotility to be the causative mechanism in the absence of obvious etiology. Material and Methods. A worldwide search identified literature describing intussusception after bariatric surgery. We also included our own patients and analyzed information regarding demographic profile, risk factors, presentation, diagnosis, and post treatment course. Results. Seventy one patients were identified between 1991 and 2011. Majority of the affected patients were females (=70, 98.6%; median time to presentation after gastric bypass surgery was 36 months. Most patients presented with abdominal pain, nausea and vomiting, but without obvious peritonitis. Sixty eight patients (96% required surgery; 48 (70.6% underwent revision of anastomosis, 16 (23.5% had reduction without resection, while 4 patients (5.9% had plication only. Amongst these, most patients (=51, 75% were found to have retrograde intussusception. Post-operatively, 9 patients presented with recurrence (range, 0.5–32 months. Five patients, who had earlier been treated without resection, eventually required revision of the anastomosis. There was no mortality noted. Conclusion. Intussusception after bariatric surgery is uncommon and its diagnosis is based on a combination of physicial, radiological and operative findings. An early surgical intervention reduces morbidity and prevents recurrence.

  2. Anaesthetic Management for Laparoscopic Gastric Bypass Procedure in Morbid Obesity

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    P Mandal

    2008-01-01

    Full Text Available Gastric bypass procedure (GBP is one of the effective operative methods for weight loss in patients with morbid obesity. The anaesthesia team has a crucial role to play in managing these patients. Therefore it is important for anaesthesiologists to be familiar with the anatomical and physiological changes along with pharmacological alter-ations associated with obesity.So that they can offer optimal perioperative care to these patients. This study describes the anaesthetic management of a series of 100 consecutive patients with an average body mass index (BMI of 46.5 kg.m -2 who underwent laparoscopic GBP over a period of three years (September′04 to September′07 in the hands of nonbariatric surgeons.Patients were aged between 16 - 36 years with more female preponderance (73: 27 and had mean duration of the procedure of 2.82 ± 1.44 hours under standard endotracheal balanced anaesthesia tech-nique. The initial mortality is 1% along with 4% incidence of both difficult intubation and postoperative respiratory failure in this series which is quite comparable with world famous bariatric surgical centers.

  3. Gastric Bypass Reduces Symptoms and Hormonal Responses in Hypoglycemia.

    Science.gov (United States)

    Abrahamsson, Niclas; Börjesson, Joey Lau; Sundbom, Magnus; Wiklund, Urban; Karlsson, F Anders; Eriksson, Jan W

    2016-09-01

    Gastric bypass (GBP) surgery, one of the most common bariatric procedures, induces weight loss and metabolic effects. The mechanisms are not fully understood, but reduced food intake and effects on gastrointestinal hormones are thought to contribute. We recently observed that GBP patients have lowered glucose levels and frequent asymptomatic hypoglycemic episodes. Here, we subjected patients before and after undergoing GBP surgery to hypoglycemia and examined symptoms and hormonal and autonomic nerve responses. Twelve obese patients without diabetes (8 women, mean age 43.1 years [SD 10.8] and BMI 40.6 kg/m(2) [SD 3.1]) were examined before and 23 weeks (range 19-25) after GBP surgery with hyperinsulinemic-hypoglycemic clamp (stepwise to plasma glucose 2.7 mmol/L). The mean change in Edinburgh Hypoglycemia Score during clamp was attenuated from 10.7 (6.4) before surgery to 5.2 (4.9) after surgery. There were also marked postsurgery reductions in levels of glucagon, cortisol, and catecholamine and the sympathetic nerve responses to hypoglycemia. In addition, growth hormone displayed a delayed response but to a higher peak level. Levels of glucagon-like peptide 1 and gastric inhibitory polypeptide rose during hypoglycemia but rose less postsurgery compared with presurgery. Thus, GBP surgery causes a resetting of glucose homeostasis, which reduces symptoms and neurohormonal responses to hypoglycemia. Further studies should address the underlying mechanisms as well as their impact on the overall metabolic effects of GBP surgery.

  4. The Protective Effect of Propofol on Erythrocytes during Cardiopulmonary Bypass

    Institute of Scientific and Technical Information of China (English)

    张诗海; 姚尚龙

    2001-01-01

    To evaluate the relationship between erythrocyte injury and intracellular calcium ion overload, and the protective effect of propofol on erythrocytes during cardiopulmonary bypass (CPB), 40 children with congenital heart diseases who underwent surgical repair under CPB were studied. The patients were randomly divided into two groups: control group (group C) and propofol group (group P). Anesthesia was maintained in the patients in group P with 6 mg*kg-1*h-1 propofol, and those in the group C inhaled 1 %-2 % isoflurane. The blood samples were taken before CPB, at the 30th min of CPB, at the end of CPB, and 2 h and 24 h after CPB to measure the content of erythrocyte intracellular calcium ion (E-Ca2+), Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities, index filtration of erythrocytes (IF), mean corpuscular volume (MCV) and the concentration of plasma free hemoglobin (F-HB). Results showed that in the control group, E-Ca2+, IF, MCV and F-Hb were gradually increased and Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities were decreased. The increase of E-Ca2+ was linearly paralleled to IF, MCV and F-Hb. In propofol group, all the above-mentioned parameters were significantly improved (P<0.05). This study suggests that erythrocyte injury is related to elevation of intracellular calcium during CPB and propofol has a protective effect on erythrocyte injury.

  5. The Protective Effect of Propofol on Erythrocytes during Cardiopulmonary Bypass

    Institute of Scientific and Technical Information of China (English)

    张诗海; 姚尚龙

    2004-01-01

    To evaluate the relationship between erythrocyte injury and intracellular calcium ion overload, and the protective effect of propofol on erythrocytes during cardiopulmonary bypass (CPB). 40 children with congenital heart diseases who underwent surgical repair under CPB were included. The patients were randomly divided into two groups: control group (group C) and propofol group (group P). Anesthesia was maintained in the patients with 6 mg/kg/h propofol in Group P, and those in the Group C inhaled 1 %-2 % isoflurane. The blood samples were taken before CPB, 30 min after CPB, at the end of CPB, and 2 h and 24 h after CPB to measure the content of erythrocyte intracellular calcium ion (E-Ca2+ ), Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities, index filtration of erythrocytes (IF), mean corpuscular volume (MCV) and the concentration of plasma free hemoglobin (F-Hb). Results showed that in the control group, E-Ca2+ , IF, MCV and F-Hb were gradually increased and Ca2+-Mg2+-ATPase and Na+-K+-ATPase activities were decreased. The increase of E-Ca2+ was linearly paralleled to IF, MCV and F-Hb. In propofol group, all the above-mentioned parameters were significantly improved (P<0. 05). This study suggests that erythrocyte injury is related to elevation of intracellular calcium during CPB and propofol has a protective effect on erythrocyte injury.

  6. Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India.

    Science.gov (United States)

    Salazar, Mariano; Vora, Kranti; De Costa, Ayesha

    2016-01-01

    Background Bypassing available facilities for childbirth has important implications for maternal health service delivery and human resources within a health system. The results are the additional expenses imposed on the woman and her family, as well as the inefficient use of health system resources. Bypassing often indicates a lack of confidence in the care provided by the facility nearest to the mother, which implies a level of dysfunctionality that the health system needs to address. Over the past decade, India has experienced a steep rise in the proportion of facility births. The initiation of programs promoting facility births resulted in a rise from 39% in 2005 to 85% in 2014. There have been no reports on bypassing facilities for childbirth from India. In the context of steeply rising facility births, it is important to quantify the occurrence of and study the relative contributions of maternal characteristics and facility functionality to bypassing. Objectives 1) To determine the extent of bypassing health facilities for childbirth among rural mothers in three districts of Gujarat, India, 2) to identify associations between the functionality of an obstetric care (OC) facility and it being bypassed, and 3) to assess the relative contribution of maternal and facility characteristics to bypassing. Design A cross-sectional survey of 166 public and private OC facilities reporting ≥30 births in the 3 months before the survey was conducted in three purposively selected districts (Dahod, Sabarkantha, and Surendranagar) in the state of Gujarat, India. Besides information on each facility, data from 946 women giving birth at these facilities were also gathered. Data were analyzed using a multilevel mixed-effects logistic regression model. Results Off all mothers, 37.7% bypassed their nearest facility for childbirth. After adjusting for maternal characteristics, for every one-unit increase in the facility's emergency obstetric care (EmOC) signal functions, the odds

  7. Bypassing health facilities for childbirth: a multilevel study in three districts of Gujarat, India

    Directory of Open Access Journals (Sweden)

    Mariano Salazar

    2016-08-01

    Full Text Available Background: Bypassing available facilities for childbirth has important implications for maternal health service delivery and human resources within a health system. The results are the additional expenses imposed on the woman and her family, as well as the inefficient use of health system resources. Bypassing often indicates a lack of confidence in the care provided by the facility nearest to the mother, which implies a level of dysfunctionality that the health system needs to address. Over the past decade, India has experienced a steep rise in the proportion of facility births. The initiation of programs promoting facility births resulted in a rise from 39% in 2005 to 85% in 2014. There have been no reports on bypassing facilities for childbirth from India. In the context of steeply rising facility births, it is important to quantify the occurrence of and study the relative contributions of maternal characteristics and facility functionality to bypassing. Objectives: 1 To determine the extent of bypassing health facilities for childbirth among rural mothers in three districts of Gujarat, India, 2 to identify associations between the functionality of an obstetric care (OC facility and it being bypassed, and 3 to assess the relative contribution of maternal and facility characteristics to bypassing. Design: A cross-sectional survey of 166 public and private OC facilities reporting ≥30 births in the 3 months before the survey was conducted in three purposively selected districts (Dahod, Sabarkantha, and Surendranagar in the state of Gujarat, India. Besides information on each facility, data from 946 women giving birth at these facilities were also gathered. Data were analyzed using a multilevel mixed-effects logistic regression model. Results: Off all mothers, 37.7% bypassed their nearest facility for childbirth. After adjusting for maternal characteristics, for every one-unit increase in the facility's emergency obstetric care (EmOC signal

  8. Reversal of Gastric Bypass Resolves Hyperoxaluria and Improves Oxalate Nephropathy Secondary to Roux-en-Y Gastric Bypass

    Science.gov (United States)

    Agrawal, Varun; Wilfong, Jonathan B.; Rich, Christopher E.; Gibson, Pamela C.

    2016-01-01

    Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) increases the risk for kidney injury. Medical therapies for hyperoxaluria have limited efficacy. A 65-year-old female was evaluated for acute kidney injury [AKI, serum creatinine (Cr) 2.1 mg/dl, baseline Cr 1.0 mg/dl]. She did not have any urinary or gastrointestinal symptoms or exposure to nephrotoxic agents. Sixteen months prior to this evaluation, she underwent RYGB for morbid obesity. Her examination was unremarkable for hypertension or edema and there was no protein or blood on urine dipstick. Kidney biopsy revealed acute tubulointerstitial nephritis with oxalate crystals in tubules. The concurrent finding of severe hyperoxaluria (urine oxalate 150 mg/day) confirmed the diagnosis of oxalate nephropathy. Despite medical management of hyperoxaluria, her AKI worsened. Laparoscopic reversal of RYGB was performed and within 1 month, her hyperoxaluria resolved (urine oxalate 20 mg/day) and AKI improved (Cr 1.7 mg/dl). Surgical reversal of RYGB may be considered in patients with oxalate nephropathy at high risk of progression who fail medical therapy. Physicians need to be aware of the possibility of oxalate nephropathy after RYGB and promptly treat the hyperoxaluria to halt further kidney damage. PMID:27781207

  9. NMOS-Based Integrated Modular Bypass for Use in Solar Systems (NIMBUS: Intelligent Bypass for Reducing Partial Shading Power Loss in Solar Panel Applications

    Directory of Open Access Journals (Sweden)

    Pieter Bauwens

    2016-06-01

    Full Text Available NMOS-based Integrated Modular Bypass for Use in Solar systems (NIMBUS is designed as a replacement for the traditional bypass diode, used in common solar panels. Because of the series connection between the individual solar cells, the power output of a photovoltaic (PV panel will drop disproportionally under partial shading. Currently, this is solved by dividing the PV panel into substrings, each with a diode bypass placed in parallel. This allows an alternative current path. However, the diodes still have a significant voltage drop (about 350 mV, and due to the fairly large currents in a panel, the diodes are dissipating power that we would rather see at the output of the panel. The NIMBUS chip, being a low-voltage-drop switch, aims to replace these diodes and, thus, reduce that power loss. NIMBUS is a smart bypass: a completely stand-alone system that detects the failing of one or more cells and activates when necessary. It is designed for a 100-mV voltage drop under a 5-A load current. When two or more NIMBUS chips are placed in parallel, an internal synchronization circuit ensures proper operation to provide for larger load currents. This paper will elaborate on the operation, design and implementation of the NIMBUS chip, as well as on the first measurements.

  10. A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting

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    Trethowan Brian A

    2011-11-01

    Full Text Available Abstract Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION, posterior ischaemic optic neuropathy (PION, and central retinal artery occlusion (CRAO. These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass; general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone, alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

  11. Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

    To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

  12. Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting:which is better in patients with chronic obstructive pulmonary disease?

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

    To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

  13. Aorta-LITA Bypass Grafting with Saphenous Vein in a Patient Undergoing Coronary Artery Surgery with Subclavian Artery Stenosis

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    Kerim Çağlı

    2011-12-01

    Full Text Available The internal thoracic artery (ITA is the primary graft for coronary artery bypass grafting and can not be used if there is subclavian artery stenosis (SAS. Aorto-axillary, carotid-subclavian bypass and also angioplasty with stenting or other interventional treatments are acceptable procedures for SAS treatment. Aorta-ITA bypass with saphenous vein can be alternative and simple technique for SAS to save Winslow pathway for patients with peripheral artery disease.

  14. Experimental Study of the APR+ Direct ECC Bypass in the Air-water Test Facility

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kihwan; Choi, Hae-Seob; Park, Kil-won; Kwon, Tae-Soon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    The APR+ is an improved Korean Nuclear Power Reactor, which has been developed as a two loop evolutionary PWR (Pressure Water Reactor) with a number of advanced design features to enhance safety based on the APR-1400 technology. The emergency core cooling system (ECC) of the APR+ is different with that of the APR-1400, though the APR+ adopted a direct vessel injection (DVI) system which is the same design features of the APR-14000. The main difference of the DVI+ is the emergency core barrel duct (ECBD) which is designed to increase the amount of the injection water to the core region. The performance of the DVI system has been an important issues for past decades, and many researchers have studied the related thermal-hydraulic technical issues such as the ECC bypass fraction, the steam condensation effect, temperature distribution, sub-cooling margin, and etc. However, the previous research cannot be directly applicable to the APR+ owing to the unique features of the DVI+. The current study will elaborate on the experimental evaluation of the direct ECC bypass performance. The 1/5 ECC bypass test facility which is designed with a linearly reduced 1/5 scale referring to the APR+ was used to investigate the effect of the DVI+ injection nozzle location and the broken cold leg velocity on the direct ECC bypass fraction. However, air is used as a working fluid to simulate the steam flow induced from the broken cold leg, and thus, the direct contact condensation effect is not considered in this study. Experimental study for the direct ECC bypass phenomena has been carryout out with various the injection mode and air velocity conditions. The tests were performed in the 1/5 scale ECC bypass test facility, and the test condition was defined using a scaling law referring to the APR+ reactor. Test results showed that the direct ECC bypass fraction was greatly enhanced compared with the reference test (w/o ECBD)

  15. Effects of bypass system on PCDD/F emission and chlorine circulation in cement kilns.

    Science.gov (United States)

    Zhan, Ming-Xiu; Fu, Jianying; Chen, Tong; Li, Yeqing; Zhang, Jiang; Li, Xiao-Dong; Yan, Jian-Hua; Buekens, Alfons

    2016-10-01

    A bypass at the kiln inlet allows the effective reduction of alkali chloride cycles and thus perhaps affects the emission of PCDD/Fs. Effects of bypass system on PCDD/F emission and chlorine circulation were studied in two typical dry cement kilns with 5000 ton/day clinker capacity in China and named CK1 and CK2, respectively. Firstly, the emission level of PCDD/Fs with the operation of bypass system was estimated in CK1, to certify that bypass system has a perfect adaption to the cement kiln regarding the PCDD/F emission even with the refuse derived fuel (RDF) as the replacement of fuel. On the other hand, the operating conditions in the CK2 were scrutinised by monitoring the concentrations of SO2, NH3 and HCl. In addition, the characteristics of raw meal, clinker, bag filter ash and bypass ash were also investigated by Energy Dispersive Spectrometer (EDS), metal and chlorine analysis. The balance of chlorine showed that 18 % of the possible accumulated chlorine could be ejected from the cement kiln system when 2 % of kiln exhaust gas was extracted. Furthermore, the emission level of PCDD/Fs in the main flue gas also decreased from 0.037 ± 0.035 ng I-TEQ/Nm(3) to 0.019 ± 0.007 ng I-TEQ/Nm(3) with a reduction efficiency of 48.2 %. Most importantly, PCDD/F emission from the bypass system was proven to have rather minor effect on the total emission factor. The congener distributions of PCDD/Fs were also analysed in the flue gas and fly ash, before and after application of bypass system, to find cues to the formation mechanism.

  16. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

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    Aymen N Naguib

    2015-01-01

    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  17. The Rationale and Results of Gastroplasty/Distal Gastric Bypass.

    Science.gov (United States)

    Salmon; McArdle

    1992-02-01

    A recent review of the results of gastroplasties done at the University of Alberta Hospital showed that there was a high incidence of late weight loss failure. Therefore a new operation, gastroplasty/distal gastric bypass, has been performed on 263 patients. This operation results In a profound (mean greatest percentage excess weight loss of 87% at approximately 2 years) and lasting weight loss (mean final percentage excess weight loss of 78%) at 4 years, range 2-7.5 years post-operatively. Only 0.9 % of patients failed to maintain at least a 40% excess weight loss. The operation achieves its effect through a moderate restriction that permits patients to eat normal table food from the time of discharge and with a mild metabsorption that is not ordinarily associated with diarrhea or notable deficiencies. Certain patients required debanding of the stoma and others developed staple-line eventration. Neither of these events after long-term follow-up resulted in weight loss failure nor in other serious side-effects. It Is concluded that moderate failure of the gastroplasty stoma and staple line does not necessarily result in weight loss failure, because the malabsorptive portion of the operation remains intact. Low hemoglobin occurred in 16% of cases and deficiency of serum iron In 34%; a much smaller number of patients had chronic or Intermittent deficiencies of these entities. Correction was easily achieved with oral replacement. Deficiencies in albumin, calcium, phosphorus and folate were rarely seen and minimal elevation of serum AST values occurred In just over 1% of patients. Chronic deficiencies or elevations were not seen in these patients. Stomal ulcer occurred in 6% of patients and bleeding associated with stomal ulcer in 1%. Half the patients with ulcer were managed with H&inf2; blockers, the other half with vagotomy. Both forms of treatment when individualized effectively prevent re-ulceration.

