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Sample records for duct segmental resection

  1. Transurethral resection of the ejaculatory duct.

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    Paick, J S

    2000-05-01

    Complete bilateral ejaculatory duct obstruction has long been recognized as an uncommon, treatable form of male infertility. Partial ejaculatory duct obstruction reflects a disturbance of ejaculation where sperm quality is impaired during transit through the distal vas deferens and ejaculatory ducts. With the advent and increased use of high-resolution transrectal ultrasonography, abnormalities of the distal ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. In an infertile man with oligospermia or azoospermia with low ejaculate volume, normal secondary sexual characteristics, testes and hormonal profile and dilated seminal vesicles, midline cyst, or calcification on transrectal ultrasonography, ejaculatory duct obstruction is suggested. Of course, other causes of infertility may be concomitantly present and need to be searched for and treated as well. In selected cases, transurethral resection has resulted in marked improvement in semen parameters and pregnancies have been achieved. As is the case with all surgical procedures, proper patient selection and surgical experience are necessary to obtain optimal results. However, it appears that the treatments currently available for relief of ejaculatory obstruction are not optimally effective. Only approximately one half of treated patients will have an improvement in semen parameters and only about one quarter of treated patients will contribute to a pregnancy. What remains to be determined is how to manage the additional nearly 50% of patients who do not benefit from transurethral resection of ejaculatory obstruction. Based on my experience, I suggest that transrectal ultrasonography should be the first diagnostic procedure used when infertile men are suspected of having ejaculatory duct obstruction; however, vasography should still be considered for a more

  2. Hepatic S4a + S5 and bile duct resection for gallbladder carcinoma.

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    Miyazaki, Masaru; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshidome, Hiroyuki; Kato, Atsushi; Yoshitomi, Hideyuki; Furukawa, Katsunori; Kimura, Fumio

    2012-05-01

    In the surgical treatment of gallbladder cancer, segment 4a + 5 hepatic resection and bile duct resection is usually recommended for T2 and/or T3 gallbladder cancer involving hepatic parenchyma without hepatic biliary confluence. This procedure does not affect liver function excessively, provided there is correct identification of hepatic S4a and S5, the most important aspect of this procedure. In this paper, the technique of hepatic S4a + 5 and bile duct resection is described in detail. This surgical procedure could be a useful option for the surgical treatment of the hepatobiliary pancreatic malignancies. Surgeons should therefore master the surgical techniques for this procedure.

  3. To Resect or Not to Resect Extrahepatic Bile Duct in Gallbladder Cancer?

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    Gavriilidis, Paschalis; Askari, Alan; Azoulay, Daniel

    2017-01-01

    The indications for and limitations of extrahepatic bile duct resection (EHBDR) in the context of gallbladder (GB) cancer are unclear. The purpose of this review was to examine the current literature to determine the impact of EHBDR on loco-regional recurrence and survival in GB cancer. The EMBASE and Medline databases were searched up to February 2016 using the terms: extrahepatic bile duct resection and gallbladder cancer. Studies published in the last 20 years were eligible for inclusion. Given the heterogeneity of the population and the study methodologies employed, qualitative data synthesis in the form of meta-analysis was deemed implausible. Twenty-four studies fulfilled the inclusion criteria. The selected studies include 6,722 (55%) EHBDRs in a total of 12,251 GB cancer operations. The 25 studies were categorized into seven groups: 1) cancer survival all stages; 2) hepatoduodenal ligament invasion; 3) outcome in EHBDR and EHBDNR; 4) pT1b tumors; 5) pT2 tumors; 6) pT3/T4 tumors; and 7) incidental GB cancer. Radical cholecystectomy with EHBDR should be used as a standard operation for tumors involving the neck or the cystic duct of the GB (either macroscopically or microscopically). In all other cases, operative strategy should be individualized to the patient. PMID:28090223

  4. To Resect or Not to Resect Extrahepatic Bile Duct in Gallbladder Cancer?

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    Gavriilidis, Paschalis; Askari, Alan; Azoulay, Daniel

    2017-02-01

    The indications for and limitations of extrahepatic bile duct resection (EHBDR) in the context of gallbladder (GB) cancer are unclear. The purpose of this review was to examine the current literature to determine the impact of EHBDR on loco-regional recurrence and survival in GB cancer. The EMBASE and Medline databases were searched up to February 2016 using the terms: extrahepatic bile duct resection and gallbladder cancer. Studies published in the last 20 years were eligible for inclusion. Given the heterogeneity of the population and the study methodologies employed, qualitative data synthesis in the form of meta-analysis was deemed implausible. Twenty-four studies fulfilled the inclusion criteria. The selected studies include 6,722 (55%) EHBDRs in a total of 12,251 GB cancer operations. The 25 studies were categorized into seven groups: 1) cancer survival all stages; 2) hepatoduodenal ligament invasion; 3) outcome in EHBDR and EHBDNR; 4) pT1b tumors; 5) pT2 tumors; 6) pT3/T4 tumors; and 7) incidental GB cancer. Radical cholecystectomy with EHBDR should be used as a standard operation for tumors involving the neck or the cystic duct of the GB (either macroscopically or microscopically). In all other cases, operative strategy should be individualized to the patient.

  5. Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor

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    Yasunao; Ishiguro; Masanobu; Hyodo; Takehito; Fujiwara; Yasunaru; Sakuma; Nobuyuki; Hojo; Koichi; Mizuta; Hideo; Kawarasaki; Alan; T; Lefor; Yoshikazu; Yasuda

    2010-01-01

    A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son,who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years.The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation.With the use of cholangiography at the time of surgery,we found the right anterior segmental duct(RASD) emptying directly into the cystic duct,and the catheter passed into the RASD.After repairing the inci...

  6. Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor.

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    Ishiguro, Yasunao; Hyodo, Masanobu; Fujiwara, Takehito; Sakuma, Yasunaru; Hojo, Nobuyuki; Mizuta, Koichi; Kawarasaki, Hideo; Lefor, Alan T; Yasuda, Yoshikazu

    2010-08-07

    A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son, who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years. The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation. With the use of cholangiography at the time of surgery, we found the right anterior segmental duct (RASD) emptying directly into the cystic duct, and the catheter passed into the RASD. After repairing the incision in the cystic duct, transplantation was successfully performed. Her postoperative course was uneventful. Biliary anatomical variations were frequently encountered, however, this variation has very rarely been reported. If the RASD was divided, the repair would be very difficult because the duct will not dilate sufficiently in an otherwise healthy donor. Meticulous preoperative evaluation of the living donor's biliary anatomy, especially using magnetic resonance cholangiography and careful intraoperative techniques, is important to prevent bile duct injury and avoid the risk to the healthy donor.

  7. Isolated segmental, sectoral and right hepatic bile duct injuries

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    Radoje B Colovic

    2009-01-01

    The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery;3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated;4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes;the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis;all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-Y repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-Y repair. Two others also underwent a Roux-en-Y repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-Y anastomosis should be considered.

  8. Efficacy comparison of precise and traditional liver resection in treatment of intrahepatic bile duct stones

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    ZHANG Shengjun

    2015-10-01

    Full Text Available ObjectiveTo compare the efficacy of precise and traditional liver resection in the treatment of intrahepatic bile duct stones. MethodsOne hundred and twenty-seven patients with intrahepatic bile duct stones who were treated with surgery in our hospital from December 2008 to December 2014 were selected and divided into precise liver resection group (n=72 and traditional liver resection group (n=55 based on the type of surgery. The operation time, intraoperative blood loss, amount of postoperative drainage, postoperative time to recovery, postoperative complications (incision infection, biliary fistula, lung infection, and pleural effusion, hospitalization cost, postoperative residual calculi, and postoperative calculus recurrence were compared between the two groups. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. Survival data were analyzed using survival function. ResultsThere were significant differences in operation time, intraoperative blood loss, amount of postoperative drainage, postoperative time to recovery, and hospitalization cost between the precise liver resection group and the traditional liver resection group (t=3.720, 58.681, 19.169, 5.990, and 6.944; all P<0.05. There were no significant differences in postoperative complications including incision infection, biliary fistula, lung infection, and pleural effusion between the two groups (all P>0.05. There were also no significant differences in the incidence rates of postoperative residual calculi and calculus recurrence between the two groups (all P>0.05. The survival analysis of postoperative calculus recurrence time showed that there was no significant difference in calculus recurrence time between the two groups (P>0.05. ConclusionCompared with traditional liver resection, precise liver resection has the advantages of shorter operation time, less intraoperative bleeding, less

  9. Pulmonary artery aneurysm with patent arterial duct: resection of aneurysm and ductal division.

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    Tefera, Endale; Teodori, Michael

    2013-10-01

    Congenital or acquired aneurysm of the pulmonary artery (PA) is rare. Although aneurysms are described following surgical treatment of patent ductus arteriosus (PDA), occurrence of this lesion in association with PDA without previous surgery is extremely uncommon. An eight-year-old patient with PDA and aneurysm of the main PA is described in this report. Clinical diagnosis of PDA was made upon presentation. Diagnosis of PA aneurysm was suspected on chest x-ray and was confirmed on transthoracic echocardiography. Successful surgical resection of the aneurysm and division of the duct were performed under cardiopulmonary bypass. The patient did well on follow-up both from clinical and echocardiographic point of view.

  10. Twenty-Year Outcome Following Central Duct Resection for Bloody Nipple Discharge

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    Nelson, R Scott; Hoehn, James L.

    2006-01-01

    Background: Patients found with pathologic nipple discharge present a diagnostic dilemma to surgeons. No one diagnostic test, including cytology or radiologic imaging, has proved superior to any other in the differentiation of benign versus malignant sources of pathologic nipple discharge. Ductoscopy has been introduced as a way to assist with identification of potential sources of pathologic nipple discharge. Ductoscopy is also useful in the resection of deep or peripheral masses that may be missed with standard blind resection. This report evaluates the risk of missed malignancy following central duct resection (CDR). Methods: Records of 56 patients who underwent CDR for pathologic nipple discharge greater than 15 years previous were reviewed. Data including type of nipple discharge, future biopsy, and pathology reports were all examined. Results: Of the 56 patients, 36 had bloody, 18 serous, and 2 green initial discharges. Fifty-seven percent were found to have intraductal papilloma as the source of discharge, with fibrocystic disease and ductal ectasia providing the next most common causes. One woman was found to have ductal cancer and one lobular carcinoma in situ at time of CDR. Patients were followed for a mean period of 22 years. Fourteen women required future biopsy. Of these, 10 had benign disease and 4 had cancer, 3 on the ipsilateral side. The 3 women with breast cancer were 9, 13, and 17 years from initial resection. Conclusions: CDR for pathologic nipple discharge is an effective way to diagnose and treat pathologic nipple discharge without missing underlying cancers. PMID:16552204

  11. Patterns of failure and prognostic factors in resected extrahepatic bile duct cancer: implication for adjuvant radiotherapy

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    Koo, Tae Ryool; Eom, Keun Yong; Kim, In Ah; Cho, Jai Young; Yoon, Yoo Seok; Hwang, Dae Wook; Han, Ho Seong; Kim, Jae Sung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2014-06-15

    To find the applicability of adjuvant radiotherapy for extrahepatic bile duct cancer (EBDC), we analyzed the pattern of failure and evaluate prognostic factors of locoregional failure after curative resection without adjuvant treatment. In 97 patients with resected EBDC, the location of tumor was classified as proximal (n = 26) and distal (n = 71), using the junction of the cystic duct and common hepatic duct as the dividing point. Locoregional failure sites were categorized as follows: the hepatoduodenal ligament and tumor bed, the celiac artery and superior mesenteric artery, and other sites. The median follow-up time was 29 months for surviving patients. Three-year locoregional progression-free survival, progression-free survival, and overall survival rates were 50%, 42%, and 52%, respectively. Regarding initial failures, 79% and 81% were locoregional failures in proximal and distal EBDC patients, respectively. The most common site was the hepatoduodenal ligament and tumor bed. In the multivariate analysis, perineural invasion was associated with poor locoregional progression-free survival (p = 0.023) and progression-free survival (p = 0.012); and elevated postoperative CA19-9 (> or =37 U/mL) did with poor locoregional progression-free survival (p = 0.002), progression-free survival (p < 0.001) and overall survival (p < 0.001). Both proximal and distal EBDC showed remarkable proportion of locoregional failure. Perineural invasion and elevated postoperative CA19-9 were risk factors of locoregional failure. In these patients with high risk of locoregional failure, adjuvant radiotherapy could be considered to improve locoregional control.

  12. Hand-Assisted Laparoscopic (HAL) Multiple Segmental Colorectal Resections: Are They Feasible and Safe?

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    Taggarshe, Deepa; Attuwaybi, Bashir O; Matier, Brian; Visco, Jeffrey J; Butler, Bryan N

    2015-04-01

    The objective of this study was to evaluate the short-term outcomes of synchronous hand-assisted laparoscopic (HAL) segmental colorectal resections. The surgical options for synchronous colonic pathology include extensive colonic resection with single anastomosis, multiple synchronous segmental resections with multiple anastomoses, or staged resections. Traditionally, multiple open, synchronous, segmental resections have been performed. There is a lack of data on HAL multiple segmental colorectal resections. A retrospective chart review was compiled on all patients who underwent HAL synchronous segmental colorectal resections by all the colorectal surgeons from our Group during the period of 1999 to 2014. Demographics, operative details, and short-term outcomes are reported. During the period, 9 patients underwent HAL synchronous multiple segmental colorectal resections. There were 5 women and 4 men, with median age of 54 (24-83) years and median BMI of 24 (19.8-38.7) kg/m(2). Two patients were on long-term corticosteroid therapy. The median operative time was 210 (120-330) minutes and median operative blood loss was 200 (75-300) mLs. The median duration for return of bowel function was 2 days and the median length of stay was 3.5 days. We had 2 minor wound infections. There were no deaths. Synchronous segmental colorectal resections with anastomoses using the hand-assisted laparoscopic technique are safe. Early conversion to open and use of stomas are advisable in challenging cases.

  13. Long-term results of treatment of injuries to the sectoral and segmental bile ducts

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    Čolović Radoje B.

    2003-01-01

    Full Text Available INTRODUCTION Surgically important variations of the sectoral and segmental bile ducts of the right lobe of the liver appear in a significant proportion of patients. Frequency of the injuries to these ducts is not known as the ligature of small ducts may pass without major consequences. MATERIAL AND METHODS Over a 27 year period (1. Jan 1974-31. Dec 2001 along with 168 patients with benign biliary strictures of type I, II, III and IV according to Bismuth's classification, we treated 13 patients with operative sectoral or segmental bile duct injuries, four patients from our institution and nine patients transferred from elsewhere. The injury was recognized at original surgery in all four patients operated in our institution. Primary repair was performed in three patients, in two patients direct end-to-end repair overT-tube and in one patient with anastomosis between the injured duct and Roux-en-Y jejunal limb, while in one patient the injured duct was ligated. In no one of nine patients transferred from elsewhere the injury was recognized during original surgery. Four patients were sent with biliary peritonitis, another four patients with external biliary fistula and one patient for pain and fever due to liver abscess. RESULTS All three patients in whom the primary repair was performed had a quick and uneventful recovery and they stayed symptom-free so far. The patient in whom the injured duct was ligated died after series of complications. Four patients sent to us with biliary peritonitis were treated with relaparotomy, lavage and drainage and all developed external biliary fistula. Three of these patients had their fistula ceased spontaneously within few weeks, while in one patient the fistula didn't show signs of ceasing so that injured duct had to be anastomosed with Roux-en-Y jejunal limb. Two out of four patients sent for external biliary fistula had it ceased spontaneously, while in two patients anastomosis between duct and Roux

  14. Impact of previous cyst-enterostomy on patients’ outcome following resection of bile duct cysts

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    Mehdi Ouaissi; Reza Kianmanesh; Emilia Ragot; Jacques Belghiti; Pietro Majno; Gennaro Nuzzo; Remi Dubois; Yann Revillon; Daniel Cherqui; Daniel Azoulay; Christian Letoublon; Fran?ois-René Pruvot; Fran?ois Paye; Patrick Rat; Karim Boudjema; Adeline Roux; Jean-Yves Mabrut; Jean-Fran?ois Gigot

    2016-01-01

    AIM:To analyze the impact of previous cyst-enterostomy of patients underwent congenital bile duct cysts(BDC) resection.METHODS:A multicenter European retrospective study between 1974 and 2011 were conducted by the French Surgical Association.Only Todani subtypes I and IVb were included.Diagnostic imaging studies and operative and pathology reports underwent central revision.Patients with and without a previous history of cystenterostomy(CE) were compared.RESULTS:Among 243 patients with Todani types I and IVb BDC,16 had undergone previous CE(6.5%).Patients with a prior history of CE experienced a greater incidence of preoperative cholangitis(75% vs 22.9%,P < 0.0001),had more complicated presentations(75% vs 40.5%,P = 0.007),and were more likely to have synchronous biliary cancer(31.3% vs 6.2%,P = 0.004) than patients without a prior CE.Overall morbidity(75% vs 33.5%;P < 0.0008),severe complications(43.8% vs 11.9%;P = 0.0026) and reoperation rates(37.5% vs 8.8%;P = 0.0032) were also significantly greater in patients with previous CE,and their Mayo Risk Score,during a median follow-up of 37.5 mo(range:4-372 mo) indicated significantly more patients with fair and poor results(46.1% vs 15.6%;P = 0.0136).CONCLUSION:This is the large series to show that previous CE is associated with poorer short-and longterm results after Todani types I and IVb BDC resection.

  15. [Causes, diagnosis and surgical treatment of strictures of lobar and segmental hepatic ducts].

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    Gal'perin, E I; Diuzheva, T G; Chevokin, A Iu; Garmaev, B G

    2005-01-01

    Causes of strictures of lobar and segmental ducts after their injuries during open and laparoscopic cholecystectomy in 53 patients were analyzed. For correction of bile outflow precision non-wireframe (n=22) and wireframe (n=20) anastomoses were used. In 10 patients a combined anastomosis was established. In 1 patient the external drainage of hepatic ducts was performed. After surgery 3 patients died. 1-15 year long-term results were studied in 48 (96%) patients. Good results were achieved in 29 (60.5%), satisfactory -- in 13 (27%) patients. Recurrences of the strictures were diagnosed in 6 patients. It is concluded that dynamic control is necessary in patients operated on for bile ducts injuries. Underestimation of remittent cholangitis leading to biliary cirrhosis worsens prognosis of the disease.

  16. Disease recurrence patterns and analysis of clinicopathological prognostic factors for recurrence after resection for distal bile duct cancer.

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    Choi, Sae Byeol; Han, Hyung Joon; Park, Pyoung Jae; Kim, Wan Bae; Song, Tae Jin; Kim, Jae Seon; Suh, Sung Ock; Choi, Sang Yong

    2015-03-01

    Surgical resection is the treatment of choice for bile duct cancers. The aim of this study was to investigate disease recurrence patterns and prognostic factors for recurrence of distal bile duct cancers after surgical resection. A retrospective study was performed on 122 patients with distal bile duct cancers who underwent R0 or R1 surgical resection at Korea University Guro Hospital from 1991 to 2010. Sites of initial disease recurrence were classified as locoregional or distant. Univariate and multivariate analyses were performed to investigate the factors affecting recurrence. Of the 122 patients, 80 patients developed recurrence. The disease-free survival rate was 63.1 per cent at one year and 36.4 per cent at three years. The patterns of recurrence at diagnosis were locoregional in 25 patients, locoregional and distant metastasis in 14 patients, and distant metastasis in 41 patients. Multivariate analyses revealed that recurrence pattern, lymph node metastasis, and differentiation are independent prognostic factors affecting disease-free survival. R status (marginal significance) and tumor differentiation were independent prognostic factors associated with locoregional recurrence. Differentiation and lymph node metastasis were independent prognostic factors associated with distant metastasis. The prognosis after recurrence was poor with a 1-year survival rate after recurrence of 26.1 per cent. Adjuvant chemo- or radiation therapy, delivered in patients mainly with R1 resection or with presence of lymph node metastasis, did not demonstrate the survival benefit. Significant factors for recurrence were tumor differentiation and lymph node metastasis. Therefore, close follow-up and adjuvant therapy will be necessary in patients with lymph node metastasis or poorly differentiated tumor.

  17. The clinical curative effect of transurethral resection of the ejaculatory duct for iatrogenic ejaculatory duct obstruction after prostatic hyperthermia

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    Liang-Yun Zhao; Xiang-An Tu; Chun-Hua Deng

    2006-01-01

    @@ Dear Sir, I am a urologic doctor from Urology Department of The First Affiliated Hospital of Sun Yat-Sen University of Medical Science. Recently our group find there are some patients diagnosed with iatrogenic ejaculatory duct obstruction (EDO) after prostatic hyperthermia.This finding showed it was dangerous that some nullibreeding patients of prostatitis were treated with prostatic hyperthermia, which could induce EDO and urethrostenosis.

  18. The Main Technical Points of Thoracoscopic Anatomical Lung Segment Resection

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    Liang CHEN

    2016-06-01

    Full Text Available Thoracoscopic segmentectomy is technically much more meticulous than lobectomy, due to the complicated anotomical variations of segmental bronchi and vessels. Preoperative three-dimensional computed tomography bronchography and angiography, 3D-CTBA could reveal the anatomical structures and variations of the segmental bronchi/vessels and locate the pulmonary nodules, which is helpful for surgery planning. Preoperative nodule localization is of vital importance for thoracoscopic segmentectomy. Techniques involved in this procedure include dissection of the targeted arteries, bronchus and intra-segmental veins, retention of the inter-segmental veins, identification of the inter-segmental boarder with the inflation-deflation method and seperation of intra-segmental pulmonary tissues by electrotome and/or endoscopic staplers. The incision margin for malignant nodules should be at least 2 cm or the diameter of the tumor. Meanwhile, sampling of N1 and N2 station lymph nodes and intraoperative frozen section is also necessary. The complication rate of thoracoscopic segmentectomy is comparatively low. The anatomic relationship between pulmonary segments and lobes is that a lobe consists of several irregular cone-shaped segments with the inter-segmental veins lies between the segments. Our center has explored a method to separate pulmonary segments from the lobe on the basis of cone-shaped principle, and we named it “Cone-shaped Segmentectomy”. This technique could precisely decide and dissect the targeted bronchi and vessels, and anatomically separate the inter-segmental boarder, which ultimately achieve a completely anatomical segmentectomy.

  19. Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

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    Kwang Yeol Paik; Seong Ho Choi

    2009-01-01

    AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in five patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, pre- and intra-operative definite localization and careful operative techniques are required.

  20. Block resection of the hepatoduodenal ligament for carcinoma of the bile duct and gallbladder. Surgical technique and a report of 11 cases.

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    Mimura, H; Takakura, N; Kim, H; Hamazaki, K; Tsuge, H; Ochiai, Y

    1991-12-01

    Carcinoma of the bile duct and gallbladder often infiltrates the entire hepatoduodenal ligament. Therefore radical resection should include block resection of the hepatoduodenal ligament. Over the last two years, block resection of the hepatoduodenal ligament for carcinoma of the bile duct and gallbladder was performed in 11 patients. When the carcinoma was located in the hilar bile duct, a combination of hemihepatectomy including the caudate lobe and ligamentetomy, "hepato-ligamentectomy", was performed (six cases). When the carcinoma was in the lower bile duct, a combination of pancreatico-duodenectomy and ligamentectomy, "ligamento-pancreatectomy", was performed (three cases). In two extremely advanced cases a combination of both hepatectomy and pancreatectomy with ligamentectomy, "hepato-ligamento-pancreatectomy", was performed. To accomplish these procedures safely, double catheter bypass of the portal circulation, devised by the authors in 1986, proved very effective in maintaining sufficient hepatic circulation and preventing portal congestion during block resection of the hepatoduodenal ligament. Histological evidence of invasion of the carcinoma cells into the hepatoduodenal ligament was detected in 10 cases, and in half of them the hepatic artery or portal vein was involved. As of April 1988, five cases in whom curative resection was performed are still alive, the longest survival period being 18 months. Four cases died in the early postoperative period, three of the deaths being due to sepsis and one to respirator malfunction.

  1. Congenital dilatation of the large and segmental intrahepatic bile ducts (Caroli's disease in two Golden retriever littermates : clinical communication

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    R.D. Last

    2006-06-01

    Full Text Available Two, sibling, male Golden retriever puppies, 13 weeks of age, were presented with congenital biliary cysts of the liver involving both hepatic and segmental bile ducts, as well as bilateral polycystic kidney disease. Ultrasonography of the livers of both pups demonstrated segmental cystic lesions that were contiguous with the bile ducts. Histopathology revealed cystic ectatic bile duct hyperplasia and dysplasia with variable portal fibrosis in the liver, while in the kidneys there were radially arranged, cylindrically dilated cysts of the collecting ducts, which extended through the medulla and cortex. This pathology was compatible with that of congenital dilatation of the large and segmental bile ducts (Caroli's disease described in humans, dogs and rats. In humans Caroli's disease has an autosomal recessive inheritance pattern, while in rats activation of the MEK5/ERK cascade initiates the biliary dysgenesis of Caroli's disease in this species. However, the exact mode of inheritance and pathogenesis of Caroli's disease in dogs is as yet unknown. Previous reports on congenital hepatic cystic diseases of the dog have described Caroli's disease like lesions in various breeds, but these are believed to be the 1st reported cases in the Golden retriever breed.

  2. Surgery for Bile Duct (Cholangiocarcinoma) Cancer

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    ... Situation Bile Duct Cancer Treating Bile Duct Cancer Surgery for Bile Duct Cancer There are 2 general ... also help plan the operation to remove it. Surgery for resectable cancers For resectable cancers, the type ...

  3. Resection of Perihilar Cholangiocarcinoma.

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    Hartog, Hermien; Ijzermans, Jan N M; van Gulik, Thomas M; Groot Koerkamp, Bas

    2016-04-01

    Perihilar cholangiocarcinoma presents at the biliary and vascular junction of the hepatic hilum with a tendency to extend longitudinally into segmental bile ducts. Most patients show metastatic or unresectable disease at time of presentation or surgical exploration. In patients eligible for surgical resection, challenges are to achieve negative bile duct margins, adequate liver remnant function, and adequate portal and arterial inflow to the liver remnant. Surgical treatment is characterized by high rates of postoperative morbidity and mortality. This article reviews the various strategies and techniques, the role of staging laparoscopy, intraoperative frozen section, caudate lobectomy, and vascular reconstruction.

  4. Step-by-step isolated resection of segment 1 of the liver using the hanging maneuver.

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    López-Andújar, Rafael; Montalvá, Eva; Bruna, Marcos; Jiménez-Fuertes, Montiel; Moya, Angel; Pareja, Eugenia; Mir, Jose

    2009-09-01

    The caudate lobe can be the origin of primary liver tumours or the sole site of liver metastases. This lobe is anatomically divided into 3 parts: Spiegel's lobe (Couinaud's segment 1), paracaval portion (Couinaud's segment 9), and the caudate process. In this series of 4 cases, we provide a step-by-step description of a surgical technique variation that can be applied to resections of lesions localized in segment 1. We believe that other than size, lesion removal in this hepatic anatomic area, which is difficult to perform, can be done more easily using this new approach because it requires minimal mobilization without unnecessary parenchyma transection of other liver parts. Therefore, it reduces the risk of lesions in the inferior vena cava and the middle hepatic vein and respects adequate margins without the use of clamping maneuvers and in an acceptable surgical time.

  5. Reconstructive procedures for segmental resection of bone in giant cell tumors around the knee

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    Aggarwal Aditya

    2007-01-01

    Full Text Available Background: Segmental resection of bone in Giant Cell Tumor (GCT around the knee, in indicated cases, leaves a gap which requires a complex reconstructive procedure. The present study analyzes various reconstructive procedures in terms of morbidity and various complications encountered. Materials and Methods: Thirteen cases (M-six and F-seven; lower end femur-six and upper end tibia -seven of GCT around the knee, radiologically either Campanacci Grade II, Grade II with pathological fracture or Grade III were included. Mean age was 25.6 years (range 19-30 years. Resection arthrodesis with telescoping (shortening over intramedullary nail ( n=5, resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail ( n=3 and resection arthrodesis with intercalary fibular autograft and simultaneous limb lengthening ( n=5 were the procedure performed. Results: Shortening was the major problem following resection arthrodesis with telescoping (shortening over intramedullary nail. Only two patients agreed for subsequent limb lengthening. The rest continued to walk with shortening. Infection was the major problem in all cases of resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail and required multiple drainage procedures. Fusion was achieved after two years in two patients. In the third patient the allograft sequestrated. The patient underwent sequestrectomy, telescoping of fragments and ilizarov fixator application with subsequent limb lengthening. The patient was finally given an ischial weight relieving orthosis, 54 months after the index procedure. After resection arthrodesis with intercalary autograft and simultaneous lengthening the resultant gap (~15cm was partially bridged by intercalary nonvascularized dual fibular strut graft (6-7cm and additional corticocancellous bone graft from ipsilateral patella. Simultaneous limb lengthening with a distal tibial corticotomy was performed on an

  6. Laparoscopic Liver Resection Using the Lateral Approach from Intercostal Ports in Segments VI, VII, and VIII.

    Science.gov (United States)

    Inoue, Yoshihiro; Suzuki, Yusuke; Fujii, Kensuke; Kawaguchi, Nao; Ishii, Masatsugu; Masubuchi, Shinsuke; Yamamoto, Masashi; Hirokawa, Fumitoshi; Hayashi, Michihiro; Uchiyama, Kazuhisa

    2017-07-31

    Laparoscopic liver resection (LLR) has been developed as a minimally invasive surgery. However, challenges such as difficulty securing visibility and limited control of forceps make it difficult to complete LLR in hepatic segments VI, VII, and VIII. To overcome these challenges, we devised a surgical technique using intercostal ports. We termed this approach the lateral approach. This work describes our experience performing LLR using this approach and discusses the safety and effectiveness of this approach. Between April 2011 and December 2016, data from 91 patients who underwent LLR with or without the intercostal port at a single institution were retrospectively analyzed regarding surgical outcomes, safety, and utility. LLR was performed for 32 patients with the intercostal port and for 59 patients without the intercostal port. The conversion rates to open surgery with and without intercostal ports were 3.1 and 25.4% (P = 0.008). In hepatic segments VII and VIII, the rates of conversion to open surgery were significantly lower for cases involving intercostal ports (6.7 vs. 42.9 and 0 vs. 38.9%; P = 0.035 and 0026, respectively); however, there were no differences in hepatic segment VI (0 vs. 7.4%; P = 0.563). There were no differences in operative time, blood loss volume, surgical margin, curative resection rate, or postoperative complication rate for LLR in all segments (VI, VII, and VIII). No adverse events due to placement of the intercostal port were observed in this set of patients. LLR using the lateral approach and intercostal ports for hepatic segments VII and VIII resulted in a significant decrease in conversion rates to open surgery.

  7. Segment boundaries of the adult rat epididymis limit interstitial signaling by potential paracrine factors and segments lose differential gene expression after efferent duct ligation

    Institute of Scientific and Technical Information of China (English)

    Terry T. Turner; Daniel S. Johnston; Scott A. Jelinsky; Jose L. Tomsig; Joshua N. Finger

    2007-01-01

    The epididymis is divided into caput, corpus and cauda regions, organized into intraregional segments separated by connective tissue septa (CTS). In the adult rat and mouse these segments are highly differentiated. Regulation of these segments is by endocrine, lumicrine and paracrine factors, the relative importance of which remains under investigation. Here, the ability of the CTS to limit signaling in the interstitial compartment is reviewed as is the effect of 15 days of unilateral efferent duct ligation (EDL) on ipsilateral segmental transcriptional profiles. Inter-segmental microperifusions of epidermal growth factor (EGF), vascular endothelial growth factor (VEGFA) and fibroblast growth factor 2 (FGF2) increased phosphorylation of mitogen activated protein kinase (MAPK) in segments 1 and 2 of the rat epididymis and the effects of all factors were limited by the CTS separating the segments. Microarray analysis of segmental gene expression determined the effect of 15 days of unilateral EDL on the transcriptome-wide gene expression of rat segments 1-4. Over 11 000 genes were expressed in each of the four segments and over 2 000 transcripts in segment 1 responded to deprivation of testicular lumicrine factors. Segments 1 and 2 of control tissues were the most transcriptionally different and EDL had its greatest effects there. In the absence of lumicrine factors, all four segments regressed to a transcriptionally undifferentiated state, consistent with the less differentiated histology. Deprivation of lumicrine factors could stimulate an individual gene's expression in some segments yet suppress it in others. Such results reveal a higher complexity of the regulation of rat epididymal segments than that is generally appreciated.

  8. [Kapandji-Sauvé procedure with distal radioulnar fusion and segmental resection of the ulna].

    Science.gov (United States)

    Haferkamp, H

    2012-02-01

    The Kapandji-Sauvé procedure aims at improvement of rotation in the distal radioulnar joint and reduction of pain. Cases of ulnar impaction syndrome can also be corrected during the same procedure. The most important indication is painful und restricted forearm rotation after fracture of the distal radius combined with obsolete dislocation or destruction of the distal radioulnar joint. It is a salvage procedure and is contraindicated when reconstruction of the radioulnar joint or shortening of the ulna is possible. Further contraindications are rheumatic arthritis and osteoporosis. The Kapandji-Sauvé procedure creates a new distal rotatory joint due to distal radioulnar fusion and segmental resection of the distal ulna. Forearm cast including the wrist for 3-4 weeks. Phyisiotherapy and intensive exercises of the fingers on postoperative day 1. After removing the cast, careful rotation exercises are possible. In 75 patients, the Kapandji-Sauvé procedure was performed between 1990 and 2003. Failure was observed in one patient with a bony regeneration between the resected ulnar segment. In 3 cases, a nonunion of the radioulnar joint was found. After revision with bone grafting, bony consolidation of the joint was identified in all cases. In 2 cases, there were problems with the proximal ulnar stump, whereby this was corrected in one case by resection of a ball-type callus. In the other case, painful ulna-snapping was reduced by shortening of the ulna. In earlier follow-up with 45 patients and later long-turn follow-up, ranging from 3-12 years, not only were significant improvement of forearm rotation and reduction of pain observed, but also good patient satisfaction was found.

  9. Intercostal Trocars Enable Easier Laparoscopic Resection of Liver Tumors in Segments 7 and 8.

    Science.gov (United States)

    Hirokawa, Fumitoshi; Hayashi, Michihiro; Asakuma, Mitsuhiro; Shimizu, Tetsunosuke; Inoue, Yoshihiro; Uchiyama, Kazuhisa

    2017-05-01

    Laparoscopic resection of posterosuperior (PS) tumors of the liver is more difficult than that of anterolateral (AL) tumors, owing to the narrow surgical field in the PS location. In this retrospective cohort study, our aim was to determine if port insertion through the intercostal space would lead to improved outcomes for laparoscopic resection of tumors in PS liver segments 7 and 8. Between January 2006 and December 2015, 153 patients underwent laparoscopic resection of solitary liver tumors at Osaka Medical College Hospital. Of these, 107 patients had AL lesions, and 46 had PS lesions. Of the 46 patients with a PS lesion, 23 underwent an abdominal-only approach, and 23 underwent the intercostal trocar approach. Multivariate analyses were performed to investigate outcomes. Conventional abdominal-only laparoscopic resection of PS liver tumors resulted in prolonged surgical time (P = 0.031), increased bleeding (P = 0.012), and a higher open conversion rate (P = 0.022) compared with AL tumors. Among patients with PS tumors, the open conversion rate was significantly higher for those treated with the abdominal-only approach than with the intercostal trocar approach (P = 0.047). Appropriate surgical margins were obtained equally using the intercostal trocar approach (P = 0.648). There was no significant difference in occurrence of complications between the abdominal-only group and the intercostal trocar group. Using the intercostal trocar approach for PS liver lesions is a safe and effective method, which significantly reduced the open conversion rate compared with the conventional abdominal-only approach.

  10. Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction.

    Science.gov (United States)

    van Gemert, Johannes; Holtslag, Irene; van der Bilt, Andries; Merkx, Matthias; Koole, Ron; Van Cann, Ellen

    2015-06-01

    Segmental resection of the mandible causes functional, aesthetic and social problems affecting health-related quality of life (HRQoL). It is often assumed that reconstruction with composite free flaps guarantees better function and aesthetics than bridging the defect with reconstruction plates. Using the European Organization for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 version 3.0 and EORTC QLQ-H&N35), we compared HRQoL in patients who received free fibula flaps versus reconstruction plates after segmental resection of the lateral mandible. Thirty-seven completed questionnaires (18 fibula reconstructions and 19 patients with reconstruction plates) were available. Reconstruction with a free fibula flap did not provide clear additional benefit to bridging the defect with a reconstruction plate after segmental resection of the lateral mandible. In particular aspects known to have the most impact on HRQoL like swallowing, speech and chewing were not influenced by the type of reconstruction. Reconstruction of segmental defects of the lateral mandible with free fibula flap and reconstruction plate resulted in comparable HRQoL. If dental rehabilitation by means of dental implants is not anticipated in the fibula, then plate reconstruction with adequate soft tissue remains a suitable technique for the reconstruction of segmental defects of the lateral mandible. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases.

    Science.gov (United States)

    Krajc, Tibor; Janik, Miroslav; Benej, Roman; Lucenic, Martin; Majer, Ivan; Demian, Juraj; Harustiak, Svetozar

    2009-12-01

    The report is a retrospective review of 238 benign tracheal stenoses of various etiologies treated between 1995 and 2008. To show that urgent segmental resection has complication rates similar to elective resection and, therefore, preoperative dilation is not necessary, we analysed records of patients who underwent either standard segmental resections with anterolateral mediastinal tracheal mobilization, single-suture anastomosis and neck flexion; or insertion of T-tube with oval-shaped horizontal arm. Primary segmental resection was performed in 164 patients (68.9%), including 14 cases with concomitant tracheo-esophageal fistula (TEF). T-tube as an initial treatment suited 74 (31.1%) patients. We encountered two partial and one complete anastomotic disruptions following subglottic resections treated by T-tube insertion and costal cartilage tracheoplasty or permanent tracheostomy. Restenosis rate in segmental resection was 3.1%. No difference in complication rate between urgent and elective segmental resections was experienced. We treated a small number of patients by endotracheal stent insertion but the results were discouraging. Urgent segmental resection without prior rigid bronchoscopy dilation is our strategy of choice whenever possible. As an alternative to dilation we prefer temporary insertion of modified T-tube. Stand-alone endoluminal dilation and stenting has yet to prove its safety and long-term efficacy.

  12. Feasibility of laparoscopic liver resection for caudate lobe: technical strategy and comparative analysis with anteroinferior and posterosuperior segments.

    Science.gov (United States)

    Araki, Kenichiro; Fuks, David; Nomi, Takeo; Ogiso, Satoshi; Lozano, Ruben R; Kuwano, Hiroyuki; Gayet, Brice

    2016-10-01

    Although laparoscopic liver resection (LLR) is now considered a standard procedure in peripheral segments, there are few reports on laparoscopic segment 1 (Sg1) resection. The aim of this study was to assess both safety and feasibility of Sg1 LLR. From 2000 to 2014, all patients who underwent LLR were identified from a prospective database. Patients with resection of Sg1 (Sg1 group) were compared with those with resection of anteroinferior segments (AI group: segments 3, 4b, 5, 6) or posterosuperior segments (PS group: segments 4a, 7, 8), in terms of tumor characteristics, surgical treatment, and short-term outcomes. There were 15, 151, and 67 patients in Sg1, AI, and PS groups. Tumor size and tumor number were similar between the three groups (p = 0.139, p = 0.102). Operative time was significantly shorter in Sg1 (150 min) and AI group (135 min) compared with PS group (180 min) (p = 0.021). Median blood loss was notably higher in PS group (140 ml) compared with Sg1 group (75 ml) and AI group (10 ml) (p = 0.001). No mortality was observed in all groups. Postoperative complication rate was 20.0 % with Sg1 group, 14.6 % with AI group, and 20.9 % with PS group (p = 0.060). The rate of major complication was significantly higher in Sg1 group (13.3 %) and PS group (11.9 %) compared with AI group (4.0 %) (p = 0.042). Resection margins were clear in all Sg1 and PS group patients, whereas two (1.3 %) patients in AI group had R1 margins (p = 0.586). The laparoscopic approach of isolated resection located in the caudate lobe is a feasible and curative surgical option in selected patients.

  13. Segmental Expression of the Bradykinin Type 2 Receptor in Rat Efferent Ducts and Epididymis and Its Role in the Regulation of Aquaporin 91

    Science.gov (United States)

    Belleannée, C.; Silva, N. Da; Shum, W.W.C.; Marsolais, M.; Laprade, R.; Brown, D.; Breton, S.

    2008-01-01

    Water and solute transport in the efferent ducts and epididymis are important for the establishment of the appropriate luminal environment for sperm maturation and storage. Aquaporin 9 (AQP9) is the main water channel in the epididymis, but its regulation is still poorly understood. Components of the kinin-kallikrein system (KKS), leading to the production of bradykinin (BK), are highly expressed in the lumen of the male reproductive tract. We report here that the epididymal luminal fluid contains a significant amount of BK (2 nM). RT-PCR performed on epididymal epithelial cells isolated by laser capture microdissection (LCM) showed abundant BK type 2 receptor (Bdkrb2) mRNA expression but no type 1 receptor (Bdkrb1). Double-immunofluorescence staining for BDKRB2 and the anion exchanger AE2 (a marker of efferent duct ciliated cells) or the V-ATPase E subunit, official symbol ATP6V1E1 (a marker of epididymal clear cells), showed that BDKRB2 is expressed in the apical pole of nonciliated cells (efferent ducts) and principal cells (epididymis). Triple labeling for BDKRB2, AQP9, and ATP6V1E1 showed that BDKRB2 and AQP9 colocalize in the apical stereocilia of principal cells in the cauda epididymidis. While uniform Bdkrb2 mRNA expression was detected in the efferent ducts and along the epididymal tubule, marked variations were detected at the protein level. BDKRB2 was highest in the efferent ducts and cauda epididymidis, intermediate in the distal initial segment, moderate in the corpus, and undetectable in the proximal initial segment and the caput. Functional assays on tubules isolated from the distal initial segments showed that BK significantly increased AQP9-dependent glycerol apical membrane permeability. This effect was inhibited by BAPTA-AM, demonstrating the participation of calcium in this process. This study, therefore, identifies BK as an important regulator of AQP9. PMID:18829705

  14. Early bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Jae Myung Cha; Myung-Hwan Kim; Se Jin Jang

    2007-01-01

    Bile duct cancers are frequently diagnosed as advanced diseases. Over half of patients with advanced bile duct cancer present with unresectable malignancies and their prognosis has been very poor even after curative resections. Although there has been a need to diagnose bile duct cancer at its early stage, it has been a difficult goal to achieve due to our lack of knowledge regarding this disease entity. Early bile duct cancer may be defined as a carcinoma whose invasion is confined within the fibromuscular layer of the extrahepatic bile duct or intrahepatic large bile duct without distant metastasis irrespective of lymph node involvement. Approximately 3%-10% of resected bile duct cancers have been reported to be early cancers in the literature. The clinicopathological features of patients with early bile duct cancer differ from those of patients with advanced bile duct cancer, with more frequent asymptomatic presentation, characteristic histopathological findings,and excellent prognosis. This manuscript is organized to emphasize the need for convening an international consensus to develop the concept of early bile duct cancer.

  15. Profile of preoperative fecal organic acids closely predicts the incidence of postoperative infectious complications after major hepatectomy with extrahepatic bile duct resection: Importance of fecal acetic acid plus butyric acid minus lactic acid gap.

    Science.gov (United States)

    Yokoyama, Yukihiro; Mizuno, Takashi; Sugawara, Gen; Asahara, Takashi; Nomoto, Koji; Igami, Tsuyoshi; Ebata, Tomoki; Nagino, Masato

    2017-10-01

    To investigate the association between preoperative fecal organic acid concentrations and the incidence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection for biliary malignancies. The fecal samples of 44 patients were collected before undergoing hepatectomy with bile duct resection for biliary malignancies. The concentrations of fecal organic acids, including acetic acid, butyric acid, and lactic acid, and representative fecal bacteria were measured. The perioperative clinical characteristics and the concentrations of fecal organic acids were compared between patients with and without postoperative infectious complications. Among 44 patients, 13 (30%) developed postoperative infectious complications. Patient age and intraoperative bleeding were significantly greater in patients with postoperative infectious complications compared with those without postoperative infectious complications. The concentrations of fecal acetic acid and butyric acid were significantly less, whereas the concentration of fecal lactic acid tended to be greater in the patients with postoperative infectious complications. The calculated gap between the concentrations of fecal acetic acid plus butyric acid minus lactic acid gap was less in the patients with postoperative infectious complications (median 43.5 vs 76.1 μmol/g of feces, P = .011). Multivariate analysis revealed that an acetic acid plus butyric acid minus lactic acid gap acid profile (especially low acetic acid, low butyric acid, and high lactic acid) had a clinically important impact on the incidence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection. Copyright © 2017. Published by Elsevier Inc.

  16. Common and Uncommon Anatomical Variants of Intrahepatic Bile Ducts in Magnetic Resonance Cholangiopancreatography and its Clinical Implication

    Science.gov (United States)

    Sarawagi, Radha; Sundar, Shyam; Raghuvanshi, Sameer; Gupta, Sanjeev Kumar; Jayaraman, Gopal

    2016-01-01

    Summary Background Preoperative knowledge of intrahepatic bile duct (IHD) anatomy is critical for planning liver resections, liver transplantations and complex biliary reconstructive surgery. The purpose of our study was to demonstrate the imaging features of various anatomical variants of IHD using magnetic resonance cholangio-pancreatography (MRCP) and their prevalence in our population. Material/Methods This observational clinical evaluation study included 224 patients who were referred for MRCP. MRCP was performed in a 1.5-Tesla magnet (Philips) with SSH MRCP 3DHR and SSHMRCP rad protocol. A senior radiologist assessed the biliary passage for anatomical variations. Results The branching pattern of the right hepatic duct (RHD) was typical in 55.3% of subjects. The most common variant was right posterior sectoral duct (RPSD) draining into the left hepatic duct (LHD) in 27.6% of subjects. Trifurcation pattern was noted in 9.3% of subjects. In 4% of subjects, RPSD was draining into the common hepatic duct (CHD) and in 0.8% of subjects into the cystic duct. Other variants were noted in 2.6% of subjects. In 4.9% of cases there was an accessory duct. The most common type of LHD branching pattern was a common trunk of segment 2 and 3 ducts joining the segment 4 duct in 67.8% of subjects. In 23.2% of subjects, segment 2 duct united with the common trunk of segment 3 and 4 and in 3.4% of subjects segment 2, 3, and 4 ducts united together to form LHD. Other uncommon branching patterns of LHD were seen in 4.9% of subjects. Conclusions Intrahepatic bile duct anatomy is complex with many common and uncommon variations. MRCP is a reliable non-invasive imaging method for demonstration of bile duct morphology, which is useful to plan complex surgeries and to prevent iatrogenic injuries. PMID:27298653

  17. 冷冻后切除第Ⅷ段肝癌%Resection of segment VIII of liver after cryotherapy for hepatocarcinoma

    Institute of Scientific and Technical Information of China (English)

    韦长元; 杨伟萍; 刘剑仑; 陈建思; 李挺; 杨南武

    2001-01-01

    Objective To study the applicable value of resection of segment VIII after cryotherapy for hepatocarcinoma. Methods As for 8 patients with hepatocarcinoma in segment VIII, the turnor was dealt with cryotherapy before resected. Results All the tumors were resected smoothly after cryotherapy with less bleeding (mean 430ml), less time (mean 138min) and without severe complications or postoperative death in this series. Conclusions Resection of segment VIII after cryotherapy for hepatocarcinoma is proved safe and feasible, whitch can decrease blood loss, save time, reduce tissue injury, and decrease postoperative recurrence.%目的评价冷冻后切除第Ⅷ段肝癌的应用价值。方法对8例第Ⅷ段肝癌先冷冻成冰球后,再作手术切除。结果冷冻后能顺利切除第Ⅷ段肝癌,术中出血平均430ml,手术时间平均138min,术后无严重并发症及手术死亡。结论冷冻后切除第Ⅷ段肝癌是安全可行的,且出血少、省时、损伤组织少和可降低复发。

  18. Resection of Segments 4, 5 and 8 for a Cystic Liver Tumor Using the Double Liver Hanging Maneuver

    Directory of Open Access Journals (Sweden)

    Atsushi Nanashima

    2008-03-01

    Full Text Available To achieve complete anatomic central hepatectomy for a large tumor compressing surrounding vessels, transection by an anterior approach is preferred but a skillful technique is necessary. We propose the modified technique of Belghiti’s liver hanging maneuver (LHM. The case was a 77-year-old female with a 6-cm liver cystic tumor in the central liver compressing hilar vessels and the right hepatic vein. At the hepatic hilum, the spaces between Glisson’s pedicle and hepatic parenchyma were dissected, which were (1 the space between the right anterior and posterior Glisson pedicles and (2 the space adjacent to the umbilical Glisson pedicle. Two tubes were repositioned in each space and ‘double LHM’ was possible at the two resected planes of segments 4, 5 and 8. Cut planes were easily and adequately obtained and the compressed vessels were secured. Double LHM is a useful surgical technique for hepatectomy for a large tumor located in the central liver.

  19. Applied 3-D anatomy of liver bile ducts in injection-corrosion casts

    Directory of Open Access Journals (Sweden)

    Jurković Dragica M.

    2013-03-01

    Full Text Available On the 20 post-autopsy adult isolated liver specimens of patients of both sexes (17 male and 3 female aged 29-88, the injection-corrosion method was used. Colored acrylate was injected into the biliary system, and uncolored acrylate into the portal vein. A total of 17 acrylate casts were of proper quality. Within the 9 portal segments, both the anatomical determination and quantity and the mode of confluence of intrahepatic bile ducts were established. Different modes of biliary tract confluence up to the sectors and hepatics were found. Besides the most frequent findings of convention­ally confluence bile ducts, there were aberrant modalities of biliary drainage in eight cases. Among them 5 cases had confluence of posterior and anterior sector ducts in the left hepatic duct and 1 case had confluence at first of anterior and then posterior sector ducts in the left hepatic duct. Also, extrahilar connection of the right posterior with left lateral into common hepatic duct, where the latter entered the medial and anterior sectors ducts in 1 case was found. There was a subsequent confluence of ducts from the 8th and 5th segments in 1 case, and from the lateral and medial sectors with or without caudate lobe in 3 cases. A common (4 or separate (2 confluence of left and right portions ducts in the left drainage system were in 6 cases, whereas in both, the left and right drainage system in 7 cases was found. Rare, there was an aberrant single channel from the right portion in 1 case, as well as the presence and biliary drainage only of the left portion of 1st segment was found. Segment 9 bile ducts drained all three subsegments (b, c and d in 10 cases, and only two (c and d in 3 cases, as well as only two (c and b of present three subsegments in 3 cases. Also, there was even one case with present 9d subsegment and without 9th segment duct. Those modalities are of interest in an applying and accurate interpretation and performance of diagnostic and

  20. What Should You Ask Your Doctor about Bile Duct Cancer?

    Science.gov (United States)

    ... support? Along with these sample questions, be sure to write down some of your own. For instance, you ... Diagnosed? How is Bile Duct Cancer Staged? Survival Statistics for Bile Duct Cancers Resectable Versus Unresectable Bile ...

  1. Tumor Implantation into the Intrahepatic Bile Duct after Percutaneous Ethanol Injection Therapy for Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Shogo Tanaka

    2009-11-01

    Full Text Available A 74-year-old man who had undergone transcatheter arterial embolization for hepatitis C virus-related hepatocellular carcinoma (Couinaud’s segment III/IV in April 2003 and percutaneous ethanol injection for recurrence at the same site in February 2006 was found to have dilation of the intrahepatic bile duct by computed tomography in October 2008. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography showed a thrombosis occupying the left hepatic duct to the lateral branches with peripheral bile duct dilation. Serum concentration of alpha-fetoprotein was elevated. We performed a left hepatectomy under a preoperative diagnosis of hepatocellular carcinoma with bile duct invasion. The cut surface of the resected specimen showed a tumor thrombosis occupying the region between the left hepatic duct and lateral branches, but no tumor in the liver parenchyma. Histologic examination showed that the thrombosis in the intrahepatic bile duct was hepatocellular carcinoma. Since part of the hepatocellular carcinoma in the region treated with percutaneous ethanol injection was adjacent to the tumor thrombosis in the intrahepatic bile duct in diagnostic imaging, we diagnosed implantation into the intrahepatic bile duct due to percutaneous ethanol injection. The postoperative course was uneventful and the patient is doing well without recurrence 8 months after the operation.

  2. Isolated Roux-en-Y anastomosis of the pancreatic stump in a duct-to-mucosa fashion in patients with distal pancreatectomy with en-bloc celiac axis resection.

    Science.gov (United States)

    Okada, Ken-Ichi; Kawai, Manabu; Tani, Masaji; Hirono, Seiko; Miyazawa, Motoki; Shimizu, Atsushi; Kitahata, Yuji; Yamaue, Hiroki

    2014-03-01

    A pancreatic fistula is one of the most serious complications in distal pancreatectomy with en bloc celiac axis resection (DP-CAR), because the pancreatic transection is performed on the right side of the portal vein, which results in a large cross-section surface, and because post-pancreatectomy hemorrhage is hard to treat by interventional radiology. Therefore, a procedure to decrease the incidence of postoperative pancreatic fistula is urgently needed. Twenty-six consecutive patients who underwent DP-CAR between April 2008 and August 2012 were reviewed retrospectively. The first 13 consecutive patients underwent DP-CAR with no anastomosis, and the subsequent 13 consecutive patients were treated with Roux-en-Y pancreaticojejunostomy (PJ) in a duct-to-mucosa fashion. Extremely high amylase levels (>4000 IU/l) of all drainage fluid specimens on postoperative day (POD) 1, 3 and 4 were detected more frequently in cases with no anastomosis (n = 7) compared to those with PJ (n = 1) (P = 0.056). The incidence of grade B/C pancreatic fistulas was 15.4% in cases with isolated Roux-en-Y anastomosis of the pancreatic stump performed in a duct-to-mucosa fashion, and we are currently examining whether this anastomosis method reduces the pancreatic fistula rate in a multicenter, randomized controlled trial for distal pancreatectomy patients (ClinicalTrials.gov NCT01384617). © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  3. Segmental resection and reconstruction of bone neoplasms%骨肿瘤病段切除并骨缺损修复

    Institute of Scientific and Technical Information of China (English)

    杨安礼

    2001-01-01

    Objective To restore the function of extrimities in patients with bone neoplasms, segmental resection and reconstruction of bone neoplasms was performed. Methods The limb was conserved and bone defect repaired by artificial prosthesis vascularized bone graft, osteoarticular allograft, sliding graft, and bone cement following segmental resection of bone neoplasms. Results 26 patients were treated. No recurrence was found and a good union of bone observed locally in vascularized bone grafting and sliding grafting, in some sites osteoarticular allograft transplantation caused rejector reaction, bone cement plugging was appropriate to repair of neoplasms in special location, functions of the joint were well recovered in arthroplastey. Conclusion It is effective that a suitable bone substitutes to repair bone defect after segmental resection of bone neoplasms, in some patients with benign or low malignancy bone tumor.%目的修复切除骨肿瘤后的骨缺损肢体,恢复其功能。方法采用特制人工金属假体、带血管蒂游离骨、异体关节、自体骨、骨水泥等修复骨缺损。结果 26例中应用带血管蒂游离骨或自体骨植骨术愈合最佳并且无复发;异体骨移植有一定的排异反应;骨水泥填塞只适用于特殊部位骨缺损的修复;人工假体修复,功能恢复良好。结论对某些良性骨肿瘤及低度恶性的骨肿瘤作病段切除后,选择适当的替代物修复缺损行之有效。

  4. Robot-assisted segmental resection of tubal pregnancy followed by end-to-end reanastomosis for preserving tubal patency and fertility

    Science.gov (United States)

    Park, Joo Hyun; Cho, SiHyun; Choi, Young Sik; Seo, Seok Kyo; Lee, Byung Seok

    2016-01-01

    Abstract The objective of this study was to evaluate whether robotic tubal reanastomosis after segmental resection of tubal pregnancy is a feasible means of preserving tubal integrity and natural fertility in those with compromised contralateral tubal condition. The study was performed at a university medical center in a retrospective manner where da Vinci robotic system-guided segmental resection of tubal ectopic mass followed by reanastomosis was performed to salvage tubal patency and fertility in those with a single viable fallopian tube. Of the 17 patients with tubal pregnancies that were selected, 14 patients with successful tubal segmental resection and reanastomosis were followed up. The reproducibility of anastomosis success and cumulative pregnancy rates of up to 24 months were analyzed. Patient mean age was 28.88 ± 4.74 years, mean amenorrheic period was 7.01 ± 1.57 weeks and mean human chorionic gonadotropin (hCG) level was 9289.00 ± 7510.00 mIU/mL. The overall intraoperative cancellation rate due to unfavorable positioning or size of the tubal mass was 17.65% (3/17), which was converted to either salpingectomy or milking of ectopic mass. Of the 14 attempted, anastomosis for all 14 cases was successful, with 1 anastomotic leakage. One patient wishing to postpone pregnancy and 2 patients where patency of the contralateral tube was confirmed during the operation, were excluded from the pregnancy outcome analysis. Cumulative pregnancy rate was 63.64% (7/11), with 3 (27.27%) ongoing pregnancies, 3 (27.27%) livebirths, and 1 missed abortion at 24 months. During the follow-up, hysterosalpingography (HSG) was performed at 6 months for those who consented, and all 10 fallopian tubes tested were patent. No subsequent tubal pregnancies occurred in the reananstomosed tube for up to a period 24 months. For patients with absent or defective contralateral tubal function, da Vinci-guided reanastomosis after segmental resection of tubal pregnancy is

  5. Intrahepatic Transposition of Bile Ducts

    Science.gov (United States)

    Delić, Jasmin; Savković, Admedina; Isaković, Eldar; Marković, Sergije; Bajtarevic, Alma; Denjalić, Amir

    2012-01-01

    Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications. PMID:22550601

  6. Current surgical treatment for bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Yasuji Seyama; Masatoshi Makuuchi

    2007-01-01

    Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD (hepatopancreatoduodenectomy) has been applied to selected patients with widespread tumors. Preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

  7. Laser-guided repair of complex bile duct strictures.

    NARCIS (Netherlands)

    Gulik, T. van; Beek, J.; Reuver, P. de; Aronson, D.C.; Delden, O. van; Busch, O.; Gouma, D.