  18. Predicting Blood Transfusion Factors in Coronary Artery Bypass Surgery

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    L. Kasraian

    2007-04-01

    Full Text Available Introduction & Objective: The ability to predict the use of blood components during bypass surgery will improve the blood banks ability to provide efficient service.Materials and Methods: This is a retrospective cross-sectional study that was carried out on patients that underwent CABG in Shiraz Namazi hospital in 2004. The sample size was 480 and we did systematic random sampling, and a questionnaire contained factors that effect on blood need was filling out. Independent t-test, multivariate logistic regression and Poason correlation were used for data analysis.Results: The average age of patients was 59.15±10.6 years, 69.2% were male and the mean Hct before surgery was 39.86±6.38% and after operation was 32.68±5.84% and the duration of surgery was 2 hours and 48 minutes. The average of pack cell was 5.76±1.52 unit and average of FFP was 2.82±7.72 unit. There was not significant correlation between ages, weighs, Hct before and after, sex and pack cell use (P> 0.05. The use of pack cell and FFP were more in urgent surgery in diabetic patients and vascular disease (P< 0.05.Conclusion: It seems that the rate of blood demanding in proportion to blood use is logical but the rate of blood usage is more than blood usage in other countries with considering of immunological and non-immunological complication of blood products, the heart surgeons must do special concern about the making decision for blood use.

  19. EFFECT OF CARDIOPULMONARY BYPASS ON PULMONARY FUNCTION IN INFANTS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To evaluate the effect of the cardiopulmonary bypass (CPB) on the pulmonary function in infants with or without pulmonary hypertension in congential ventricular septal defect (VSD). Methods Twenty infants with VSD were enrolled in the study from Jan. to Dec. 2004. They were divided into two groups: pulmonary hypertension group and non-pulmonary hypertension group, ten infants respectively. Pulmonary function parameters were measured before CPB and 3, 6, 9, 12, 15, 18, 21, 24h after CPB, the following data were recorded: duration for mechanical ventilation (Tmv) and staying in the cardiac intensive care unit (Tcicu) after cardiac surgery. Results Before CPB, the pulmonary function parameters in non-pulmonary hypertension group were more superior than in pulmonary hypertension group ( P < 0. 01 ). By contraries, the pulmonary function parameters in every time stage after CPB statistically significant decreased in non-pulmonary hypertension group ( P < 0. 05),especially at 6, 9, and 15h after CPB ( P < 0. 01 ). In pulmonary hypertension group, the pulmonary function parameters in 3h after CPB were more improved than before CPB, though there was no statistical significance. But they had statistically significant decreased at 9, 12, 15h after CPB ( P <0. 05). There was a similar change in pulmonary function between two groups at 21,24h after CPB. Conclusion Exposure to CPB adversely affects pulmonary function after surgical repair of VSD in infants. We consider that the benefits of the surgical correction in infants with pulmonary hypertension outweight the negative effects of CPB on pulmonary function. We should improve cardiac function to avoid the presence of the nadir trough in pulmonary function. The infants with pulomonary hypertension also have ability to wean from mechanical ventilation as soon as possible, if the hemodynamics is stable, and without the responsive pulmonary hypertension or pulmonary hypertension crisis after surgical repair.

  20. Hyperhomocysteinemia and mortality after coronary artery bypass grafting.

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    Domenico Girelli

    Full Text Available BACKGROUND: The independent prognostic impact, as well as the possible causal role, of hyperhomocysteinemia (HHcy in coronary artery disease (CAD is controversial. No previous study specifically has addressed the relationship between HHcy and mortality after coronary artery bypass grafting (CABG surgery. The aim of this study is to evaluate the prognostic impact of HHcy after CABG surgery. METHODOLOGY AND PRINCIPAL FINDINGS: We prospectively followed 350 patients who underwent elective CABG between May 1996 and May 1999. At baseline, fasting total homocysteine (tHcy levels were measured in all participants, and a post-methionine loading (PML test was performed in 77.7% of them (n = 272. After a median follow-up of 58 months, 33 patients (9.4% had died, 25 because of cardiovascular events. HHcy, defined by levels higher than the 90th percentile (25.2 micromol/L of the population's distribution, was significantly associated to total and cardiovascular mortality (P = 0.018 [log-rank test 5.57]; P = 0.002 [log-rank test 9.76], respectively. The PML test had no prognostic value. After multiple adjustment for other univariate predictors by Cox regression, including statin therapy (the most powerful predictor in uni-/multivariate analyses, high-sensitivity C Reactive Protein (hs-CRP levels, and all known major genetic (MTHFR 677C-->T polymorphism and non-genetic (B-group vitamin status and renal function tHcy determinants, HHcy remained an independent prognostic factor for mortality (HRs: 5.02, 95% CIs 1.88 to 13.42, P = 0.001. CONCLUSIONS: HHcy is an important prognostic marker after CABG, independent of modern drug therapy and biomarkers.

  1. Image guidance for robotic minimally invasive coronary artery bypass.

    Science.gov (United States)

    Figl, Michael; Rueckert, Daniel; Hawkes, David; Casula, Roberto; Hu, Mingxing; Pedro, Ose; Zhang, Dong Ping; Penney, Graeme; Bello, Fernando; Edwards, Philip

    2010-01-01

    A novel system for image guidance in totally endoscopic coronary artery bypass (TECAB) is presented. Key requirement is the availability of 2D-3D registration techniques that can deal with non-rigid motion and deformation. Image guidance for TECAB is mainly required before the mechanical stabilisation of the heart, when the most dominant source of misregistration is the deformation and non-rigid motion of the heart. To augment the images in the endoscope of the da Vinci robot, we have to find the transformation from the coordinate system of the preoperative imaging modality to the system of the endoscopic cameras. In a first step we build a 4D motion model of the beating heart. Intraoperatively we can use the ECG or video processing to determine the phase of the cardiac cycle, as well as the heart and respiratory frequencies. We then take the heart surface from the motion model and register it to the stereo endoscopic images of the da Vinci robot resp. of a validation system using photo-consistency. To take advantage of the fact that there is a whole image sequence available for registration, we use the different phases together to get the registration. We found the similarity function to be much smoother when using more phases. This also showed promising behaviour in convergence tests. Images of the vessels available in the preoperative coordinate system can then be transformed to the camera system and projected into the calibrated endoscope view using two video mixers with chroma keying. It is hoped that the augmented view can improve the efficiency of TECAB surgery and reduce the conversion rate to more conventional procedures.

  2. Strategies to prevent intraoperative lung injury during cardiopulmonary bypass

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    Siminelakis Stavros N

    2010-01-01

    Full Text Available Abstract During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB, hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.

  3. Investigation on the Core Bypass Flow in a Very High Temperature Reactor

    Energy Technology Data Exchange (ETDEWEB)

    Hassan, Yassin

    2013-10-22

    Uncertainties associated with the core bypass flow are some of the key issues that directly influence the coolant mass flow distribution and magnitude, and thus the operational core temperature profiles, in the very high-temperature reactor (VHTR). Designers will attempt to configure the core geometry so the core cooling flow rate magnitude and distribution conform to the design values. The objective of this project is to study the bypass flow both experimentally and computationally. Researchers will develop experimental data using state-of-the-art particle image velocimetry in a small test facility. The team will attempt to obtain full field temperature distribution using racks of thermocouples. The experimental data are intended to benchmark computational fluid dynamics (CFD) codes by providing detailed information. These experimental data are urgently needed for validation of the CFD codes. The following are the project tasks: • Construct a small-scale bench-top experiment to resemble the bypass flow between the graphite blocks, varying parameters to address their impact on bypass flow. Wall roughness of the graphite block walls, spacing between the blocks, and temperature of the blocks are some of the parameters to be tested. • Perform CFD to evaluate pre- and post-test calculations and turbulence models, including sensitivity studies to achieve high accuracy. • Develop the state-of-the art large eddy simulation (LES) using appropriate subgrid modeling. • Develop models to be used in systems thermal hydraulics codes to account and estimate the bypass flows. These computer programs include, among others, RELAP3D, MELCOR, GAMMA, and GAS-NET. Actual core bypass flow rate may vary considerably from the design value. Although the uncertainty of the bypass flow rate is not known, some sources have stated that the bypass flow rates in the Fort St. Vrain reactor were between 8 and 25 percent of the total reactor mass flow rate. If bypass flow rates are on the

  4. Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue

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    Hafiz Abdul Moiz Fakih

    2016-02-01

    Full Text Available Background: Cryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB. Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vasculitis, clinically manifested as ischemic events, such as cutaneous ulcerations, glomerulonephritis, arthritis, or peripheral neuropathies among the most reported associated comorbidities. Management of CPB and systemic protection in this rare but unique scenario requires individualized planning. We report the case of a patient with active cryoglobulinemia who was preoperatively managed with plasmapheresis. He underwent hypothermic coronary bypass with no precipitation and flare during and after surgery. Case presentation: We describe the case of a 59-year-old Caucasian male with clinically significant idiopathic cryoglobulinemia and history of recurrent skin lesions and toe amputations secondary to cold exposure. He presented with 2-h duration of chest pain and new onset atrial fibrillation. After cardiac catheterization, a diagnosis of three-vessel coronary artery disease was established and coronary artery bypass grafting (CABG was scheduled. Because of a high risk of flare-up during surgery, the patient was preemptively treated with two sessions of plasmapheresis before bypass. He then underwent hypothermic CABG. The pre- and perioperative course was unremarkable without any clinical evidence of precipitation. The patient was discharged on day 6 postoperatively without any complications. Conclusion: Preoperative plasmapheresis before hypothermic coronary bypass can prevent fatal cryoglobulinemia-related complications in patients with active disease.

  5. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  6. Superficial temporal artery to proximal posterior cerebral artery bypass through the anterior temporal approach

    Directory of Open Access Journals (Sweden)

    Satoru Takeuchi

    2015-01-01

    Full Text Available Background: The superficial temporal artery (STA to proximal posterior cerebral artery (PCA (P2 segment bypass is one of the most difficult procedures to perform because the proximal PCA is located deep and high within the ambient cistern. STA to proximal PCA bypass is usually performed through a subtemporal approach or posterior transpetrosal approach, and rarely through a transsylvian approach. The aim of this study was to describe the operative technique of STA to proximal PCA bypass through a modified transsylvian approach (anterior temporal approach. Methods: STA to proximal PCA bypass was performed through an anterior temporal approach in three patients with intracranial aneurysm. We describe the details of the surgical technique. Results: The STA was successfully anastomosed to the proximal PCA in all cases. One patient suffered hemiparesis and aphasia due to infarction in the anterior thalamoperforating artery territory. Conclusions: STA to proximal PCA bypass can be performed through an anterior temporal approach in selected patients. We recommend that every precaution, including complete hemostasis, placement of cellulose sponges beneath the recipient artery to elevate the site of the anastomosis, and placement of a continuous drainage tube at the bottom of the operative field to avoid blood contamination during the anastomosis, should be taken to shorten the temporary occlusion time.

  7. [Evolution and quality of the diet of women with severe and morbid obesity undergoing gastric bypass].

    Science.gov (United States)

    Rebolledo, Annabella; Basfi-fer, Karen; Rojas, Pamela; Codoceo, Juana; Inostroza, Jorge; Carrasco, Fernando; Ruz, Manuel

    2009-03-01

    Evolution and quality of the diet of women with severe and morbid obesity undergoing gastric bypass. The objective of this study was to evaluate the changes of dietary intake and quality of the diet in patients undergoing gastric bypass. In forty-four women with severe and morbid obesity it was assessed their nutrient intakes before and 6, 12, and 18 months after gastric bypass by using three-day food records. Vitamin and mineral intakes from supplements were strictly controlled though personalized records. With the exceptions of calcium and vitamin A, energy and nutrient intakes were significantly decreased at 6, 12, and 18 month after bypass compared to the pre-surgery period. Dietary intakes of calcium, iron, zinc, copper, folic acid, vitamin C, and vitamin E were below 100% of adequacy from the 6th month after the surgery and thereafter. This situation is reverted when nutrient intakes supplied by supplements are taken into account. Although a "U" shape trend was observed in the nutrient intakes results during the experimental period, in most cases the differences between the observed values at month 12 and 18 were not significant. In conclusion, these patients had important reductions of their energy and nutrient intakes as result of gastric bypass. Routine supplements may correct this situation, nevertheless, the anatomical alterations inherent to this type of surgery may cause that total nutrient intakes reaching adequacy values slightly above 100%, may not necessarily be able to avoid the development of nutritional deficiencies.

  8. Bypasses of the antimycin a block of mitochondrial electron transport in relation to ubisemiquinone function.

    Science.gov (United States)

    Alexandre, A; Lehninger, A L

    1984-10-26

    Two different bypasses around the antimycin block of electron transport from succinate to cytochrome c via the ubiquinol-cytochrome c oxidoreductase of intact rat liver mitochondria were analyzed, one promoted by N,N,N',N'-tetramethyl-p-phenylenediamine (TMPD) and the other by 2,6-dichlorophenolindophenol (DCIP). Both bypasses are inhibited by myxothiazol, which blocks electron flow from ubiquinol to the Rieske iron-sulfur center, and by 2-hydroxy-3-undecyl-1,4-naphthoquinone, which inhibits electron flow from the iron-sulfur center to cytochrome c1. In the bypass promoted by TMPD its oxidized form (Wurster's blue) acts as an electron acceptor from some reduced component prior to the antimycin block, which by exclusion of other possibilities is ubisemiquinone. In the DCIP bypass its reduced form acts as an electron donor, by reducing ubisemiquinone to ubiquinol; reduced DCIP is regenerated again at the expense of either succinate or ascorbate. The observations described are consistent with and support current models of the Q cycle. Bypasses promoted by artificial electron carriers provide an independent approach to analysis of electron flow through ubiquinol-cytochrome c oxidoreductase.

  9. Particles deposition induced by the magnetic field in the coronary bypass graft model

    Science.gov (United States)

    Bernad, Sandor I.; Totorean, Alin F.; Vekas, Ladislau

    2016-03-01

    Bypass graft failures is a complex process starting with intimal hyperplasia development which involve many hemodynamic and biological factors. This work presents experimental results regarding the possibility to use magnetic drug delivery to prevent the development of the intimal hyperplasia using a simplified but intuitive model. The primary goal is to understand the magnetic particle deposition in the anastomosis region of the bypass graft taking into account the complex flow field created in this area which involves recirculation region, flow mixing and presence of particles with high residence time. The three-dimensional geometry model was used to simulate the motion and accumulation of the particles under the magnetic field influence in anastomotic region of the coronary bypass graft. The flow patterns are evaluated both numerically and experimentally and show a good correlation in term of flow parameters like vortex length and flow stagnation point positions. Particle depositions are strongly dependent on the magnet position and consequently of the magnetic field intensity and field gradient. Increased magnetic field controlled by the magnet position induces increased particle depositions in the bypass graft anastomosis. The result shows that particle depositions depend on the bypass graft angle, and the deposition shape and particle accumulation respectively, depend by the flow pattern in the anastomosis region.

  10. [Bone mineral density disminution post Roux-Y bypass surgery].

    Science.gov (United States)

    Papapietro, Karin; Massardo, Teresa; Riffo, Andrea; Díaz, Emma; Araya, A Verónica; Adjemian, Daniela; Montesinos, Gustavo; Castro, Gabriel

    2013-01-01

    Introducción: La cirugía bariátrica tiene complicaciones metabólicas importantes como la pérdida de masa ósea. Objetivo: Evaluar la densidad mineral ósea (DMO) posterior a by-pass gástrico en Y de Roux (BPYR) en pacientes con indicación de suplemento estándar de calcio y vitamina D. Método: En pacientes con BPYR por obesidad mórbida, 76 mujeres y 22 hombres de diversa edad, con instrucción nutricional, suplemento de calcio y vitamina D, se midió la DMO en columna lumbar y caderas con densitómetro radiológico de doble haz 2 a 3 años post-cirugía. Veinte mujeres fueron seguidas con DMO hasta 54 meses en promedio. Según criterios de Organización Mundial de la Salud (OMS), se comparó con población control joven y de su edad según sexo, evaluando osteopenia y osteoporosis. Resultados: Hubo correlación negativa de DMO con edad; positiva de DMO con índice de masa corporal y con exceso de peso preoperatorio. En mujeres menores de 45 años, se observó disminución de DMO en 26,8%, sin casos de osteoporosis y en 65,7% en las mayores de 45 años (p = 0,0011), correspondiendo a 45,7% de osteopenia y 20% de osteoporosis, predominantemente en columna lumbar. El subgrupo de mujeres con mayor seguimiento, presentó disminución progresiva de DMO, especialmente en cadera izquierda. En hombres se observó 36% de osteopenia y 14% de osteoporosis. Conclusión: Pacientes de ambos sexos y diversa edad, despues de un BPYR, presentaron osteopenia y osteoporosis, a pesar de suplemento precoz de calcio y vitamina D. Consideramos importante medir DMO seriada, individualizando terapias y controlando factores de riesgo.

  11. PROTEIN MALNUTRITION INCIDENCE COMPARISON AFTER GASTRIC BYPASS VERSUS BILIOPANCREATIC DIVERSION.

    Science.gov (United States)

    Suárez Llanos, José Pablo; Fuentes Ferrer, Manuel; Alvarez-Sala-Walther, Luis; García Bray, Bruno; Medina González, Laura; Bretón Lesmes, Irene; Moreno Esteban, Basilio

    2015-07-01

    Introducción: la cirugía bariátrica es muy empleada actualmente y en las malabsortivas, las complicaciones nutricionales son habituales. Objetivos: comparar la incidencia de malnutrición proteica e ingesta estimada de proteínas en pacientes intervenidos de bypass gástrico en Y-de-Roux (BGYR) y derivación biliopancreática (DBP), y la influencia de algunos factores de riesgo. Métodos: estudio restrospectivo comparando el desarrollo de hipoalbuminemia en 92 pacientes intervenidos mediante DBP y 121 de DBP (prequirúrgico, a los 3, 6, 12, 18 y 24 meses postquirúrgicos). La ingesta proteica se estimó mediante prealbúmina. Se evaluó la influencia del índice de masa corporal (IMC) previo, la edad y el sexo. Resultados: se encontró hipoprealbuminemia en torno al 40% de los pacientes a los 3 meses tras ambas técnicas, disminuyendo hasta el 10% a los dos años. La incidencia de hipoalbuminemia fue cercana al 20% durante el primer año tras DBP, persistiendo posteriormente en un 10-15% de los casos. Tras el BGYR, dicha incidencia fue menor (5-9% en todos los momentos). Así, durante el primer año postquirúrgico la hipoalbuminemia fue más frecuente tras DBP [3 meses: (OR:3,9;p = 0,006; 95%CI:1,5- 10,4), 6 meses (OR:5,0; p = 0,002; 95% CI:1,8-13,8), y al año (OR:4,4;p = 0,007;95%;CI:1,5-12,8)], pero no así después. Un mayor IMC prequirúrgico favoreció la inicidencia de hipoalbuminemia (OR:1,03; p = 0,046; 95% CI:1-1,06), así como una mayor edad a los 6 meses postquiúrgicos. Conclusión: los pacientes intervenidos mediante DBP tuvieron mayor riesgo de presentar hipoproteinemia que tras BGYR, especialmente durante el primer año postquirúrgico. Un mayor IMC postquirúrgico y la edad (a los 6 meses) podrían favorecer la aparición de hipoproteinemia.