    2009-01-01

    BACKGROUND: The repair of bile duct strictures (BDS) requires identification of healthy bile duct proximal to the stenosis. Identification may be difficult in complex bile duct injuries after cholecystectomy or partial liver resection. AIM: We describe a technique to identify the prestenotic bile du

  8. Systematic review and meta-analysis of outcomes after liver resection in patients with hepatocellular carcinoma (HCC) with and without bile duct thrombus

    Science.gov (United States)

    Navadgi, Suresh; Chang, Chi-Chun; Bartlett, Adam; McCall, John; Pandanaboyana, Sanjay

    2016-01-01

    Introduction This meta-analysis aimed to compare perioperative and survival outcomes in patients who underwent hepatectomy with and without Bile Duct Tumour Thrombus (BDTT). Methods A comprehensive search of Cochrane Library, PubMed, MEDLINE and EMBASE was performed to identify relevant articles. The perioperative, postoperative and long term outcomes were compared. Results Eleven studies including 6051 patients met the inclusion criteria. The perioperative outcomes were comparable between the 2 groups. The BDTT group had higher proportion poorly differentiated tumours (OR = 1.87, X2 = 10.00, df = 6, p = 0.002, I2 = 40%), Lymphovascular invasion (LVI) (OR = 4.85, X2 = 28.21, df = 9, p = <0.001, I2 = 68%) and Macrovascular invasion (MVI) (OR = 5.41, X2 = 8.73, df = 9, p = <0.001, I2 = 0%). There was no difference in 1 and 3 year survival, however 5-yr survival was poorer in the BDTT group (OR = 0.37, X2 = 37.04, df = 7, p = <0.001, I2 = 81%). The mean difference (MD) in overall survival in the BDTT group was −20 months [−32.31, −7.06], p = 0.002, I2 = 95%. Conclusion Patients with HCC with BDTT had more advanced stage HCC with adverse histological features including higher rates of MVI, LVI and poor differentiation. Hepatectomy in this group of patients offers similar survival at 3 years but inferior long-term survival and should be considered when feasible. PMID:27037199

  9. Multimodal navigated skull base tumor resection using image-based vascular and cranial nerve segmentation: A prospective pilot study

    Directory of Open Access Journals (Sweden)

    Parviz Dolati

    2015-01-01

    Conclusion: Image-based preoperative vascular and neural element segmentation with 3D reconstruction is highly informative preoperatively and could increase the vigilance of neurosurgeons for preventing neurovascular injury during skull base surgeries. Additionally, the accuracy found in this study is superior to previously reported measurements. This novel preliminary study is encouraging for future validation with larger numbers of patients.

  10. Primary treatment of mandibular ameloblastoma with segmental resection and free fibula reconstruction: achieving satisfactory outcomes with low implant-prosthetic rehabilitation uptake.

    Science.gov (United States)

    Ooi, Adrian; Feng, Jiajun; Tan, Hiang Khoon; Ong, Yee Siang

    2014-04-01

    Ameloblastoma is a locally aggressive and disfiguring oral cavity tumour and surgical management is the mainstay of treatment. The ideal management of ameloblastoma should minimise recurrence, restore function and appearance and present minimal donor site morbidity. Conservative management is associated with minimal downtime but high recurrence rates. By contrast, segmental mandibulectomy with appropriate margins have much lower recurrence rates but presents the challenge of reconstruction. Osseointegrated (OI) implants and permanent dental prosthesis, while ideal, are not always available. We conducted a retrospective review on 30 consecutive patients at our centre with unicystic and multicystic ameloblastoma who were treated with segmental mandibular resection and free fibula flap reconstruction. Only three patients underwent OI implant insertion, with 40% of the patients not receiving any form of dental rehabilitation. We performed a functional and aesthetic outcome survey to determine patient satisfaction with this form of treatment. At an average follow-up of 5 years, there were no recurrences of tumour in our population. Of the 26 patients who responded to the survey, 96% of the patients reported that they were satisfied with their appearance, 88% reported an absolutely normal diet and 93% of the patients reported no problems with donor site function. Overall, we found that low uptake of dental rehabilitation did not adversely affect patient satisfaction and outcomes. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Salivary duct carcinoma

    DEFF Research Database (Denmark)

    Breinholt, Helle; Elhakim, Mohammad Talal; Godballe, Christian;

    2016-01-01

    1990 to 2005 were identified. Histological slides were reviewed, and data concerning demographics, tumour site, clinical stage, treatment profiles and follow-up were retrieved. Survival estimates and prognostic factors were evaluated by comparing Kaplan-Meier plots using the Mantel-Haenszel log......-rank test. RESULTS: Salivary duct carcinoma showed an incidence of 0.04/100.000 inhabitants/year. Distant recurrence was seen in 52% of patients. Five-year overall survival, disease-specific survival and recurrence-free survival were 32%, 42% and 35%, respectively. Univariate analyses suggested that overall...... stage (III/IV) and vascular invasion have a negative impact on all survival measures. Involved resection margins correlated with a poorer overall survival and disease-specific survival, whereas adjuvant radiotherapy improved overall survival and recurrence-free survival. CONCLUSIONS: Salivary duct...

  12. Intestinal prolapse through a persistent omphalomesenteric duct causing small-bowel obstruction.

    Science.gov (United States)

    Pauleau, Ghislain; Commandeur, Diane; Andro, Christophe; Chapellier, Xavier

    2012-07-11

    Persistent omphalomesenteric duct as a cause of small-bowel obstruction is an exceptional finding. A neonate presented with occlusion due to intestinal prolapse through a persistent omphalomesenteric duct. Remnants of the duct were successfully resected, and the postoperative course was uneventful. We discuss the presentation of omphalomesenteric duct and its management.

  13. Large Segment Bone Allograft Reconstruction Following Femur Tumors Resection%大段异体骨移植重建股骨肿瘤性缺损

    Institute of Scientific and Technical Information of China (English)

    贾金鹏; 毕文志; 韩纲; 王威; 许猛; 李静东

    2012-01-01

    目的 探讨大段异体骨移植在股骨肿瘤扩大切除后缺损重建中的作用及临床效果.方法 回顾性分析从2005年1月至2010年1月共30例患者.均行股骨肿瘤保肢手术并采用大段异体骨重建肿瘤切除后缺损的患者.结果 22例患者获得随访,8例患者失访.10例患者死于多发转移.12例存活的患者随访时间为20个月至7年,平均随访时间4.2年.所有患者术后X线片显示异体骨位置良好.6例发生延迟愈合或不愈合.其中有5例发生应力性骨折,1例患者发生深部感染.2例患者发生内固定失败.1例患者局部复发.所有患者中未发现明显的排斥反应.结论 大段异体骨移植能够获重建股骨肿瘤后较大的骨缺损,满足了部分股骨肿瘤保肢治疗的需要,是股骨肿瘤保肢治疗中一种可以选择的方法.%Objective Probe into the feasibility of the clinical outcome of large segment bone allograft for reconstruction of the defect after femur tumor resection. Methods During January 2005 to January 2010, 30 patients were carried out limb-spanng surgery due to femur tumors, and large segment bone allograft was used to reconstruction the bone defects after tumor resection. Results 22 patients were followed up; 8 patients were lost of follow-up. 10 patients died of generalized metastases. Patients were followed up from 20 months to 7 years. The mean follow-up was 4. 2 years. There were 6 patients had delayed union or nonunion, 5 patients had stress fractures, 1 patient occurred primary deep infection. Failure of the internal fixation system occurred in 2 patients, lpatient had local recurrences. No evident immune rejection was observed. Conclusions Large segment bone allograft can meet to the present demand in reconstruction of the massive defect following femur tumor resection, and still to be a very useful alternative to prosthesis in limb-sparing surgery of femur tumors.

  14. Efficacy of transurethral resection of ejaculatory duct for treatment of ejaculatory duct obstruction: Report of 60 cases%经尿道射精管切开术治疗射精管梗阻的效果(附60例报告)

    Institute of Scientific and Technical Information of China (English)

    涂响安; 赵良运; 赵亮; 王文卫; 邓立文; 陈羽; 邓春华

    2011-01-01

    目的:探讨经尿道射精管切开术(transurethral resection of ejaculatory duct,TURED)治疗射精管梗阻( ejaculatory duct obstruction,EDO)的效果.方法:2004年10月至2010年10月期间收治60例EDO患者,常规采用精液分析、精浆果糖和经直肠超声检查对其进行诊断,必要时行输精管造影检查.60例EDO患者均行TURED治疗,术后随访其疗效.结果:60例EDO患者的精液量为0.2~3.5 mL,平均(1.10±0.76) mL,pH值5.8 ~7.6,平均6.5±1.4;精浆果糖为一次射精0~ 51.4 μmol,平均为(5.86±2.19) μmol.经直肠超声检查结果为:单纯射精管扩张者15例,前列腺囊肿6例,单纯双侧精囊扩张10例,单侧精囊扩张4例,精囊扩张并射精管扩张10例,精囊扩张合并前列腺囊肿5例,单侧精囊扩张并对侧精囊发育不良或缺乏2例,精囊扩张并射精管扩张和钙化3例,单侧精囊扩张并射精管扩张和对侧精囊发育不良或缺乏5例.所有患者均完成手术,术后随访6 ~ 78个月.60例EDO患者行TURED术后,51例(85.0%)精液检查有不同程度的改善,16例(26.7%)妻子妊娠.结论:TURED是治疗EDO的一种简单、微创和有效的方法.

  15. Mucin-hypersecreting bile duct neoplasm characterized by clinicopathological resemblance to intraductal papillary mucinous neoplasm (IPMN of the pancreas

    Directory of Open Access Journals (Sweden)

    Harimoto Norifumi

    2007-08-01

    Full Text Available Abstract Background Although intraductal papillary mucinous neoplasm (IPMN of the pancreas is acceptable as a distinct disease entity, the concept of mucin-secreting biliary tumors has not been fully established. Case presentation We describe herein a case of mucin secreting biliary neoplasm. Imaging revealed a cystic lesion 2 cm in diameter at the left lateral segment of the liver. Duodenal endoscopy revealed mucin secretion through an enlarged papilla of Vater. On the cholangiogram, the cystic lesion communicated with bile duct, and large filling defects caused by mucin were observed in the dilated common bile duct. This lesion was diagnosed as a mucin-secreting bile duct tumor. Left and caudate lobectomy of the liver with extrahepatic bile duct resection and reconstruction was performed according to the possibility of the tumor's malignant behavior. Histological examination of the specimen revealed biliary cystic wall was covered by micropapillary neoplastic epithelium with mucin secretion lacking stromal invasion nor ovarian-like stroma. The patient has remained well with no evidence of recurrence for 38 months since her operation. Conclusion It is only recently that the term "intraductal papillary mucinous neoplasm (IPMN," which is accepted as a distinct disease entity of the pancreas, has begun to be used for mucin-secreting bile duct tumor. This case also seemed to be intraductal papillary neoplasm with prominent cystic dilatation of the bile duct.

  16. Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach

    Institute of Scientific and Technical Information of China (English)

    Ying-Jun Chen; Zuo-Jun Zhen; Huan-Wei Chen; Eric CH Lai; Fei-Wen Deng; Qing-Han Li; Wan Yee Lau

    2014-01-01

    BACKGROUND: With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle's maneuver, especially in patients with cirrhosis. METHOD: From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie assistance. RESULTS: The types of liver resection included right hepatectomy (n=1), right posterior sectionectomy (n=1), left hepatectomy and common bile duct exploration (n=1), segment 4b resection (n=1), left lateral sectionectomy (n=2), and wedge resection (n=2). Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3 minutes. The mean duration of vascular inflow occlusion was 54.5 minutes. The mean intraoperative blood loss was 361 mL. No patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 days. CONCLUSION: Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approach was safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.

  17. Impact of blood loss on outcome after liver resection

    NARCIS (Netherlands)

    de Boer, Marieke T.; Molenaar, I. Quintus; Porte, Robert J.

    2007-01-01

    Partial liver resections are the treatment of choice for patients with a malignant liver or bile duct tumor. The most frequent indications for partial liver resections are colorectal metastasis, hepatocellular carcinoma (HCC) and cholangiocarcinoma. Liver resection is the only therapy with a chance

  18. Latent vitellointestinal duct sinus presenting with massive lower gastrointestinal bleeding in an adolescent.

    Science.gov (United States)

    Patel, Ramnik V; Evans, Kathryn; Sau, Indranil; Huddart, Simon

    2014-09-16

    A 12-year-old boy with a history, at birth, of a weeping pink fleshy lesion after his umbilical cord detached, requiring repeated chemical cauterisation, presented with massive lower gastrointestinal bleeding and required resuscitation and blood transfusion. Augmented Tc99m nuclear medicine scan confirmed ectopic gastric mucosa. The lateral view suggested its attachment behind the umbilicus. At exploration, a latent vitellointestinal duct sinus with ectopic gastric mucosal mass was found. Segmental resection of the sinus and mass excision with primary anastomosis and incidental appendicectomy was curative. Pink fleshy mass discharging coloured fluid at the umbilicus following detachment of umbilical cord should be considered a remnant of vitellointestinal duct unless proved otherwise. A pink lesion with yellowish discharge resistant to chemical cauterisation should raise the suspicion of embryonic structures. Latent vitellointestinal sinus is a new lesion in the spectrum of umbilical anomalies. Lateral view of the nuclear medicine scan is helpful in locating the site.

  19. Imaging findings of neuroendocrine neoplasm in biliary duct with liver metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Jung Hwa; Chung, Dong Jin; Hahn, Sung Tae; Lee, Jae Moon [Dept. of Radiology, Yeouido St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2013-09-15

    A 64-year-old man was transferred to our hospital because of indigestion and jaundice. The initial abdominal CT and MRI revealed a 2.0 cm enhancing mass in the proximal common bile duct (CBD) with several enlarged lymph nodes. The mass was presumed to be a cholangiocarcinoma, and a CBD segmental resection and choledochojejunostomy was performed. However, the final diagnosis was that of a mixed endocrine-exocrine carcinoma, a high-grade neuroendocrine neoplasm. Seven months after the operation, a follow-up abdominal CT study revealed multiple small arterial enhancing nodules in both hepatic lobes. A sono-guided liver biopsy confirmed these as metastastic mixed endocrine-exocrine carcinoma. This case is unique in that the imaging study regarding the neuroendocrine neoplasm of biliary duct has not been previously reported.

  20. [Surgical therapy of proximal extrahepatic bile duct tumors (Klatskin tumors)].

    Science.gov (United States)

    Timm, S; Gassel, H-J; Thiede, A

    2007-08-01

    Due to their anatomical position, the tendency of early infiltrative growth and their poor prognosis without treatment, klatskin tumors are challenging concerning diagnosis and therapy. In contrast to other tumors of the gastrointestinal tract, for which exact diagnostic and stage dependent therapeutic guidelines could be formulated, clear recommendations for klatskin tumors are missing. Thus, survival rates after local resection, e. g. resection of the bile duct bifurcation alone, show high rates of R1/2 resection and early tumor recurrence. With an additional hepatic resection formally curative resections and long-term survival can be improved. Extended liver resections including the portal vein provide the highest rates of R0 resections for hilar carcinomas of the extrahepatic bile duct. Survival rates after liver transplantation for klatskin tumors are not yet convincing. Promising first results have been reported for the combination of neoadjuvant treatment and liver transplantation and might show future perspectives for the treatment of klatskin tumors.

  1. 胆道探查术中胆总管下端穿通伤15例诊治分析%Diagnosis and treatment of penetrating injury in distal segment of common bile duct during biliary tract exploration

    Institute of Scientific and Technical Information of China (English)

    杜立学; 张煜; 吴武军; 耿西林; 李晖; 刘青光

    2009-01-01

    回顾性分析15例在胆道探查术中发牛胆道下端穿通伤患者的临床资料.9例为术中发现,行胆总管T形管引流并十二指肠侧后腹膜间隙引流,平均住院16 d,均痊愈;6例为术后发现,4例再次手术引流,住院8~12周痊愈,2例因感染性休克多脏器功能衰竭死亡.胆道穿通伤于术中及时发现、正确处理、充分引流,可获痊愈;术后早期发现,施以有效引流也可避免严重的并发症发生.%Clinical data of 15 patients with penetrating injury in the distal segment of the common bile duct during biliary tract exploration were retrospectively analyzed.Nine injuries were found during the surgical procedures and successfully treated with common bile duct T tube and peritoneal drainage before discharged from the hospital (mean hospitalization time 16 days).Six penetrating wounds were found post-operatively, and underwent another operation.Four patients were fully recovered at 8 to 12 weeks, and 2 died from multiple organ failure caused by infectious shock.Our investigation suggests that for the penetrating injury in the distal part of the common bile duct, early diagnosis, proper management and effective draining may improve the survival of the patients and avoid serious complications.

  2. Proximal Gastrojejunal Reconstruction after Pancreaticoduodenal Resection

    Directory of Open Access Journals (Sweden)

    M. Wayne

    2012-01-01

    Full Text Available Introduction. Reconstruction by proximal gastrojejunostomy, and distal biliary and pancreatic anastomoses is infrequently used after resection of the head of the pancreas because of fear of fistulas and cholangitis. Pancreaticoduodenectomy is being performed more frequently for cystic malignant and premalignant lesions. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct, since multi-centricity is characteristic of some of these malignancies. Since endoscopic access of the bile duct and pancreatic duct is difficult and unsuccessful in 50–70% after B II or Roux Y reconstruction, we prospectively studied the merit and complications (early and late of proximal gastrojejunal (PGJ reconstruction after pancreaticoduodenal resection. Material and Methods. Thirty nine consecutive, non-radomized patients underwent pancreaticoduodenectomy and PGJ reconstruction over 14 mos. There were 21 males and 18 females. Results. 7 patients with IPMN have undergone repeat CT scanning for surveillance, with 3 requiring repeat EUS and ERCP. There were no technical difficulties accessing the pancreas or the pancreatic duct, supporting the PGJ reconstruction. Conclusion. Proximal gastrojejunal reconstruction following pancreaticoduodenal resection may be safely done with similar morbidity to traditional pancreaticojejunal reconstructions. PGJ reconstruction may be of greater value when direct visual access to the bile duct or pancreatic duct is necessary, and should be considered when doing resection for mucinous cysts or IPMN of the head of the pancreas.

  3. Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery: An algorithmic approach

    Institute of Scientific and Technical Information of China (English)

    Georgios Fragulidis; Athanasios Marinis; Andreas Polydorou; Christos Konstantinidis; Georgios Anastasopoulos; John Contis; Dionysios Voros; Vassilios Smyrniotis

    2008-01-01

    AIM:To investigate injuries of anatomy variants of hepatic duct confluence during hepatobiliary surgery and their impact on morbidity and mortality of these procedures. An algorithmic approach for the management of these injuries is proposed.METHODS: During a 6-year period 234 patients who had undergone major hepatobiliary surgery were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic and magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy and fistulography.RESULTS: Thirty (12.8%) patients who developed postoperative bile leaks were identified. Endoscopic stenting and percutaneous drainage were successful in 23 patients with bile leaks from the liver cut surface.In the rest seven patients with injuries of hepatic duct confluence, biliary variations were recognized and a stepwise therapeutic approach was considered.Conservative management was successful only in 2 patients. Volume of the liver remnant and functional liver reserve as well as local sepsis were used as criteria for either resection of the corresponding liver segment or construction of a biliary-enteric anastomosis. Two deaths occurred in this group of patients with hepatic duct confluence variants (mortality rate 28.5%).CONCLUSION: Management of major biliary fistulae that are disconnected from the mainstream of the biliary tree and related to injury of variants of the hepatic duct confluence is extremely challenging. These patients have a grave prognosis and an early surgical procedure has to be considered.

  4. Amputation neuroma mimics common hepatic duct carcinoma.

    Science.gov (United States)

    Koike, N; Todoroki, T; Kawamoto, T; Inagawa, S; Yoshida, S; Fukao, K

    2000-01-01

    Most amputation neuromas of the biliary tract occur in the cystic duct stump after cholecystectomy and are asymptomatic. However, when they arise in the main hepatic duct and are associated with obstructive jaundice, it is difficult to distinguish them from carcinoma. We describe a case in which preoperative differential diagnosis was difficult. A 60-year-old man was admitted to the Institute of Clinical Medicine, University of Tsukuba, with a chief complaint of jaundice. Cholangiography showed an irregularly elevated nodular lesion on the lateral wall of the common hepatic duct and multiple floating stones in the choledochus. Ultrasonography and computed tomography revealed one-sided regional thickening of the common hepatic duct associated with dilatation of the intrahepatic and extrahepatic bile ducts. Carbohydrate antigen 19-9 level was markedly elevated to 11,200 IU/mL in the bile juice, but was only 38 IU/mL in the serum, below the limit of abnormality. Cholangioscopy showed papillary tumor with coarse granular surface mimicking papillary carcinoma, but biopsy revealed no malignancy. The patient underwent hepaticocholedochus resection. Although the macroscopic finding from the surgical specimens was papillary carcinoma of the common hepatic duct penetrating to the hepatoduodenal ligament, histopathological examination revealed an amputation neuroma consisting of hypertrophic nerve tissues and giant cells containing foreign bodies, probably as a consequence of a previous cholecystectomy. The postoperative course was uneventful and the patient has been living well for the 5 years since the resection.

  5. Mammary Duct Ectasia

    Science.gov (United States)

    ... tenderness or inflammation of the clogged duct (periductal mastitis). Mammary duct ectasia most often occurs in women ... that's turned inward (inverted) A bacterial infection called mastitis also may develop in the affected milk duct, ...

  6. [Resection of Klatskin tumors].

    Science.gov (United States)

    Seehofer, D; Kamphues, C; Neuhaus, P

    2012-03-01

    Curative treatment of Klatskin tumors by radical surgical procedures with surgical preparation distant to the tumor region results in 5-year survival rates of 30-50%. This requires mandatory en bloc liver resection and resection of the extrahepatic bile duct often together with vascular resection. Nevertheless, the ideal safety margin of 0.5-1 cm remote from the macroscopic tumor extensions cannot be achieved in all cases. Based on hilar anatomy the probability of an adequate safety margin is higher using extended right hemihepatectomy together with portal vein resection compared to left hemihepatectomy. However, due to severe atrophy of the left liver lobe solely left-sided hepatectomy is feasible in some patients. In cases of eligibility for both procedures right hemihepatectomy is preferentially used due to the higher oncological radicality if sufficient liver function is present. Postoperative hepatic insufficiency and bile leakage after demanding biliary reconstruction, often with several small orifices, contribute to the postoperative complication rate of this complex surgical disease pattern.

  7. Congenital double bile duct presenting as recurrent cholangitis in a child

    Directory of Open Access Journals (Sweden)

    K.D. Chakravarty

    2015-12-01

    Full Text Available Double common bile duct (DCBD is a rare congenital anomaly. Most of these bile duct anomalies are associated with bile duct stones, anomalous pancreaticobiliary junction (APBJ, pancreatitis and bile duct or gastric cancers. Early detection and treatment is important to avoid long term complications. Surgical resection of the anomalous bile duct and reconstruction of the biliary enteric anastomosis is the treatment of choice. We report a rare case of DCBD anomaly in a girl, who presented with recurrent cholangitis. She had type Va DCBD anomaly. She underwent successful resection of the bile duct and reconstruction of the biliary enteric anastomosis. Preoperative imaging and diagnosis of the congenital biliary anomaly is very important to avoid intraoperative bile duct injury. Review of the literature shows very few cases of type Va DCBD, presenting with either bile duct stones or APBJ.

  8. Main-duct intraductal papillary mucinous adenoma of the pancreas

    Directory of Open Access Journals (Sweden)

    Takuma Kensuke

    2011-11-01

    Full Text Available Abstract Background The prevalence of carcinoma in main-duct intraductal papillary mucinous neoplasm (IPMN is high, and surgical resection is recommended for all patients with a main-duct IPMN. Results A main-duct IPMN with typical imagings including protruding lesions in the dilated main pancreatic duct was resected, but the histology was intraductal papillary mucinous adenoma of the pancreas. Discussion It has been reported that the presence of mural nodules and dilatation of MPD are significantly higher in malignant IPMNs. The presented case had protruding lesions in the dilated main pancreatic duct on endoscopic ultrasonography, but the histology was adenoma. Conclusion Preoperative distinction between benign and malignant IPMNs is difficult.

  9. [Laparoscopic liver resection: lessons learned after 132 resections].

    Science.gov (United States)

    Robles Campos, Ricardo; Marín Hernández, Caridad; Lopez-Conesa, Asunción; Olivares Ripoll, Vicente; Paredes Quiles, Miriam; Parrilla Paricio, Pascual

    2013-10-01

    After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc. To report our experience in laparoscopic liver resections (LLRs). Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS. 6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections. There was no perioperative mortality, and morbidity was 3%. With TLS the resection was completed in 23/28 cases, whereas with HAS it was completed in all 104 cases. Transfusion: 4,5%; operating time: 150min; and mean length of stay: 3,5 days. The 1-, 3- and 5-year survival rates for the primary malignant tumours were 100, 86 and 62%, and for colorectal metastases 92, 82 and 52%, respectively. LLR via both TLS and HAS in selected cases are similar to the results of open surgery (similar 5-year morbidity, mortality and survival rates) but with the advantages of minimally invasive surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  10. Topical intraperitoneal papaverine to minimize non-viable bowel resection from non-occlusive bowel ischemia in neonatal segmental volvulus: A case report

    Directory of Open Access Journals (Sweden)

    Roger Chen Zhu

    2016-10-01

    Full Text Available Arrest in the embryologic intestinal rotation around the superior mesenteric artery prevents proper mesenteric attachment and subjects the gut to volvulus and ischemia which may lead to bowel resection. The length of non-viable resected bowel has been shown by Teitelbaum et al. to be an independent predictor of survival in patients with postoperative short bowel syndrome (RR = 5.74, P = .003. Non-occlusive mesenteric ischemia (NOMI is a feed-forward loop of vasoconstriction that aggravates the primary ischemic injury. It is an initially reversible process and a potential point of intervention for preservation of viable bowel. The Boley et al. algorithm for management of adult NOMI utilizes intravascular papaverine infusion to increase intracellular cAMP, decreasing calcium concentration and halting vasospasm. We present a modified version of this approach using topical papaverine in the setting of neonatal post-ischemic NOMI, with the goal of minimizing bowel resection.

  11. Intraoperative laparoscope augmentation for port placement and resection planning in minimally invasive liver resection.

    Science.gov (United States)

    Feuerstein, Marco; Mussack, Thomas; Heining, Sandro M; Navab, Nassir

    2008-03-01

    In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, two major intraoperative issues in laparoscopic liver resection are the optimal planning of ports as well as the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided (e.g., clipped) prior to the resection. We propose an intuitive and precise method to plan the placement of ports. Preoperatively, self-adhesive fiducials are affixed to the patient's skin and a computed tomography (CT) data set is acquired while contrasting the liver vessels. Immediately prior to the intervention, the laparoscope is moved around these fiducials, which are automatically reconstructed to register the patient to its preoperative imaging data set. This enables the simulation of a camera flight through the patient's interior along the laparoscope's or instruments' axes to easily validate potential ports. Intraoperatively, surgeons need to update their surgical planning based on actual patient data after organ deformations mainly caused by application of carbon dioxide pneumoperitoneum. Therefore, preoperative imaging data can hardly be used. Instead, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. After patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and a 3-D volume is reconstructed during patient exhalation. Without any further need for patient registration, the reconstructed volume can be directly augmented on the live laparoscope video, since prior calibration enables both the volume and the laparoscope to be positioned and oriented in the tracking coordinate frame. The augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.

  12. 肾上段肝下下腔静脉肿瘤的手术治疗%Resection for tumors of the suprarenal infrahepatic segment of the inferior vena cava

    Institute of Scientific and Technical Information of China (English)

    陈建飞; 程志雷; 田远虎; 蔡俊; 苗成利; 罗成华; 朱继业

    2016-01-01

    目的 探讨不同类型肾上段肝下下腔静脉肿瘤的手术治疗方法.方法 回顾性分析8例肾上段肝下下腔静脉肿瘤患者的临床资料.根据肿瘤侵犯的范围不同及侧支形成情况分别采取肿瘤切除+下腔静脉血管重建术,肿瘤切除+右肾切除术.采用配对资料t检验的方式检测肿瘤切除术后肾功能的恢复情况.结果 肾上段肝下下腔静脉肿瘤完整切除.术后12 d患者肾功能均恢复正常.随访,7例24个月无复发,1例切除术后12个月复发而再次手术,再次切除后随访12个月未复发.结论 肾上段肝下下腔静脉肿瘤根据术前增强CT及下腔静脉造影,可判断肿瘤侵犯的范围以及侧支循环形成的情况,提高肿瘤切除率,保护肾功能.%Objective To evaluate surgical treatment for different types of tumor of the suprarenal infrahepatic segment of the inferior vena cava (IVC).Methods A retrospective analysis was made on 8cases of IVC leiomyosarcoma at the suprarenal infrahepatic IVC segment.According to the extent of tumor invasion and collateral circulations,operations included tumor resection plus inferior vena cava reconstruction or tumor resection plus right nephrectomy.Results Tumors were completly resected in all patients.Renal function recovered after operation.During a follow up of 24 mons,7 cases had no recurrence.One case with recurrence after 12 months underwent successful resection and is doing well after a follow-up of 12 months.Conclusion CT and inferior vena cavography can determine the extent of tumor invasion and collateral circulations helping select appropriate surgical aproach before the operation resulting in less renal injury.

  13. 完全腹腔镜肝Ⅶ段肿瘤切除术10例报告%Total laparoscopic partial liver resection for tumor originated from segment Ⅶ:a report of 10 cases

    Institute of Scientific and Technical Information of China (English)

    陈钟; 陈二林; 唐伟东; 常仁安; 朱李誽

    2014-01-01

    Objective To investigate the feasibility and safety of total laparoscopic partial liver resection for tumor originated from segment Ⅶ and introduce the surgical technique.Methods From Jun. 2013 to Mar.2014,10 cases of laparoscopic partial liver resection for tumor originated from segment Ⅶ in our hospital were analyzed retrospectively,including 8 cases of hepatocellular carcinoma,1 case of liver metastasis from colon cancer and 1 case of focal nodular hyperplasia.Child Classification and ICG R15 were used to evaluate hepatic reservation function preoperatively and three-dimensional CT imaging was used to assess the anatomical structure surrounding liver tumor such as blood vessels,intraoperative surgical approach is selected according to the liver lesion site and using ultrasonic knives,clips,Hem-o-lok and other laparoscopic equipments to dissect liver and complete partial liver resection.Results Total laparoscopic partial liver resection was carried successfully on 10 cases,with operative time between 105 to 215 minutes, blood loss between 50 to 500 ml. All patients recovered from the operation successfully with no complications.The average hospital stay postoperation was 7.0 d.Except one case of primary liver cancer with tumor rupture before operation were found to have peritonaeum metastasis about 2 months follow-up after operation,the rest has been found no evidence of tumor recurrence as yet.Conclusion Preoperative assessment of liver function and CT imaging,intraoperative adequate dissection and skilled application of the laparoscopic precise hepatectomy are the essential for successful and safe completion of laparoscopic partial liver resection for tumor originated from segment Ⅶ.%目的:探讨完全腹腔镜肝Ⅶ段肿瘤手术切除的可行性、安全性和手术技巧。方法回顾性分析2013年6月-2014年3月期间我院行完全腹腔镜下肝Ⅶ肿瘤切除10例患者的临床资料,其中原发性肝细胞癌8

  14. Multimodal Navigation in Endoscopic Transsphenoidal Resection of Pituitary Tumors Using Image-Based Vascular and Cranial Nerve Segmentation: A Prospective Validation Study.

    Science.gov (United States)

    Dolati, Parviz; Eichberg, Daniel; Golby, Alexandra; Zamani, Amir; Laws, Edward

    2016-11-01

    Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative cerebrospinal fluid leakage, and optic nerve injuries are all well-known complications, and the risk of adverse events is more likely in less-experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation coupled with neuronavigation in localizing neurovascular structures during TSS. Twenty-five patients with a pituitary tumor underwent preoperative 3-T magnetic resonance imaging (MRI), and MRI images loaded into the navigation platform were used for segmentation and preoperative planning. After patient registration and subsequent surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe or Doppler probe on or as close as possible to the target. Preoperative segmentation of the internal carotid artery and cavernous sinus matched with the intraoperative endoscopic and micro-Doppler findings in all cases. Excellent correspondence between image-based segmentation and the endoscopic view was also evident at the surface of the tumor and at the tumor-normal gland interfaces. Image guidance assisted the surgeons in localizing the optic nerve and chiasm in 64% of cases. The mean accuracy of the measurements was 1.20 ± 0.21 mm. Image-based preoperative vascular and neural element segmentation, especially with 3-dimensional reconstruction, is highly informative preoperatively and potentially could assist less-experienced neurosurgeons in preventing vascular and neural injury during TSS. In addition, the accuracy found in this study is comparable to previously reported neuronavigation measurements. This preliminary study is encouraging for future prospective intraoperative validation with larger numbers of patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Rehablitation of the devitalization and replantation after resection of malignant tumor segment around the knee%膝关节周围骨恶性肿瘤瘤段切除灭活再植术的康复治疗

    Institute of Scientific and Technical Information of China (English)

    俞光荣; 蔡宣松; 梅炯; 郭获萍; 袁锋

    2000-01-01

    Objective To study the rehabilitation related to recovery of the limb function for the devitalizationand replantation after resection of malignant tumor segment around the knee. Methods Seventy nine patients with themalignant tumor around the knee (proximal tibia 21 cases, distal femur 58 cases) were reviewed. There were 35 malesand 44 females, aged ranged from 8 to 66 years (mean, 31.5 years). The tumors commonly seen were osteosarcomas(57), giant cell tumors (6), MFH (6) and chondrosarcomas (5). The devitalization and replantation after intraarticu-lar resection of tumor segment (CRIRT) was performed in 75 cases, that after extraarticular resection of tumor seg-ment (CRERT) was used in 4 cases. Functional training with different programs were performed in three periods aftersurgery. Results Seventy nine patients were followed up for 1~ 7 years (mean, 4.2 years). 5 years survival rate was42 % (33 cases). Functional assessment using Ennekings criteria was evaluated. The mean score in 44 cases of CRIRTwas 20(14~25) points and satisfactory (good or excellent results were 77% (34/44). The mean score in 4 CRERTcases was 24(22~28) points and all were satisfactory. Conclusion The devitalization and replantation after resectionof tumor segment is a good limb salvage surgery for malignant tumor segment around the knee. Rehabilitation programshelp recovery of the limb function. (Shanghai Med J, 2000,23:724-727)%目的 探讨膝关节周围骨恶性肿瘤瘤段切除灭活再植术功能恢复相关的康复治疗。方法本组79例,其中胫骨上端21例,股骨远端58例。常见肿瘤中骨肉瘤57例,巨细胞瘤6例,恶性纤维组织细胞瘤6例,软骨肉瘤5例。关节内瘤段切除灭活再植75例,关节外瘤段切除灭活再植4例。术后分3个阶段采用不同的康复计划进行功能训练。结果79例随访1~7年(平均4.2年),5年生存率42%(33例)。按Enneking法功能评定,关节内瘤段切除灭活再植44

  16. NI-18MULTIMODAL NAVIGATION IN ENDOSCOPIC TRANS-SPHENOIDAL RESECTION OF PITUITARY TUMORS USING IMAGE-BASED VASCULAR AND CRANIAL NERVE SEGMENTATION: A PROSPECTIVE VALIDATION STUDY

    Science.gov (United States)

    Dolati, Parviz; Raber, Michael; Golby, Alexandra; Laws, Edward

    2014-01-01

    Trans-Sphenoidal surgery (TSS) is a well-known approach for treatment of pituitary tumors. However, in inexperienced hands, the risk of lateral misdirection and vascular damage, intraoperative CSF leakage, and optic nerve injury are all well-known complications of this procedure. This prospective study was conducted to validate the accuracy of image-based segmentation in localization of neurovascular structures during TSS. METHODS: Eight patients with pituitary tumor underwent preoperative 3TMRI, which included thin sectioned 3D space T2, 3D Time of Flight and MPRAGE sequences. Images were reviewed by an expert independent neuroradiologist. Imaging sequences were loaded in BrainLab iPlanNet (6/8) and Stryker (2/8) for segmentation and pre-op planning. After patient registration to the intra-op neuronavigation system and surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe. The pulses of the bilateral ICA were confirmed using micro-Doppler. RESULTS: Pre-operative segmentation of the ICA and cavernous sinus matched with the intra-operative endoscopic and micro-Doppler findings in all cases (Dice-coefficient =1). This information reassured surgeons regarding the lateral extent of bone removal at the sellar floor and the limits of lateral explorations. Perfect correspondence between image-based segmentation and endoscopic view was also found at the surface of the tumor and tumor-normal gland interfaces. This helped in preventing unnecessary removal of the normal pituitary gland. Image-guidance helped surgeon to localize the optic nerve and chiasm in 63% of case and Diaphragma sella in 50% of cases, which helped to determine the limits of upward exploration and decrease the risk of CSF leakage. CONCLUSION: Image-based pre-operative vascular and neural element segmentation especially with 3D reconstruction is highly informative preoperatively and helps young and inexperienced neurosurgeons to prevent

  17. [Melanoma of the bile ducts. Report of a case and review of the literature].

    Science.gov (United States)

    González, Q H; Medina-Franco, H; Aldrete, J S

    2001-01-01

    Primary malignant melanomas of the bile ducts are extremely rare, with only seven cases previously reported in the literature published in English. This report concerns a 67-year-old woman with a primary melanoma at the confluence of the hepatic ducts. She underwent resection and hepaticojejunostomy. Seventeen years later, she remains alive with no evidence of recurrence. A thorough review of the literature was done. Surgical resection can offer hope for long-term survival.

  18. Reconstruction of irradiated mandible after segmental resection of osteoradionecrosis-a technique employing a microvascular latissimus dorsi flap and subsequent particulate iliac bone grafting

    DEFF Research Database (Denmark)

    Hillerup, Soren; Elberg, Jens Jorgen; Thorn, Jens Jorgen

    2014-01-01

    The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot......, and the defect site was primed with a LD musculocutaneous flap wrapped around the reconstruction plate to bring in vascularized tissue and optimize healing conditions for a subsequent particulate iliac free bone graft reconstruction. The management of defect closure was successful in all 15 patients. Twelve...

  19. Percutaneous Transhepatic Bile Duct Ablation with n-Butyl Cyanoacrylate in the Treatment of a Biliary Complication after Split Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Andrea Lauterio

    2009-01-01

    Full Text Available Biliary complications continue to be a major cause of morbidity after split-liver transplantation (SLT. In this report we describe an uncommon late biliary complication. One year after SLT the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes. The segmentary bile duct of hepatic segment VI-VII draining in the left duct was unidentified and tied at the time of the in situ split-liver procedure. We perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n-butyl cyanoacrylate (NABC. The management of biliary complications after SLT requires a multidisciplinary approach. The use of NBCA in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage. Further studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and cost.

  20. Pancreatic fistula through the distal common bile duct

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.

    2002-01-01

    Full Text Available Pancreatic fistula is usually caused by acute or chronic pancreatitis, injury and operations of the pancreas. The pancreatic juice comes either from the main pancreatic duct or from side branches. Extremely rare pancreatic fistula may come through the distal end of the common bile duct that is not properly sutured or ligated after traumatic or operative transaction. We present a 58-year old man who developed a life threatening high output pancreatic fistula through the distal end of the common bile duct that was simply ligated after resection for carcinoma. Pancreatic fistula was developed two weeks after original surgery and after two emergency reoperations for serious bleeding from the stump of the right gastric artery resected and ligated during radical limphadenectomy. The patient was treated conservatively by elevation of the drain- age bag after firm tunnel round the drain was formed so that there was no danger of spillage of the pancreatic juice within abdomen.

  1. Robotic suture of a large caval injury caused by endo-GIA stapler malfunction during laparoscopic wedge resection of liver segments VII and VIII en-bloc with the right hepatic vein.

    Science.gov (United States)

    Boggi, Ugo; Moretto, Carlo; Vistoli, Fabio; D'Imporzano, Simone; Mosca, Franco

    2009-01-01

    Primary endo-GIA stapler malfunction occurred during robotic wedge resection of liver segments VII and VIII en-bloc with the right hepatic vein, in an obese woman diagnosed with single liver metastasis from a previous carcinoid tumour. Haemorrhage was soon controlled by clamping the vena cava below the injury using two wristed forceps angled at 90 degrees . With the two instruments locked in the holding position the ensuing operative strategy was discussed between surgeon and anaesthesia teams. Using the third robotic arm the caval injury was repaired laparoscopically with interrupted polypropylene sutures. The patient was transfused with two units of packed red blood cells, recovered uneventfully, and was discharged on post-operative day five. We conclude that even the most advanced technologies can fail and that surgeons should be fully aware of the consequences of these malfunctions and be prepared for repair. From this point of view, the da Vinci surgical system seems to have some advantages over classical laparoscopic methods including the ability to lock the wristed instruments in the holding position, the use of three arms by the same operating surgeon, and the extreme facilitation of intracorporeal suturing and knot-tying in deep and narrow spaces, extremely difficult if not impossible with conventional laparoscopic instruments.

  2. 五子衍宗丸对梗阻性无精症患者经尿道射精管口电切术术后精子质量的改善作用%Effect of Wuzi Yanzong Pill in improving sperm quality of patients with obstructive azoospermia after transurethral resection of ejaculatory ducts

    Institute of Scientific and Technical Information of China (English)

    雒向宁; 王文娟; 杨波; 刘贺亮

    2011-01-01

    Objective It is to approach the improving effect of Wuzi Yanzong Pill ( WYP) for the sperm quality of azoospermia patients with ejaculatory duct obstruction ( EDO ) after transurethral resection of the ejaculatory duct ( TURED ).Methods 41 azoospermia patients with EDO were randomly divided into experimental group ( n = 20 ) and control group ( n =21 ). All patients were administered with TURED. 1 month after the operation, the patients were treated with WYP for 6 months in experimental group, and did nothing in control group. Results 41 patients underwent operation successfully , 9 patients lost to follow up during. The sperm density , sperm viability and eupyrene sperm rate were improved in both groups, and there were significant differences between two groups ( P < 0. 05 ). Conclusion WYP can remarkahly improve the sperm quality of azoospermia patients with EDO treated with TURED , and increase TURED effectiveness. It is likely to increase the natural pregnancy rate of the EDO patients after TURED treatment.%目的 探讨五子衍宗丸对射精管梗阻性无精子症(EDO)患者经尿道射精管口电切术(TURED)后精子质量的改善作用.方法 41例EDO患者随机分为实验组(n=20)与对照组(n=21),2组患者均接受TURED治疗,术后1个月,实验组患者开始服用五子衍宗丸6个月,对照组不予其他干预治疗.结果 41例患者均成功接受手术治疗,实际完成观察32例,失访9例.2组治疗均能提高精子密度、精子活力与精子正常形态百分率,且实验组明显优于对照组(P<0.05).结论 EDO患者TURED术后辅助服用五子衍宗丸可显著改善患者精子质量,增强TURED手术的效果,有可能提高TURED术后患者的自然受孕几率.

  3. Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

    Directory of Open Access Journals (Sweden)

    Theodoros Mariolis-Sapsakos

    2012-01-01

    Full Text Available Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

  4. Intraoperative frozen section analysis of the proximal bile ducts in hilar cholangiocarcinoma is of limited value.

    Science.gov (United States)

    Mantel, Hendrik T J; Westerkamp, Andrie C; Sieders, Egbert; Peeters, Paul M J G; de Jong, Koert P; Boer, Marieke T; de Kleine, Ruben H; Gouw, Annette S H; Porte, Robert J

    2016-07-01

    Frozen section analysis (FS) during cancer surgery is widely used to assess resection margins. However, in hilar cholangiocarcinoma (HCCA), FS may be less reliable because of the specific growth characteristics of the tumor. The aim of this study was to determine the accuracy and consequences of intraoperative FS of the proximal bile duct margins in HCCA. Between 1990 and 2014, 67 patients underwent combined extrahepatic bile duct resection and partial liver resection for HCCA with the use of FS. Sensitivity and specificity of FS was 68% and 97%, respectively. Seventeen of 67 patients (25%) displayed a positive bile duct margin at FS. The false-negative rate was 16% (eight patients). Ten patients (15%) with a positive bile duct margin underwent an additional resection in an attempt to achieve negative margins, which succeeded in three patients (4%). However, only one of these three patients did not have concomitant lymph node metastases, which are associated with a poor prognosis by itself. The use of FS of the proximal bile duct is of limited clinical value because of the relatively low sensitivity, high risk of false-negative results, and the low rate of secondary obtained tumor-free resection margins. Supported by the literature, a new approach to the use of FS in HCCA should be adopted, reserving the technique only for cases in which a substantial additional resection is possible.

  5. Surgical treatment of congenital biliary duct cyst

    Directory of Open Access Journals (Sweden)

    Wang De-chun

    2012-03-01

    Full Text Available Abstract Background It is acknowledged that total cyst excision is a safe and ideal surgical treatment for congenital biliary duct cyst, compared to simple internal drainage. The aim of this study was to determine the optimal operation occasion and the effect of laparoscopy on congenital biliary duct cyst based upon total cyst excision. Methods From January 2002 to January 2011, 217 patients were admitted to Southwest Hospital for congenital biliary duct cyst. To determine the optimal surgery occasion, we divided these subjects into three groups, the infant group (age ≤ 3 years, the immaturity group (3 18 years, and then evaluated the feasibility, risk and long-term outcome after surgery in the three groups. To analyze the effect of laparoscopic technique on congenital biliary duct cyst, we divided the patients into the laparoscopy and the open surgery groups. Results Among the three groups, the morbidity from cholangiolithiasis before surgical treatment had obvious discrepancy (p 0.05. Similarly, no significant discrepancy was observed in the morbidity from postoperative complications or long-term postoperative complications (p > 0.05 between the laparoscopic and the open surgery groups. Conclusions We conclude that total cyst excision should be performed as early as possible. The optimal treatment occasion is the infant period, and laparoscopic resection may be a new safe and feasible minimally invasive surgery for this disease.

  6. Repair of bile duct defect with degradable stent and autologous tissue in a porcine model

    Institute of Scientific and Technical Information of China (English)

    Yue-Long Liang; Yi-Chen Yu; Kun Liu; Wei-Jia Wang; Jiang-Bo Ying; Yi-Fan Wang; Xiu-Jun Cai

    2012-01-01

    AIM:To introduce and evaluate a new method to repair bile duct defect with a degradable stent and autologous tissues.METHODS:Eight Ba-Ma mini-pigs were used in this study.Experimental models with common bile duct (CBD) defect (0.5-1.0 cm segment of CBD resected) were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-(1,3-propanediol)-co-(1,2-propanediol)].In addition,a vascularized greater omentum was placed around the stent and both ends of CBD.Cholangiography via gall bladder was performed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture.Complete blood count was examined pre-and post-operatively to estimate the inflammatory reaction.Liver enzymes and serum bilirubin were examined pre-and post-operatively to evaluate the liver function.Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis.The other three pigs were raised for one year for long-term observation.RESULTS:All the animals underwent surgery successfully.There was no intraoperative mortality and no bile leakage during the observation period.The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation,the difference was not statistically significant (P =0.652).The plasma level of alanine aminotransferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation (P =0.810).Nevertheless,the plasma level of γ-glutamyl transferase was increased after operation in both groups (P =0.004),especially 2 wk after operation.The level of serum total bilirubin after operation was not significantly elevated compared with that before operation (P =0.227),so did the serum direct bilirubin (P =0.759).By cholangiography via gall bladder,we found that the stent maintained its integrity of shape and was still in situ at month 1,and it disappeared

  7. Persistent omphalomesenteric duct causing small bowel obstruction in an adult

    Institute of Scientific and Technical Information of China (English)

    Haridimos Markogiannakis; Dimitrios Theodorou; Konstantinos G Toutouzas; Panagiotis Drimousis; Sotirios Georgios Panoussopoulos; Stilianos Katsaragakis

    2007-01-01

    An extremely rare case of persistent omphalomesenteric duct causing small bowel obstruction is presented. A 20-year-old female patient without medical history presented with colicky abdominal pain, vomiting, absence of passage of gas and feces, and abdominal distension of 24 h duration. Physical examination and blood tests were normal. Abdominal X-ray showed small bowel obstruction.Computed tomography of the abdomen demonstrated dilated small bowel and a band originating from the umbilicus and continuing between the small bowel loops;an omphalomesenteric duct remnant was suspected. In exploratory laparotomy, persistent omphalomesenteric duct causing small bowel obstruction was identified and resected. The patient had an uneventful recovery and was discharged on the 5th postoperative day. Although persistent omphalomesenteric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.

  8. Extrahepatic right hepatic duct diverticulum:a rare entity

    Institute of Scientific and Technical Information of China (English)

    Eduardo SM Fernandes; Raquel L Bernardo; Moacir M Fernandes; Rogério MC Araújo; Renato Sebbe; Asterio Monte; José F Coelho; Antonio AP Souza; Joaquim Ribeiro Filho

    2010-01-01

    BACKGROUND: Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classiifcation in 1977. The classiifcation is the most extensively used, but does not include some rare variations. We present a case of hepatic duct diverticulum, one of the variations, and discuss its diagnosis and treatment. METHODS: A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting. She was ifnally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT: The patient underwent resection of the hepatic duct diverticulum and cholecystectomy, and was asymptomatic 26 months after surgery. CONCLUSIONS: Hepatic duct diverticulum is a rare form of choledochal cyst, not included in Todani's classiifcation. Todani's classiifcation including this and other uncommon variations of choledochal cysts must be reviewed. The best diagnostic imaging methods and treatment for choledochal cysts must be deifned.

  9. Intraductal and invasive adenocarcinoma of duct of Luschka, mimicking chronic cholecystitis and cholelithiasis

    Directory of Open Access Journals (Sweden)

    Cheema Muhammad

    2009-01-01

    Full Text Available Abstract Background Intraductal and invasive adenocarcinoma of duct of Luschka is rare. To the best of our knowledge, this is the second case report of intraductal and invasive carcinoma arising from ducts of Luschka. Case presentation Patient presented to hospital with signs and symptoms of chronic cholecystitis and cholelithiasis. Ultrasound examination revealed thickening of gallbladder wall with abnormal septation around liver bed. Patient underwent laparoscopic cholecystectomy and resection of the adjacent liver bed. Histologic examination confirmed an intraductal and invasive adenocarcinoma arising from Luschka ducts. Conclusion Adenocarcinoma of ducts of Luschka should be considered among differential diagnoses for the patients with typical clinical presentations of chronic cholecystitis and cholelithiasis.

  10. Detection of benign hilar bile duct stenoses – A retrospective analysis in 250 patients with suspicion of Klatskin tumour

    Directory of Open Access Journals (Sweden)

    Uwe Scheuermann

    2016-06-01

    Conclusion: Despite improvements of preoperative diagnostics, it remains difficult to differentiate between benign and malignant hilar bile duct stenosis. Even explorative laparotomy was not able to safely exclude Klatskin tumour in all cases and therefore major liver resection was inevitable.

  11. A procedure for the calculation of flow through axisymmetric ducts

    Directory of Open Access Journals (Sweden)

    P. S. Heyns

    1983-03-01

    Full Text Available A procedure for the calculation of flow through axisymmetric ducts as are typically found in turbomachines, is presented. The procedure is based on a streamline curvature method with the governing equations formulated along quasi-orthogonals in the flow field. This formulation allows the procedure to be used for segments of a duct wherein the flow direction is predominantly radial. It is assumed that the flow on specific stream surfaces is isentropic, but normal entropy gradients may exist because of processes which took place upstream of the duct.

  12. Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis.

    Science.gov (United States)

    Aydin, Unal; Yazici, Pinar; Coker, Ahmet

    2007-01-01

    Spontaneous rupture of intrahepatic biliary ducts is a rare cause of acute abdomen due to biliary peritonitis. We report a 92-year-old woman with 48-h history of upper abdominal pain, nausea and vomiting and peritoneal signs. CT scan showed free fluid in the abdomen and mild dilatation of the common bile duct. Exploratory laparotomy showed bile in the abdominal cavity with leak-age from a ruptured bile duct radicle in segment 3, as confirmed on intraoperative cholangiography. She underwent cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation with primary suture and placement of a T-tube. She had an uneventful recovery.

  13. Pancreaticobiliary duct changes of periampullary carcinomas: Quantitative analysis at MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Dong Sheng, E-mail: victoryhope@163.com [Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041 (China); Department of Radiology, No.4 West China Teaching Hospital of Sichuan University, Chengdu 610041 (China); Chen, Wei Xia, E-mail: wxchen25@126.com [Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041 (China); Wang, Xiao Dong, E-mail: tyfs03yz@163.com [Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041 (China); Acharya, Riwaz, E-mail: riwaz007@hotmail.com [Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041 (China); Jiang, Xing Hua, E-mail: 13881865517@163.com [Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041 (China)

    2012-09-15

    Purpose: To quantitatively analyse the pancreaticobiliary duct changes of periampullary carcinomas with volumetric interpolated breath-hold examination (VIBE) and true fast imaging with steady-state precession (true FISP) sequence, and investigate the value of these findings in differentiation and preoperative evaluation. Materials and methods: Magnetic resonance (MR) images of 71 cases of periampullary carcinomas (34 cases of pancreatic head carcinoma, 16 cases of intrapancreatic bile duct carcinoma and 21 cases of ampullary carcinoma) confirmed histopathologically were analysed. The maximum diameter of the common bile duct (CBD) and main pancreatic duct (MPD), dilated pancreaticobiliary duct angle and the distance from the end of the proximal dilated pancreaticobiliary duct to the major papilla were measured. Analysis of variance and the Chi-squared test were performed. Results: These findings showed significant differences among the three subtypes: the distance from the end of proximal dilated pancreaticobiliary duct to the major papilla and pancreaticobiliary duct angle. The distance and the pancreaticobiliary duct angle were least for ampullary carcinoma among the three subtypes. The percentage of dilated CBD was 94.1%, 93.8%, and 100% for pancreatic head carcinoma, intrapancreatic bile duct carcinoma and ampullary carcinoma, respectively. And that for the dilated MPD was 58.8%, 43.8%, and 42.9%, respectively. Conclusion: Quantitative analysis of the pancreaticobiliary ductal system can provide accurate and objective assessment of the pancreaticobiliary duct changes. Although benefit in differential diagnosis is limited, these findings are valuable in preoperative evaluation for both radical resection and palliative surgery.