  12. Extracranial to intracranial bypass for the treatment of cerebral aneurysms in the pediatric population.

    Science.gov (United States)

    Strickland, Ben A; Attenello, Frank; Russin, Jonathan J

    2016-12-01

    Cerebral aneurysms are rare in the pediatric population, making a definitive treatment algorithm difficult. Microsurgical clipping is the first choice for treatment but is not always feasible, while high recurrence rates and radiation exposure make endovascular options less favorable. Extracranial-intracranial (EC-IC) bypass, though not commonly performed in the pediatric aneurysm population, has been reported in a small number of studies to be both safe and effective for the management of cerebral aneurysms. The authors present the case of a child with a distal middle cerebral artery (MCA) aneurysm in eloquent territory, successfully treated with a superficial temporal artery (STA) to MCA bypass and trapping. A review of the current literature on pediatric EC-IC bypass in the treatment of intracranial aneurysms is presented.

  13. Redox-mediated bypass of restriction point via skipping of G1pm

    Directory of Open Access Journals (Sweden)

    Greene James J

    2006-07-01

    Full Text Available Abstract Background It is well known that cancer cells bypass the restriction point, R, and undergo uncontrolled cell proliferation. Hypothesis and evidence We suggest here that fibrosarcoma cells enter G1ps directly from M, skipping G1pm, hence bypassing R, in response to redox modulation. Evidence is presented from the published literature that demonstrate a shortening of the cycle period of transformed fibroblasts (SV-3T3 compared to the nontransformed 3T3 fibroblasts, corresponding to the duration of G1pm in the 3T3 fibroblasts. Evidence is also presented that demonstrate that redox modulation can induce the CUA-4 fibroblasts to bypass R, resulting in a cycle period closely corresponding to the cycle period of fibrosarcoma cells (HT1080. Conclusion The evidence supports our hypothesis that a low internal redox potential can cause fibrosarcoma cells to skip the G1pm phase of the cell cycle.

  14. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

  15. [Intraluminal Aspect of Femoro-femoral Cross-over Bypass Graft Mimics Bladder Stone].

    Science.gov (United States)

    Sonak, I; Wiedemann, A; Heppner, H J

    2016-04-01

    Iatrogenic bladder perforation with delayed diagnosis and treatment in the context of the placement of a vascular prosthesis, e.g. a femoro-femoral cross-over bypass graft, is extremely rare. This is emphasised by the present publication, which is the second published case study worldwide. To identify such a situation is very important because there is a risk of inappropriate treatment if such a bypass complication remains undetected, and the potential complications of an improperly intended "treatment of a bladder stone" may be deleterious or even lethal. Therefore, the involved disciplines should be aware of this possibility in order to initiate relevant diagnostic measures, especially diagnostic cystoscopy, without any delay if symptoms such as voiding disorders or alguria coincide with vascular bypass grafting.

  16. Hybrid approach to limb salvage in the setting of an infected femoral-femoral bypass graft.

    Science.gov (United States)

    Jones, Douglas W; Meltzer, Andrew J; Schneider, Darren B

    2014-08-01

    Prosthetic vascular graft infection in patients with advanced peripheral arterial disease can lead to multiple additional procedures, including extra-anatomic bypass or even amputation. We report the case of an 88-year-old woman with critical limb ischemia and an infected prosthetic femoral-femoral bypass graft. Using a planned hybrid 2-stage approach, we performed endovascular recanalization of the native left iliac arterial system using remote access via the superficial femoral artery to avoid infected groin wounds. Recanalization of the patient's Trans-Atlantic Inter-Society Consensus II D chronic iliac occlusion allowed for removal of the infected graft and placement of a profunda femoris artery to proximal posterior tibial artery bypass, thereby restoring inflow and avoiding the infected left groin. Newer endovascular techniques coupled with open surgical options may lead to limb salvage in patients with previously unreconstructable peripheral arterial disease.

  17. (Updated) NCI Fiscal 2016 Bypass Budget Proposes $25 Million for Frederick National Lab | Poster

    Science.gov (United States)

    By Nancy Parrish, Staff Writer; image by Richard Frederickson, Staff Photographer The additional funding requested for Frederick National Laboratory for Cancer Research (FNLCR) in the Fiscal 2016 Bypass Budget was $25 million, or approximately 3.5 percent of the total additional funding request of $715 million. Officially called the Professional Judgment Budget, the Bypass Budget is a result of the National Cancer Act of 1971, which authorizes NCI to submit a budget directly to the president, to send to Congress. With a focus on NCI’s research priorities and areas of cancer research with potential for investment, the Bypass Budget specifies additional funding, over and above the current budget, that is needed to advance

  18. Gastric Adenocarcinoma after Gastric Bypass for Morbid Obesity: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Maxwel Capsy Boga Ribeiro

    2013-01-01

    Full Text Available Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.

  19. Prospective randomized clinical study of arterial pumps used for routine on pump coronary bypass grafting.

    Science.gov (United States)

    Keyser, Andreas; Hilker, Michael K; Diez, Claudius; Philipp, Alois; Foltan, Maik; Schmid, Christof

    2011-05-01

    In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern.

  20. Report: Heparin-induced thrombocytopenia associated with cardiopulmonary bypass: Preliminary attempt with recombinant human thrombopoietin therapy.

    Science.gov (United States)

    Yuan, Shi-Min

    2015-09-01

    Recombinant human thrombopoietin (rhTPO) is popularly used for the treatment of chemotherapy-induced thrombocytopenia. However, rhTPO therapy for heparin-induced thrombocytopenia relating to cardiopulmonary bypass has not been previously described. A young patient developed heparin-induced thrombocytopenia during open-heart surgery. Postoperative rhTPO therapy (15000 units injection hypodermatica once daily for consecutive 3 days) made a quick platelet recovery without any side effects. Heparin-induced thrombocytopenia associated with cardiopulmonary bypass is more likely to be benign, and is curable to rhTPO therapy. The preliminary rhTPO administration of heparin-induced thrombocytopenia in association with cardiopulmonary bypass shows satisfactory pharmaceutical effects with lower dose, shorter duration treatment and shorter platelet increase time and recovery time in comparison with those for the treatment of chemotherapy-induced thrombocytopenia. rhTPO therapy does not produce any side effects and it could avoid or minimize necessary blood product infusions.

  1. The influence of stenosis degrees and graft suture position on local hemodynamics of coronary bypass

    Science.gov (United States)

    Totorean, A. F.; Bernad, S. I.; Susan-Resiga, R. F.

    2016-06-01

    Bypass graft failure is mainly caused by intimal hyperplasia (IH) that occurs at the graft anastomosis after coronary artery bypass grafting (CABG) surgery. It has been shown that local hemodynamics influences the process of IH initiation and progression. A main concern at this type of surgery is to increase the graft patency, respectively to improve the local hemodynamics. This paper analyzes the influence of different degree of stenosis severity and graft suture position on graft patency, taking into consideration the local hemodynamics. Bypass configurations with anastomosis angle of 45° were numerically investigated, with respect to wall shear stress and pressure variation. We can assume that in the conditions of our study, different stenosis degrees and position of the graft suture influence the local blood flow conditions, and, nevertheless, the graft patency.

  2. Gastric bypass surgery: Improving psoriasis through a GLP-1-dependent mechanism?

    DEFF Research Database (Denmark)

    Faurschou, Annesofie; Zachariae, Claus; Skov, Lone

    2011-01-01

    bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. Interestingly, however, it has been described that improvement...... of psoriasis is initiated immediately following surgery before any weight loss could have happened. We hypothesize that the glucose-lowering gut incretin hormone glucagon-like peptide-1 (GLP-1) is responsible for this effect. The levels of GLP-1 have been shown to increase up to 20 times after gastric bypass...... surgery. This most likely contributes importantly to the acute remission of type 2 diabetes, which is often induced by gastric bypass operations. The hormone is not hypersecreted after the purely restrictive bariatric procedure gastric banding and no case reports exist on improvement in psoriasis...

  3. Stagnant loop syndrome resulting from small-bowel irradiation injury and intestinal by-pass

    Energy Technology Data Exchange (ETDEWEB)

    Swan, R.W.

    1974-01-01

    Stagnant or blind-loop syndrome includes vitamin B12 malabsorption, steatorrhea, and bacterial overgrowth of the small intestine. A case is presented to demonstrate this syndrome occurring after small-bowel irradiation injury with exaggeration postenterocolic by-pass. Alteration of normal small-bowel flora is basic to development of the stagnant-loop syndrome. Certain strains of bacteria as Bacteriodes and E. coli are capable of producing a malabsorption state. Definitive therapy for this syndrome developing after severe irradiation injury and intestinal by-pass includes antibiotics. Rapid symptomatic relief from diarrhea and improved malabsorption studies usually follow appropriate antibiotic therapy. Recolonization of the loop(s) with the offending bacterial species may produce exacerbation of symptoms. Since antibiotics are effective, recognition of this syndrome is important. Foul diarrheal stools should not be considered a necessary consequence of irradiation injury and intestinal by-pass.

  4. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    Full Text Available Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138, hemofiltration was done during CPB. Control group (n = 145, patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05, and the PH showed metabolic acidosis in group H (P < 0.05. The mixed venous oxygen saturation decreased in group H than group C (P < 0.05. The number of transfused packed red blood cells was lower in group H than group C (P < 0.05. The hematocrit was higher in group H than group C (P < 0.05. The urine output was lower in group H than group C (P < 0.05. Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.

  5. Evaluation of orthotopic liver transplantation with no veno-venous bypass

    Institute of Scientific and Technical Information of China (English)

    黄东胜; 郑树森; 吴健; 梁廷波; 王伟林; 沈岩; 张珉

    2002-01-01

    To assess the feasibility and outcome of orthotopic liver transplantation(OLT) with no veno-venous bypass(v-v hypass)in adult patients.Methods:Between 1999 and 2001 ,43 adult patients underwent OLT with v-v bypass,33 with no v-v bypass.The operation time,anhepatic time,amount of blood loss,amount of blood transfusion,ICU stay days of the two groups were compared.renal function and gastrointestinal function in the two groups were examined.Results:There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with v-v bypass or not.With no v-v hypass,the average operation time was 5.7±1.3 hours,anhepatic time was 64±13 minutes,median amount of blood loss in operation was 4000±820mL,median amount of blood transfused intracperatively was 4650±910mL,median ICU stay was 5.7 days;all those were lower or shorter than those with v-v hypass.and these differences betweent the two groups had statistical significances.Conclusion:OLT with no v-v bypass is safe and can be performed in the majority of adult patients.The practice of liver transplantation with no v-v hypass is associated with shorter total operation time.shorter anhepatic time,lower blood product ussege,and shorter ICU stay compared with standard technique of OLT with routine use of v-v bypass.

  6. Carbon dioxide production during cardiopulmonary bypass: pathophysiology, measure and clinical relevance.

    Science.gov (United States)

    Ranucci, Marco; Carboni, Giovanni; Cotza, Mauro; de Somer, Filip

    2017-01-01

    Carbon dioxide production during cardiopulmonary bypass derives from both the aerobic metabolism and the buffering of lactic acid produced by tissues under anaerobic conditions. Therefore, carbon dioxide removal monitoring is an important measure of the adequacy of perfusion and oxygen delivery. However, routine monitoring of carbon dioxide removal is not widely applied. The present article reviews the main physiological and pathophysiological sources of carbon dioxide, the available techniques to assess carbon dioxide production and removal and the clinically relevant applications of carbon dioxide-related variables as markers of the adequacy of perfusion during cardiopulmonary bypass.

  7. Endovascular management of an acquired aortobronchial fistula following aortic bypass for coarctation.

    LENUS (Irish Health Repository)

    O'Sullivan, Katie E

    2013-09-20

    Aortobronchial fistula (ABF) in the setting of aortic coarctation repair is very rare but uniformly fatal if untreated. Endovascular stenting of the descending aorta is now the first-choice approach for ABF presenting with haemoptysis and offers a less-invasive technique with improved outcomes, compared with open repair. We report a case of late ABF occurring following bypass for aortic coarctation. Management focused on two key manoeuvres: use of a covered endovascular stent to occlude the aortic bypass thus controlling the fistula and dilatation and stenting of native coarctation.

  8. Development of the roller pump for use in the cardiopulmonary bypass circuit.

    Science.gov (United States)

    Cooley, D A

    1987-06-01

    In 1937, John Gibbon proposed his concept of extracorporeal circulation as an aid to cardiac surgery. Subsequently, a number of different types of pumps were tried in the extracorporeal circuit. Today, the pump used most often is a positive displacement twin roller pump, originally patented by Porter and Bradley in 1855. The rotary pump has undergone some minor modifications prior to its use in clinical cardiopulmonary bypass. Cardiovascular surgeons owe much to Porter and Bradley for an invention that has proved both efficient and effective for cardiopulmonary bypass and has allowed operations on an open heart in a relatively dry, bloodless field.

  9. Management of a patient with hyperkalemic periodic paralysis requiring coronary artery bypass grafts

    Directory of Open Access Journals (Sweden)

    Sanjay Orathi Patangi

    2012-01-01

    Full Text Available Hyperkalemic periodic paralysis (HPP is an autosomal-dominant inherited muscle disease characterized by episodes of flaccid weakness and intermittent myotonia. There are no previous reports in the literature about anesthesia for cardiac surgery with cardiopulmonary bypass in this disorder. We describe perioperative anesthetic management for on-pump coronary artery bypass grafting in a 75-year-old man with a history of hyperkalemic periodic paralysis. This case report outlines our management strategy and the issues encountered during the perioperative period.

  10. EFFECTS OF GRAPHITE SURFACE ROUGHNESS ON BYPASS FLOW COMPUTATIONS FOR AN HTGR

    Energy Technology Data Exchange (ETDEWEB)

    Rich Johnson; Yu-Hsin Tung; Hiroyuki Sato

    2011-07-01

    Bypass flow in a prismatic high temperature gas reactor (HTGR) occurs between graphite blocks as they sit side by side in the core. Bypass flow is not intentionally designed to occur in the reactor, but is present because of tolerances in manufacture, imperfect installation and expansion and shrinkage of the blocks from heating and irradiation. It is desired to increase the knowledge of the effects of such flow, which has been estimated to be as much as 20% of the total helium coolant flow. Computational fluid dynamic (CFD) simulations can provide estimates of the scale and impacts of bypass flow. Previous CFD calculations have examined the effects of bypass gap width, level and distribution of heat generation and effects of shrinkage. The present contribution examines the effects of graphite surface roughness on the bypass flow for different relative roughness factors on three gap widths. Such calculations should be validated using specific bypass flow measurements. While such experiments are currently underway for the specific reference prismatic HTGR design for the next generation nuclear plant (NGNP) program of the U. S. Dept. of Energy, the data are not yet available. To enhance confidence in the present calculations, wall shear stress and heat transfer results for several turbulence models and their associated wall treatments are first compared for flow in a single tube that is representative of a coolant channel in the prismatic HTGR core. The results are compared to published correlations for wall shear stress and Nusselt number in turbulent pipe flow. Turbulence models that perform well are then used to make bypass flow calculations in a symmetric onetwelfth sector of a prismatic block that includes bypass flow. The comparison of shear stress and Nusselt number results with published correlations constitutes a partial validation of the CFD model. Calculations are also compared to ones made previously using a different CFD code. Results indicate that

  11. Running Control Mode for In-Duct FGD with No-Bypass Design

    Institute of Scientific and Technical Information of China (English)

    Li

    2010-01-01

    The desulfuration system in the second phase project of Sanhe Power Plant is the first such system that adopts in-duct FGD with no-bypass design by domestic power plants. Different from that of the conventional FGD with bypass design, a running control mode, which is important for the security of the absorbing tower within the designed ranges, shall be made to ensure the flue gas temperature and dust concentration at the inlet of the absorbing tower. The stable running of the system shows that the control mode is feasible.

  12. Endovascular management of an acquired aortobronchial fistula following aortic bypass for coarctation.

    Science.gov (United States)

    O'Sullivan, Katie E; Bolster, Ferdia; Lawler, Leo P; Hurley, John

    2014-01-01

    Aortobronchial fistula (ABF) in the setting of aortic coarctation repair is very rare but uniformly fatal if untreated. Endovascular stenting of the descending aorta is now the first-choice approach for ABF presenting with haemoptysis and offers a less-invasive technique with improved outcomes, compared with open repair. We report a case of late ABF occurring following bypass for aortic coarctation. Management focused on two key manoeuvres: use of a covered endovascular stent to occlude the aortic bypass thus controlling the fistula and dilatation and stenting of native coarctation.

  13. Methylene Blue for Vasoplegia When on Cardiopulmonary Bypass During Double-Lung Transplantation.

    Science.gov (United States)

    Carley, Michelle; Schaff, Jacob; Lai, Terrance; Poppers, Jeremy

    2015-10-15

    Vasoplegia syndrome, characterized by hypotension refractory to fluid resuscitation or high-dose vasopressors, low systemic vascular resistance, and normal-to-increased cardiac index, is associated with increased morbidity and mortality after cardiothoracic surgery. Methylene blue inhibits inducible nitric oxide synthase and guanylyl cyclase, and has been used to treat vasoplegia during cardiopulmonary bypass. However, because methylene blue is associated with increased pulmonary vascular resistance, its use in patients undergoing lung transplantion has been limited. Herein, we report the use of methylene blue to treat refractory vasoplegia during cardiopulmonary bypass in a patient undergoing double-lung transplantation.

  14. Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Postoperative Complication

    OpenAIRE

    Zalesin, Kerstyn C.; Wendy M. Miller; Barry Franklin; Dharani Mudugal; Avdesh Rao Buragadda; Judith Boura; Katherine Nori-Janosz; David L. Chengelis; Krause, Kevin R.; McCullough, Peter A

    2010-01-01

    Introduction. Few data are available on vitamin A deficiency in the gastric bypass population. Methods. We performed a retrospective chart review of gastric bypass patients (n = 69, 74% female). The relationship between serum vitamin A concentration and markers of protein metabolism at 6-weeks and 1-year post-operative were assessed. Results. The average weight loss at 6-weeks and 1-year following surgery was 20.1 ± 9.1 kg and 44.1 ± 17.1 kg, respectively. At 6 weeks and 1 year after surgery,...