  14. Laparoscopic resection of colon cancer and synchronous liver metastasis.

    Science.gov (United States)

    Geiger, Timothy M; Tebb, Zachary D; Sato, Erika; Miedema, Brent W; Awad, Ziad T

    2006-02-01

    The recommended surgical approach to synchronous colorectal metastasis has not been clarified. Simultaneous open liver and colon resection for synchronous colorectal carcinoma has been shown beneficial when compared to staged resections. A review of the literature has shown the benefits of both laparoscopic colon resection for colorectal cancer and laparoscopic left lateral segmentectomy in liver disease. We present the case of a 60-year-old male with sigmoid colon carcinoma and a synchronous solitary liver metastasis localized to the left lateral segment. Using laparoscopic techniques, we were able to achieve simultaneous resection of the sigmoid colon and left lateral liver segment.

  15. [Pancreato-biliary maljunctions and congenital cystic dilatation of the bile ducts in adults].

    Science.gov (United States)

    Kianmanesh, R; Régimbeau, J M; Belghiti, J

    2001-08-01

    Pancreato-biliary maljunctions (PBM) in adults are defined by the presence of an abnormally long common pancreato-biliary duct (more than 15 mm long) formed outside the duodenal wall and/or by high amylase level in the bile. The high amylase level in the bile is the functional expression of a chronic toxic reflux of pancreatic juices into the biliary tree. The presence of the PBM have two basic consequences: (i) formation of congenital cystic dilatations of the bile duct (CCBD) during embryogenesis and (ii) cancerous degeneration of extrahepatic bile ducts including the gall bladder. CCBD are commonly found in Southeast of Asia and in Japan where more than two-thirds of the worldwide cases are reported. Women are more frequently touched. The main manifestations are pain, cholangitis and acute pancreatitis. Cancerous degeneration mainly due to chronic pancreatico-biliary reflux consecutive to the presence of PBM is the most serious complication of CCBD. Its global incidence is about 16% and increases by age and after cysto-digestive derivations widely performed in the past. In 80% of the cases a cholangiocarcinoma involving the extrahepatic portion of the biliary tree including dilated segments such as the gall bladder and/or cystic wall is found. The treatment of choice of most common types of CCBD with PMD is complete excision of most of the sites where cancer may arise and should interrupt the pancreato-biliary reflux. This treatment significantly reduces the incidence of bile duct cancer to 0.7%. However, despite the absence of mortality, the overall morbidity rates reach from 20% to 40%. In the complete excision, the entire common bile duct from porta hepatis to the intrapancreatic portion of the choledochus and the gall bladder are resected. The bile continuity is assured by a hepatico-jejunal Y anastomosis. When there is no CCBD, the high risk of gall bladder cancer in the presence of a PBM justifies by itself a preventive cholecystectomy even if no biliary

  16. Curved-Duct

    Directory of Open Access Journals (Sweden)

    Je Hyun Baekt

    2000-01-01

    Full Text Available A numerical study is conducted on the fully-developed laminar flow of an incompressible viscous fluid in a square duct rotating about a perpendicular axis to the axial direction of the duct. At the straight duct, the rotation produces vortices due to the Coriolis force. Generally two vortex cells are formed and the axial velocity distribution is distorted by the effect of this Coriolis force. When a convective force is weak, two counter-rotating vortices are shown with a quasi-parabolic axial velocity profile for weak rotation rates. As the rotation rate increases, the axial velocity on the vertical centreline of the duct begins to flatten and the location of vorticity center is moved near to wall by the effect of the Coriolis force. When the convective inertia force is strong, a double-vortex secondary flow appears in the transverse planes of the duct for weak rotation rates but as the speed of rotation increases the secondary flow is shown to split into an asymmetric configuration of four counter-rotating vortices. If the rotation rates are increased further, the secondary flow restabilizes to a slightly asymmetric double-vortex configuration. Also, a numerical study is conducted on the laminar flow of an incompressible viscous fluid in a 90°-bend square duct that rotates about axis parallel to the axial direction of the inlet. At a 90°-bend square duct, the feature of flow by the effect of a Coriolis force and a centrifugal force, namely a secondary flow by the centrifugal force in the curved region and the Coriolis force in the downstream region, is shown since the centrifugal force in curved region and the Coriolis force in downstream region are dominant respectively.

  17. Particle deposition in industrial duct bends.

    Science.gov (United States)

    Peters, Thomas M; Leith, David

    2004-07-01

    A study of particle deposition in industrial duct bends is presented. Particle deposition by size was measured by comparing particle size distributions upstream and downstream of bends that had geometries and flow conditions similar to those used in industrial ventilation. As the interior surface of the duct bend was greased to prevent particle bounce, the results are applicable to liquid drops and solid particles where duct walls are sticky. Factors investigated were: (i) flow Reynolds number (Re = 203 000, 36 000); (ii) particle Reynolds number (10 vertical); and (vii) construction technique (smooth, gored, segmented). Measured deposition was compared with models developed for bends in small diameter sampling lines (Re 20 microm, deposition was slightly greater in the horizontal-to-horizontal orientation than in the horizontal-to-vertical orientation due to gravitational settling. Penetration was not a multiplicative function of bend angle as theory predicts, due to the developing nature of turbulent flow in bends. Deposition in a smooth bend was similar to that in a gored bend; however, a tight radius segmented bend (R0 = 1.7) exhibited much lower deposition. For more gradual bends (3 < R0 < 12), curvature ratio had negligible effect on deposition.

  18. Metastatic melanoma to the common bile duct causing obstructive jaundice: A case report

    Institute of Scientific and Technical Information of China (English)

    Radoje B Colovic; Nikica M Grubor; Miodrag D Jovanovic; Marjan T Micev; Natasa R Colovic

    2007-01-01

    Metastatic melanoma to the common bile duct is very rare with only 18 cases reported so far. We report a 46 year old women who, 18 mo after excision of a skin melanoma, developped a painless progressive obstructive jaundice. At operation a melanoma within the distal third of the common bile duct was found. There were no other secondaries within the abdomen. The common bile duct, including the tumor, was resected and anastomosed with Roux-en-Y jejunal limb. The patient survived 31 mo without any sign of local recurrence and was submitted to three other operations for axillar and brain secondaries, from which she finally died. Radical resection of metastatic melanoma to the common bile duct may result in lifelong relief of obstructive jaundice.It is safe and relatively easy to perform. In other cases, a less aggressive approach, stenting or bypass procedures,should be adopted.

  19. Particle deposition in ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sippola, Mark Raymond [Univ. of California, Berkeley, CA (United States)

    2002-09-01

    Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 μm were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on the

  20. Particle deposition in ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sippola, Mark R.

    2002-09-01

    Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 {micro}m were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on

  1. Augmented reality in a tumor resection model.

    Science.gov (United States)

    Chauvet, Pauline; Collins, Toby; Debize, Clement; Novais-Gameiro, Lorraine; Pereira, Bruno; Bartoli, Adrien; Canis, Michel; Bourdel, Nicolas

    2017-08-15

    Augmented Reality (AR) guidance is a technology that allows a surgeon to see sub-surface structures, by overlaying pre-operative imaging data on a live laparoscopic video. Our objectives were to evaluate a state-of-the-art AR guidance system in a tumor surgical resection model, comparing the accuracy of the resection with and without the system. Our system has three phases. Phase 1: using the MRI images, the kidney's and pseudotumor's surfaces are segmented to construct a 3D model. Phase 2: the intra-operative 3D model of the kidney is computed. Phase 3: the pre-operative and intra-operative models are registered, and the laparoscopic view is augmented with the pre-operative data. We performed a prospective experimental study on ex vivo porcine kidneys. Alginate was injected into the parenchyma to create pseudotumors measuring 4-10 mm. The kidneys were then analyzed by MRI. Next, the kidneys were placed into pelvictrainers, and the pseudotumors were laparoscopically resected. The AR guidance system allows the surgeon to see tumors and margins using classical laparoscopic instruments, and a classical screen. The resection margins were measured microscopically to evaluate the accuracy of resection. Ninety tumors were segmented: 28 were used to optimize the AR software, and 62 were used to randomly compare surgical resection: 29 tumors were resected using AR and 33 without AR. The analysis of our pathological results showed 4 failures (tumor with positive margins) (13.8%) in the AR group, and 10 (30.3%) in the Non-AR group. There was no complete miss in the AR group, while there were 4 complete misses in the non-AR group. In total, 14 (42.4%) tumors were completely missed or had a positive margin in the non-AR group. Our AR system enhances the accuracy of surgical resection, particularly for small tumors. Crucial information such as resection margins and vascularization could also be displayed.

  2. Laparoscopic liver resection: Experience based guidelines.

    Science.gov (United States)

    Coelho, Fabricio Ferreira; Kruger, Jaime Arthur Pirola; Fonseca, Gilton Marques; Araújo, Raphael Leonardo Cunha; Jeismann, Vagner Birk; Perini, Marcos Vinícius; Lupinacci, Renato Micelli; Cecconello, Ivan; Herman, Paulo

    2016-01-27

    Laparoscopic liver resection (LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant (both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments (1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of laparoscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

  3. Thermo-chemo-radiotherapy for advanced bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Naoto Egawa; Katsuyuki Karasawa; Tadayoshi Matsuda; Kouji Tsuruta; Atsutake Okamoto

    2005-01-01

    AIM: Complete resection of the bile duct carcinoma is sometimes difficult by subepithelial spread in the duct wall or direct invasion of adjacent blood vessels. Nonresected extrahepatic bile duct carcinoma has a dismal prognosis,with a life expectancy of about 6 mo to 1 year. To improve the treatment results of locally advanced bile duct carcinoma, we have been conducting a clinical trial using regional hyperthermia in combination with chemoradiation therapy.METHODS: Eight patients complaining of obstructive jaundice with advanced extrahepatic bile duct underwent thermo-chemo-radiotherapy (TCRT). All tumors were located in the upper bile duct and involved hepatic bifurcation, and obstructed the bile duct completely.Radiofrequency capacitive hyperthermia was administered simultaneously with chemotherapeutic agents once weekly immediately following radiotherapy at 2 Gy.We administered heat to the patient for 40 min after the tumor temperature had risen to 42 ℃. The chemotherapeutic agents employed were cis-platinum (CDDP,50 mg/m2) in combination with 5-fluorouracil (5-FU,800 mg/m2) or methotrexate (MTX, 30 mg/m2) in combination with 5-FU (800 mg/m2). Number of heat treatments ranged from 2 to 8 sessions. The bile duct at autopsy was histologically examined in three patients treated with TCRT.RESULTS: In respect to resolution of the bile duct, there were three complete regression (CR), two partial regression (PR), and three no change (NC). Mean survival was 13.2±10.8 mo (mean±SD). Four patients survived for more than 20 mo. Percutaneous transhepatic biliary drainage (PTBD) tube could be removed in placement of self-expandable metallic stent into the patency-restored bile duct after TCRT. No major side effects occurred. At autopsy, marked hyalinization or fibrosis with necrosis replaced extensively bile duct tumor and wall, in which suppressed cohesiveness of carcinoma cells and degenerative cells were sparsely observed.CONCLUSION: Although the number of cases is

  4. What Is Bile Duct Cancer?

    Science.gov (United States)

    ... the liver. Types of bile duct cancer by cell type Bile duct cancers can also be divided ... Our Volunteers More ACS Sites Bookstore Shop Cancer Atlas Press Room Cancer Statistics Center Volunteer Learning Center ...

  5. Gallbladder and Bile Duct Disorders

    Science.gov (United States)

    ... Disorders Overview of Gallbladder and Bile Duct Disorders Cholecystitis Gallstones Biliary Pain Without Gallstones Narrowing of the ... ducts are blocked, the gallbladder may become inflamed ( cholecystitis ). Biliary pain without gallstones (acalculous biliary pain) can ...

  6. Invasive carcinoma derived from branch duct-type IPMN may be a more aggressive neoplasm than that derived from main duct-type IPMN.

    Science.gov (United States)

    Okabayashi, Takehiro; Shima, Yasuo; Kosaki, Takuhiro; Sumiyoshi, Tatsuaki; Kozuki, Akihito; Iiyama, Tastuo; Takezaki, Yuka; Kobayashi, Michiya; Nishimori, Isao; Ogawa, Yasuhiro; Hanazaki, Kazuhiro

    2013-06-01

    The present study aimed to evaluate the long-term follow-up results of patients with intraductal papillary mucinous neoplasm (IPMN) and to estimate the degree of IPMN malignancy based on pathological and molecular features of resected specimens. The detection rate of IPMN has increased over the last decade; however, the management of this neoplasm remains controversial. This is particularly so for branch duct-type IPMN, which carries a high potential for malignancy and risk of recurrence. We retrospectively reviewed a single institution's prospective pancreatic resection database to identify IPMN patients who underwent pancreatectomy with curative intent. The clinicopathological variables of 100 patients resected for IPMN were analyzed with a detailed review of histopathological results (borderline lesions, non-invasive carcinoma and invasive carcinoma) to determine the grade of IPMN malignancy based on transforming growth factor (TGF)-β/SMAD4 signaling. The incidence of malignant change was significantly higher in patients with main duct-type IPMN (69.7%) compared with branch duct-type IPMN cases (17.9%). However, patients with an invasive carcinoma had a significantly worse outcome if it was derived from branch duct-type IPMN compared with those derived from main duct-type IPMN, and TGF-β mRNA expression was significantly increased in the former patient group. Immunohistochemistry also showed higher numbers of SMAD4-positive cells in patients with carcinoma derived from branch duct-type IPMN. Our results demonstrated that invasive carcinoma derived from branch duct-type IPMN is more aggressive than that derived from main duct-type IPMN, once invasive morphological change takes place. Determining TGF-β and/or SMAD4 status at initial diagnosis may be useful for stratifying IPMN patients into treatment regimens.

  7. Malignant tumors of Stensen's duct.

    Science.gov (United States)

    Steiner, M; Gould, A R; Miller, R L; Johnson, J A

    1999-01-01

    A rare case of squamous cell carcinoma arising in Stensen's duct is reported. The literature concerning malignant neoplasia originating in this site is reviewed, with attention given to the histopathologic diversity of neoplasms occurring in the duct, criteria for determination of origin in the duct, and outcomes of therapy.

  8. Isolated Pancreatic Uncinate Duct IPMN.

    Science.gov (United States)

    Maker, Ajay V; Maker, Vijay K

    2017-04-01

    The ventral pancreas originally forms as an evagination of the common bile duct at 32 days gestation and its duct, the uncinate duct, eventually rotates with the ventral anlage to join the dorsal pancreas and fuse with the main pancreatic duct. Thus, though often considered a "branch" duct of the pancreas, embryologically, the uncinate duct is the "main" pancreatic duct of the ventral pancreas. This concept is not fully addressed in the current definitions of intraductal papillary mucinous neoplasms of the pancreas (IPMN) where international consensus guidelines consider the main-duct IPMN as high risk for malignancy and most small branch-duct IPMN as low risk for malignancy. Thus, it is important to recognize that isolated uncinate-duct IPMN can occur and, based on its embryologic origin and increased association with high-grade dysplasia and invasive cancer, may be managed conceptually as a main duct type of disease rather than a branch duct until better biomarkers of malignancy are discovered. The images provide an example of this unique disease process.

  9. Related issues in repair of bile duct injury and traumatic biliary stricture

    Directory of Open Access Journals (Sweden)

    WANG Shuguang

    2017-02-01

    Full Text Available Inappropriate treatment of bile duct injury and traumatic biliary stricture may cause serious consequences such as recurrent cholangitis, formation of hepatolithiasis, and biliary cirrhosis. This article elaborates on the influencing factors for the effect of the repair of bile duct injury and traumatic biliary stricture, repair principles, timing of repair or reconstruction, and related methods and techniques. It is pointed out that if there is no significant local infection and the bile duct wall defect is <2 cm, end-to-end anastomosis should be used for repair; if the bile duct wall defect is >2 cm, Roux-en-Y hepaticojejunostomy should be used for reconstruction. If the upper wall of the bile duct had a large defect and the lower wall has an integral structure, pedicled umbilical vein graft, pedicled jejunal wall seromuscular flap, or gastric wall seromuscular flap should be used for repair. The patients with severe congestion and edema at the site of injury should be treated with sufficient external drainage of the injured bile duct and then selective repair or reconstruction. Patients with hepatic duct stenosis in the liver lobe or hepatic segments and liver tissue atrophy can be treated with hepalobectomy or segmental hepatectomy. The key to successful repair is exposure and removal of high hilar bile duct stricture, while segmental hepatectomy of the Ⅳb segment can fully expose the left and right hepatic pedicles and help with the incision of the left and right hepatic ducts and secondary hepatic ducts, and therefore, it is a good method for exposing high bile duct stricture.

  10. Cornice Duct System

    Energy Technology Data Exchange (ETDEWEB)

    Wayne Place; Chuck Ladd

    2004-10-29

    SYNERGETICS, INC., has designed, developed, and tested an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The following report details work conducted in the second budget period to develop the Cornice Duct System into a viable product for use in a variety of residential or small commercial building settings. A full-scale prototype has been fabricated and tested in a laboratory test building at the Daylighting Facility at North Carolina State University., Based on the results of that testing, the prototype design as been refined, fabricated, installed, and extensively tested in a residential laboratory house. The testing indicates that the device gives substantially superior performance to a standard air distribution system in terms of energy performance and thermal comfort. Patent Number US 6,511,373 B2 has been granted on the version of the device installed and tested in the laboratory house. (A copy of that patent is attached.) Refinements to the device have been carried through two additional design iterations, with a particular focus on reducing installation time and cost and refining the air control system. These new designs have been fabricated and tested and show substantial promise. Based on these design and testing iterations, a final design is proposed as part of this document. That final design is the basis for a continuation in part currently being filed with the U.5, Patent office.

  11. [A case of curative resection after downsizing chemotherapy in initially unresectable locally advanced intrahepatic cholangiocarcinoma].

    Science.gov (United States)

    Aoki, Yu; Suzuki, Takayuki; Kato, Atsushi; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshitomi, Hideyuki; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Takano, Shigetsugu; Okamura, Daiki; Suzuki, Daisuke; Sakai, Nozomu; Kagawa, Shingo; Miyazaki, Masaru

    2014-11-01

    This case report describes an 83-year-old man with intrahepatic cholangiocarcinoma who was referred by a local hospital. Abdominal computed tomography (CT) showed a large tumor in hepatic segments 4, 5, and 8 involving the right hepatic vein and inferior vena cava, which is normally indicative of an unresectable locally advanced tumor. After systemic chemotherapy with gemcitabine and cisplatin, the observed decrease in the level of tumor marker suggested that the cancer was responding to treatment, while radiological findings showed the main tumor shrunk without the presence of distant metastases. Thus, hepatic left trisectionectomy with bile duct resection was performed after portal vein embolization. Pathological examination revealed negative margins (R0). Eighteen months after surgery, the patient is free of disease and shows no signs of recurrence. An initially unresectable, locally advanced biliary tract cancer may be down sized by chemotherapy, which makes radical resection possible, at least in a proportion of patients. This approach provides longer survival and may have a potential for disease eradication as a new multidisciplinary approach for patients with unresectable locally advanced biliary tract cancer.

  12. 14 CFR 25.1103 - Induction system ducts and air duct systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Induction system ducts and air duct systems....1103 Induction system ducts and air duct systems. (a) Each induction system duct upstream of the first... auxiliary power unit bleed air duct systems, no hazard may result if a duct failure occurs at any...

  13. Effects of conventional versus laparoscopic surgery in treatment of congenital bile duct dilatation: a comparative analysis

    Directory of Open Access Journals (Sweden)

    CHEN Houbin

    2015-06-01

    Full Text Available ObjectiveTo compare the clinical effects of conventional versus laparoscopic surgery in adults with congenital bile duct dilatation. MethodsA retrospective analysis was performed on the clinical data of 37 patients with congenital bile duct dilation who were treated in our hospital from February 2011 to February 2013. All the 37 cases underwent bile duct cyst resection and common hepatic duct-jejunal Roux-en-Y anastomosis; 20 of them (study group underwent laparoscopic surgery, while the other 17 cases (control group underwent open surgery. The mean operative time, mean intraoperative blood loss, mean length of hospital stay after surgery, mean time to first flatus after surgery, and postoperative complications were compared between the two groups. Comparison of continuous data between the two groups was made by t test, while comparison of categorical data was made by chi-square test. ResultsCompared with the control group, the study group had a significantly longer operative time (P<0.05 but significantly less mean intraoperative blood loss, mean length of hospital stay after surgery, and mean time to first flatus after surgery (P<0.05. The incidence of postoperative complications showed no significant difference between the two groups (P>0.05. ConclusionCompared with conventional surgery, laparoscopic bile duct cyst resection and common hepatic duct-jejunal Roux-en-Y anastomosis is less invasive and safer and leads to faster recovery in adults with congenital bile duct dilation, and it is worthy of clinical application.

  14. 3C DUCT DESIGN METHOD

    Institute of Scientific and Technical Information of China (English)

    Huan-RueiShiu; Feng-ChuOu; Sih-LiChen

    2002-01-01

    A new 3C duct design method is proposed for designing a high quality, energy-efficiency cost-effective air duct system. It not only considers the demand of volume flow rate, but also takes into consideration a number of issues including system pressure balance, noise, vibration, space limitation and total system cost. This new method comprises three major calculation procedures:initial computer-aided design (CAD), computer-aided simulation (CAS) and correction processes (CP). An example is presented in this study to understand the characteristics of 3C method. It shows that 3C duct design method provides a simple computation procedure for an optimum air duct system. It also shortens the design schedule, prevents human calculation errors, and reduces the dependence on designer experience. In addition to apply in a new duct system design, 3C duct design method is also a powerful design tool for the expansion of an existing duct system.

  15. Morphological studies on the seasonal changes in the epididymal duct of the one-humped camel (camelus dromedarius

    Directory of Open Access Journals (Sweden)

    Ahmed El-Zuhry Zayed

    2012-02-01

    Full Text Available The present work was carried out on 20 testes and epididymis of sexually mature camels to elucidate the gross anatomical, morphometerical, light microscopical and scanning electron microscopical features of the epididymis in different seasons. Anatomically, the epididymal duct of a camel consists of three parts head, body and tail. Histomorphologically, the epididymal duct is subdivided into initial, middle and terminal segments, of which the middle segment is further subdivided into proximal, intermediate and distal parts. There is a gradual decrease in the epithelial height of the epididymal duct from the initial to the terminal segments. This mechanically facilities passage of the sperms toward the terminal segment. High epithelium in the initial segment may indicate a more absorptive power of the epithelium in this segment. The seasonal reproductivety of the epididymal duct in the camel expressed by variations in the weight and volume of the epididymis, total diameter of the epididymal duct, epithelial height, length of the stereocilia, thickness of the muscular coat and cellular distributions in different segments. The spring months offer ideal circumstances for maximal reproductive activity in this species. The cellular components of the epididymal duct epithelium of the camel displays important morphological changes from season to another showing signs of increasing activity during spring in comparison to decreasing activity in other seasons. PAS positive granules are demonstrated in different segments of the epididymal duct and intraepithelial glands in different seasons. These granules are relatively more numerous in spring. The lamina propria surrounding the epididymal duct contains a layer of the elastic fibers which is very thick in winter, thick in spring and thin in other seasons. This increase in thickness of the elastic fibers predisposes for the increase in the total diameter of the epididymal duct in spring. It was conclude

  16. Iatrogenic injury of an aberrant right posterior sectoral bile duct

    Directory of Open Access Journals (Sweden)

    John Cantrell

    2011-08-01

    Full Text Available A 34-year-old woman presented with a history of a previous laparoscopic cholecystectomy, followed within a few days by a formal laparotomy for a suspected bile duct injury. Approximately one week after the laparotomy, she developed a sinus on the anterior abdominal wall that was draining bile. She was then referred to our institution for further management. The earlier surgery was done at another hospital, and these details were not clear. A CT scan, including a CT sinogram, was performed. The sinogram was done by inserting a catheter into the sinus and running in diluted contrast under gravity. CT images showed the sinus tract communicating with a collection in the gallbladder fossa, as well as contrast opacification of the segment 6 and 7 bile ducts. A week later, an endoscopic retrograde cholangiopancreatography (ERCP examination was performed. This showed no filling of the right posterior sectoral ducts but normal opacification of the other ducts. These findings led to the diagnosis of an aberrant right posterior sectoral bile duct that was not identified prior to surgery and that was damaged at the time of laparoscopic cholecystectomy. This duct now drained into the gallbladder fossa, causing the collection and draining sinus.

  17. Liver resection with a new technique

    Directory of Open Access Journals (Sweden)

    Mustafa Turan

    2014-06-01

    Full Text Available Aim. In this retrospective study, we scrutinized the patients in whom we had used Radio-Frequency (RF technique in liver resection procedures. Methods. In this retrospective study, indications for liver resection were malignant tumors in 17 (Elective cases and 6 patients with trauma etiology (Emergency cases. Results. Left lateral segmentectomy (segments II-III was done in 9 patients. Segment VI resection was performed in 4 patients. Non-anatomical (wedge resections were done in 10 patients. The average time necessary for transection of the liver parenchyma was 34±5 min. in Elective group and 37±5min. in Emergency group. Average blood loss was 32±5 mL in Elective group and 89±8 mL in Emergency group. In the postoperative period, we did not see any subcapsular or perihepatic hematoma responsible for delayed hemorrhage. No signs of infectious disease or abscesses were observed. Conclusion. This RF assisted technique is effective in bloodless liver resections.

  18. Registration-free laparoscope augmentation for intra-operative liver resection planning

    Science.gov (United States)

    Feuerstein, Marco; Mussack, Thomas; Heining, Sandro M.; Navab, Nassir

    2007-03-01

    In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, a major issue in laparoscopic liver resection is the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided prior to the resection. To navigate the surgeon to these vessels, pre-operative abdominal imaging data can hardly be used due to intraoperative organ deformations mainly caused by appliance of carbon dioxide pneumoperitoneum and respiratory motion. While regular respiratory motion can be gated and synchronized intra-operatively, motion caused by pneumoperitoneum is individual for every patient and difficult to estimate. Therefore, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. The C-arm is able to visualize soft tissue by means of its new flat panel detector and is calibrated offline to relate its current position and orientation to the coordinate system of a reconstructed volume. Also the laparoscope is optically tracked and calibrated offline, so both laparoscope and C-arm are registered in the same tracking coordinate system. Intra-operatively, after patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and scanned during patient exhalation. Immediately, a three-dimensional volume is reconstructed. Without any further need for patient registration, the volume can be directly augmented on the live laparoscope video, visualizing the contrasted vessels. This augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.

  19. Asymptomatic common bile duct stones.

    Science.gov (United States)

    Rosseland, A R; Glomsaker, T B

    2000-11-01

    Patients with asymptomatic bile duct stones exhibit typical signs, such as elevated liver function tests, dilated bile ducts on ultrasound, a history of jaundice, or pancreatitis. The incidence of asymptomatic bile duct stones is about 10%, but up to 2% of patients show no signs of the disease. Bile duct stones can be diagnosed by using clinical judgement, scoring systems, or discriminant function tests. Which diagnostic modality is most reliable, cost-effective and safe, varies with different hospitals. Which therapy is most effective, safe and the cheapest also varies with different departments, but in the future an increasing number of departments will use the one-stage laparoscopic approach.

  20. Noise reduction of spiral ducts.

    Science.gov (United States)

    Lapka, Wojciech; Cempel, Czesław

    2007-01-01

    The paper presents noise reduction (NR) of spiral ducts as a result of computational modeling of acoustic wave propagation. Three-dimensional models were created with the finite element method in COMSOL Multiphysics version 3.3. Nine models of spiral ducts with 1-9 spiral leads were considered. Time-harmonic analysis was used to predict NR, which was shown in spectral and interval frequency bands. Spiral duct performance can be seen as a comparison of NR before and after a change from a circular to a spiral duct.