  15. Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Hesse, B; Eiberg, J

    1997-01-01

    . In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration...... antiplatelet therapy or vein graft diameter. Only 2 of the 20 intragraft platelet depositions occurred in areas where intra-operative vascular injury was suspected. In the composite graft and the PTFE grafts, diffuse activity was observed throughout the entire bypass. In conclusion, focal activity...

  16. Patency rates and the role of newer grafts in coronary artery bypass grafting.

    Science.gov (United States)

    Rai, Mridula; Rustagi, Tarun

    2013-10-01

    Coronary artery bypass grafting (CABG) was one of major surgical advances of the 20th century and it has proven to be one of the most effective and long-lasting therapies in the treatment of ischemic heart disease. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. We seek to review the emerging role and patency rates of newer arterial grafts in comparison with the traditional saphenous vein grafts.

  17. Gas Turbine Engine Having Fan Rotor Driven by Turbine Exhaust and with a Bypass

    Science.gov (United States)

    Suciu, Gabriel L. (Inventor); Chandler, Jesse M. (Inventor)

    2016-01-01

    A gas turbine engine has a core engine incorporating a core engine turbine. A fan rotor is driven by a fan rotor turbine. The fan rotor turbine is in the path of gases downstream from the core engine turbine. A bypass door is moveable from a closed position at which the gases from the core engine turbine pass over the fan rotor turbine, and moveable to a bypass position at which the gases are directed away from the fan rotor turbine. An aircraft is also disclosed.

  18. Experimental and Numerical Evaluation of the By-Pass Flow in a Catalytic Plate Reactor for Hydrogen Production

    DEFF Research Database (Denmark)

    Sigurdsson, Haftor Örn; Kær, Søren Knudsen

    2011-01-01

    Numerical and experimental study is performed to evaluate the reactant by-pass flow in a catalytic plate reactor with a coated wire mesh catalyst for steam reforming of methane for hydrogen generation. By-pass of unconverted methane is evaluated under different wire mesh catalyst width to reactor...

  19. 75 FR 62919 - Notice of Final Federal Agency Actions on the Route 250 Bypass Interchange at McIntire Road...

    Science.gov (United States)

    2010-10-13

    ... of Route 250 Bypass and McIntire Road. The project would reduce traffic congestion and improve... at McIntire Road Project in Virginia AGENCY: Federal Highway Administration (FHWA), DOT. ACTION... the Route 250 Bypass Interchange at McIntire Road project in the City of Charlottesville,...

  20. A GASTROINTESTINAL SIMULATION SYSTEM (GISS) FOR DISSOLUTION OF DRUGS BEFORE AND AFTER ROUX-EN-Y GASTRIC BYPASS : FIRST RESULTS

    NARCIS (Netherlands)

    Yska, J. P.; Punter, R. J.; Woerdenbag, H. J.; Apers, J. A.; Emous, M.; Totte, E.; Frijlink, H. W.; Wilffert, B.; van Roon, E. N.

    2014-01-01

    Introduction Roux-en-Y gastric bypass (RYGB) surgery is the most commonly performed procedure in bariatric surgery, greatly reducing stomach size and bypassing much of the small intestine. Hence it may reduce the absorption and bioavai-lability of oral medications, especially modified release produc

  1. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P. van den Heuvel; F. Unger (Felix); R. Beyar; W.K. Lindeboom (Wietze); V. de Valk (Vincent); S. Milo; R. Simon (Rudiger); G.F.O. Tyers (Frank); D. Regensburger; P.A. Crean (Peter); I.M. Penn (Ian); E. McGovern; C. van Cauwelaert; P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the

  2. Effects of angiotensin-converting enzyme inhibition in low-risk patients early after coronary artery bypass surgery

    NARCIS (Netherlands)

    Rouleau, Jean L.; Warnica, Wayne J.; Baillot, Richard; Block, Pierre J.; Chocron, Sidney; Johnstone, David; Myers, Martin G.; Calciu, Cristina-Dana; Dalle-Ave, Sonia; Martineau, Pierre; Mormont, Christine; van Gilst, Wiek H.

    2008-01-01

    Background-Early after coronary artery bypass surgery (CABG), activation of numerous neurohumoral and endogenous vasodilator systems occurs that could be influenced favorably by angiotensin-converting enzyme inhibitors. Methods and Results-The Ischemia Management with Accupril post -bypass Graft via

  3. 40 CFR 75.18 - Specific provisions for monitoring emissions from common and by-pass stacks for opacity.

    Science.gov (United States)

    2010-07-01

    ... emissions from common and by-pass stacks for opacity. 75.18 Section 75.18 Protection of Environment... Provisions § 75.18 Specific provisions for monitoring emissions from common and by-pass stacks for opacity. (a) Unit using common stack.When an affected unit utilizes a common stack with other affected...

  4. TISSUE-TYPE PLASMINOGEN-ACTIVATOR AND FIBRIN MONOMERS SYNERGISTICALLY CAUSE PLATELET DYSFUNCTION DURING RETRANSFUSION OF SHED BLOOD AFTER CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    DEHAAN, J; SCHONBERGER, J; HAAN, J; VANOEVEREN, W; EIJGELAAR, A

    1993-01-01

    Reduced hemostasis and bleeding tendency after cardiopulmonary bypass results from platelet dysfunction induced by the bypass procedure. The causes of this acquired platelet dysfunction are still subject to discussion, although, recently, greater emphasis has been placed on an overstimulated fibrino

  5. Hernia de Petersen: Complicación del bypass gástrico: hallazgos tomográficos Petersen's hernia: Complication of gastric bypass: CT findings

    Directory of Open Access Journals (Sweden)

    Cecilia Carrera

    2012-09-01

    Full Text Available El bypass gástrico en Y de Roux (BGYR es una de las técnicas de elección en pacientes con obesidad mórbida y en la actualidad es el procedimiento de cirugía bariátrica más utilizado. Consiste en una técnica mixta, es decir, tiene un carácter principalmente restrictivo y genera un cierto grado de malabsorción. Puede realizarse por cirugía convencional o laparoscópica, siendo esta última la de elección. La anastomosis retrocólica crea un espacio en el mesenterio, posibilitando la formación de un tipo de hernia transmesentérica denominada "hernia de Petersen". El objetivo de este trabajo es describir y analizar los hallazgos tomográficos de la hernia de Petersen en pacientes con antecedente de bypass gástrico. Se analizaron las historias clínicas de 92 pacientes con antecedente de BGYR (realizados todos en nuestra institución. Tres pacientes presentaron un cuadro de obstrucción intestinal y se les realizó tomografía computada multislice (TCMS de abdomen. En función de los hallazgos tomográficos consistentes con hernia interna, los pacientes fueron intervenidos quirúrgicamente y se confirmó la presencia de hernia de Petersen. El conocimiento de la técnica quirúrgica, los cambios anatómicos y las posibles complicaciones es de gran utilidad para diagnosticar la causa de dolor abdominal en pacientes sometidos a bypass gástrico. La TCMS brinda información sobre las estructuras extraluminales y su alta resolución espacial permite examinar tanto los cambios anatómicos como las probables complicaciones secundarias al bypass gástrico.The Roux-en-Y gastric bypass (RYGBP is one of the techniques of choice in patients with morbid obesity, and at present, it is the most commonly performed bariatric procedure. It is a mixed technique, it is mainly restrictive but it also generates some degree of malabsorption. This procedure may be performed with a conventional surgical approach or with laparoscopic techniques, with the latter

  6. Simple hyperaemia test as a screening method in the postoperative surveillance of infrainguinal in situ vein bypasses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Sillesen, H; Schroeder, T V

    1995-01-01

    . The optimal value of the waveform parameters for discrimination between bypasses with and without evidence of stenoses was determined by receiver operating characteristics (ROC) analysis. MAIN RESULTS: Complete Duplex scanning of the entire graft revealed an increase in the peak systolic velocity by a factor......OBJECTIVES: To develop a simple protocol for ultrasound Duplex surveillance of infrainguinal vein bypasses. DESIGN: The value of three Doppler waveform parameters, obtained from a single point of the bypass, for identification of stenoses was studied in 91 in situ vein bypasses. Midgraft peak...... response assessed by TAMV ratio proved the best parameter for identification of graft stenoses. A TAMV ratio of 2.0 or less correctly identified 21 of the 24 lesions (sensitivity 88%, specificity 75%) and none of the three bypasses with evidence of stenoses and TAMV ratios exceeding 2.0 failed during...

  7. Interpositional carotid artery bypass strategies in the surgical management of aneurysms and tumors of the skull base.

    Science.gov (United States)

    Liu, James K; Couldwell, William T

    2003-03-15

    Cerebral revascularization is an important component in the surgical management of complex skull base tumors and aneurysms. Patients who harbor complex aneurysms that cannot be clipped directly and in whom parent vessel occlusion cannot be tolerated may require cerebrovascular bypass surgery. In cases in which skull base tumors encase the carotid artery (CA) and a resection is desired, a cerebrovascular bypass may be necessary in planned CA occlusion or sacrifice. In this review the authors discuss options for performing high-flow anterograde interposition CA bypass for lesions of the skull base. The authors review three important bypass techniques involving saphenous vein grafts: the cervical-to-petrous internal carotid artery (ICA), petrous-to-supraclinoid ICA, and cervical-to-supraclinoid ICA bypass. These revascularization techniques are important tools in the surgical treatment of complex aneurysms and tumors of the skull base and cavernous sinus.

  8. 4D flow MRI assessment of extracranial-intracranial bypass: qualitative and quantitative evaluation of the hemodynamics

    Energy Technology Data Exchange (ETDEWEB)

    Sekine, Tetsuro [University Hospital Zurich/University of Zurich, Department of Medical Radiology, Division of Nuclear Medicine, Zurich (Switzerland); Nippon Medical School, Department of Radiology, Tokyo (Japan); Takagi, Ryo; Amano, Yasuo; Orita, Erika; Matsumura, Yoshio; Kumita, Shin-ichiro [Nippon Medical School, Department of Radiology, Tokyo (Japan); Murai, Yasuo [Nippon Medical School, Department of Neurological Surgery, Tokyo (Japan)

    2016-03-15

    Our aim was to assess the feasibility of using time-resolved 3D phase-contrast (4D flow) MRI to characterize extracranial-intracranial (EC-IC) bypass. We enrolled 32 patients who underwent EC-IC bypass (15 men, 17 women; mean age 66.4 years). In all, 16 underwent radial artery graft (RAG) bypass and 16 underwent superficial temporal artery (STA) bypass. 4D flow MRI, time-of-flight (TOF) magnetic resonance angiography (MRA), and computed tomography angiography (CTA) were performed. Bypass patency, flow direction, and blood flow volume (BFV) of each artery were determined by 4D flow MRI. Arterial diameters were measured by TOF-MRA and CTA. We compared RAG and STA bypasses by evaluating the flow direction and BFV of each artery. We evaluated the correlation between arterial diameters (measured by CTA or MRA) and the BFV and the detectability of flow direction (measured by 4D flow MRI) of each artery. 4D flow MRI confirmed the patency of each bypass artery. Flow direction of the M1 segment of the middle cerebral artery and BFV in the bypass artery differed between RAG and STA groups (p < 0.01). BFV in the bypass slightly correlated with the diameters on CTA (p < 0.05, R{sup 2} = 0.287). Of the 29 arteries in the circle of Willis, nine were not depicted on 4D flow MRI. Cutoff values for arterial diameters on CTA and TOF-MRA for detecting the artery on 4D flow MRI were 2.4 and 1.8 mm, respectively. 4D flow MRI provided unique information for characterizing EC-IC bypasses, although this detectability is limited when addressing small arteries with slow flow. (orig.)

  9. Adherence to treatment after coronary bypass surgery: Psychological aspects

    Directory of Open Access Journals (Sweden)

    Maria V. Iakovleva

    2016-01-01

    Full Text Available Poor adherence to treatment is a problem of great importance and striking magnitude. Its consequences are increased health care costs and poor health outcomes. It defined the objective of this research, which is the study of psychological characteristics of patients with different degrees of adherence to rehabilitation treatment after coronary bypass surgery. Ninety male and female patients with CHD, aged 46---71, were examined. The study was carried out using the questionnaire of ways of coping and the technique for diagnosing the types of attitude toward the disease, and the study of medical history. The analysis of the types of attitude toward the disease revealed that adherent patients show higher values on the harmonious type; patients with poor adherence show higher values on the apathetic, as well as the melancholic type of attitude toward illness. This study shows that wide range of psychological characteristics is significant for the definition of adherence to treatment. It is essential to consider the patient’s personality and his characteristics, such as attitude toward the disease, because they influence the adherence and, therefore, the effectiveness of therapy in the postoperative period. La escasa adherencia a la terapia es un problema de gran importancia ampliamente extendido. Sus consecuencias son el aumento de costes del tratamiento y su baja eficacia. El objetivo de la investigación fue el estudio de las características psicológicas de pacientes con diferentes grados de adherencia al tratamiento de rehabilitación después de la cirugía de derivación coronaria. Se recogieron datos clínicos de 90 pacientes de ambos sexos con cardiopatía coronaria, sometidos a cirugía de derivación coronaria, con edades comprendidas entre 46-71 a˜nos. Los cuestionarios administrados fueron el cuestionario de estilos de afrontamiento y la técnica de diagnóstico de tipos de actitud hacia la enfermedad. Además se realizó un estudio

  10. Taste matters-effects of bypassing oral stimulation on hormone and appetite responses

    NARCIS (Netherlands)

    Spetter, M.S.; Mars, M.; Viergever, M.A.; Graaf, de C.; Smeets, P.A.M.

    2014-01-01

    The interaction between oral and gastric signals is an important part of food intake regulation. Previous studies suggest that bypassing oral stimulation diminishes the suppression of hunger and increases gastric emptying rate. However, the role of appetite hormones, like cholecystokinin-8 and ghrel

  11. 78 FR 23953 - Draft Environmental Impact Statement/Environmental Impact Report for Yolo Bypass Salmonid Habitat...

    Science.gov (United States)

    2013-04-23

    ... Bureau of Reclamation Draft Environmental Impact Statement/Environmental Impact Report for Yolo Bypass.... We published the notice of intent in the Federal Register on March 4, 2013 (78 FR 14117). The public.... Dated: March 29, 2013. Russell W. Grimes, Chief, Environmental Compliance and Conservation Branch,...

  12. 78 FR 14117 - Draft Environmental Impact Statement/Environmental Impact Report for Yolo Bypass Salmonid Habitat...

    Science.gov (United States)

    2013-03-04

    ... Bureau of Reclamation Draft Environmental Impact Statement/Environmental Impact Report for Yolo Bypass... Water Resources intend to prepare an environmental impact statement/ environmental impact report (EIS... addressed in the environmental impact statement/ environmental impact report: 1. March 14, 2013, 1:30-3:30...

  13. Is there a relationship between serum S-100 beta protein and neuropsychologic dysfunction after cardiopulmonary bypass?

    NARCIS (Netherlands)

    Westaby, S; Saatvedt, K; White, S; Katsumata, T; van Oeveren, W; Bhatnagar, NK; Brown, S; Halligan, PW

    2000-01-01

    Objectives: Over the past decade, the glial protein S-100 beta has been used to detect cerebral injury in a number of clinical settings including cardiac surgery. Previous investigations suggest that S-100 beta is capable of identifying patients with cerebral dysfunction after cardiopulmonary bypass

  14. Cost-effectiveness of percutaneous coronary intervention versus bypass surgery from a Dutch perspective

    NARCIS (Netherlands)

    R.L.J. Osnabrugge (Ruben); E.A. Magnuson (Elizabeth); P.W.J.C. Serruys (Patrick); C.A.M. Campos (Carlos); K.K. Wang (Kenneth); D. van Klaveren (David); V. Farooq (Vasim); M.S. Abdallah (Mouin S.); H. Li (Haiying); K.A. Vilain (Katherine A.); E.W. Steyerberg (Ewout); M-C. Morice (Marie-Claude); K.D. Dawkins (Keith D.); F.W. Mohr (Friedrich); Kappetein, A.P. (A. Pieter); D.J. Cohen (David J.)

    2015-01-01

    textabstractAims Recent cost-effectiveness analyses of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have been limited by a short time horizon or were restricted to the US healthcare perspective. We, therefore, used individual patient-level data from the SYNT

  15. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating pat

  16. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

    NARCIS (Netherlands)

    D.J. Cohen (David J.); B.A. van Hout (Ben); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); C.M. Miguel (Carlos); P. den Heijer (Peter); M.M. Vrakking (M. M.); K.K. Wang (Kenneth); E.M. Mahoney (Elizabeth M.); S. Audi (Salma); K. Leadly (Katrin); K.D. Dawkins (Keith); A.P. Kappetein (Arie Pieter)

    2011-01-01

    textabstractBACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in

  17. Effects of hypothermic cardiopulmonary bypass on the pharmacodynamics and pharmacokinetics of rocuronium

    NARCIS (Netherlands)

    Smeulers, NJ; Wierda, MKH; vandenBroek, L; Huet, RCGG; Hennis, PJ

    1995-01-01

    Objective: To study the influence of hypothermic cardiopulmonary bypass (CPB) on the pharmacodynamics and pharmacokinetics of rocuronium. Design: Prospective, descriptive study. Setting: Operating room at a university hospital. Participants: Ten ASA class III end IV patients, ranging in age from 35

  18. The Dutch experience in percutaneous transluminal angioplasty of narrowed saphenous veins used for aortocoronary arterial bypass

    NARCIS (Netherlands)

    W.H.T. Plokker; H.J. Meester (Hannie); P.W.J.C. Serruys (Patrick)

    1991-01-01

    textabstractOf 19,994 percutaneous transluminal coronary angioplasty procedures performed in The Netherlands between April 1980 and January 1989, the long-term follow-up of 454 patients who underwent angioplasty of greater than or equal to 1 saphenous vein bypass graft was reviewed. In 46% of patien

  19. Changes in left ventricular functions after coronary artery by-pass surgery

    Directory of Open Access Journals (Sweden)

    Habib Çil

    2010-09-01

    Full Text Available Objectives: The aim of this study was to evaluate the left ventricular functions with transthoracic echocardiography after coronary bypass surgery.Methods: Sixty-four patients who underwent coronary bypass surgery between January 2008 and March 2009 were retrospectively evaluated. The diagnosis, age and gender of the patients, presence of diabetes mellitus and/or hypertension, smoking, and left ventricle functions before and after surgery were recorded.Results: The mean age of the patients was 58 ± 6,2 years. Forty-four of 64 patients were male, and 20 were female. The lowest ejection fraction was measured in two patients as 30% preoperatively. The mean preoperative and postoperative left ventricle ejection fractions were 48 ± 5.4% and 58 ± 2.4% respectively. This difference was found statistically significant. The mortality rate of by-pass surgery was 4.68% (3 patients.Conclusion: The left ventricular functions were significantly recovered after coronary by-pass surgery.

  20. Regional myocardial shortening in relation to graft-reactive hyperemia and flow after coronary bypass surgery

    NARCIS (Netherlands)

    R.W. Brower (Ronald); P.W.J.C. Serruys (Patrick); E. Bos (Egbert); J. Nauta (Jan)

    1979-01-01

    textabstractExtent of regional shortening of myocardium in areas newly perfused by bypass grafting was determined in 56 patients by a new technique employing four to six radiopaque markers sutured in pairs to the epicardium near the coronary anastomosis. Paradoxical systolic expansion (PSE) was mani

  1. Renal Tubular Acidosis after Jejunoileal Bypass for Morbid Obesity: role of secondary hyperparathyroidism

    DEFF Research Database (Denmark)

    Andersen, NN; Ladefoged, NN

    1991-01-01

    The effect of calcium infusion was studied in patients with renal tubular acidosis (RTA) and secondary hyperparathyroidism. Both developed after jejunoileal bypass operation (JIB) for morbid obesity. In three of four cases the acidification defect was abolished, probably due to a decrease of seru...

  2. Acute pancreatitis as an adverse event in patients with the duodenal-jejunal bypass liner

    NARCIS (Netherlands)

    Betzel, B; Homan, J.; Aarts, E.; Janssen, I.; Spanier, M.; Wahab, P.J.; Groenen, M.; Berends, F.

    2015-01-01

    Placement of the duodenal-jejunal bypass liner (DJBL) is a minimally invasive technique for the management of patients with type 2 diabetes mellitus and obesity. Acute pancreatitis was seen in 5 of 167 patients (3 %) in our series. It is suggested that acute pancreatitis in patients with the DJBL re

  3. Pregnant woman with fatal complication after laparoscopic Roux-en-Y gastric bypass

    DEFF Research Database (Denmark)

    Renault, Kristina; Gyrtrup, Hans Jørgen; Damgaard, Karen

    2012-01-01

    In Europe, an increasing number of women have bariatric surgery; therefore, obstetricians are likely to encounter these patients. We report a 22-year-old woman, who had previously undergone uncomplicated laparoscopic Roux-en-Y gastric bypass. She was admitted with severe abdominal pain at 35 weeks...

  4. In situ cephalic vein bypasses from axillary to the brachial artery after catheterization injuries.

    Science.gov (United States)

    Hudorovic, Narcis; Lovricevic, Ivo; Ahel, Zaky

    2010-07-01

    The need to bypass to the brachial artery is rare. Over a five-year period, 16 patients had suffered iatrogenic post-catheterization injuries of the upper extremity. We have performed 16 bypasses, in 16 patients, mean age was 65 years (range 47-75), to the brachial artery originating from an artery proximal to the shoulder joint. In all cases, the axillary artery was the donor artery. All bypasses were created by using the cephalic vein with the in situ technique and distal anastomoses were made to a distance-free section of brachial artery. No operative mortality, neurological complications or major upper-extremity amputation was associated with the procedure. Life-long-conduit analysis showed 75% patency in the five-year period. After iatrogenic post-catheterization trauma of arterial system of upper extremity, bypasses from axillary to brachial artery with the cephalic vein with the in situ technique is a safe operation with satisfactory long-term patency.

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

    Institute of Scientific and Technical Information of China (English)

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

    2004-01-01

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

  6. The effect of pulsatile cardiopulmonary bypass on lung function in elderly patients

    NARCIS (Netherlands)

    Engels, Gerwin E.; Dodonov, Mikhail; Rakhorst, Gerhard; van Oeveren, Willem; Milano, Aldo D.; Gu, Y. John; Faggian, Giuseppe

    2014-01-01

    Purpose: Cardiopulmonary bypass is still a major cause of lung injury and delay in pulmonary recovery after cardiac surgery. Although it has been shown that pulsatile flow induced by intra-aortic balloon pumping is beneficial for preserving lung function, it is not clear if the same beneficial effec

  7. HEMOSTATIC FUNCTION OF ASPIRIN-TREATED PLATELETS VULNERABLE TO CARDIOPULMONARY BYPASS - ALTERED SHEAR-INDUCED PATHWAY

    NARCIS (Netherlands)

    TABUCHI, N; HUET, RCGG; STURK, A; EIJSMAN, L; WILDEVUUR, CRH

    1995-01-01

    The impaired hemostasis of aspirin-treated patients is an annoying problem during and after cardiopulmonary bypass, The hemostatic function of platelets comprises two mechanisms: the shear-induced and the cyclooxygenase pathways, Because the latter is inhibited in aspirin-treated patients, the hemos

  8. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a novel...

  9. Median sternotomy for double lung transplantation with cardiopulmonary bypass in seven consecutive patients

    DEFF Research Database (Denmark)

    Kohno, Mitsutomo; Steinbrüchel, Daniel A

    2012-01-01

    We describe our technique of using median sternotomy to perform double lung transplantations with cardiopulmonary bypass. By sparing the respiratory muscles, median sternotomy is probably less invasive and preserves lung function. Furthermore, it causes less long-term discomfort than intercostal...

  10. ENDOTOXIN RELEASE AND TUMOR-NECROSIS-FACTOR FORMATION DURING CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    JANSEN, NJG; VANOEVEREN, W; GU, YJ; VANVLIET, MH; EIJSMAN, L; WILDEVUUR, CRH

    1992-01-01

    Endotoxin, when released into the systemic circulation during cardiopulmonary bypass (CPB), might induce activation of plasmatic systems and blood cells during CPB, in addition to a material-dependent blood activation during CPB. However, the role of endotoxin in the development of this so-called wh

  11. Endotoxin release in cardiac surgery with cardiopulmonary bypass : pathophysiology and possible therapeutic strategies. An update

    NARCIS (Netherlands)

    Kats, Suzanne; Schonberger, Jacques P. A. M.; Brands, Ruud; Seinen, Willem; van Oeveren, Wim

    2011-01-01

    Cardiac surgery with cardiopulmonary bypass provokes a systemic inflammatory response syndrome caused by the surgical trauma itself, blood contact with the non-physiological surfaces of the extracorporeal circuit, endotoxemia, and ischemia. The role of endotoxin in the inflammatory response syndrome

  12. COMPOUNDING PHARMACIES' POTENTIAL TO CREATE Graft Storage Solutions for Bypass Surgeries.

    Science.gov (United States)

    Guth, Michael A S

    2015-01-01

    Several studies have addressed the optimal storage conditions for vascular grafts during bypass surgery. These studies have repeatedly shown that placing vascular graft conduits in isotonic saline solutions, and to a lesser extent in heparinized autologous blood, leads to a profound decline in endothelial cell viability. Endothelial damage to vein grafts can occur at multiple points during a coronary artery bypass graft surgery procedure: graft harvesting, handling, flushing, storage, anastomosis, and arterialization (e.g., damage caused by exposure to arterial blood pressure). This damage to endothelial cells causes the release of pro-inflammatory chemical signals that trigger thrombosis, intimal hyperplasia, and accelerated graft atherosclerosis, all of which ultimately contribute to graft failure. Cardiothoracic surgeons performing coronary artery bypass graft surgery and vascular surgeons performing peripheral artery bypass graft surgery have attempted to overcome the damage to the vascular grafts by using buffers to maintain the physiological pH of the storage solution. However, the endothelial layers in the grafts would benefit from having proper oxygenation and antioxidants added to the storage solution. Compounding pharmacies can perform a vital role in ensuring the patency of the vascular grafts by creating compounded flushing and storage solutions that have an optimal mix of nitric oxide substrates, antioxidants, and other nutrients for the endothelium. Maintaining structural and functional viability of the endothelia in grafts by using an appropriate vessel storage medium would lead to improved long-term graft patency.

  13. Should blood flow during cardiopulmonary bypass be individualized more than to body surface area?

    DEFF Research Database (Denmark)

    Thomassen, Sisse Anette; Larsson, A; Andreasen, Jan Jesper;

    Blood flow during cardiopulmonary bypass (CPB) is calculated on body surface area (BSA). Increasing comorbidity, age and weight of today's cardiac patients question this calculation as it may not reflect individual metabolic requirement. The hypothesis was that a measured cardiac index (CI) prior...... not improve cerebral and systemic oxygenation compared to a blood flow based on BSA....

  14. Functional Imaging in Hyperinsulinemic Hypoglycemia after Gastric Bypass Surgery for Morbid Obesity

    NARCIS (Netherlands)

    de Heide, Loek J. M.; Glaudemans, Andor W. J. M.; Oomen, Peter H. N.; Apers, Jan A.; Totte, Eric R. E.; van Beek, Andre P.

    2012-01-01

    Context: Hyperinsulinemic hypoglycemia after Roux-en-Y gastric bypass (RYGB) has been increasingly reported. It is induced by beta-cell hyperplasia often referred to as nesidioblastosis. Positron emission tomography (PET) with [11C]-5-hydroxytryptophan (C-11-HTP) and 6-[18F]fluoro-3,4-dihydroxy-L-ph

  15. Gastric bypass surgery reveals independency of obesity and diabetes melitus type 2

    DEFF Research Database (Denmark)

    Fenger, Mogens; Hansen, Dorte Lindqvist; Worm, Dorte

    2016-01-01

    BACKGROUND: Roux-en-Y gastric bypass surgery is widely applied to ameliorate morbid obesity, including diabetes in people with type 2 diabetes. The latter vanish a few days after surgery for many, but not in all patients before any weight reduction has occurred. The explanation for this change in...

  16. Aluminum-contaminant transport by surface runoff and bypass flow from an acid sulphate soil

    NARCIS (Netherlands)

    Minh, L.Q.; Tuong, T.P.; Mensvoort, van M.E.F.; Bouma, J.

    2002-01-01

    Quantifying the process and the amount of acid-contaminant released to the surroundings is important in assessing the environmental hazards associated with reclaiming acid sulphate soils (ASS). The roles of surface runoff and bypass flow (i.e. the rapid downward flow of free water along macropores t

  17. Prevalence and impact of dumping syndrome on qol after primary gastric bypass surgery

    NARCIS (Netherlands)

    Emous, M.; Ubels, F.L.; Apers, J.A.; Wolffenbuttel, B.H.R.; Totté, E.; Van Beek, A.P.

    2014-01-01

    Introduction: Worldwide gastric bypass is still the most frequent performed weight loss operations for morbid obesity and it's effectively is proven. Although dumping has been widely recognized as complication after RYGB, almost no data are available on the prevalence and the consequences of this sy

  18. Low Incidence of Early Postoperative Cerebral Edema After Coronary Artery Bypass Grafting

    NARCIS (Netherlands)

    Ottens, Thomas H.; Hendrikse, J; Slooter, Arjen J. C.; van Herwerden, LA; Dieleman, Stefan; van Dijk, Diederik

    2015-01-01

    Objective: Using magnetic resonance imaging, the authors studied the influence of a single high dose of intraoperative dexamethasone on the severity of cerebral edema that can occur early after coronary artery bypass grafting (CABG). It was hypothesized that high-dose intraoperative dexamethasone re

  19. Serum lactate as a prognostic factor in coronary artery bypass graft operation by on pump method

    OpenAIRE

    Jabbari, Ali; Banihashem, Nadia; Alijanpour, Ebrahim; Vafaey, Hamid Reza; Alereza, Hakimeh; Rabiee, Seyed Mozafar

    2013-01-01

    Background: Lactic acidosis in cardiac surgical patients is a manifestation of systemic inflammation and excess pro-inflammatory cytokine production. This investigation was designed to integrate basic concepts about lactate acidosis with a clinically used of serum lactate in patients under coronary artery bypass surgery (CABG) by on pump method.

  20. Effect of cardiopulmonary bypass on leukocyte activation : changes in membrane-bound elastase on neutrophils

    NARCIS (Netherlands)

    Tang, M; Gu, YJ; Wang, WJ; Xu, YP; Chen, CZ

    2004-01-01

    Background: Neutrophil elastase is known to be released from the activated leukocytes as a result of cardiopulmonary bypass (CPB). However, its biological effect on organ injury is questionable because it is quickly bound by natural proteinase inhibitors (PIs). Recently, membrane-bound elastase ( MB

  1. Mild preoperative renal dysfunction as a predictor of longterm clinical outcome after coronary bypass surgery

    NARCIS (Netherlands)

    van de Wal, RMA; van Brussel, BL; Voors, AA; Smilde, TDJ; van Swieten, HA; van Gilst, WH; van Veldhuisen, DJ; Plokker, HWT

    2005-01-01

    Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of pr

  2. Predictors of cognitive function in candidates for coronary artery bypass graft surgery.

    Science.gov (United States)

    Ernest, Christine S; Elliott, Peter C; Murphy, Barbara M; Le Grande, Michael R; Goble, Alan J; Higgins, Rosemary O; Worcester, Marian U C; Tatoulis, James

    2007-03-01

    Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery.

  3. Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities

    DEFF Research Database (Denmark)

    Mérie, Charlotte; Køber, Lars; Olsen, Peter Skov;

    2012-01-01

    The risk of stroke after coronary artery bypass grafting (CABG) is known to increase dramatically with age. During recent years, the age of patients operated on has increased and concomitant therapy has changed. Therefore, we have re-evaluated the risk of stroke after CABG....

  4. Treatment of giant hiatal hernia by laparoscopic Roux-en-Y gastric bypass

    NARCIS (Netherlands)

    L.E. Duinhouwer (Lucia); L.U. Biter (L. Ulas); B.P.L. Wijnhoven (Bas); G.H.H. Mannaerts (Guido)

    2015-01-01

    textabstractIntroduction Obesity is a risk factor for hiatal hernia. In addition, much higher recurrence rates are reported after standard surgical treatment of hiatal hernia in morbidly obese patients. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective surgical treatment for morbid obesi

  5. Carotid-subclavian bypass for subclavian steal syndrome following coarctation repair in infancy

    Directory of Open Access Journals (Sweden)

    Scott Chowning

    2012-01-01

    Full Text Available A 19 year old man presented with dizziness that was exacerbated while using left arm. On investigation, subclavian steal syndrome (SSS was diagnosed. He underwent left carotid to subclavian bypass with relief of symptoms. Subclavian steal syndrome, although rare, should be considered in the differential diagnosis in patients with the history of subclavian artery manipulation in the past in proper settings.

  6. Hypercoagulability in relation to coronary artery bypass graft patency and clinical outcome

    DEFF Research Database (Denmark)

    Zacho, Mette; Rafiq, Sulman; Kelbæk, Henning;

    2013-01-01

    Hypercoagulability evaluated with thrombelastography (TEG) has been reported to be associated to thrombembolic events in patients undergoing coronary artery bypass graft surgery (CABG). The objective of this study was to test the hypothesis that graft patency and post-CABG thrombembolic events ar...

  7. Off-pump Y-graft coronary artery bypass in a patient with situs inversus totalis

    NARCIS (Netherlands)

    Arrigoni, Sara Camilla; Oosterhof, Richard; Mariani, Massimo Alessandro

    2010-01-01

    Situs inversus is the mirror image of situs solitus. Situs inversus with dextrocardia is termed 'situs inversus totalis'. Since situs inversus totalis is a rare condition, there are a only a few reports about off-pump coronary artery bypass (OPCAB) in these patients. A 67-year-old man with a diagnos

  8. Hematological Disorders following Gastric Bypass Surgery: Emerging Concepts of the Interplay between Nutritional Deficiency and Inflammation

    Directory of Open Access Journals (Sweden)

    Mingyi Chen

    2013-01-01

    Full Text Available Obesity and the associated metabolic syndrome are among the most common and detrimental metabolic diseases of the modern era, affecting over 50% of the adult population in the United States. Surgeries designed to promote weight loss, known as bariatric surgery, typically involve a gastric bypass procedure and have shown high success rates for treating morbid obesity. However, following gastric bypass surgery, many patients develop chronic anemia, most commonly due to iron deficiency. Deficiencies of vitamins B1, B12, folate, A, K, D, and E and copper have also been reported after surgery. Copper deficiency can cause hematological abnormalities with or without neurological complications. Despite oral supplementation and normal serum concentrations of iron, copper, folate, and vitamin B12, some patients present with persistent anemia after surgery. The evaluation of hematologic disorders after gastric bypass surgery must take into account issues unique to the postsurgery setting that influence the development of anemia and other cytopenias. In this paper, the clinical characteristics and differential diagnosis of the hematological disorders associated with gastric bypass surgery are reviewed, and the underlying molecular mechanisms are discussed.

  9. Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Postoperative Complication

    Directory of Open Access Journals (Sweden)

    Kerstyn C. Zalesin

    2011-01-01

    Conclusion. Vitamin A deficiency is common after bariatric surgery and is associated with a low serum concentration of pre-albumin. This fat-soluble vitamin should be measured in patients who have undergone gastric bypass surgery and deficiency should be suspected in those with evidence of protein-calorie malnutrition.

  10. DIET MICRONUTRIENT ADEQUACY OF WOMEN AFTER 1 YEAR OF GASTRIC BYPASS

    Science.gov (United States)

    LEIRO, Larissa Silveira; Melendez-ARAÚJO, Mariana Silva

    2014-01-01

    Background The more effective treatment for severe obesity is bariatric surgery. Gastric bypass is a surgical technique used worldwide; however, as well as other techniques; it has postoperative risks, including nutrient deficiency. Aim To determine the amounts of dietary iron, calcium, vitamin D and vitamin B12 ingested by patients of a public hospital one year after gastric bypass, and compare with the recommendations of the Recommended Dietary Allowances. Methods This was a transverse descriptive study and the sample consisted of 36 women, with at least one year of gastric bypass. Data collected included sociodemographic, anthropometric and diet variables. Dietetic information was collected through a validated food frequency questionnaire. Ingestion of iron, calcium, vitamin D and vitamina B12 was evaluated in comparison with the Recommended Dietary Allowances, as well as correlation of micronutrient ingestion with time of surgery. Results There was inadequate consumption of iron, calcium and vitamin D. The vitamin B12 intake was considered adequate. There was statistically significant positive correlation between the time of surgery and the ingestion of iron, vitamin B12 and vitamin D. Conclusion The intake of iron, calcium and vitamin D of women one year after gastric bypass was inadequate, emphasizing the importance of multiprofessional monitoring postoperatively to prevent nutrient deficiencies. PMID:25409960

  11. Efficiency and safety of leukocyte filtration during cardiopulmonary bypass for cardiac surgery

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    1999-01-01

    Background. Leukocyte filtration of systemic blood during cardiopulmonary bypass surgery to reduce post-operative morbidity has not yet been established because of the enormous leukocyte release from the third space. This study was designed to examine the efficiency and safety of leukocyte filtratio

  12. Patient Directed Perfusion Pressure on Bypass, an Analogy from Electrical Engineering—A New Concept

    Science.gov (United States)

    Warwick, Richard; Poole, Robert; Palmer, Kenneth; Johnson, Ian; Poullis, Michael

    2010-01-01

    Abstract: Organ ischemia, particularly mesenteric and renal, can occur despite a seemingly adequate perfusion flow and pressure during a period of cardiopulmonary bypass. The blood pressure to run bypass at remains a contentious issue. We present the concept that perfusion pressure during cardiopulmonary bypass should be patient specific, depending on an individual’s resting pre-procedural blood pressure. Four simulated arterial traces with variable morphology, but identical systolic and diastolic blood pressures, were analyzed to calculate the medical mean, arithmetic mean, and root mean square of the blood pressure tracing. Using the standard medical formula for calculation of mean blood pressure, you can potentially underestimate perfusion pressure by 12 mmHg in a normotensive subject. The root mean square pressure calculates the equivalent non pulsatile pressure that will deliver the same hydraulic power to the circulation as its pulsatile equivalent. Patient specific perfusion pressures, calculated via root mean square may potentially help reduce the incidence of organ ischemia during cardiopulmonary bypass. Clinical trials are needed to confirm or refute this concept. PMID:20437793

  13. Patient directed perfusion pressure on bypass, an analogy from electrical engineering--a new concept.

    Science.gov (United States)

    Warwick, Richard; Poole, Robert; Palmer, Kenneth; Johnson, Ian; Poullis, Michael

    2010-03-01

    Organ ischemia, particularly mesenteric and renal, can occur despite a seemingly adequate perfusion flow and pressure during a period of cardiopulmonary bypass. The blood pressure to run bypass at remains a contentious issue. We present the concept that perfusion pressure during cardiopulmonary bypass should be patient specific, depending on an individual's resting pre-procedural blood pressure. Four simulated arterial traces with variable morphology, but identical systolic and diastolic blood pressures, were analyzed to calculate the medical mean, arithmetic mean, and root mean square of the blood pressure tracing. Using the standard medical formula for calculation of mean blood pressure, you can potentially underestimate perfusion pressure by 12 mmHg in a normotensive subject. The root mean square pressure calculates the equivalent non pulsatile pressure that will deliver the same hydraulic power to the circulation as its pulsatile equivalent. Patient specific perfusion pressures, calculated via root mean square may potentially help reduce the incidence of organ ischemia during cardiopulmonary bypass. Clinical trials are needed to confirm or refute this concept.