  1. A Rare Case of Intraductal Papillary Mucinous Neoplasm of the Biliary Duct in a Patient with Prostate Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Ravish Parekh

    2016-12-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are mucin-producing papillary neoplasms of the pancreatic or biliary ductal system that exhibit variable cellular atypia and cause ductal dilation. There are few reported cases of IPMN arising from the biliary tree in the literature. It has a higher propensity to undergo malignant transformation compared to IPMN arising from the pancreatic duct. An 80-year-old male underwent cross-sectional tomography (CT imaging of the abdomen for evaluation of prostate adenocarcinoma, which revealed an incidental 2.3 × 2.7 cm soft tissue mass centered at the porta hepatis with diffuse dilatation of the left intrahepatic biliary ductal system and mild prominence of the right intrahepatic ductal system. Endoscopic ultrasound showed 2 adjacent hilar masses involving the common hepatic duct and the left hepatic duct with protrusion of the tissue into the lumen of the duct and upstream ductal dilatation. Endoscopic retrograde cholangiopancreatography revealed a large filling defect in the common hepatic duct extending into the left hepatic duct. A large amount of clot and soft tissue with a fish-egg appearance was retrieved. The patient underwent left hepatic lobectomy, radical resection of the common hepatic duct with Roux-en-Y hepaticojejunostomy to the right hepatic duct. Histopathological examination of the resected specimen revealed intraductal papillary mucinous neoplasm with diffuse high-grade dysplasia. Follow-up CT scan of the abdomen 2 months after the surgery was negative for any masses.

  2. A Rare Case of Intraductal Papillary Mucinous Neoplasm of the Biliary Duct in a Patient with Prostate Adenocarcinoma

    Science.gov (United States)

    Parekh, Ravish; Krol, Gregory; Piraka, Cyrus; Batra, Surinder

    2016-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) are mucin-producing papillary neoplasms of the pancreatic or biliary ductal system that exhibit variable cellular atypia and cause ductal dilation. There are few reported cases of IPMN arising from the biliary tree in the literature. It has a higher propensity to undergo malignant transformation compared to IPMN arising from the pancreatic duct. An 80-year-old male underwent cross-sectional tomography (CT) imaging of the abdomen for evaluation of prostate adenocarcinoma, which revealed an incidental 2.3 × 2.7 cm soft tissue mass centered at the porta hepatis with diffuse dilatation of the left intrahepatic biliary ductal system and mild prominence of the right intrahepatic ductal system. Endoscopic ultrasound showed 2 adjacent hilar masses involving the common hepatic duct and the left hepatic duct with protrusion of the tissue into the lumen of the duct and upstream ductal dilatation. Endoscopic retrograde cholangiopancreatography revealed a large filling defect in the common hepatic duct extending into the left hepatic duct. A large amount of clot and soft tissue with a fish-egg appearance was retrieved. The patient underwent left hepatic lobectomy, radical resection of the common hepatic duct with Roux-en-Y hepaticojejunostomy to the right hepatic duct. Histopathological examination of the resected specimen revealed intraductal papillary mucinous neoplasm with diffuse high-grade dysplasia. Follow-up CT scan of the abdomen 2 months after the surgery was negative for any masses. PMID:28100995

  3. Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930559 An experimental study on effective hep-atic blood flow and hepatic energy metabolismfollowing acute obstructive cholangitis and bil-iary obstruction.SUN Wenbing (孙文兵),et al.Hepatobili Surg,Center,Southwest Hosp,Chongqing 630000.Chin J Digest 1992;12(5):261—263.The changes of effective hepatic blood flow(E-HBF)and hepatic energy metabolism were stud-ied following acutc obstructive cholangitis(AOC)and bile duct ligation(BDL)in rats.The resultsshowed that EHBF was significantly decreased at24hs after and further decreased at 48hs afterBDL.And EHBF was significantly decreased at

  4. Stopping duct quacks: Longevity of residential duct sealants

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.; Walker, Iain S.; Dickerhoff, Darryl J.

    2000-08-01

    Duct leakage has been identified as a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums or branches in the duct system. At each of these connections a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have shown that these seals tend to fail over time periods ranging from days to years. We have used several test methods over the last few years to evaluate the longevity of duct sealants when subjected to temperatures and pressures representative of those found in the field. Traditional cloth duct tapes have been found to significantly under-perform other sealants and have been banned from receiving duct tightness credits in California's energy code (California Energy Commission 1998). Our accelerated testing apparatus has been redesigned since its first usage for improved performance. The methodology is currently under consideration by the American Society for Testing and Materials (ASTM) as a potential new test method. This report will summarize the set of measurements to date, review the status of the test apparatus and test method, and summarize the applications of these results to codes and standards.

  5. Propagation of sound waves in ducts

    DEFF Research Database (Denmark)

    Jacobsen, Finn

    2000-01-01

    Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described....

  6. Radiotherapy of bile duct carcinoma; Effectiveness of external irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Shiina, Takeki; Itami, Jun; Uno, Takashi; Kato, Hajime; Tani, Masanao; Kawai, Saburou (National Medical Center of Hospital, Tokyo (Japan))

    1992-10-01

    Twenty-six patients with cholangiocarcinoma and nineteen patients with carcinoma of the gallbladder treated with external radiotherapy were analyzed. Of the twenty-six patients, eighteen had cancer of the hepatic hilus (Klatskin), four intrahepatic and the remaining four extrahepatic cholangiocarcinoma. All but two of the patients had advanced disease. Thirty-three patients received primary irradiation for unresectable tumors, ten patients adjuvant irradiation after non-curative gross tumor resection, and two patients preoperative radiotherapy. Patients with cholangiocarcinoma who underwent radiotherapy with relatively small radiation field tolerated the treatment well, but there was no significant difference in survival according to field size or radiation doses (TDF). On the other hand, patients with carcinoma of gallbladder were treated with larger field size and lower dose. In the patients without gross tumor resection, those receiving radiation doses[>=]90 TDF had significantly longer survival than <90 TDF (p<0.05). Regarding to the field size, patients irradiated by smaller field size ([<=]100 cm[sup 2]) had longer survival (p=0.07). The patients with gross tumor resection had significantly longer survival than that without resection in both cholangiocarcinoma and carcinoma of gallbladder. Postmortem examination revealed tumor recurrence even in the patients with gross tumor resection, but widespread distant metastases were present simultaneously. Cholangitis and liver abscess were special and lethal conditions related to these carcinomas, and intensive therapy must be developed for these conditions. External radiotherapy may be effective in the treatment of bile duct carcinoma in terms of palliation and survival. (author).

  7. Biliary endoprostheses in tumors at the hepatic duct bifurcation

    Energy Technology Data Exchange (ETDEWEB)

    Lammer, J.; Neumayer, K.; Steiner, H.

    1986-11-01

    In 51 patients with tumors at the hepatic duct bifurcation, endoprostheses were transhepatically inserted into the bile ducts. Patients with Bismuth-3-tumors (i.e. bilateral biliary obstruction) were treated by insertion of 2 or more endoprostheses. Long-term success presumed drainage of all obstructed ducts, because cholangitis has been a common problem secondary to undrained segments. Furthermore the debris and the high viscosity of infected bile increased the risk for obstruction of the endoprostheses, which was observed in 6%. The mean time of survival was 7 months with a maximum of 26 months. In our experience endoprostheses can be used successfully in unresectable Klatskin tumours, which increases the comfort for the patients in their last months of life.

  8. Propagation of sound waves in ducts

    DEFF Research Database (Denmark)

    Jacobsen, Finn

    2000-01-01

    Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described.......Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described....

  9. Sound propagation through nonuniform ducts

    Science.gov (United States)

    Nayfeh, A. H.

    1976-01-01

    Methods of determining the transmission and attenuation of sound propagating in nonuniform ducts with and without mean flows are discussed. The approaches reviewed include purely numerical techniques, quasi-one-dimensional approximations, solutions for slowly varying cross sections, solutions for weak wall undulations, approximation of the duct by a series of stepped uniform cross sections, variational methods and solutions for the mode envelopes.

  10. Laparoscopic common bile duct exploration.

    Science.gov (United States)

    Stoker, M E; Leveillee, R J; McCann, J C; Maini, B S

    1991-10-01

    Operative common bile duct exploration, performed in conjunction with cholecystectomy, has been considered the treatment of choice for choledocholithiasis in the presence of an intact gallbladder. With the advent of laparoscopic cholecystectomy, the management of common bile duct stones has been affected. More emphasis is being placed on endoscopic sphincterotomy and options other than operative common duct exploration. Because of this increasing demand, we have developed a new technique for laparoscopic common bile duct exploration performed in the same operative setting as laparoscopic cholecystectomy. A series of five patients who successfully underwent common bile duct exploration, flexible choledochoscopy with stone extraction, and T-tube drainage, all using laparoscopic technique, is reported. Mean postoperative length of hospital stay was 4.6 days. Outpatient T-tube cholangiography was performed in all cases and revealed normal ductal anatomy with no retained stones. Follow-up ranged from 6 weeks to 4 months, and all patients were asymptomatic and had normal liver function tests.

  11. Ascariasis of the pancreatic duct.

    Science.gov (United States)

    Klimovskij, Michail; Dulskas, Audrius; Kraulyte, Zita; Mikalauskas, Saulius

    2015-09-15

    Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole.

  12. The statistical evaluation of duct tape end match as physical evidence

    Science.gov (United States)

    Chan, Ka Lok

    Duct tapes are often submitted to crime laboratories as evidence associated with abductions, homicides, or construction of explosive devices. As a result, trace evidence examiners are often asked to analyze and compare commercial duct tapes so that they can establish possible evidentiary links. Duct tape end matches are believed to be the strongest association between exemplar and question samples because they are considered as evidence with unique individual characteristics. While end match analysis and comparison have long been undertaken by trace evidence examiners, there is a significant lack of scientific research for associating two or more segments of duct tapes. This study is designed to obtain statistical inferences on the uniqueness of duct tape tears. Three experiments were devised to compile the basis for a statistical assessment of the probability of duct tape end matches along with a proposed error rate. In one experiment, we conducted the equivalent of 10,000 end match examinations with an error rate of 0%. In the second experiment, we performed 2,704 end match examinations having 0% error rate. In the third experiment, using duct tape by an Elmendorf Tear tester, we conducted 576 end match examinations with an error rate of 0% and having all samples correctly associated. The results of this study indicate that end matches are distinguishable among a single roll of duct tape and between two different rolls of duct tape having very similar surface features and weave pattern.

  13. PMR Graphite Engine Duct Development

    Science.gov (United States)

    Stotler, C. L.; Yokel, S. A.

    1989-01-01

    The objective was to demonstrate the cost and weight advantages that could be obtained by utilizing the graphite/PMR15 material system to replace titanium in selected turbofan engine applications. The first component to be selected as a basis for evaluation was the outer bypass duct of the General Electric F404 engine. The operating environment of this duct was defined and then an extensive mechanical and physical property test program was conducted using material made by processing techniques which were also established by this program. Based on these properties, design concepts to fabricate a composite version of the duct were established and two complete ducts fabricated. One of these ducts was proof pressure tested and then run successfully on a factory test engine for over 1900 hours. The second duct was static tested to 210 percent design limit load without failure. An improved design was then developed which utilized integral composite end flanges. A complete duct was fabricated and successfully proof pressure tested. The net results of this effort showed that a composite version of the outer duct would be 14 percent lighter and 30 percent less expensive that the titanium duct. The other type of structure chosen for investigation was the F404 fan stator assembly, including the fan stator vanes. It was concluded that it was feasible to utilize composite materials for this type structure but that the requirements imposed by replacing an existing metal design resulted in an inefficient composite design. It was concluded that if composites were to be effectively used in this type structure, the design must be tailored for composite application from the outset.

  14. A novel design of posterior leaflet butterfly resection for mitral valve repair.

    Science.gov (United States)

    Asai, Tohru; Kinoshita, Takeshi; Nishimura, Osamu; Kambara, Atsushi; Suzuki, Tomoaki; Matsubayashi, Keiji

    2011-01-01

    A new design for posterior leaflet resection, "butterfly resection," is proposed. It is a combination of two triangular resections in the prolapsing posterior leaflet segment. This method minimizes resection in the target segment, and it prevents systolic anterior motion by reducing the height of the posterior leaflet according to the amount of excess tissue. We have used this technique for 60.4% (29 of 48) of posterior leaflet prolapse cases with zero hospital mortality and no morbidity. Postbypass transesophageal echocardiography identified no more than mild regurgitation and no sign of systolic anterior motion. During 13.1 ± 6.8 months of follow-up, patients neither died nor needed reoperation.

  15. Segmental Colitis Complicating Diverticular Disease

    Directory of Open Access Journals (Sweden)

    Guido Ma Van Rosendaal

    1996-01-01

    Full Text Available Two cases of idiopathic colitis affecting the sigmoid colon in elderly patients with underlying diverticulosis are presented. Segmental resection has permitted close review of the histopathology in this syndrome which demonstrates considerable similarity to changes seen in idiopathic ulcerative colitis. The reported experience with this syndrome and its clinical features are reviewed.

  16. 14 CFR 29.1103 - Induction systems ducts and air duct systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Induction systems ducts and air duct systems. 29.1103 Section 29.1103 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF....1103 Induction systems ducts and air duct systems. (a) Each induction system duct upstream of the...

  17. Migratory intralaryngeal thyroglossal duct cyst

    Directory of Open Access Journals (Sweden)

    Karlatti Pradeep

    2010-01-01

    Full Text Available Intralaryngeal thyroglossal duct cysts are rare; a migrating one, rarer still. Such a case may be a cause for confusion and it is important to understand this entity and its typical findings.

  18. 肺癌解剖性肺段切除与肺楔形切除术后肺功能评估临床研究%Clinical Study of Preoperative Evaluation of Pulmonary Function and Pulmonary Wedge Resection of Lung Cancer after Pulmonary Segmental Anatomy

    Institute of Scientific and Technical Information of China (English)

    赖启勋

    2014-01-01

    Objective To investigate the feasibility of video-assisted thoracoscopic lung resection, safety and operation indications. Methods From 2011 January to 2014 January in our hospital underwent thoracoscopic anatomic lung resection in 100 cases, using standard completely thoracoscopic lobectomy incision, according to anatomic fol owed by high 2.5mm white nail nail bin treatment of segmental pulmonary arteries, segmental vein, with high 3.5mm blue nail nail bin treatment bronchial, and systematic lymph node dissection. Results 12 cases were successful y completed thoracoscopic anatomic resection pulmonary segment resection. Operation time was 115~260min, average 182min; the intraoperative blood loss was 100 ~ 300ml, average 230ml. Chest drainage time 2 ~ 6D, average 3.5d. Postoperative hospital stay was 3 ~11d, average 7.5d. No two operation, no blood, no peri operation period death. The postoperative pathology: 6 cases of adenocarcinoma, 2 cases of squamous cellcarcinoma, wherein the primary non smal celllung cancer were classified as stage a. 12 cases were fol owed up for 1 ~ 24 months, average 9 months, 10 cases had no recurrence, metastasis of lung cancer. Conclusion Thoracoscopic anatomic segmentectomy with other comorbidities for non small celllung cancer and pulmonary function in stageⅠa dif erence or not suitable for lobectomy, is a safe and feasible option.%目的比较肺癌解剖性肺段切除与肺楔形切除术后肺功能的变化。方法圆011年1月~圆014年1月在我院行肺癌解剖性肺段切除与肺楔形切除术各50例,用标准的全胸腔镜肺叶切除术切口,根据解剖随后用高2.5mm白钉治疗节段性肺动脉和静脉,高3.5mm蓝色钉治疗支气管,及系统性淋巴结清扫。结果100例均顺利完成肺癌解剖性肺段切除与肺楔形切除术。手术时间115~260min,平均182min;术中出血量100~300ml,平均230ml。胸腔引流时间2~6d,平均3.5d。术后住院3~11d,平均7.5d。术后肺功能无差异

  19. Laparoscopic Colon Resection

    Science.gov (United States)

    ... thorough evaluation by a surgeon qualified in laparoscopic colon resection in consultation with your primary ... Olympic Blvd., Suite 600 Los Angeles, CA 90064 Tel: (310) 437-0544 Fax: (310) 437- ...

  20. Papillary carcinoma in a thyroglossal duct: case report

    Directory of Open Access Journals (Sweden)

    Antonio Santos Martins

    1999-11-01

    Full Text Available CONTEXT: Thyroglossal duct cysts are the most common congenital cervical abnormality in childhood. Malignant lesions are rare in thyroglossal duct cysts (about 1%. OBJECTIVE: To report a case of papillary carcinoma in thyroglossal duct cysts. DESIGN: Case report. CASE REPORT: The patient was a 21-year-old female with a four-month history of an anterior midline neck mass but without other symptoms. The physical examination revealed a 4.0 cm diameter, smooth, painless, cystic nodule at the level of the hyoid bone. The thyroid gland was normal by palpation and no neck lymph nodes were found. Indirect laryngoscopy, fine-needle biopsy aspiration and cervical ultrasound were normal and compatible with the physical findings of a thyroglossal duct cyst. The patient underwent surgery with this diagnosis, under general anesthesia, and the mass was resected by the usual Sistrunk procedure. There were no local signs of invasion of the tissue surrounding the cyst or duct at surgery. The patient was discharged within 24 hours. Histopathological examination of the specimen showed a 3.5 x 3.0 x 3.0 cm thyroglossal cyst, partially filled by a solid 1.0 x 0.5 cm brownish tissue. Histological sections showed a papillary carcinoma in the thyroid tissue of a thyroglossal cyst, with normal thyroid tissue at the boundary of the carcinoma. There was no capsule invasion and the margins were negative. The follow-up of the patient consisted of head and neck examinations, ultrasonography of the surgical region and thyroid, and total body scintigraphy. The patient has been followed up for two years with no further evidence of disease.

  1. TWO NEW DUCT LEAKAGE TESTS

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.W.

    1998-12-01

    Two variations on the tests for duct leakage currently embodied in ASHRAE Standard 152P (Method of Test for Determining the Design and Seasonal Efficiencies of Residential Thermal Distribution Systems) are presented. Procedures are derived for calculating supply and return duct leakage to/from outside using these new variations. Results of these tests are compared with the original ones in Standard 152P on the basis of data collected in three New York State homes.

  2. Duct Leakage Repeatability Testing

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sherman, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-01-01

    Duct leakage often needs to be measured to demonstrate compliance with requirements or to determine energy or Indoor Air Quality (IAQ) impacts. Testing is often done using standards such as ASTM E1554 (ASTM 2013) or California Title 24 (California Energy Commission 2013 & 2013b), but there are several choices of methods available within the accepted standards. Determining which method to use or not use requires an evaluation of those methods in the context of the particular needs. Three factors that are important considerations are the cost of the measurement, the accuracy of the measurement and the repeatability of the measurement. The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques using data from the literature and recently obtained field data. We will also briefly discuss the first two factors. The main question to be answered by this study is to determine if differences in the repeatability of these tests methods is sufficient to indicate that any of these methods is so poor that it should be excluded from consideration as an allowed procedure in codes and standards.

  3. Alumina Ceramics Vacuum Duct for the 3GeV-RCS of the J-PARC

    CERN Document Server

    Kinsho, Michikazu; Ogiwara, Norio; Saito, Yoshio

    2005-01-01

    It was success to develop alumina ceramics vacuum ducts for the 3GeV-RCS of J-PARC at JAERI. There are two types of alumina ceramics vacuum ducts needed, one being 1.5m-long duct with a circular cross section for use in the quadrupole magnet, the other being 3.5m-long and bending 15 degrees, with a race-track cross section for use in the dipole magnet. These ducts could be manufactured by joining several duct segments of 0.5-0.8 m in length by brazing. The alumina ceramics ducts have copper stripes on the outside surface of the ducts to reduce the duct impedance. One of the ends of each stripe is connected to a titanium flange by way of a capacitor so to interrupt an eddy current circuit. The copper stripes are produced by an electroforming method in which a stripe pattern formed by Mo-Mn metallization is first sintered on the exterior surface and then overlaid by PR-electroformed copper (Periodic current Reversal electroforming method). In order to reduce emission of secondary electrons when protons or elect...

  4. Invasive carcinoma derived from branch duct-type IPMN may be a more aggressive neoplasm than that derived from main duct-type IPMN

    OpenAIRE

    OKABAYASHI, TAKEHIRO; Shima, Yasuo; KOSAKI, TAKUHIRO; SUMIYOSHI, TATSUAKI; KOZUKI, AKIHITO; IIYAMA, TASTUO; Takezaki, Yuka; Kobayashi, Michiya; Nishimori, Isao; Ogawa, Yasuhiro; Hanazaki, Kazuhiro

    2013-01-01

    The present study aimed to evaluate the long-term follow-up results of patients with intraductal papillary mucinous neoplasm (IPMN) and to estimate the degree of IPMN malignancy based on pathological and molecular features of resected specimens. The detection rate of IPMN has increased over the last decade; however, the management of this neoplasm remains controversial. This is particularly so for branch duct-type IPMN, which carries a high potential for malignancy and risk of recurrence. We ...

  5. Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Tae Kyoung; Kim, Kyoung Won; Kim, Ah Young; Kim, Pyo Nyun; Ha, Hyun Kwon; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-06-01

    To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation. The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct. The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3)

  6. A large mural nodule in branch duct intraductal papillary mucinous adenoma of the pancreas: a case report.

    Science.gov (United States)

    Haruki, Koichiro; Wakiyama, Shigeki; Futagawa, Yasuro; Shiba, Hiroaki; Misawa, Takeyuki; Yanaga, Katsuhiko

    2015-12-01

    Indications for resection of branch duct intraductal papillary mucinous neoplasms (IPMNs) remain controversial because of their low tendency to be malignant. Surgical resection should be recommended if any factors indicating malignancy are present. However, preoperative differentiation between benign and malignant tumors is very difficult, especially in cases of branch duct IPMNs. We herein report a case of branch duct intraductal papillary mucinous adenoma (IPMA) of the pancreas with a large mural nodule of 25 mm. A 74-year-old woman was admitted for examination and treatment for a cystic tumor in the head of the pancreas. Magnetic resonance cholangiopancreatography and computed tomography showed a cystic lesion, 50 mm in diameter, with an irregular mural nodule in the pancreatic head. Endoscopic ultrasonography demonstrated a multicystic tumor connected with the main pancreatic duct (MPD). The mural nodule had a diameter of 18 mm, and the MPD had a slight dilation of 6 mm. These findings suggested a high potential for malignancy. The patient underwent pancreaticoduodenectomy with lymph node dissection. The excised pancreas showed multiple cysts located in the branch pancreatic duct with a maximum diameter of 75 mm. The mural nodule had a maximum diameter of 25 mm. The tumor was diagnosed as an IPMA by pathological examination. After operation, the patient was discharged without any complications. Two years after resection, the patient remains in remission with no evidence of tumor recurrence.

  7. Resected Pleomorphic Carcinoma of the Gallbladder

    Directory of Open Access Journals (Sweden)

    Masanari Shimada

    2012-12-01

    Full Text Available Pleomorphic carcinoma is a rare lesion and the literature contains few reports of pleomorphic carcinoma of the gallbladder. The present study reports a rare case of primary pleomorphic carcinoma of the gallbladder for which we were able to perform curative surgery. A 77-year-old woman with dementia developed nausea and anorexia, and computed tomography demonstrated irregular thickening of the gallbladder wall. Drip infusion cholangiography and endoscopic retrograde cholangiopancreatography revealed no stenosis of the common and intrahepatic bile ducts. We suspected carcinoma of the gallbladder without lymph node metastasis and invasion to the common bile duct. We guessed it to be resectable and performed open laparotomy. At operation, the fundus of the gallbladder was adherent to the transverse colon, but no lymph node and distant metastases were detected. Therefore, we performed curative cholecystectomy with partial colectomy. Histopathology and immunostaining showed coexistence of an adenocarcinoma, squamous cell carcinoma and sarcomatous tumor of spindle-shaped cell, as well as transition zones between these tumors. We diagnosed stage I pleomorphic carcinoma of the gallbladder. No recurrence has been observed for one and a half years. The biological behavior of pleomorphic carcinoma of the gallbladder remains unknown. It will be necessary to accumulate more case reports of this tumor in order to define diagnostic criteria.

  8. Resection planning for robotic acoustic neuroma surgery

    Science.gov (United States)

    McBrayer, Kepra L.; Wanna, George B.; Dawant, Benoit M.; Balachandran, Ramya; Labadie, Robert F.; Noble, Jack H.

    2016-03-01

    Acoustic neuroma surgery is a procedure in which a benign mass is removed from the Internal Auditory Canal (IAC). Currently this surgical procedure requires manual drilling of the temporal bone followed by exposure and removal of the acoustic neuroma. This procedure is physically and mentally taxing to the surgeon. Our group is working to develop an Acoustic Neuroma Surgery Robot (ANSR) to perform the initial drilling procedure. Planning the ANSR's drilling region using pre-operative CT requires expertise and around 35 minutes' time. We propose an approach for automatically producing a resection plan for the ANSR that would avoid damage to sensitive ear structures and require minimal editing by the surgeon. We first compute an atlas-based segmentation of the mastoid section of the temporal bone, refine it based on the position of anatomical landmarks, and apply a safety margin to the result to produce the automatic resection plan. In experiments with CTs from 9 subjects, our automated process resulted in a resection plan that was verified to be safe in every case. Approximately 2 minutes were required in each case for the surgeon to verify and edit the plan to permit functional access to the IAC. We measured a mean Dice coefficient of 0.99 and surface error of 0.08 mm between the final and automatically proposed plans. These preliminary results indicate that our approach is a viable method for resection planning for the ANSR and drastically reduces the surgeon's planning effort.

  9. Total laparoscopic liver resection in 78 patients

    Institute of Scientific and Technical Information of China (English)

    Lei Zhang; Ya-Jin Chen; Chang-Zhen Shang; Hong-Wei Zhang; Ze-Jian Huang

    2009-01-01

    AIM: To summarize the clinical experience of laparoscopic hepatectomy at a single center.METHODS: Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma ( n = 39), metastatic liver carcinoma ( n = 10), and benign liver neoplasms ( n = 29) underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients.RESULTS: The lesions were located in segments Ⅰ ( n = 3), Ⅱ ( n = 16), Ⅲ ( n = 24), Ⅳ ( n = 11), Ⅴ ( n = 11),Ⅵ ( n = 9), and Ⅷ ( n = 4). The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three ( n = 4),two ( n = 8) and one ( n = 66) in the study cohort. The surgical procedures included left hemi-hepatectomy ( n = 7), left lateral lobectomy ( n = 14), segmentectomy ( n = 11), local resection ( n = 39), and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer ( n = 7). Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion (400-800 mL). There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred.CONCLUSION: Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.

  10. Parotid Duct Repair by Facial Vein Graft versus Gore-Tex, A Sialographic Evaluation.

    Science.gov (United States)

    Gheisari, R; Mohamadinezhad, C; Mehravaran, R; Ziaei, M

    2013-06-01

    The most common method for parotid duct anastomosis is suturing. A ductal defect of greater than 1cm may prevent a direct anastomosis. The goal of this study was a sialographic evaluation to compare repairing a parotid duct with facial vein graft versus Gore-Tex tub in 19 dogs. Nineteen dogs were studied in this experimental trial. Extra oral transverse incisions were made in buccal regions bilaterally to expose parotid ducts and a defect (2 cm) was performed in similar areas (right and left). The right resected duct was repaired with facial vein graft and the left anastomosis was performed by using the Gore-Tex tube microscopically. Sialography was used to evaluate the ductal leakage. Statistical analysis was performed, using SPSS software and McNemar's test. Based on the sialography evaluation; the ductal leakage was seen in five cases (26.31%) on the right side and in seven cases (36.84%) in the left side. Statistical analysis using McNemar's test suggested no statistically significant difference between ductal leakages in right and left parotid ducts (p> 0.05). The results of this study suggest that the efficacies of Gore-Tex tube and vein graft in parotid duct anastomosis are similar, but the use of Gore-Tex tube had a number of advantages, including reduced morbidity of the graft and short operation time.