  14. Mechanisms by which Human Cells Bypass Damaged Bases during DNA Replication after Ultraviolet Irradiation

    Directory of Open Access Journals (Sweden)

    James E. Cleaver

    2002-01-01

    Full Text Available The replication of damaged DNA involves cascading mechanisms of increasing complexity but decreasing accuracy. The most accurate mechanism uses low-fidelity DNA polymerases, Pol H and Pol I, which have active sites sufficiently large to accommodate a pyrimidine dimer. Replicative bypass of DNA damage by these polymerases produces an accurately replicated, newly synthesized strand. Pol H negative cells (XP-V cell lines either adopt a proposed secondary bypass mechanism or a recombinational mode. The mechanism of the secondary bypass is unclear, but a number of experiments suggests roles for excision repair to remove damage ahead of replication forks, hRad6/18 proteolysis to clear the blocked forks, and the Rad17-RFC and 9-1-1 complexes to establish a new replication apparatus. This alternative pathway requires functional p53. In Pol H negative cells in which p53 is also inactive, the arrested fork fragments into DNA double strand breaks. Foci containing PCNA, Mre11/Rad50/Nbs1, and gamma-H2Ax can then be detected, along with chromosomal rearrangement and high frequencies of sister chromatid exchanges. The recruitment of recombination components to the arrested forks represents the ultimate failure of replication machinery to relieve the arrested state and bypass the damage. The resulting chromosomal instability in surviving cells will contribute to malignant transformation.

  15. Duodenal-jejunal bypass sleeve - a potential alternative to bariatric surgery?

    DEFF Research Database (Denmark)

    Rohde, Ulrich; Gylvin, Silas; Vilmann, Peter;

    2014-01-01

    Overweight and obesity are risk factors for several co-morbidities reducing life expectancy. Conservative treatment of obesity is generally ineffective in the long-term. Bariatric surgery has proven effective, but is associated with potential complications. Duodenal-jejunal bypass sleeve is a nov...

  16. Activation of hemostasis after off-pump coronary artery bypass graft surgery

    NARCIS (Netherlands)

    Lo, B.

    2007-01-01

    The aim of this thesis was to study the activation of hemostasis and inflammation, in patients undergoing off-pump (OPCAB) and on-pump coronary artery bypass graft (CABG) surgery and the relationship of coagulation and inflammation to clinical outcome. We hypothesized that activation of hemostasis a

  17. APROTININ PRESERVES HEMOSTASIS IN ASPIRIN-TREATED PATIENTS UNDERGOING CARDIOPULMONARY BYPASS

    NARCIS (Netherlands)

    TABUCHI, N; HUET, RCG; STURK, A; EIJSMAN, L; WILDEVUUR, CRH

    1994-01-01

    Various clinical trials have shown that hemostasis is improved by the administration of aprotinin during cardiopulmonary bypass. However, this effect has not been proved for those patients treated preoperatively with aspirin. Therefore, a double-blind, placebo-controlled study was conducted to test

  18. Effects of Fertilizer Nitrogen on Short-Term Nitrogen Loss in Bypass Flow in a Vertisol

    NARCIS (Netherlands)

    Sigunga, D.O.; Janssen, B.H.; Oenema, O.

    2008-01-01

    Bypass flow, the vertical flow of free water along the walls of macropores or preferential flow paths in the soil, can lead to movement of fertilizer nutrients beyond the reach of plants. Fertilizer type and the rate of application, as well as the amount, frequency, and intensity of rainfall, can in

  19. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings.

    Science.gov (United States)

    Lakusic, Nenad; Mahovic, Darija; Kruzliak, Peter; Cerkez Habek, Jasna; Novak, Miroslav; Cerovec, Dusko

    2015-01-01

    Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.

  20. The combined ipsilateral antegrade-retrograde approach to insert an endoluminal femoropopliteal bypass

    NARCIS (Netherlands)

    Lensvelt, M.M.A.; Zeebregts, C.J.A.; Stoer-Bouwman, M.; Reijnen, M.M.P.J.

    2011-01-01

    The endoluminal femoropopliteal bypass is a minimally invasive treatment modality for occlusive superficial femoral artery disease. Technical failure of endovascular treatment of chronic total occlusions is often caused by the inability to re-enter the true lumen. Re-entry devices have a high techni

  1. Prolonged ischemic heart disease and coronary artery bypass - relation to contractile reserve

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Bangsgaard, Regitze; Carstensen, Steen;

    2002-01-01

    OBJECTIVE: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have...

  2. Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery.

    Science.gov (United States)

    2016-11-18

    Patients Waiting for Elective Isolated Coronary Artery Bypass Grafting (CABG); Patients Waiting for Aortic Valve Repair/Replacement for Moderate Aortic Stenosis or Severe Regurgitation; Patients Waiting for Mitral Valve Repair/Replacement for Moderate Stenosis or Severe Regurgitation; Patients Waiting for Combined Procedures. (CAGB and Valve)

  3. Hyperglycemia as an Effect of Cardiopulmonary Bypass: Intra-operative Glucose Management

    OpenAIRE

    Najmaii, Samira; Redford, Daniel; Larson, Douglas F.

    2006-01-01

    Cardiopulmonary bypass (CPB) is associated with surgical stress, hypothermia, hyperoxia, enhancement of neuroendocrine outflow, and administration of glucogenic catecholamines that are associated with glucogonolysis and glucogenesis that result in hyperglycemia. The hyperglycemic state during CPB has been associated with adverse outcomes, such as infection, neurological impairment, cardiac dysfunction, prolonged hospitalization, and higher mortality rates. This report justifies vigilant monit...

  4. A bulldog clamp that was forgotten during a coronary artery bypass operation 8 years ago.

    Science.gov (United States)

    Celkan, Mehmet Adnan; Bayatli, Kivanc

    2012-10-01

    Prevention of retained foreign bodies in the pericardial cavity is critical for patient safety. We report a patient with a bulldog clamp that was forgotten during a coronary artery bypass operation 8 years ago, which was detected by chance and removed.

  5. The use of a Perma-Flow graft for coronary artery bypass surgery.

    Science.gov (United States)

    Schmid, C; Weyand, M; Kerber, S; Breithardt, G; Scheld, H H

    1996-01-01

    We report on our first clinical use of a Perma-Flow graft for coronary artery bypass surgery (CABG). It may well be that repeated successful use of this graft will offer a chance for revascularization to patients who might otherwise have been denied for lack of appropriate vessels.

  6. The use of by-pass grafts for obstructive lesions of tibial and peroneal arteries.

    Science.gov (United States)

    Danza, R

    1982-01-01

    Lesions of the distal arteries of the leg are of similar frequency and importance as proximal lesions. Most frequently distal and proximal lesions are present. When distal intraoperative arteriography is carried out before a femoropopliteal by-pass, 68% of cases have associated distal lesions. When the popliteal artery is occluded, the by-pass must extend to the tibio-peroneal trunk, a tibial artery or the peroneal artery. In this paper 79 of these distal by-passes are reported, together with the results. Although there are arterial lesions limited to the ankle, it is not frequent to find this type of pathology. Of 900 patients with occlusive disease treated surgically, we only found 35 such cases (3.9%). However, the presence of this lesion may endanger the function and the integrity of the limb. This paper describes the clinical picture and pathology of the disease process, as well as the treatment by short venous by-pass at the ankle.

  7. A cost-effective retractor and heart stabilizer for minimal-access coronary bypass.

    Science.gov (United States)

    Rousou, J A; Engelman, R M; Flack, J E; Deaton, D W

    1998-05-01

    Exposure for internal mammary artery harvesting and immobilization of the coronary artery during the performance of minimally invasive direct coronary artery bypass grafting requires the use of appropriate retractors and instruments. We have successfully used existing retractors and instruments, modified for such use, which are reusable and cost effective. The use of such a retractor and cardiac stabilizer is described.

  8. Leptomeningeal contrast enhancement in moyamoya: its potential role in postoperative assessment of circulation through the bypass

    Energy Technology Data Exchange (ETDEWEB)

    Komiyama, M.; Nakajima, H.; Nishikawa, M.; Yasui, T. [Dept. of Neurosurgery, Osaka City General Hospital (Japan); Kitano, S.; Sakamoto, H. [Dept. of Paediatric Neurosurgery, Osaka City General Hospital (Japan)

    2001-01-01

    Leptomeningeal contrast enhancement (LMCE) is one of the MRI features of moyamoya. Its clinical significance, however, is not elucidated. Our purpose was to characterise LMCE on MRI and to evaluate its role in the assessment of circulation through a surgically established bypass in moyamoya. We studied 16 patients with idiopathic moyamoya (seven males, nine females, includingt four children, aged 7 to 54 years, mean 24 years) who underwent T1-weighted MRI before and after intravenous contrast medium. The presence of LMCE, its intensity and anatomical distribution, catheter angiographic findings, and relation of LMCE to the bypass surgery were assessed. More LMCE was seen in the cerebrum in most patients with moyamoya than in normal controls. LMCE in the brain stem and cerebellum was minimal, similar to that seen in the controls. LMCE was less prominent following surgery than before operation or in patients who did not undergo surgery. In three patients examined both before and after operation LMCE became less prominent following bypass surgery. As LMCE becomes less prominent after ''effective'' bypass surgery, this may be used for evaluation of effectiveness of surgery in moyamoya. (orig.)

  9. Hypoglykæmi efter gastric bypass er en diagnostisk og behandlingsmæssig udfordring

    DEFF Research Database (Denmark)

    Nielsen, Joan Bach; Gribsholt, Sigrid Bjerge; Pedersen, Michael Høgild;

    2014-01-01

    Treatment of severe obesity by Roux-en-Y gastric bypass (RYGB) causes sustained weight losses and improves health complica-tions. RYGB is, however, also associated with adverse effects. Dumping is a well-known complication causing invalidating symptoms, and lately there have been mounting concerns...

  10. Vasopressor Agents without Volume Expansion as a Safe Alternative to Venovenous bypass during Cavaplasty Liver Transplantation

    Institute of Scientific and Technical Information of China (English)

    WU You-min; Tanyal Oyos; Rou-Yee Chenhsu; Daniel A Katz; Johnny E Brian; Stephen C Rayhill

    2004-01-01

    @@ Background Cavaplasty orthotopic liver transplan-tation (OLT)offers advantages for hepatectomy and implantation and eliminates the risk of outflow ob-struction. However, it does require clamping of the cava. This study describes the use of a vasopressor without fluid expansion or venovenous bypass ( VB ) for hemodynamic control during the andhepatic phase.

  11. Numerical Simulation of Coronary Artery Bypass Graft with an Assistant Graft

    Institute of Scientific and Technical Information of China (English)

    WANG Wei; WANG Feng

    2014-01-01

    The conventional bypass design is to implant a graft on the stenosed host artery allowing blood to flow bypass the stenotic artery. However, restenosis is a challenging problem which finally results in reoperation. The purpose of this paper is to propose a new bypass graft design of coronary artery with an assistant graft for the treatment of coronary artery stenosis. An additional assistant graft was employed in the new design compared with the conventional ETS anastomosis. Numerical simulations were performed by means of finite volume method using computational fluid dynamics (CFD) solver. Results demonstrated that the new anastomoses model provided a more smooth flow at the distal ETS anastomosis without any stagnation point on anastomotic bed and vortex formation in the heel region. Oscillatory shear index (OSI) and time-averaged wall shear stress gradient (TAWSSG) at the artery bed of the distal ETS anastomosis were reduced. The coronary artery bypass graft with an assistant graft is feasible to improve the local hemodynamics and diminish the probability of restenosis in the treatment of coronary artery stenosis.

  12. Giant and complex aneurysms treatment with preservation of flow via bypass technique.

    Science.gov (United States)

    Thines, L; Proust, F; Marinho, P; Durand, A; van der Zwan, A; Regli, L; Lejeune, J-P

    2016-02-01

    Due to their anatomical characteristics and the complexity of the procedures required to obtain their complete occlusion, the treatment of giant intracranial aneurysms is a real challenge. Direct reconstructive strategies, whether by interventional neuroradiology (coils, stents) or microsurgical (clipping) means, are not always applicable and, in patients that would not tolerate parent or collateral artery sacrifice, the adjunction of a revascularization procedure using a bypass technique might be necessary. Cerebral arterial bypasses can be classified according to their function (3 types: flow replacement, flow reversal or protective), the branching mode of the graft used (3 types: pedicled, interpositional or in situ), the sites of anastomosis (2 types: extracranial-intracranial or intracranial-intracranial) and the class of flow they are supposed to provide (3 types: low-, intermediate- or high-flow). In this article, the authors review the different aspects in the management of patients with a giant intracranial aneurysm using a bypass: preoperative work-up, types of bypass and indications, surgical techniques and results.

  13. Awake off-pump coronary artery bypass surgery in 25 patients

    Institute of Scientific and Technical Information of China (English)

    GUO Huiming(郭惠明); Murali Chakravarthy; Vivek Jawali; K Jayaprakash; NV Shivananda

    2003-01-01

    Objectives To test the fea-sibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Results The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotony. There was no mortality. Mean length of stay in the intensive care tnit was 16.2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypassesin conscious patients without endotracheal general an esthesia.

  14. Prospective diagnosis of marginal ulceration following Roux-en-Y gastric bypass with computed tomography

    Directory of Open Access Journals (Sweden)

    Alexander J. Adduci, MD, PhD

    2015-01-01

    Full Text Available Marginal ulcers are reported to be the most common complication following Roux-en-Y gastric bypass surgery. Despite their frequency, they are rarely diagnosed prospectively with cross-sectional imaging. We present four cases in which the diagnosis of marginal ulceration was made prospectively with CT and confirmed with endoscopy.

  15. Oral bioavailability of moxifloxacin after Roux-en-Y gastric bypass surgery

    NARCIS (Netherlands)

    De Smet, Julie; Colin, Pieter; De Paepe, Peter; Ruige, Johannes; Batens, Helene; Van Nieuwenhove, Yves; Vogelaers, Dirk; Blot, Stijn; Van Bocxlaer, Jan; Van Bortel, Luc M.; Boussery, Koen

    2012-01-01

    Objectives: Roux-en-Y gastric bypass surgery is the most commonly performed procedure for the treatment of morbid obesity. This anatomical alteration may affect the absorption and consequently the bioavailability of oral drugs. This study aims to investigate the oral bioavailability of moxifloxacin

  16. Alterations of hormonally active fibroblast growth factors after Roux-en-Y gastric bypass surgery

    NARCIS (Netherlands)

    P.L.M. Jansen; J. van Werven; E. Aarts; F. Berends; I. Janssen; J. Stoker; F.G. Schaap

    2011-01-01

    Thirty-five morbidly obese patients underwent Roux-en-Y gastric bypass surgery (RYGB). In addition to weight loss, these patients showed significant improvement of insulin resistance and a reduction of hepatic fat content. Three months after surgery, the serum bile salts were slightly but significan

  17. Structure-function analysis of ribonucleotide bypass by B family DNA replicases

    Energy Technology Data Exchange (ETDEWEB)

    Clausen, Anders R.; Murray, Michael S.; Passer, Andrew R.; Pedersen, Lars C.; Kunkel, Thomas A. [NIH

    2013-11-01

    Ribonucleotides are frequently incorporated into DNA during replication, they are normally removed, and failure to remove them results in replication stress. This stress correlates with DNA polymerase (Pol) stalling during bypass of ribonucleotides in DNA templates. Here we demonstrate that stalling by yeast replicative Pols δ and ε increases as the number of consecutive template ribonucleotides increases from one to four. The homologous bacteriophage RB69 Pol also stalls during ribonucleotide bypass, with a pattern most similar to that of Pol ε. Crystal structures of an exonuclease-deficient variant of RB69 Pol corresponding to multiple steps in single ribonucleotide bypass reveal that increased stalling is associated with displacement of Tyr391 and an unpreferred C2´-endo conformation for the ribose. Even less efficient bypass of two consecutive ribonucleotides in DNA correlates with similar movements of Tyr391 and displacement of one of the ribonucleotides along with the primer-strand DNA backbone. These structure–function studies have implications for cellular signaling by ribonucleotides, and they may be relevant to replication stress in cells defective in ribonucleotide excision repair, including humans suffering from autoimmune disease associated with RNase H2 defects.