  11. A rare case report of patent vitellointestinal duct causing bowel obstruction in an adult.

    Science.gov (United States)

    Bhandari, Tika Ram; Shahi, Sudha; Gautam, Manish; Pandey, Sanjay

    2017-08-24

    Patent vitellointestinal duct occurs in about 2% of the population which unusually leads to small intestinal obstruction associated with high morbidity and mortality. Here we are reporting an unusual case of patent vitellointestinal duct causing small intestinal obstruction in an adult patient. A 22-year-old male without any medical illness presented as an emergency with a 3day hystory of abdominal pain, multiple episode of vomiting and abdominal distention. Distended abdomen and sign of peritonitis were found on abdominal examination. Abdominal X-rays revealed multiple small intestinal air-fluid levels. A patent vitellointestinal duct extending from distal ileum to the posterior wall of the umbilicus was found causing closed loop ileal obstruction during laparotomy. Resection of a vitellointestinal duct along with gangrenous distal ileum and cecum with ileocolostomy was performed. He was discharged on the 8 th postoperative day. Diagnosing and management of cause of intestinal obstruction in patients without history of abdominal surgery is very challenging. Early resuscitation and timely surgical intervention of intestinal obstruction due to a rare patent vitellointestinal duct can be life-saving measure. The patent vitellointestinal duct is an uncommon entity in adults and moreover this disorder leading to intestinal obstruction is very rare. Surgeons should be aware of this infrequent cause of small bowel obstruction to allow for early diagnosis and to facilitate better patient outcomes. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  12. Thirteen-Year Disease-Free Survival after Surgery for Cystic Duct Carcinoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Zine Abedine Benchellal

    2008-11-01

    Full Text Available Cystic duct carcinoma is known to have a better prognosis compared to its location in other biliary ducts. Only one case with a survival over ten years has been previously published. The authors report a case of survival over 13 years without recurrence or metastasis. Preoperative diagnosis of cystic duct tumor was carried in a 66-year-old male. Under the diagnosis of carcinoma of the cystic duct, the patient underwent en bloc resection of the gallbladder, cystic duct, hepaticocholedochus and lymph node dissection. A Roux-en-Y hepaticojejunostomy was performed. Histological examination revealed a moderately differentiated adenocarcinoma of the cystic duct. Five months later the patient underwent second look surgery for benign obstruction of the hepaticojejunal anastomosis. The patient is still doing well 13 years later without any local recurrence or metastasis. To our knowledge, this is the longest disease-free survival ever published in the literature. This case sustains that better and longer survival is possible with a real chance of potential cure if radical surgery is performed.

  13. Functional outcome of en bloc resection of a giant cell tumour of the distal radius and arthrodesis of the wrist and distal ulna using an ipsilateral double barrel segmental ulna bone graft combined with a modified Sauve-Kapandji procedure.

    Science.gov (United States)

    Zhang, W; Zhong, J; Li, D; Sun, C; Zhao, H; Gao, Y

    2017-05-01

    Giant cell tumour of the distal radius is a locally aggressive lesion. In this study, we performed a wrist arthrodesis reconstruction with an ipsilateral double barrel segmental ulnar bone graft combined with a modified Sauve-Kapandji procedure for a giant cell tumour of the distal radius. From January 2007 to September 2013, we followed eight patients for a mean duration of 36 months. One patient developed a recurrence and was treated by amputation; the other seven patients achieved radiological union in about 8 months. There was no wrist instability, deformation or dislocation; the mean range of motion of the forearm achieved 75° of supination and 70° of pronation. The patients could recover reasonable grip strength. This new operative procedure can excise the tumour with a low rate of recurrence, fewer functional deficits and fewer complications than reported for other procedures. IV, therapeutic.

  14. Risk Factors associated with Paraurethral Duct Dilatation following Gonococcal Paraurethral Duct Infection in Men

    Science.gov (United States)

    Fan, Wenge; Zhang, Qingsong; Wang, Lin; Ye, Xun; Jiang, Tingwang

    2016-01-01

    No studies have explored the risk factors for paraurethral duct dilatation following paraurethral duct infection by Neisseria gonorrhoeae in men undergoing ceftriaxone therapy. The present study was performed to explore the risk factors for paraurethral duct dilatation following paraurethral duct infection by N. gonorrhoeae in men undergoing ceftriaxone therapy and thus guide clinical interventions. We compared the demographic, behavioral, and clinical data of men with paraurethral duct infection by N. gonorrhoeae with and without dilatation of the paraurethral duct. Univariate analysis showed significant differences in age, disease course of the infected paraurethral duct, Chlamydia trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae between the patient and control groups (Pgonorrhoeae in men. Age, C. trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae are also risk factors. Thus, educating patients to undergo timely therapy and treating the C. trachomatis infection may be effective interventions. PMID:27861521

  15. The Prevalence of Hjortsjo Crook Sign of Right Posterior Sectional Bile Duct and Bile Duct Anatomy in ERCP

    Directory of Open Access Journals (Sweden)

    Hanan M. Alghamdi

    2017-01-01

    Full Text Available Aim. The frequency of the Right Posterior Sectional Bile Duct (RPSBD hump sign in cholangiogram when it crosses over the right portal vein known as Hjortsjo Crook Sign and the bile duct anatomy are studied. Knowledge of the implication of positive sign can facilitate safe resection for both bile duct and portal vein. Methods. Prospectively, we included 237 patients with indicated ERCP during a period from March 2010 to January 2015. Results. The mean age (±SD and male to female ratio were 38.8 (±19.20 and 1 : 1.28, respectively. All patients are Arab from Middle Eastern origin, had biliary stone disease, and underwent diagnostic and therapeutic ERCP. Positive Hjortsjo Crook Sign was found in 17.7% (42 of patients. The sign was found to be equally more frequent in Nakamura’s RPSBD anatomical variant types I, II, and IV in 8.4% (20, 6.8% (16, and 2.1% (5, respectively, while rare anatomical variant type III showed no positive sign. Conclusion. Hjortsjo Crook Sign frequently presents in RPSBD variation types I, II, and IV in our patients.

  16. An isolated nasolacrimal duct osteoma.

    Science.gov (United States)

    Kim, Joo Yeon; Kwon, Jae Hwan

    2013-07-01

    Osteomas of the nose and paranasal sinus are common benign tumors that can extend to surrounding structures and result in orbital or intracranial involvement. Presenting symptoms include facial pain, headache, cerebral symptoms, ocular symptoms, and so on, depending on the location and size of the tumor. They commonly occur within the frontal, ethmoid, maxillary, and sphenoid sinuses; however, there are rare cases of reported osteomas in the nasal cavity, turbinate, or orbit. Our case report describes a patient with nasolacrimal duct osteoma who presented with ipsilateral ocular pain, epiphora, and medial canthal swelling. We performed intranasal dacryocystorhinostomy using a nasal endoscope and removed the lacrimal duct osteoma. This report describes symptoms and management of an isolated nasolacrimal duct stone with a review of the literature.

  17. A huge intraductal papillary mucinous carcinoma of the bile duct treated by right trisectionectomy with caudate lobectomy

    Directory of Open Access Journals (Sweden)

    Jo Sungho

    2009-12-01

    Full Text Available Abstract Background Because intraductal papillary mucinous neoplasm of the bile duct (IPMN-B is believed to show a better clinical course than non-papillary biliary neoplasms, it is important to make a precise diagnosis and to perform complete surgical resection. Case presentation We herein report a case of malignant IPMN-B treated by right trisectionectomy with caudate lobectomy and extrahepatic bile duct resection. Radiologic images showed marked dilatation of the left medial sectional bile duct (B4 resulting in a bulky cystic mass with multiple internal papillary projections. Duodenal endoscopic examination demonstrated very patulous ampullary orifice with mucin expulsion and endoscopic retrograde cholangiogram confirmed marked cystic dilatation of B4 with luminal filling defects. These findings suggested IPMN-B with malignancy potential. The functional volume of the left lateral section was estimated to be 45%. A planned extensive surgery was successfully performed. The remnant bile ducts were also dilated but had no macroscopic intraluminal tumorous lesion. The histopathological examination yielded the diagnosis of mucin-producing oncocytic intraductal papillary carcinoma of the bile duct with poorly differentiated carcinomas showing neuroendocrine differentiation. The tumor was 14.0 × 13.0 cm-sized and revealed no stromal invasiveness. Resection margins of the proximal bile duct and hepatic parenchyma were free of tumor cell. The patient showed no postoperative complication and was discharged on 10th postoperative date. He has been regularly followed at outpatient department with no evidence of recurrence. Conclusion Considering a favorable prognosis of IPMN-B compared to non-papillary biliary neoplasms, this tumor can be a good indication for aggressive surgical resection regardless of its tumor size.

  18. The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children.

    Science.gov (United States)

    Oluigbo, Chima O; Wang, Jichuan; Whitehead, Matthew T; Magge, Suresh; Myseros, John S; Yaun, Amanda; Depositario-Cabacar, Dewi; Gaillard, William D; Keating, Robert

    2015-06-01

    OBJECT Focal cortical dysplasia (FCD) is one of the most common causes of intractable epilepsy leading to surgery in children. The predictors of seizure freedom after surgical management for FCD are still unclear. The objective of this study was to perform a volumetric analysis of factors shown on the preresection and postresection brain MRI scans of patients who had undergone resective epilepsy surgery for cortical dysplasia and to determine the influence of these factors on seizure outcome. METHODS The authors reviewed the medical records and brain images of 43 consecutive patients with focal MRI-documented abnormalities and a pathological diagnosis of FCD who had undergone surgical treatment for refractory epilepsy. Preoperative lesion volume and postoperative resection volume were calculated by manual segmentation using OsiriX PRO software. RESULTS Forty-three patients underwent first-time surgery for resection of an FCD. The age range of these patients at the time of surgery ranged from 2 months to 21.8 years (mean age 7.3 years). The median duration of follow-up was 20 months. The mean age at onset was 31.6 months (range 1 day to 168 months). Complete resection of the area of an FCD, as adjudged from the postoperative brain MR images, was significantly associated with seizure control (p = 0.0005). The odds of having good seizure control among those who underwent complete resection were about 6 times higher than those among the patients who did not undergo complete resection. Seizure control was not significantly associated with lesion volume (p = 0.46) or perilesion resection volume (p = 0.86). CONCLUSIONS The completeness of FCD resection in children is a significant predictor of seizure freedom. Neither lesion volume nor the further resection of perilesional tissue is predictive of seizure freedom.

  19. Successful endoscopic procedures for intraductal papillary neoplasm of the bile duct:A case report

    Institute of Scientific and Technical Information of China (English)

    Kohei; Tsuchida; Michiko; Yamagata; Yasuyuki; Saifuku; Dan; Ichikawa; Kazunari; Kanke; Toshimitsu; Murohisa; Masaya; Tamano; Makoto; Iijima; Yukiko; Nemoto; Wataru; Shimoda; Toshiaki; Komori; Hirokazu; Fukui; Kazuhito; Ichikawa; Hitoshi; Sugaya; Kazuhito; Miyachi; Takahiro; Fujimori; Hideyuki; Hiraishi

    2010-01-01

    Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct(IPNB),which consists of papillary proliferation of dysplastic biliary epithelium.As even benign papillary tumors are considered as premalignant,some investigators recommend aggressive surgical therapy for IPNB,although no guidelines are available to manage this disease.Few reports have described long-term follow-up of patients with benign IPNB without radical resection....

  20. Modified posterior vertebral column resection for Kümmell disease

    Science.gov (United States)

    Liu, Feng-Yu; Huo, Li-Shuang; Liu, Sen; Wang, Hui; Zhang, Li-Jun; Yang, Da-Long; Ding, Wen-Yuan

    2017-01-01

    Abstract Rationale: Kümmell's disease is defined as delayed traumatic vertebral collapse disease in which patients develop a kyphosis after asymptomatic minor spinal trauma. Both anterior approach and posterior approach have been reported, however, there is no standard treatment for Kümmell's disease. Patient concerns: We described a successful modified posterior vertebral column resection in a patient with Kümmell's disease. A 65-year-old woman reported persistent back pain for almost three months. Diagnoses: Kümmell's disease was diagnosed based on computer tomography (CT) and magnetic resonance imaging (MRI). Interventions: Modified posterior vertebral column resection combined with short-segment fixation was designed to treat this disease. Outcomes: The procedure was successful without any complications. Patient reported that symptoms were obviously improved in one week after operation. Lessons: Modified posterior vertebral column resection combined with short-segment fixation is an effective treatment option for Kümmell's disease. PMID:28151882

  1. Prostate resection - minimally invasive

    Science.gov (United States)

    ... invasive URL of this page: //medlineplus.gov/ency/article/007415.htm Prostate resection - minimally invasive To use ... into your bladder instead of out through the urethra ( retrograde ... on New Developments in Prostate Cancer and Prostate Diseases. Evaluation and treatment of lower ...

  2. Regeneração hepática induzida por ressecção segmentar do fígado, em rato Hepatic regeneration induced by segmental liver resection, in rats

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2004-02-01

    Full Text Available OBJETIVO: Avaliar a regeneração progressiva do parênquima hepatocitário, nos seus aspectos macro e microscópicos, em pós-operatório imediato e tardio de ressecção segmentar do fígado. MÉTODO: Foram estudados 10 ratos machos albinos da raça Wistar, pesando entre 250 e 300 gramas, submetidos à hepatectomia parcial de lobo esquerdo, com retirada de cerca de 20% da massa total do órgão. Os animais foram divididos aleatoriamente em dois grupos (n=5 para estudo no 7º (Grupo 1 e 21º (Grupo 2 dias pós-operatórios. Decorrido o tempo de acompanhamento, avaliou-se o aspecto macroscópico e microscópico do fígado. RESULTADOS: No Grupo 1, após sete dias, os animais apresentavam a cavidade abdominal com poucas aderências. O fígado mostrava reação cicatricial no local da ressecção, porém seu tamanho já era próximo ao normal. O exame histopatológico mostrou freqüentes sinais de poliploidia dos hepatócitos, além de tecido de granulação frouxo e desordenado, acompanhado de escasso infiltrado de células inflamatórias. O Grupo 2, após 21 dias, mostrava poucas aderências na cavidade abdominal, e o fígado com aspecto e dimensões próximos ao normal. A histologia mostrou tecido cicatricial mais denso, ordenado, sem sinais inflamatórios. Observou-se apenas pequeno grau de poliploidia hepatocitária. CONCLUSÃO: Após remoção cirúrgica de 20% do parênquima hepático houve aumento temporário da renovação celular verificado por poliploidia hepatocitária.BACKGROUND: To assess the progression of liver regeneration after partial hepatic resection. METHODS: Ten Wistar adult rats, of both sexes were studied. After anesthesia with ether, the animals were submitted to a left lobe parcial hepatectomy . Rats were randomly divided into two groups (n=5 according to the day macro and microscopic studies were carried out, 7th (Group 1 or 21st postoperative days. RESULTS: All rats survived throughout the experimental protocol. The

  3. [A case of main-duct IPMN with multicentric invasive carcinoma].

    Science.gov (United States)

    Nakadai, Eri; Yoshitomi, Hideyuki; Shimizu, Hiroaki; Otsuka, Masayuki; Kato, Atsushi; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Suzuki, Daisuke; Nakajima, Masayuki; Okamura, Daiki; Sakai, Nozomu; Miyazaki, Masaru

    2014-11-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas often contains multifocal lesions, and total pancreatectomy is sometimes needed for curative resection. We report here our experience with a case of IPMN with multiple invasive carcinoma foci that was successfully treated with total pancreatectomy. A 66-year-old man had jaundice, and a computed tomography (CT) scan revealed a hypovascular mass in the pancreas head in conjunction with calcification and dilation of the entire main pancreatic duct. He was diagnosed with pancreas head cancer and chronic pancreatitis, and a pancreaticoduodenectomy was planned. Intraoperative pathological examination revealed papillary growth of high grade dysplasia in the main and branch duct epithelium and perineural invasion of the atypical glands. After 2 additional resections, we performed a total pancreatectomy. Pathological findings showed that the pancreas head tumor was an invasive carcinoma derived from main-duct IPMN of the pancreas. It was a mucinous carcinoma with calcification. Moreover, we found other multiple, discontinuous invasive foci in the body and tail of the pancreas which were undetectable by preoperative imaging. This case was highly suggestive for preoperative diagnosis for pancreas tumor and developmental pattern of main-duct IPMN.

  4. Fragmentation of common bile duct and pancreatic duct stones by extracorporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham Gyum [Ansan Junior College, Seoul (Korea, Republic of); Son, Soon Yong; Lee, Won Hong [Asan Medical Center, Seoul (Korea, Republic of)

    1998-06-01

    To determine its usefulness and safety of extracorporeal shock-wave lithotripsy in common bile duct and pancreatic duct stones, we analyzed the results of 13 patients with common bile duct stones and 6 patients with pancreatic duct stones which were removed by endoscopic procedures using the balloon or basket, who was performed the extracorporeal shock-wave lithotripsy using the ultrasonography for stone localization with a spark gap type Lithotriptor(Dornier MPL 9000, Germany). Fragmentation and complete clearance of the common bile duct and pancreatic duct stones were obtained in 19 of 19 patients(100%). Apart from transient attacks of fever in 2 of 13 patients with common bile duct stones(15%) and mild elevation of serum amylase and lipase in 2 of 6 patients with pancreatic duct stones(33%), no other serious side effects were observed. In our experiences, extracorporeal shock-wave lithotripsy is a safe and useful treatment for endoscopically unretrievable common bile duct and pancreatic duct stones.

  5. Vitellointestinal Duct Anomalies in Infancy

    Science.gov (United States)

    Kadian, Yogender Singh; Verma, Anjali; Rattan, Kamal Nain; Kajal, Pardeep

    2016-01-01

    Background: Vitellointestinal duct (VID) or omphalomesenteric duct anomalies are secondary to the persistence of the embryonic vitelline duct, which normally obliterates by weeks 5–9 of intrauterine life. Methods: This is a retrospective analysis of a total of 16 patients of symptomatic remnants of vitellointestinal duct from period of Jan 2009 to May 2013. Results: Male to female ratio (M:F) was 4.3:1 and mean age of presentation was 2 months and their mode of presentation was: patent VID in 9 (56.25%) patients, umbilical cyst in 2(12.25%), umbilical granuloma in 2 (12.25%), and Meckel diverticulum as content of hernia sac in obstructed umbilical hernia in 1 (6.25%) patient. Two patients with umbilical fistula had severe electrolyte disturbance and died without surgical intervention. Conclusion: Persistent VID may have varied presentations in infancy. High output umbilical fistula and excessive bowel prolapse demand urgent surgical intervention to avoid morbidity and mortality. PMID:27433448

  6. Fan/Ram Duct Program

    Science.gov (United States)

    1973-10-01

    mwm^mmmt c INPUT I ] H—f TRANSIENT ROUTINE P"" CONTROL """I FAN ] COMPRESSOR MAIN BURNER I DUCT HZ HIGH TURBINE in— LOW TURBINE I...and pressure ratio. 6. Low Turbine Low turbine characteristics, identical In form to those of the high turbine, are shown in figures 27 and 28. 7

  7. Clinical analysis of efficacy and quality of life of segmental bowel resection for bowel endometriosis%节段性肠切除术治疗肠道子宫内膜异位症患者的临床疗效及生命质量分析

    Institute of Scientific and Technical Information of China (English)

    刘多; 沈慧敏; 梁炎春; 王伟; 刘田雨; 尚春亮; 姚书忠

    2016-01-01

    Objective To evaluate the efficacy and quality of life of segmental bowel resection for bowel endometriosis. Methods Totally 62 symptomatic patients with bowel endometriosis undergoing segmental bowel resection were recruited. A visual analogue scale (VAS) and the 36-item short form health survey (SF-36) questionnaire were administered before and at least 1 year after surgery, respectively. Pregnancy rates were also recorded. Results Sixty-two patients in total underwent follow-up ranging from 12 to 74 months. All patients complained of obvious pain symptoms, including dysmenorrhea, dyspareunia, pain on defecation and chronic pelvic pain. The relief of dysmenorrhea (2.9 ± 2.2 versus 7.5 ± 2.9), dyspareunia (0.7 ± 0.5 versus 4.3 ± 2.2) and pain on defecation (1.6 ± 0.7 versus 7.3 ± 1.9) after surgery was statistically significant (all P<0.01). The scores for all 8 domains of the SF-36 questionnaire were significant improved after segmental bowel resection (all P<0.01). The complication rate was 45% (28/62), including 18 cases of urinary retention, 4 rectovaginal fistulas, 2 cases of vaginal dehiscence, and 1 case each of thrombogenesis, pelvic abscess and general peritonitis. All of the patients with complications recovered well throughout follow-up. The postoperative pregnancy rate of the previous infertile patients was 6/10. Among the 6 gestational cases, 2 had labour, 2 underwent caesarean sections, one had a spontaneous natural abortion, and one underwent uterine curettage. Conclusion Segmental bowel resection could significantly relieve pain and improve quality of life for patients with bowel endometriosis.%目的:探讨节段性肠切除术治疗肠道子宫内膜异位症患者的临床疗效并分析其生命质量。方法收集2008年1月1日至2013年12月31日于中山大学附属第一医院妇产科行节段性肠切除术治疗的肠道子宫内膜异位症患者62例,所有患者分别于术前及术后至少12个月完成视觉模拟评

  8. 后路一期半椎体切除节段性内固定融合治疗先天性脊柱侧凸%The Treatment of Hemivertebra Resection via the Posterior Approach along with Segments Internal Fixation for Congenital Kyphoscoliosis

    Institute of Scientific and Technical Information of China (English)

    孔维云; 张国华; 王宇飞; 杨克敏; 高薇; 李光全

    2013-01-01

    Objective To study the surgical strategies and techniques for the correction of congenital kyphoscoliosis with hemivertebra and evaluate the surgical results. Methods From June 2010 to June 2011,there were 6 congenital kyphoscoliostic patients with fully segmented hemivertebra were undergone hemivertebra resection through posterior approach, which included 4 males and 2 females with an average age of 15.7 years. The average Cobb angle of scoliosis was 73.4° (range, 52°~87°), the average Cobb angle of segmental kyphosis was 67.4° (range, 43°~89°) . The highest level of hemivertebrae was T9 and the lowest was L2. The surgical strategies were designed as followed:For the 2 cases without structural compensative curve, the posterior hemiverte-brae resection and short segmental internal fixation were performed. For the 4 cases with structural compensative curve, whose Risser signs were classified into 2-5, the hemivertebrae resection and long segmental internal fixa-tion were performed, and the compensative curve was included in the instrumentation level. Results The opera-tion time was 2.5~4.0 h (average,3.5 hours), the blood loss was 700-2 000 mL (mean,1 367 mL) . Numb-ness happened in one lower extremity postoperatively in 1 patient, and the symptom released in 1 month. The aver-age postoperative Cobb angle in coronal plane was 21.4° (11°~28°) with a correction rate of 67.9%. The aver-age postoperative Cobb angle in sagittal plane was 17.8° (12°~35°) with a correction rate of 75.2%. The fol-low-up period was from 26 months to 36 months (average, 26 months),no pseudoarthrosis,and obvious correc-tion loss either in coronal or sagittal plane was noted. Conclusion Hemivertebra resection and individualized oper-ation way has a good capability of correcting congenital kyphoscoliosis caused by hemivertebra.%目的探讨合并有半椎体畸形的脊柱侧后凸患者的手术矫正策略和方法,并对手术矫正效果进行评估.方法2010年6月至2011

  9. Extrahepatic bile duct atresia from the pathologist’s perspective: pathological features and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Peter Van Eyken

    2014-06-01

    Full Text Available Extrahepatic biliary atresia (EHBA refers to stenosis or atresia of the extrahepatic biliary tree. It accounts for 25-30% of cases of neonatal cholestasis. If left untreated, EHBA progresses to biliary cirrhosis and is universally fatal within the first 2 years of life. Early diagnosis is crucial since surgical treatment (Kasai procedure is the only treatment option. Histopathologic examination of liver biopsy specimens is a key element in the diagnostic work-up of infants with suspected EHBA. Pathologic diagnosis aims at excluding non-surgically correctable causes of neonatal cholestasis thereby leading to surgical exploration for confirmation of the diagnosis. All published data indicate that pathologists can diagnose EHBA with high sensitivity, high specificity and reasonable interobserver agreement. The most useful histologic features in the diagnosis of EHBA are portal tract changes including ductular proliferation and bile plugs in ducts and ductules. These lesions are not pathognomonic but can be seen in extrahepatic obstruction of any cause. Total parenteral nutrition (TPN-associated cholestasis and alpha1-antitrypsin (A1AT deficiency cannot be differentiated from EHBA without access to clinical data and may lead to false-positive diagnosis. False-negative interpretation may be caused by early age at diagnosis or by small/indequate specimens. The pathologist also plays a role in the examination of the resected fibrotic segment and of explant specimens. Histopathology can yield prognostic information, being also an indispensable tool in research for the possible pathogenesis of this disease. A well-coordinated, multidisciplinary approach is required in the assessment of suspected cases of EHBA.  Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in

  10. [Statistical study of mandibular resections].

    Science.gov (United States)

    Sidibe, C A; Dichamp, J; Razouk, O; Bertrand, J C; Guilbert, G

    1994-01-01

    A retrospective study of mandibular resections performed from 1980 to 1984 was conducted to evaluate age, sex, aetiology, etc. The number of mandibular resections appears to have declined at the Institute of Stomatology and Maxillofacial Surgery of the Pitié-Salpêtrière Hospital. Different factors are involved included early diagnosis, improved surgical techniques and better patient follow-up. Partial mandibular resections are increasingly performed (52% of the cases) compared with total resections. Finally, a better understanding of the pathologies involved, especially tumours, has led to an adaptation of the resection techniques to avoid extensive mutilations.

  11. Segmentation: Identification of consumer segments

    DEFF Research Database (Denmark)

    Høg, Esben

    2005-01-01

    It is very common to categorise people, especially in the advertising business. Also traditional marketing theory has taken in consumer segments as a favorite topic. Segmentation is closely related to the broader concept of classification. From a historical point of view, classification has its...... and analysed possible segments in the market. Results show that the statistical model used identified two segments - a segment of so-called "fish lovers" and another segment called "traditionalists". The "fish lovers" are very fond of eating fish and they actually prefer fish to other dishes...... origin in other sciences as for example biology, anthropology etc. From an economic point of view, it is called segmentation when specific scientific techniques are used to classify consumers to different characteristic groupings. What is the purpose of segmentation? For example, to be able to obtain...

  12. Laparoscopic pancreatic resection.

    Science.gov (United States)

    Harrell, K N; Kooby, D A

    2015-10-01

    Though initially slow to gain acceptance, the minimally invasive approach to pancreatic resection grew during the last decade and pancreatic operations such as the distal pancreatectomy and pancreatic enucleation are frequently performed laparoscopically. More complex operations such as the pancreaticoduodenectomy may also confer benefits with a minimally invasive approach but are less widely utilized. Though most research to date comparing open and laparoscopic pancreatectomy is retrospective, the current data suggest that compared with open, a laparoscopic procedure may afford postoperative benefits such as less blood loss, shorter hospital stay, and fewer wound complications. Regarding oncologic considerations, despite initial concerns, laparoscopic resection appears to be non-inferior to an open procedure in terms of lymph node retrieval, negative margin rates, and long-term survival. New technologies, such as robotics, are also gaining acceptance. Data show that while the laparoscopic approach incurs higher cost in the operating room, the resulting shorter hospital stay appears to be associated with an equivalent or lower overall cost. The minimally invasive approach to pancreatic resection can be safe and appropriate with significant patient benefits and oncologic non-inferiority based on existing data.

  13. Management of Sigmoid Volvulus Avoiding Sigmoid Resection

    Science.gov (United States)

    Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Zarogoulidis, Paul; Sarika, Eirini; Stylianaki, Aikaterini; Zisoglou, Maria; Zervas, Vasilis; Bareka, Metaxia; Christofis, Christos; Iordanidis, Alkis

    2012-01-01

    Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided. PMID:22754489

  14. Management of Sigmoid Volvulus Avoiding Sigmoid Resection

    Directory of Open Access Journals (Sweden)

    Nikolaos Katsikogiannis

    2012-05-01

    Full Text Available Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided.