  18. Bypass surgery for unresectable oesophageal cancer: early and late results in 124 cases.

    Science.gov (United States)

    Mannell, A; Becker, P J; Nissenbaum, M

    1988-03-01

    The early and late results of bypass surgery in 124 patients with unresectable oesophageal cancer are reported. Patients were grouped according to the extent of disease: group A, tumour localized to the oesophagus where severe pulmonary disease contra-indicated oesophagectomy (n = 9); group B, tumour less than or equal to 10 cm in length with mediastinal invasion (n = 81); group C, tumour greater than 10 cm in length with mediastinal invasion and/or fixed malignant lymph nodes (n = 33). Extent of disease was not recorded in one patient. The operative mortality was 4 per cent but 9 other patients died in hospital (hospital mortality, 11 per cent). Mortality was increased in patients undergoing colon bypass and in those with a large tumour load but these differences failed to reach statistical significance. The most frequent complication was neck sepsis, secondary to leakage from the proximal end of the excluded oesophagus. Eighty-nine per cent of the survivors could eat a normal, unrestricted diet on discharge and eighty-two per cent of survivors had complete and lasting relief from dysphagia. Median survival after bypass was 5 months but survival was significantly improved by radiotherapy to the tumour (P less than 0.001). Gastric bypass with radiotherapy is indicated in patients with extra-oesophageal spread of malignancy and in patients with tumours localized to the oesophagus who are unfit for resection. Bypass surgery may be contra-indicated in patients with a primary tumour greater than 10 cm in length and/or fixed lymph node metastases because mortality is increased and survival after operation is short.

  19. Pressure and oxygen debt on bypass - potential quality markers of perfusion?

    Science.gov (United States)

    Poullis, Mike; Palmer, K; Al-Rawi, O; Johnson, I; Ridgeway, T

    2012-05-01

    No markers of quality of perfusion pressure and oxygen delivery during cardiopulmonary bypass (CPB), to complement rewarming rate, maximum temperature on rewarming, lowest haematocrit, and blood glucose, exist. Using the electronic acquisition of blood pressure on bypass (JOCAP system), the percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, median, mode, standard deviation, variance, and average, maximum and cumulative oxygen debt were calculated. Numerous different readouts of achievement of maintenance of constant pressure on bypass and oxygen debt are now easily achievable with perfusion electronic data management systems. Mean, median, and mode offer poor discrimination of pressure control during CPB. Percentage of time perfusion pressure was below 30, 40, 50, 60 and 70 mmHg, average deviance, confidence interval, and standard deviation all have discriminatory power, but need clinical correlation for their significance. A composite score involving non-pressure readouts (e.g. oxygen delivery, arterial and venous saturations, and flow rates) may need to be integrated into any perfusion quality marker. Assessment of adequacy of constant perfusion pressure and oxygen delivery may allow the scientific evaluation of pressure and oxygen delivery on bypass for patients to be compared accurately. Currently, in studies involving CPB, blood pressure targets are stated with no quantitative assessment of adequacy of achievement of these targets. Electronic data monitoring during cardiopulmonary bypass, when correlated with clinical outcome, may help to provide a marker of quality of perfusion pressure during CPB and may, indeed, allow patient-specific perfusion pressure strategies to be developed.

  20. Effects of massage therapy on sleep quality after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Flavia Baggio Nerbass

    2010-01-01

    Full Text Available INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0, during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3 using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m² were randomized into control (n = 20 and massage therapy (n = 20 groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006 and Day 2 (p=0.028 in addition, they reported a more effective sleep during all three days (p=0.019 when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

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

    Science.gov (United States)

    PALERMO, Mariano; SERRA, Edgardo

    2016-01-01

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

  2. Does Off-Pump Coronary Artery Bypass Grafting Negatively Impact Long-Term Survival and Freedom from Reintervention?

    Directory of Open Access Journals (Sweden)

    Shahzad G. Raja

    2013-01-01

    Full Text Available Recently published evidence has raised concerns about worse late mortality and increasing need for reintervention after off-pump coronary artery bypass grafting. We undertook this study to assess the impact of off-pump coronary artery bypass grafting on survival and freedom from reintervention at 10 years. From January 2002 to December 2002, 307 consecutive patients who had isolated multivessel off-pump coronary artery bypass grafting at our institution were compared to a control group of 397 patients that underwent multivessel on-pump coronary artery bypass grafting during the same period. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. Kaplan-Meier survival was similar for the two cohorts. After adjusting for clinical covariates, off-pump coronary artery bypass grafting did not emerge as a significant independent predictor of long-term mortality (Hazard Ratio 0.91; 95% Confidence Interval 0.70–1.12, readmission to hospital for cardiac cause (Hazard Ratio 0.96; 95% Confidence Interval 0.78–1.10, or the need for reintervention (Hazard Ratio 0.93; 95% Confidence Interval 0.87–1.05. Off-pump coronary artery bypass grafting compared with on-pump coronary artery bypass grafting does not adversely impact survival or freedom from reintervention at a 10-year follow-up.

  3. Evaluation of the influence of bypass flow gap distribution on the core hot spot in a prismatic VHTR core

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min-Hwan, E-mail: mhkim@kaeri.re.kr [Korea Atomic Energy Research Institute, 1045 Daedeokdaero, Yoseong, Daejeon 304-353 (Korea, Republic of); Lim, Hong-Sik [Korea Atomic Energy Research Institute, 1045 Daedeokdaero, Yoseong, Daejeon 304-353 (Korea, Republic of)

    2011-08-15

    Highlights: > A procedure to evaluate the local gap size variation between graphite blocks was developed and applied to a prismatic core VHTR. > The analysis for the core bypass flow and hot spot was carried out based on the calculated gap distributions. > The predicted gap size is large enough to affect the flow distribution in the core. > The bypass gap and flow distributions are closely related to the local hot spot temperature and its location. > The core restraint mechanism preventing outward movement of graphite block reduces the bypass gap size and hot spot temperature. - Abstract: Core bypass flow in VHTR is one of the key issues for core thermal margins and efficiency. The bypass flow in the prismatic core varies during core cycles due to the irradiation shrinkage/swelling and thermal expansion of the graphite blocks. A procedure to evaluate the local gap size variation between graphite blocks was developed and applied to a prismatic core VHTR. The influence of the core restraint mechanism on the bypass flow gap was evaluated. The predicted gap size is as much as 8 mm when the graphite block is exposed to its allowable limit of fast neutron fluence. The analysis for the core bypass flow and hot spot was carried out based on the calculated gap distributions. The results indicate that the bypass gap and flow distributions are closely related to the local hot spot and its location and the core restraint mechanism preventing outward movement of the graphite block by a fastening device reduces the bypass gap size, which results in the decrease of maximum fuel temperature not less than 100 deg. C, when compared to the case without it.

  4. The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.

    Science.gov (United States)

    Harris, P L; Woollard, K; Bartoli, A; Makey, A R

    1980-01-01

    Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed.

  5. Investigation of the excluded stomach after Roux-en-Y gastric bypass: The role of percutaneous endoscopy

    Institute of Scientific and Technical Information of China (English)

    Kanwar RS Gill; J Mark McKinney; Mark E Stark; Ernest P Bouras

    2008-01-01

    Accessing the bypassed portion of the stomach via conventional endoscopy is difficult following Roux-en-Y gastric bypass surgery. However, endoscopic examination of the stomach and small bowel is possible through percutaneous access into the bypassed stomach (BS) with a combined radiologic and endoscopic technique. We present a case of obscure overt gastrointestinal (GI) bleeding where the source of bleeding was thought to be from the BS. After conventional endoscopic methods failed to examine the BS, percutaneous endoscopy (PE) was used as an alternative to surgical exploration.

  6. Simple hyperaemia test as a screening method in the postoperative surveillance of infrainguinal in situ vein bypasses

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Sillesen, H; Schroeder, T V

    1995-01-01

    . The optimal value of the waveform parameters for discrimination between bypasses with and without evidence of stenoses was determined by receiver operating characteristics (ROC) analysis. MAIN RESULTS: Complete Duplex scanning of the entire graft revealed an increase in the peak systolic velocity by a factor...... follow-up. CONCLUSIONS: Single point waveform analysis of vein bypass velocity profile at rest and during reactive hyperaemia is a simple screening method providing diagnostic and prognostic information which may be of value in the postoperative surveillance of infrainguinal vein bypasses....

  7. Perioperative pentoxifylline therapy attenuates early postoperative neuro-cognitive decline in patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Sambhunath Das

    2015-01-01

    Full Text Available Background: Postoperative cognitive decline (POCD after coronary artery bypass grafting (CABG is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07, digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09 and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008, digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008 and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02. The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.

  8. ¿Cambio de paradigma desde el bypass gástrico Roux-en-Y al (mini) bypass gástrico debido a problemas de glucosa?

    OpenAIRE

    Himpens, Jaques

    2014-01-01

    El bypass gástrico Roux-en-Y funciona de la siguiente manera sobre la diabetes mellitus tipo 2: En obesos mórbidos la diabetes tipo2 inicia con la presencia de resistencia a la insulina con un incremento del péptido C, o sea incremento de las necesidades de insulina que los no obesos tienen para mantener el estado euglucemico. Cuando la secreción de insulina es insuficiente, se desarrolla la diabetes. Esta secreción de insulina está modulada por las incretinas y posiblemente por anti-incretin...

  9. Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience.

    Science.gov (United States)

    Craver, J M; Weintraub, W S; Jones, E L; Guyton, R A; Hatcher, C R

    1992-01-01

    Six hundred ninety-nine patients have required emergency coronary artery bypass after failed elective percutaneous coronary angioplasty during the decade September 1980 through December 1990. This represents 4% of 9860 patients having 12,146 elective percutaneous coronary angioplasty procedures during this interval. Emergency coronary artery bypass was required for acute refractory myocardial ischemia in 82%. Hospital mortality rate for all patients was 3.1%; 3.7% in patients with refractory myocardial ischemia but 0.8% in patients without refractory myocardial ischemia, p = 0.08. Postprocedural Q-wave myocardial infarctions were observed in 21% versus 2.4%, p less than 0.0001, and intra-aortic balloon pumping was required in 19% with versus 0.8% without refractory myocardial ischemia, p less than 0.0001. Multivessel disease, p = 0.004, age older than 65 years, p = 0.005, and refractory myocardial ischemia, p = 0.08, interacted to produce the highest risk of in-hospital death. Follow-up shows that there have been 28 additional late deaths, including 23 of cardiac causes for a 91% survival at 5 years. Freedom from both late death and Q-wave myocardial infarction at 5 years was 61%. In the group going to emergency coronary artery bypass with refractory myocardial ischemia, the late cardiac survival was 90%, and in those without ischemia, 92% at 5 years, p = not significant. The MI--free survival in the group with refractory ischemia, however, was 56% versus 83% in the group without ischemia, p less than 0.0001. Multivariate analysis showed the highest late event rates for patients with Q-wave myocardial infarction at the initial emergency coronary artery bypass, age older than 65 years, angina class III or IV, and prior coronary bypass surgery. In spite of a continuing high incidence of early acute myocardial infarction and an increasing operative mortality rate (7%) in the latest 3 years cohort of patients, excellent late survival and low subsequent cardiac event

  10. Bypass during Liver Transplantation: Anachronism or Revival? Liver Transplantation Using a Combined Venovenous/Portal Venous Bypass-Experiences with 163 Liver Transplants in a Newly Established Liver Transplantation Program.

    Science.gov (United States)

    Mossdorf, Anne; Ulmer, Florian; Junge, Karsten; Heidenhain, Christoph; Hein, Marc; Temizel, Ilknur; Neumann, Ulf Peter; Schöning, Wenzel; Schmeding, Maximilian

    2015-01-01

    Introduction. The venovenous/portal venous (VVP) bypass technique has generally become obsolete in liver transplantation (LT) today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion) can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass.

  11. To ventilate or not after minimally invasive direct coronary artery bypass surgery : The role of epidural anesthesia

    NARCIS (Netherlands)

    de Vries, AJ; Mariani, MA; van der Maaten, JMAA; Loef, BG; Lip, H

    2002-01-01

    Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single inst

  12. Filtration of activated granulocytes during cardiopulmonary bypass surgery : A morphologic and immunologic study to characterize the trapped leukocytes

    NARCIS (Netherlands)

    Smit, JJJ; de Vries, AJ; Gu, YJ; van Oeveren, W

    2000-01-01

    Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction, This

  13. David M. Hume memorial lecture. In situ vein bypass in the treatment of femoropopliteal atherosclerotic disease: a ten year study.

    Science.gov (United States)

    Hall, K V; Rostad, H

    1978-08-01

    The in situ vein bypass technic for femoropopliteal atherosclerotic disease is described. Several factors influence the long-term results, the most important being a history of myocardial disease, the size of the vein graft, and sufficient runoff.

  14. Imaging findings of myocardial revascularization at multidetector computed tomography: where are the bypass grafts?: an iconographic essay

    Energy Technology Data Exchange (ETDEWEB)

    Ripari, Marcelo Targa; Santaniello, Rogerio; Sasdelli Neto, Roberto; Nomura, Cesar Higa; Chate, Rodrigo Caruso; Passos, Rodrigo Bastos Duarte; Kay, Fernando Uliana; Funari, Marcelo Buarque de Gusmao [Hospital Albert Einstein, Sao Paulo, SP (Brazil). Dept. of Imaging], e-mail: mtripari@uol.com

    2009-09-15

    Multidetector coronary computed tomography angiography is a precise method for evaluating post-coronary revascularization arterial and venous bypass grafts, and is somehow superseding coronary catheterization that is an invasive and more expensive technique. The present iconographic essay is aimed at anatomically demonstrating the bypass grafts most frequently utilized, how to differentiate between arterial and venous grafts and how to find them. The studies were performed in 64-row multidetector computed tomography equipment, with breath hold, controlled heart rate and appropriate protocols with later MPR, MIP and 3D reconstructions according to electrocardiogram. The localization of the bypass grafts and anastomoses at computed tomography studies focused on chest and coronary arteries may represent a difficulty in the images analysis by the radiologist who is not familiar with the matter, so the knowledge of the surgical techniques adopted and possible courses of the saphenous bypass grafts and arterial grafts can aid in the analysis of both studies, avoiding diagnostic errors. (author)

  15. Coronary bypass surgery in patients aged 70 years and over: Mortality, morbidity, & length of stay. Dar al-fouad experience

    Directory of Open Access Journals (Sweden)

    Ahmed Ghali

    2014-03-01

    This study supports the continued performance of coronary artery bypass grafting in patients 70 years. Advanced age alone should not deter a cardiac surgeon from offering such a potentially beneficial intervention.

  16. Night blindness due to vitamin A deficiency associated with copper deficiency myelopathy secondary to bowel bypass surgery.

    Science.gov (United States)

    AlHassany, Ali Abdul Jabbar

    2014-04-29

    We present an interesting case of combined vitamin A and copper deficiency after a history of gastric bypass surgery where symptoms improved after parenteral copper and vitamin A treatment. Gastric bypass surgery as a cause of fat soluble vitamin deficiency is generally under-reported. Copper deficiency has been reported after gastric bypass surgery. Vitamin A deficiency after gastric bypass surgery has also been reported in the literature, but the reported cases again fall below the actual figures. B12 and folate deficiencies can produce a type of myelopathy similar to that produced by copper deficiency, and differentiation on the basis of laboratory tests, neurophysiology and improvement of symptoms after replacement therapy might be the hallmark of diagnosis. Combinations of vitamin deficiencies were previously reported, but no cases of combined vitamin A and copper deficiency could be found in the literature.

  17. Jejunoileal bypass as the main procedure in the onset of immune-related conditions: the model of BADAS.

    Science.gov (United States)

    Carubbi, Francesco; Ruscitti, Piero; Pantano, Ilenia; Alvaro, Saverio; Benedetto, Paola Di; Liakouli, Vasiliki; Giuliani, Antonio; Piccione, Federica; Ciccia, Francesco; Amicucci, Gianfranco; Triolo, Giovanni; Giacomelli, Roberto; Cipriani, Paola

    2013-05-01

    Bariatric surgery represents a common approach for the control of severe morbid obesity, reducing caloric intake by modifying the anatomy of the gastrointestinal tract. Following jejunoileal bypass, a large spectrum of complications has been described, with rheumatic manifestation present in up to 20% of cases. Although bowel bypass syndrome, also called blind loop syndrome, is a well-recognized complication of jejunoileal bypass, the same syndrome was recognized in patients who had not had intestinal bypass surgery, and the term the 'bowel-associated dermatosis-arthritis syndrome' (BADAS) was coined. The pathogenesis of BADAS is as yet poorly understood and only few data concerning this issue have been published in the literature. The aim of the present paper is to review the literature and to discuss putative pathogenic mechanisms of BADAS, focusing on the immune system.

  18. Management of Super-super Obese Patients: Comparison Between Mini (One Anastomosis) Gastric Bypass and Sleeve Gastrectomy.

    Science.gov (United States)

    Madhok, Brijesh; Mahawar, Kamal K; Boyle, Maureen; Carr, William R J; Jennings, Neil; Schroeder, Norbert; Balupuri, Shlok; Small, Peter K

    2016-07-01

    Management of super-super obese patients poses a particular challenge for bariatric surgeons. Many staged algorithms exist for these patients. Essentially all of these involve a lower-risk procedure like sleeve gastrectomy first before a definitive second-stage procedure like gastric bypass or duodenal switch. This study compares our results with 19 mini (one anastomosis) gastric bypass and 56 sleeve gastrectomy in super-super obese patients. Sleeve gastrectomy patients were significantly older. There was no mortality or major complication in either group. There was no minor complication in mini (one anastomosis) gastric bypass group compared to two in the sleeve gastrectomy group. Mini (one anastomsosis) gastric bypass patients experienced significantly higher weight loss compared to sleeve gastrectomy patients at 6 months, 1 year, and 2 years after surgery.

  19. Measurement of Blood Flow in an Intracranial Artery Bypass From the Internal Maxillary Artery by Intraoperative Duplex Sonography.

    Science.gov (United States)

    Yu, Zaitao; Shi, Xiang'en; Brohi, Shams Raza; Qian, Hai; Liu, Fangjun; Yang, Yang

    2017-02-01

    This study explored the hemodynamic characteristics of a subcranial-intracranial bypass from the internal maxillary artery by measuring blood flow on intraoperative duplex sonography. The hemodynamic parameters of the internal maxillary artery (n = 20), radial artery (n = 20), internal maxillary artery-middle cerebral artery bypass (n = 42), and internal maxillary artery-posterior cerebral artery bypass (n = 9) were measured by intraoperative duplex sonography. There was no significant difference in the internal diameters of the internal maxillary and radial arteries (mean ± SD, 2.51 ± 0.34 versus 2.56 ± 0.22 mm; P = .648). The mean radial artery graft length for subcranial-intracranial bypasses was 88.5 ± 12.78 mm (95% confidence interval [CI], 80.8-90.2 mm). Internal maxillary artery-middle cerebral artery bypasses required a shorter radial artery graft than internal maxillary artery-posterior cerebral artery bypasses (77.8 ± 2.47 versus 104.8 ± 4.77 mm; P = .001). The mean flow volumes were 85.3 ± 18.5 mL/min (95% CI, 76.6-93.9 mL/min) for the internal maxillary artery, 72.6 ± 26.4 mL/min (95% CI, 64.3-80.9 mL/min) for internal maxillary artery-middle cerebral artery bypasses, and 45.4 ± 6.7 mL/min (95% CI, 40.7-50.0 mL/min) for internal maxillary artery-posterior cerebral artery bypasses. All grafts were opened after the success of the salvage procedures had been established, and the early patency rates (1 month after the operation) were 95% for internal maxillary artery-middle cerebral artery bypasses and 100% the internal maxillary artery-posterior cerebral artery bypasses. Measurement of blood flow by intraoperative sonography can be helpful in decision making and predicting graft patency and success after neurosurgical bypass procedures.

  20. Optimal design and installation of ultra high bypass ratio turbofan nacelle

    Science.gov (United States)

    Savelyev, Andrey; Zlenko, Nikolay; Matyash, Evgeniy; Mikhaylov, Sergey; Shenkin, Andrey

    2016-10-01

    The paper is devoted to the problem of designing and optimizing the nacelle of turbojet bypass engine with high bypass ratio and high thrust. An optimization algorithm EGO based on development of surrogate models and the method for maximizing the probability of improving the objective function has been used. The designing methodology has been based on the numerical solution of the Reynolds equations system. Spalart-Allmaras turbulence model has been chosen for RANS closure. The effective thrust losses has been uses as an objective function in optimizing the engine nacelle. As a result of optimization, effective thrust has been increased by 1.5 %. The Blended wing body aircraft configuration has been studied as a possible application. Two variants of the engine layout arrangement have been considered. It has been shown that the power plant changes the pressure distribution on the aircraft surface. It results in essential diminishing the configuration lift-drag ratio.

  1. Methylmercury cycling, bioaccumulation, and export from agricultural and non-agricultural wetlands in the Yolo Bypass

    Science.gov (United States)

    Windham-Myers, Lisamarie; Marvin-DiPasquale, Mark; Fleck, Jacob; Alpers, Charles N.; Ackerman, Josh; Eagles-Smith, Collin; Stricker, Craig; Stephenson, Mark; Feliz, David; Gill, Gary; Bachand, Philip; Brice, Ann; Kulakow, Robin

    2010-01-01

    This 18-month field study addresses the seasonal and spatial patterns and processes controlling methylmercury (MeHg) production, bioaccumulation, and export from natural and agricultural wetlands of the Yolo Bypass Wildlife Area (YBWA). The data were collected in conjuntion with a Proposition 40 grant from the State Water Resources Control Board in support of the development of Best Management Practices (BMP's) for reducing MeHg loading from agricultural lands in the wetland-dominated Yolo Bypass to the Sacramento-San Joaquin River Delta. The four managemenr-based questions addressed in this study were: 1. Is there a different among agricultural and managfed wetland types in terms of Me Hg dynamic (production, degradation, bioaccumulation, or export)?

  2. Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Nygård, Eigil; Sørensen, Lars H; Hviid, Lamia B;

    2004-01-01

    OBJECTIVE: This study was designed to assess the effects of a perioperative dosing regimen of amiodarone administration, high thoracic epidural anesthesia (TEA), or a combination of the 2 regimens on atrial fibrillation (AF) after coronary artery bypass grafting (CABG). DESIGN AND SETTING......: The study was prospective, controlled, and randomized and was performed in a tertiary health care center associated with a university. PARTICIPANTS: One hundred sixty-three patients scheduled for coronary artery bypass graft surgery. INTERVENTIONS: In this 2 x 2 factorial-designed study the patients were...... randomized to 1 of 4 regimens in which group E had perioperative TEA, group E+A had TEA and amiodarone, group A had amiodarone, and group C served as control. The epidural catheter was inserted at T1-3 the day before surgery. TEA groups received TEA for 96 hours. The amiodarone regimen consisted of a single...

  3. Overexpression of isocitrate lyase-glyoxylate bypass influence on metabolism in Aspergillus niger

    DEFF Research Database (Denmark)

    Meijer, Susan Lisette; Otero, José Manuel; Olivares Hernandez, Roberto

    2009-01-01

    glyoxylate would increase, leading to excess formation of malate and succinate compared to the wild-type. However, metabolic network analysis showed that an increased icl expression did not result in an increased glyoxylate bypass flux. The analysis did show a global response with respect to gene expression......In order to improve the production of succinate and malate by the filamentous fungus Aspergillus niger the activity of the glyoxylate bypass pathway was increased by over-expression of the isocitrate lyase (icl) gene. The hypothesis was that when isocitrate lyase was up-regulated the flux towards......, leading to an increased flux through the oxidative part of the TCA cycle. Instead of an increased production of succinate and malate, a major increase in fumarate production was observed. The effect of malonate, a competitive inhibitor of succinate dehydrogenase (SDH), on the physiological behaviour...

  4. Combinatorial optimization of order picking and export choosing for bypass type automatic stereoscopic warehouse

    Directory of Open Access Journals (Sweden)

    Jinye WANG

    Full Text Available The automatic stereo warehouse system is a storage system with multi-storey warehouse, by which the automation access and integrated automation management are realized in the computer's direct control and management. The emerging, bypass automatic stereo warehouse has gained more and more application in rapid access. The stacker's working time directly affects the efficiency of the warehouse. To improve the bypass automatic warehouse efficiency and analyze the stacker route, an integrated optimization model considering the export selection and the path picking is established. The model aims to the picking task cycle and develops the population's generating method of genetic algorithm, then solves the optimization model. The last section in this stage is the initial point of the next optimization stage, using the nearest neighbor method to find the optimal export location. Simulation and practical application show that the model and the algorithm are feasible and effective.

  5. Continuous crossover femoropopliteal bypass in a 68-year-old gentleman with rest pain.

    LENUS (Irish Health Repository)

    Smith, F M

    2012-02-03

    Patients who have had multiple previous attempts at limb salvaging surgery frequently go on to have an amputation. This, however, results both in psychological perturbation for the patient and high rehabilitation costs for the community. Successful limb salvage surgery therefore has an important role in vascular surgery. We describe the management of a patient with critical limb ischemia that had previously undergone multiple limb salvage procedures and whose limb was saved by the use of a continuous femoropopliteal crossover bypass graft. The patient, who may have been deemed by some as a candidate for amputation, has full use of his limb 6 months after surgery with ankle brachial pressure index readings of 0.6. Continuous femoropopliteal crossover bypass grafting is a poorly described surgical technique that may be appropriate in a subgroup of patients and may allow salvage of a limb that otherwise may have been deemed fit for amputation.

  6. The Effect of Magnetohydrodynamic (MHD) Energy Bypass on Specific Thrust for a Supersonic Turbojet Engine

    Science.gov (United States)

    Benyo, Theresa L.

    2010-01-01

    This paper describes the preliminary results of a thermodynamic cycle analysis of a supersonic turbojet engine with a magnetohydrodynamic (MHD) energy bypass system that explores a wide range of MHD enthalpy extraction parameters. Through the analysis described here, it is shown that applying a magnetic field to a flow path in the Mach 2.0 to 3.5 range can increase the specific thrust of the turbojet engine up to as much as 420 N/(kg/s) provided that the magnitude of the magnetic field is in the range of 1 to 5 Tesla. The MHD energy bypass can also increase the operating Mach number range for a supersonic turbojet engine into the hypersonic flight regime. In this case, the Mach number range is shown to be extended to Mach 7.0.

  7. Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

    Science.gov (United States)

    Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

    2014-01-01

    Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

  8. Zinc Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review.

    Science.gov (United States)

    Mahawar, Kamal K; Bhasker, Aparna Govil; Bindal, Vivek; Graham, Yitka; Dudeja, Usha; Lakdawala, Muffazal; Small, Peter K

    2017-02-01

    Up to 50% of patients have zinc deficiency before bariatric surgery. Roux-en-Y gastric bypass (RYGB) is the commonest bariatric procedure worldwide. It can further exacerbate zinc deficiency by reducing intake as well as absorption. The British Obesity and Metabolic Surgery Society, therefore, recommends that zinc level should be monitored routinely following gastric bypass. However, the American guidance does not recommend such monitoring for all RYGB patients and reserves it for patients with 'specific findings'. This review concludes that clinically relevant Zn deficiency is rare after RYGB. Routine monitoring of zinc levels is hence unnecessary for asymptomatic patients after RYGB and should be reserved for patients with skin lesions, hair loss, pica, dysgeusia, hypogonadism or erectile dysfunction in male patients, and unexplained iron deficiency anaemia.

  9. Intravenous zinc therapy for acquired zinc deficiency secondary to gastric bypass surgery: a case report.

    Science.gov (United States)

    Vick, Garrett; Mahmoudizad, Rod; Fiala, Katherine

    2015-01-01

    Zinc deficiency may result from either a congenitally inherited defect of zinc absorption or is acquired secondarily from a variety of factors affecting dietary zinc intake, absorption, or loss. We report a case of acquired zinc deficiency secondary to gastric bypass surgery that resulted in vulvar cutaneous manifestations of delayed onset, with failure to clear after oral supplementation with zinc. The patient experienced improvement of symptoms only after administration of intravenous zinc supplementation. Upon review of the current literature, it is thought that the patient's original suboptimal response to oral supplementation and improvement after receiving intravenous zinc were related to the intentional surgical alteration and bypass of the absorptive capacity of the duodenum and jejunum. With the current prevalence of obesity and availability of surgical weight loss therapies, it is important to be mindful of the resulting nutritional deficiencies, their clinical manifestations, and factors affecting the efficacy of therapeutic approaches as seen in this case.

  10. Endoscopic treatment of the fistulas after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass

    Directory of Open Access Journals (Sweden)

    Luís Gustavo Santos Périssé

    2015-06-01

    Full Text Available OBJECTIVE: to evaluate the use of endoscopic self-expandable metallic prostheses in the treatment of fistulas from sleeve gastrectomy and Roux en y gastric bypass.METHODS: all patients were treated with fully coated auto-expandable metallic prostheses and were submitted to laparoscopic or CT-guided drainage, except for those with intracavitary drains. After 6-8 weeks the prosthesis was removed and if the fistula was still open a new prostheses were positioned and kept for the same period.RESULTS: the endoscopic treatment was successful in 25 (86.21% patients. The main complication was the migration of the prosthesis in seven patients. Other complications included prosthesis intolerance, gastrointestinal bleeding and adhesions. The treatment failed in four patients (13.7% one of which died (3.4%.CONCLUSION: endoscopic treatment with fully coated self-expandable prosthesis was effective in treating most patients with fistula after sleeve gastrectomy and roux en y gastric bypass.

  11. Bypass Diode Temperature Tests of a Solar Array Coupon Under Space Thermal Environment Conditions

    Science.gov (United States)

    Wright, Kenneth H., Jr.; Schneider, Todd A.; Vaughn, Jason A.; Hoang, Bao; Wong, Frankie; Wu, Gordon

    2016-01-01

    Tests were performed on a 56-cell Advanced Triple Junction solar array coupon whose purpose was to determine margin available for bypass diodes integrated with new, large multi-junction solar cells that are manufactured from a 4-inch wafer. The tests were performed under high vacuum with coupon back side thermal conditions of both cold and ambient. The bypass diodes were subjected to a sequence of increasing discrete current steps from 0 Amp to 2.0 Amp in steps of 0.25 Amp. At each current step, a temperature measurement was obtained via remote viewing by an infrared camera. This paper discusses the experimental methodology, experiment results, and the thermal model.

  12. Environmental Assessment and Finding of No Significant Impact - Mckay Bypass Canal Extension

    Energy Technology Data Exchange (ETDEWEB)

    N/A

    1998-09-01

    The Department of Energy (DOE) has prepared an environmental assessment (EA) (DOE/EA-1262) to extend the McKay Bypass Canal on the east side of the Rocky Flats Environmental Technology Site (Site), located north of Golden, Colorado. The McKay Bypass Canal Extension (Extension) is needed to route water from the existing canal around the Walnut Creek drainage, thus preventing potential co-mingling of Broomfield city water (collected from the Coal Creek drainage) with Site runoff water. The EA describes and analyzes the environmental effects of the Proposed Action (using a buried pipeline for the extension), and the alternatives of taking no action, using an open ditch for the extension, and using an aboveground pipeline for the extension. The EA was the subject of a public comment period from July 22 to August 6, 1998. Written comments regarding the EA were received from the City of Broomfield and the Colorado Department of Public Health and Environment.

  13. The role of oral vitamin K antagonists in the outcome of infrainguinal bypass procedures.

    Science.gov (United States)

    Giannoukas, Athanasios D; Paraskevas, Kosmas I; Koutsias, Stylianos; Argyriou, Christos; Saleptsis, Vasilios; Palombo, Domenico

    2014-08-01

    We investigated the role of oral vitamin K antagonists (VKAs) in graft patency, limb salvage, major and minor bleeding rates in patients undergoing infrainguinal bypass surgery. Five randomized-controlled trials (RCTs; n = 3746 patients) comparing VKA versus non-VKA treatment outcomes in patients undergoing infrainguinal bypass surgery were analyzed. The VKA treatment was associated with improved graft patency rates when a vein graft was used (risk ratio [RR]: 0.74; P = .0004), while there was no difference with prosthetic grafts (RR: 1.07; P = .39). The VKA treatment was also associated with improved limb salvage rates (RR: 0.33; P = .0008). Major and minor bleeding complications were higher in the VKA group. In conclusion, VKA treatment is associated with improved graft patency and limb salvage rates when a vein graft is used at the price of an increased risk of bleeding. Due to the inconsistent results, further well-designed RCTs are needed.

  14. Severe Hypocalcemia due to Vitamin D Deficiency after Extended Roux-en-Y Gastric Bypass.

    Science.gov (United States)

    Miñambres, I; Chico, A; Pérez, A

    2011-01-01

    Vitamin D deficiency is a well-known comorbidity of obesity that can be exacerbated after bariatric surgery and can predispose the patient for hypocalcemia. Vitamin D and calcium doses to prevent and treat vitamin D deficiency after weight loss surgery are not well defined. We describe a patient who developed severe hypocalcemia due to vitamin D deficiency 5 years after an extended Roux-en-Y gastric bypass for a type II obesity. No precipitating factors were present and malabsorption induced by the bypass was considered to be the main causative factor. High doses of vitamin D and calcium were needed to reach and maintain normal calcium and vitamin D concentrations. This case emphasises the importance of routine screening for vitamin D deficiency in obese individuals and reflects that while consensus does not exist regarding optimal dosage, vitamin D replacement should be tittered based on calcidiol levels.

  15. Severe Hypocalcemia due to Vitamin D Deficiency after Extended Roux-en-Y Gastric Bypass

    Directory of Open Access Journals (Sweden)

    I. Miñambres

    2011-01-01

    Full Text Available Vitamin D deficiency is a well-known comorbidity of obesity that can be exacerbated after bariatric surgery and can predispose the patient for hypocalcemia. Vitamin D and calcium doses to prevent and treat vitamin D deficiency after weight loss surgery are not well defined. We describe a patient who developed severe hypocalcemia due to vitamin D deficiency 5 years after an extended Roux-en-Y gastric bypass for a type II obesity. No precipitating factors were present and malabsorption induced by the bypass was considered to be the main causative factor. High doses of vitamin D and calcium were needed to reach and maintain normal calcium and vitamin D concentrations. This case emphasises the importance of routine screening for vitamin D deficiency in obese individuals and reflects that while consensus does not exist regarding optimal dosage, vitamin D replacement should be tittered based on calcidiol levels.

  16. By-pass Devices as Effective Means of Protection from the Hydraulic Hammer

    Directory of Open Access Journals (Sweden)

    Khalid S. Al-Rababa

    2005-01-01

    Full Text Available Switching-off the parallel working pump units causes sudden discharge changes in parallel pipe lines, as a result of that hydraulic shocks takes place. The damping of these shocks can be achieved by the installation of the by-pass devices between the parallel lines of the piping system. The analytical calculations demonstrate that the reduction in hydraulic shocks reaches 40% and considerable part of the electric power (from 5 up to 21% is economized by using the by-pass devices, the duration of pressure decline decreases by more than 1,5 times. Comparison of the calculations based on the developed algorithm with the results of practical studies at the pumping station (Syrdarya has shown good convergence of analytical and experimental outcomes.

  17. Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Hesse, B; Eiberg, J;

    1997-01-01

    of flow in the graft. Platelet deposition was assessed by gamma-camera images of thigh and crus obtained 4 and/or 24 h after surgery. Areas of focally increased activity were recorded and graded as moderate or intense. In the 24 vein bypasses, a median of two (range 0-5) areas of focally increased....... In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration...... radioactivity were seen at the proximal anastomosis (n = 21), in the body of the graft (n = 20) or at the distal anastomosis (n = 9). The activity was moderate in 27 cases and intense in 23 cases. Scintigraphic evidence of focal platelet aggregation in vein grafts was not correlated with preoperative...

  18. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT

    DEFF Research Database (Denmark)

    Frederiksen, Katrine Diemer; Hanson, Stine; Hansen, Stinus;

    2016-01-01

    Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral densit...... increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.......Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density...

  19. Introduction of a synthetic CO₂-fixing photorespiratory bypass into a cyanobacterium.

    Science.gov (United States)

    Shih, Patrick M; Zarzycki, Jan; Niyogi, Krishna K; Kerfeld, Cheryl A

    2014-04-01

    Global photosynthetic productivity is limited by the enzymatic assimilation of CO2 into organic carbon compounds. Ribulose-1,5-bisphosphate carboxylase/oxygenase (RuBisCO), the carboxylating enzyme of the Calvin-Benson cycle, poorly discriminates between CO2 and O2, leading to photorespiration and the loss of fixed carbon and nitrogen. With the advent of synthetic biology, it is now feasible to design, synthesize, and introduce biochemical pathways in vivo. We engineered a synthetic photorespiratory bypass based on the 3-hydroxypropionate bi-cycle into the model cyanobacterium, Synechococcus elongatus sp. PCC 7942. The heterologously expressed cycle is designed to function as both a photorespiratory bypass and an additional CO2-fixing pathway, supplementing the Calvin-Benson cycle. We demonstrate the function of all six introduced enzymes and identify bottlenecks to be targeted in subsequent bioengineering. These results have implications for efforts to improve photosynthesis and for the "green" production of high value products of biotechnological interest.

  20. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Thorsteinsson, Kristinn; Andreasen, Jan Jesper; Torp-Pedersen, Christian

    2015-01-01

    . Methods: All patients who underwent isolated CABG in 1996-2012 in Denmark were identified through nationwide administrative registers and included. The cumulative incidence of admission to a nursing home after CABG was estimated. A cause specific Cox-regression model was constructed to identify predictors......O5 Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: A nationwide cohort study Kristinn Thorsteinsson, Jan Jesper Andreasen, Christian Torp Pedersen, Kirsten Fonager, Rikke Nørmark Mortensen, Kristian Kragholm, Gunnar Gislason, Lars Køber....... Aalborg, Denmark Background: Data on nursing home admission in patients >80 years of age after isolated coronary artery bypass grafting (CABG) are scarce. Aim: The purpose of this study was to evaluate longevity and subsequent admission to nursing home stratified by age in a nationwide CABG cohort...