  15. Monitoring of Grouting Compactness in a Post-Tensioning Tendon Duct Using Piezoceramic Transducers.

    Science.gov (United States)

    Jiang, Tianyong; Kong, Qingzhao; Wang, Wenxi; Huo, Linsheng; Song, Gangbing

    2016-08-22

    A post-tensioning tendon duct filled with grout can effectively prevent corrosion of the reinforcement, maintain bonding behavior between the reinforcement and concrete, and enhance the load bearing capacity of concrete structures. In practice, grouting of the post-tensioning tendon ducts always causes quality problems, which may reduce structural integrity and service life, and even cause accidents. However, monitoring of the grouting compactness is still a challenge due to the invisibility of the grout in the duct during the grouting process. This paper presents a stress wave-based active sensing approach using piezoceramic transducers to monitor the grouting compactness in real time. A segment of a commercial tendon duct was used as research object in this study. One lead zirconate titanate (PZT) piezoceramic transducer with marble protection, called a smart aggregate (SA), was bonded on the tendon and installed in the tendon duct. Two PZT patch sensors were mounted on the top outside surface of the duct, and one PZT patch sensor was bonded on the bottom outside surface of the tendon duct. In the active sensing approach, the SA was used as an actuator to generate a stress wave and the PZT sensors were utilized to detect the wave response. Cement or grout in the duct functions as a wave conduit, which can propagate the stress wave. If the cement or grout is not fully filled in the tendon duct, the top PZT sensors cannot receive much stress wave energy. The experimental procedures simulated four stages during the grout pouring process, which includes empty status, half grouting, 90% grouting, and full grouting of the duct. Experimental results show that the bottom PZT sensor can detect the signal when the grout level increases towards 50%, when a conduit between the SA and PZT sensor is formed. The top PZT sensors cannot receive any signal until the grout process is completely finished. The wavelet packet-based energy analysis was adopted in this research to

  16. Monitoring of Grouting Compactness in a Post-Tensioning Tendon Duct Using Piezoceramic Transducers

    Directory of Open Access Journals (Sweden)

    Tianyong Jiang

    2016-08-01

    Full Text Available A post-tensioning tendon duct filled with grout can effectively prevent corrosion of the reinforcement, maintain bonding behavior between the reinforcement and concrete, and enhance the load bearing capacity of concrete structures. In practice, grouting of the post-tensioning tendon ducts always causes quality problems, which may reduce structural integrity and service life, and even cause accidents. However, monitoring of the grouting compactness is still a challenge due to the invisibility of the grout in the duct during the grouting process. This paper presents a stress wave-based active sensing approach using piezoceramic transducers to monitor the grouting compactness in real time. A segment of a commercial tendon duct was used as research object in this study. One lead zirconate titanate (PZT piezoceramic transducer with marble protection, called a smart aggregate (SA, was bonded on the tendon and installed in the tendon duct. Two PZT patch sensors were mounted on the top outside surface of the duct, and one PZT patch sensor was bonded on the bottom outside surface of the tendon duct. In the active sensing approach, the SA was used as an actuator to generate a stress wave and the PZT sensors were utilized to detect the wave response. Cement or grout in the duct functions as a wave conduit, which can propagate the stress wave. If the cement or grout is not fully filled in the tendon duct, the top PZT sensors cannot receive much stress wave energy. The experimental procedures simulated four stages during the grout pouring process, which includes empty status, half grouting, 90% grouting, and full grouting of the duct. Experimental results show that the bottom PZT sensor can detect the signal when the grout level increases towards 50%, when a conduit between the SA and PZT sensor is formed. The top PZT sensors cannot receive any signal until the grout process is completely finished. The wavelet packet-based energy analysis was adopted in this

  17. Repair of a common bile duct defect with a decellularized ureteral graft

    Science.gov (United States)

    Cheng, Yao; Xiong, Xian-Ze; Zhou, Rong-Xing; Deng, Yi-Lei; Jin, Yan-Wen; Lu, Jiong; Li, Fu-Yu; Cheng, Nan-Sheng

    2016-01-01

    AIM To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model. METHODS Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube (T-tube group, n = 6) or a silicone stent (stent group, n = 6). Six pigs underwent bile duct reconstruction with a graft alone (stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological analysis. RESULTS The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless group. CONCLUSION Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications. PMID:28082809

  18. Treatment of the lacrimal excretory system after resection of medial canthal and eyelid tumors.

    Science.gov (United States)

    Older, J J

    1979-06-01

    A simplified method of lacrimal excretory system repair is presented. If part of a canaliculus is resected during removal of an eyelid tumor, the remaining section of the canaliculus can be exteriorized to the lacrimal lake. A silicone tube is threaded into the canaliculus and allowed to remain in place for one to two weeks. If both canaliculi and the common canaliculus are removed during resection for a medial canthal tumor, a silicone tube can be threaded into the nasolacrimal duct and brought out the area of the medial canthal angle. Conjunctiva which is wrapped around the tube can then form a new drainage canal into the remainder of the lacrimal excretory system.

  19. [Common bile duct stones and their complications].

    Science.gov (United States)

    Millat, B; Borie, F

    2000-12-01

    At the time of cholecystectomy for symptomatic cholelithiasis, 7-20% of patients have common bile duct stones. Nearly one third of them are asymptomatic. Routine cholangiography during cholecystectomy allows the diagnosis and treatment of common bile duct stones during the same operation. Selective indication for the diagnosis of common bile duct stones based on the positive predictive value of indicators limits treatment to symptomatic cases. No single indicator is however completely accurate in predicting common bile duct stones and the natural history of asymptomatic cases is uncertain. Endoscopic stone extraction preceding cholecystectomy is not superior to one-stage surgical treatment. Diagnosis and treatment of common bile duct stones are feasible laparoscopically. Complications of common bile duct stones are cholangitis and acute pancreatitis; if severe, they require specific therapeutic approaches.

  20. Prevalence, distribution, and differential diagnosis of nasopalatine duct cysts

    Science.gov (United States)

    CECCHETTI, F.; OTTRIA, L.; BARTULI, F.; BRAMANTI, N. E.; ARCURI, C.

    2012-01-01

    SUMMARY Introduction. Nasopalatine duct cysts (NPDCs) are the most common developmental epithelial non-odontogenic cysts of the maxillae. Their origin, however, is still a source of considerable debate. Aims. The aim of this investigation is to describe and discuss the etiology, differential diagnosis, clinic-pathological characteristics as well as to report the relative frequency and distribution of nasopalatine duct cysts in population (NPDCs) with a literature’s review on the topic. Methods The retrospective study was carried out using 36 clinical cases, with histopatological confirmation for NPDC, radiographs and oral photographs. Data included age and gender of the patient, radiographic findings, etiological factors, treatment, and prognosis of NPDC. Few surgical consideration are discussed. Results The study results report a clear male predilection with a 3:1 ratio. No statistically significant correlation was observed between the size of the lesion and patient’s gender. Lesions were usually asymptomatic. All cysts were located in the anterior maxillary midline region. Panoramic X-rays and computed tomography was used to identify the lesion. Surgical treatment was performed under local anesthesia including the dissection and removal of the cyst, adopting a usually palatine approach, with an enveloping flap from 1.4 to 2.4. Conclusions The etiology of NPDC is unclear and a male predilection was observed. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case. PMID:23285406

  1. A feasibility study of a 3-D finite element solution scheme for aeroengine duct acoustics

    Science.gov (United States)

    Abrahamson, A. L.

    1980-01-01

    The advantage from development of a 3-D model of aeroengine duct acoustics is the ability to analyze axial and circumferential liner segmentation simultaneously. The feasibility of a 3-D duct acoustics model was investigated using Galerkin or least squares element formulations combined with Gaussian elimination, successive over-relaxation, or conjugate gradient solution algorithms on conventional scalar computers and on a vector machine. A least squares element formulation combined with a conjugate gradient solver on a CDC Star vector computer initially appeared to have great promise, but severe difficulties were encountered with matrix ill-conditioning. These difficulties in conditioning rendered this technique impractical for realistic problems.

  2. Endoscopic resection of esthesioneuroblastoma.

    Science.gov (United States)

    Gallia, Gary L; Reh, Douglas D; Lane, Andrew P; Higgins, Thomas S; Koch, Wayne; Ishii, Masaru

    2012-11-01

    Esthesioneuroblastoma, or olfactory neuroblastoma, is an uncommon malignant tumor arising in the upper nasal cavity. Surgical approaches to this and other sinonasal malignancies involving the anterior skull base have traditionally involved craniofacial resections. Over the past 10 years to 15 years, there have been advances in endoscopic approaches to skull base pathologies, including malignant tumors. In this study, we review our experience with purely endoscopic approaches to esthesioneuroblastomas. Between January 2005 and February 2012, 11 patients (seven men and four women, average age 53.3 years) with esthesioneuroblastoma were treated endoscopically. Nine patients presented with newly diagnosed disease and two were treated for tumor recurrence. The modified Kadish staging was: A, two patients (18.2%); B, two patients (18.2%); C, five patients (45.5%); and D, two patients (18.2%). All patients had a complete resection with negative intraoperative margins. Three patients had 2-deoxy-2-((18)F)fluoro-d-glucose avid neck nodes on their preoperative positron emission tomography-CT scan. These patients underwent neck dissections; two had positive neck nodes. Perioperative complications included an intraoperative hypertensive urgency and pneumocephalus in two different patients. Mean follow-up was over 28 months and all patients were free of disease. This series adds to the growing experience of purely endoscopic surgical approaches in the treatment of skull base tumors including esthesioneuroblastoma. Longer follow-up on larger numbers of patients is required to clarify the utility of purely endoscopic approaches in the management of this malignant tumor.

  3. A case of the hepatic hilar bile duct cancer with external radiation. Efficacy and severe side effect of external radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Andoh, Hideaki; Yasui, Ouki; Ise, Norihito [Akita Univ. (Japan). School of Medicine

    2003-04-01

    Hepatic hilar bile duct cancer was difficult to cure by surgical treatment and its prognosis was very poor. We present the case of non-curative resection of hepatic hilar bile duct cancer, controlled with external radiation. 72 years-old-female, she complained jaundice and diagnosed hepatic hilar bile duct cancer with abdominal ultrasonography. Hepatic hilar resection was performed but curative resection could not be done, because cancer was diffusely spreaded to the hepatic and duodenal ends of the bile duct. After surgery, external radiation (1.8 Gy/day; total 50.4 Gy) was performed. Three months after operation, sometimes, cholangitis was occurred but we could not detect the intrahepatic bile duct dilatation and improved with antibiotics. After seven months, she was dead for sepsis, liver abscess and biliary cirrhosis. From autopsy findings, severe hepatic hilar fibrosis around the irradiation area, stenosis of the hepatico-jejunostomy and portal vein were existed but could not detect the remnant cancer cells. External radiation was sometimes effective, especially for this case. But we should consider the side effect of fibrosis and preventive treatments such as biliary stenting or early biliary drainage. (author)

  4. Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement

    Directory of Open Access Journals (Sweden)

    Olga N. Tucker

    2008-01-01

    Full Text Available Synchronous major vessel resection during pancreaticoduodenectomy (PD for borderline resectable pancreatic adenocarcinoma remains controversial. In the 1970s, regional pancreatectomy advocated by Fortner was associated with unacceptably high morbidity and mortality rates, with no impact on long-term survival. With the establishment of a multidisciplinary approach, improvements in preoperative staging techniques, surgical expertise, and perioperative care reduced mortality rates and improved 5-year-survival rates are now achieved following resection in high-volume centres. Perioperative morbidity and mortality following PD with portal vein resection are comparable to standard PD, with reported 5-year-survival rates of up to 17%. Segmental resection and reconstruction of the common hepatic artery/proper hepatic artery (CHA/PHA can be performed to achieve an R0 resection in selected patients with limited involvement of the CHA/PHA at the origin of the gastroduodenal artery (GDA. PD with concomitant major vessel resection for borderline resectable tumours should be performed when a margin-negative resection is anticipated at high-volume centres with expertise in complex pancreatic surgery. Where an incomplete (R1 or R2 resection is likely neoadjuvant treatment with systemic chemotherapy followed by chemoradiation as part of a clinical trial should be offered to all patients.

  5. Postoperative radiotherapy dose correlates with locoregional control in patients with extra-hepatic bile duct cancer

    Energy Technology Data Exchange (ETDEWEB)

    Im, Jung Ho; Seong, Jinsil; Lee, Jeong Shim; Kim, Yong Bae; Kim, Kyung Sik; Lee, Woo Jung [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Ik Jae; Park, Jun Sung; Yoon, Dong Sup [Sangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (≥50 Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.

  6. Methods of evaluating cleanliness of ventilation ducts

    Institute of Scientific and Technical Information of China (English)

    曹勇; 罗运有; 于丹; 甘丽斯

    2009-01-01

    A testing system for evaluating cleanliness of ventilation ducts was constructed. Comparisons of four evaluation methods for quantifying the amount of dust on the inner surface of ventilation ducts are presented. The experimental results show that the wiping by solvent method is more efficient than that by the wiping method,especially used on low cleanliness duct surface. The gravimetric tape method is an efficient method of collecting dust samples on the duct surface with low amounts of dust,particularly used to check the cleanliness level after the cleaning work. The optical method can be set up rapidly and is useful for fieldwork measurements.

  7. Management of Duodenal Adenomas Involving the Ampulla of Vater – A Warning against Limited Resection

    Directory of Open Access Journals (Sweden)

    Jeremy Rossaak

    2008-03-01

    Full Text Available Duodenal adenomas are uncommon, however, when present a proportion have dysplasia associated with the adenoma and therefore require treatment. The options range from less invasive endoscopic treatments to a pancreaticoduodenectomy. This case report describes two patients with adenomas involving the ampulla of Vater. One patient had familial adenomatous polyposis, the other was a renal transplant patient with a large adenoma. Both patients’ adenomas contained high-grade dysplasia. Both patients underwent a pancreaticoduodenectomy. Histology of both specimens demonstrated that the adenoma had migrated up the bile duct for at least 7 mm, and the pancreatic duct for 8 mm in one patient. Limited resection of ampullary adenomas may leave residual adenomatous tissue in the bile duct with the risk of recurrent adenomatous disease and malignant transformation.

  8. Results of a pancreatectomy with a limited venous resection for pancreatic cancer.

    Science.gov (United States)

    Illuminati, Giulio; Carboni, Fabio; Lorusso, Riccardo; D'Urso, Antonio; Ceccanei, Gianluca; Papaspyropoulos, Vassilios; Pacile, Maria Antonietta; Santoro, Eugenio

    2008-01-01

    The indications for a pancreatectomy with a partial resection of the portal or superior mesenteric vein for pancreatic cancer, when the vein is involved by the tumor, remain controversial. It can be assumed that when such involvement is not extensive, resection of the tumor and the involved venous segment, followed by venous reconstruction will extend the potential benefits of this resection to a larger number of patients. The further hypothesis of this study is that whenever involvement of the vein by the tumor does not exceed 2 cm in length, this involvement is more likely due to the location of the tumor being close to the vein rather than because of its aggressive biological behavior. Consequently, in these instances a pancreatectomy with a resection of the involved segment of portal or superior mesenteric vein for pancreatic cancer is indicated, as it will yield results that are superposable to those of a pancreatectomy for cancer without vascular involvement. Twenty-nine patients with carcinoma of the pancreas involving the portal or superior mesenteric vein over a length of 2 cm or less underwent a macroscopically curative resection of the pancreas en bloc with the involved segment of the vein. The venous reconstruction procedures included a tangential resection/lateral suture in 15 cases, a resection/end-to-end anastomosis in 11, and a resection/patch closure in 3. Postoperative mortality was 3.4%; morbidity was 21%. Local recurrence was 14%. Cumulative (standard error) survival rate was 17% (9%) at 3 years. A pancreatectomy combined with a resection of the portal or superior mesenteric vein for cancer with venous involvement not exceeding 2 cm is indicated in order to extend the potential benefits of a curative resection.

  9. Biliary cystadenoma with bile duct communication depicted on liver-specific contrast agent-enhanced MRI in a child

    Energy Technology Data Exchange (ETDEWEB)

    Marrone, Gianluca; Carollo, Vincenzo; Luca, Angelo [Mediterranean Institute of Transplantation and High Specialization Therapy (ISMETT), Diagnostic and Interventional Radiology, Palermo (Italy); Maggiore, Giuseppe [University Hospital S. Chiara, Gastroenterology and Hepatology, Department of Paediatrics, Pisa (Italy); Sonzogni, Aurelio [Riuniti Hospital, Pathology Department, Bergamo (Italy)

    2011-01-15

    Biliary cystadenoma is a benign, but potentially malignant, cystic neoplasm of the biliary ducts occurring most commonly in middle-aged females and very rarely in children. We present a 9-year-old boy with biliary cystadenoma, diagnosed by MRI using a new liver-specific contrast agent (gadoxetic acid) that is eliminated by the biliary system. The images clearly demonstrate the communication between the multiloculated cystic mass and the biliary tree, suggesting the possibility of biliary cystadenoma. Due to the malignant potential of a cystadenoma, the lesion was resected. The resection was complete and the postoperative course was uneventful. (orig.)

  10. Use of linear radiofrequency device in liver resection

    Directory of Open Access Journals (Sweden)

    Stojanović Miroslav P.

    2010-01-01

    Full Text Available Background/Aim. Linear radiofrequency device (LRFD is disposable tool designed for liver parenchyma transection using controlled radiofrequency to 'seal' blood vessels and bile ducts, making liver resection easier and safer compared to classical resectional techniques. The aim of this study was to determine real value of the LRFD compared to the standard 'keliclasia' technique. Methods. This prospective study analyzed the significant intraoperative parameters and postoperative results of the 200 patients who underwent surgery at the Surgery Clinic of Clinical Centre in Niš, between January 1, 2001, and January 1, 2009. The patients were divided into two groups: the control Keli group (144 patients with the 'keliclasia' resection technique and the control RF group (with resection performed using LRFD - Tissue Link / Dissection Sealer (DS - 3.0 (56 patients. The following parameters were analyzed: duration of liver ischemia, liver parenchyma transection time, intraoperative blood loss, significant intraoperative and postoperative complication rate, duration of hospitalization and mortality. Results. LRFD was used in 56 liver resections. The average duration of liver ischemia in the RF group was shorter than in the Keli group (7 versus 22 minutes. Parenchymal liver transection was significantly slower in the RF group than in the Keli group (2.05 versus 4.34 cm2/minutes, respectively. There was less intraoperative bleeding using LRFD 'Keliclasia' tehniquethan in the control group (390 mL compared to 420 mL, respectively. After the use of LRFD two cases of biliary leak and 4 pleural effusions were registered. Conclusion. LRFD is simple device for safe liver transection with decreased need for liver ischemia and singificant reducing of the intraoperative blood loss. High price for disposable device and slow parenchyma transection are disadvantages of this device.

  11. Measure Guideline: Sealing and Insulating of Ducts in Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, R.; Puttagunta, S.

    2011-12-01

    This document begins with a discussion on potential cost and performance benefits of duct sealing and insulating. It continues with a review of typical duct materials and components and the overall procedures for assessing and improving the duct system.

  12. Measure Guideline. Sealing and Insulating Ducts in Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, R. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Puttagunta, S. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States)

    2011-12-01

    This document begins with a discussion on potential cost and performance benefits of duct sealing and insulating. It continues with a review of typical duct materials and components and the overall procedures for assessing and improving the duct system.

  13. Endoscopic resection of subepithelial tumors

    Institute of Scientific and Technical Information of China (English)

    Arthur; Schmidt; Markus; Bauder; Bettina; Riecken; Karel; Caca

    2014-01-01

    Management of subepithelial tumors(SETs) remains challenging. Endoscopic ultrasound(EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods.

  14. Cerebellar anatomy as applied to cerebellar microsurgical resections

    Directory of Open Access Journals (Sweden)

    Alejandro Ramos

    2012-06-01

    Full Text Available OBJECTIVE: To define the anatomy of dentate nucleus and cerebellar peduncles, demonstrating the surgical application of anatomic landmarks in cerebellar resections. METHODS: Twenty cerebellar hemispheres were studied. RESULTS: The majority of dentate nucleus and cerebellar peduncles had demonstrated constant relationship to other cerebellar structures, which provided landmarks for surgical approaching. The lateral border is separated from the midline by 19.5 mm in both hemispheres. The posterior border of the cortex is separated 23.3 mm from the posterior segment of the dentate nucleus; the lateral one is separated 26 mm from the lateral border of the nucleus; and the posterior segment of the dentate nucleus is separated 25.4 mm from the posterolateral angle formed by the junction of lateral and posterior borders of cerebellar hemisphere. CONCLUSIONS: Microsurgical anatomy has provided important landmarks that could be applied to cerebellar surgical resections.

  15. Radiated noise of ducted fans

    Science.gov (United States)

    Eversman, Walter

    The differences in the radiated acoustic fields of ducted and unducted propellers of the same thrust operating under similar conditions are investigated. An FEM model is created for the generation, propagation, and radiation of steady, rotor alone noise and exit guide vane interaction noise of a ducted fan. For a specified number of blades, angular mode harmonic, and rotor angular velocity, the acoustic field is described in a cylindrical coordinate system reduced to only the axial and radial directions. It is found that, contrary to the usual understanding of the Tyler and Sofrin (1962) result, supersonic tip speed rotor noise can be cut off if the tip Mach number is only slightly in excess of unity and if the number of blades is relatively small. If there are many blades, the fundamental angular mode number is large, and the Tyler and Sofrin result for thin annuli becomes more relevant. Shrouding of subsonic tip speed propellers is a very effective means of controlling rotor alone noise.

  16. An improved multimodal method for sound propagation in nonuniform lined ducts.

    Science.gov (United States)

    Bi, WenPing; Pagneux, Vincent; Lafarge, Denis; Aurégan, Yves

    2007-07-01

    An efficient method is proposed for modeling time harmonic acoustic propagation in a nonuniform lined duct without flow. The lining impedance is axially segmented uniform, but varies circumferentially. The sound pressure is expanded in term of rigid duct modes and an additional function that carries the information about the impedance boundary. The rigid duct modes and the additional function are known a priori so that calculations of the true liner modes, which are difficult, are avoided. By matching the pressure and axial velocity at the interface between different uniform segments, scattering matrices are obtained for each individual segment; these are then combined to construct a global scattering matrix for multiple segments. The present method is an improvement of the multimodal propagation method, developed in a previous paper [Bi et al., J. Sound Vib. 289, 1091-1111 (2006)]. The radial rate of convergence is improved from O(n(-2)), where n is the radial mode indices, to O(n(-4)). It is numerically shown that using the present method, acoustic propagation in the nonuniform lined intake of an aeroengine can be calculated by a personal computer for dimensionless frequency K up to 80, approaching the third blade passing frequency of turbofan noise.

  17. Double-duct liquid metal magnetohydrodynamic engine

    Science.gov (United States)

    Haaland, Carsten M.

    1995-01-01

    An internal combustion, liquid metal (LM) magnetohydrodynamic (MHD) engine and an alternating current (AC) magnetohydrodynamic generator, are used in combination to provide useful AC electric energy output. The engine design has-four pistons and a double duct configuration, with each duct containing sodium potassium liquid metal confined between free pistons located at either end of the duct. The liquid metal is forced to flow back and forth in the duct by the movement of the pistons, which are alternatively driven by an internal combustion process. In the MHD generator, the two LM-MHD ducts pass in close proximity through a Hartmann duct with output transformer. AC power is produced by operating the engine with the liquid metal in the two generator ducts always flowing in counter directions. The amount of liquid metal maintained in the ducts may be varied. This provides a variable stroke length for the pistons. The engine/generator provides variable AC power at variable frequencies that correspond to the power demands of the vehicular propulsion. Also the engine should maintain nearly constant efficiency throughout the range of power usage. Automobiles and trucks could be powered by the invention, with no transmission or power converter devices being required.

  18. A rare case of bile duct cyst

    Institute of Scientific and Technical Information of China (English)

    Qing-Gang Wang; Shu-Tian Zhang

    2009-01-01

    Choledochal cyst is an uncommon disease usually seen in young women and can be divided into five types. We report a 66-year-old woman who was diagnosed with types Ⅱ and Ⅱ bile duct cyst simultaneously after surgery, which is a rare type of bile duct cyst.

  19. Fingerprint Segmentation

    OpenAIRE

    Jomaa, Diala

    2009-01-01

    In this thesis, a new algorithm has been proposed to segment the foreground of the fingerprint from the image under consideration. The algorithm uses three features, mean, variance and coherence. Based on these features, a rule system is built to help the algorithm to efficiently segment the image. In addition, the proposed algorithm combine split and merge with modified Otsu. Both enhancements techniques such as Gaussian filter and histogram equalization are applied to enhance and improve th...

  20. New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method

    Science.gov (United States)

    Sakai, Yuji; Ishihara, Takeshi; Tsuyuguchi, Toshio; Tawada, Katsunobu; Saito, Masayoshi; Kurosawa, Jo; Tamura, Ryo; Togo, Seiko; Mikata, Rintaro; Tada, Motohisa; Yokosuka, Osamu

    2011-01-01

    The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis. Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice, endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus. Pancreatogram was slightly and insufficiently obtained by injecting the contrast media via the common channel of the duodenal main papilla. We tried to cannulate selectively into the pancreatic duct for a clear image. However, the selective cannulation of the pancreatic duct was difficult because of instability of the papilla. On the other hand, selective cannulation of the bile duct was relatively easily achieved. Therefore, after the imaging of the bile duct, a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted. As a result, selective pancreatic duct cannulation became possible. It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is difficult (“selective pancreatic duct difficult cannulation case”). PMID:22110840

  1. Pancreatic duct holder for facilitating duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy.

    Science.gov (United States)

    Sugiyama, Masanori; Suzuki, Yutaka; Abe, Nobutsugu; Ueki, Hisayo; Masaki, Tadahiko; Mori, Toshiyuki; Atomi, Yutaka

    2009-01-01

    Duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy may be technically difficult, particularly in cases in which the remnant pancreas is soft with a small main pancreatic duct. We devised a pancreatic duct holder for duct-to-mucosa pancreatojejunostomy. The holder has a cone-shaped tip. A one-third circle of the tip is cut away, which makes a slit. As the tip is inserted gently into the pancreatic duct, the duct can be adequately expanded. The holder provides a good surgical field for anastomosis. A slit of the tip allows needle insertion. The holder facilitates stitches of the jejunum also. Twelve patients underwent pancreatoduodenectomy, followed by duct-to-mucosa pancreatojejunostomy using the holder. The holder allowed 8 or more stitches in duct-to-mucosa anastomosis, even in patients with a small pancreatic duct. No patients developed prolonged pancreatic leakage or pancreatic fistula postoperatively. In conclusion, the pancreatic duct holder is a simple and useful tool for facilitating duct-to-mucosa pancreatojejunostomy.

  2. Bile duct hamartomas (von Mayenburg complexes) mimicking liver metastases from bile duct cancer: MRC findings

    Institute of Scientific and Technical Information of China (English)

    Yasuhiko Nagano; Kenichi Matsuo; Katsuya Gorai; Kazuya Sugimori; Chikara Kunisaki; Hideyuki Ike; Katsuaki Tanaka; Toshio Imada; Hiroshi Shimada

    2006-01-01

    We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.

  3. 内镜胰管探查在精准胰腺导管内乳头状黏液瘤切除术中的应用%Application of endoscopic pancreatic duct exploration in precise pancreatectomy for intraductal papillary mucinous neoplasms

    Institute of Scientific and Technical Information of China (English)

    尚东; 张庆凯; 张桂信

    2012-01-01

    The diagnostic rate of intraductal papillary mucinous neoplasms (IPMNs) has been increased as the improvement of imaging and endoscopic techniques.All main duct type and mixed variant IPMNs should be resected as long as the patient is a good surgical candidate with reasonable life expectancy.Evaluation of resection margin ( especially circumferential margins) is very important to prevent the recurrence of IPMNs,and intraoperative pancreatoscopy plays an important role in determining the appropriate size for pancreatic resection.In this article,the experience in the treatment of 1 patient with IPMNs by precise pancreatectomy guided by endoscopy-assisted intraoperative pancreatic duct inspection was introducted.

  4. The utility of fistulography in the diagnosis of thyroglossal duct cyst with fistulous tract: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Honghua Zhu, MD

    2015-01-01

    Full Text Available Thyroglossal duct cyst (TGDC is one of the most common congenital, midline, cervical lesions originating from an embryonic thyroglossal duct remnant. It is usually diagnosed clinically. Imaging is used to confirm the clinical diagnosis, and fistulography is very helpful in the diagnosis and surgical planning for thyroglossal fistulous tract. Fistulographs show the direction, length, and anatomy of the remnant tracts and the small tracts connecting a TGDC to the tongue base at the foramen cecum. This report presents a case of TGDC in a 12-year-old boy and demonstrates the utility of fistulography imaging in the diagnosis of TGDC with fistulous tract. In this case, fistulography was performed after cannulating the external opening of the fistula. The patient underwent a resection, including thyroglossal tract removal and further excision of the mid portion of the hyoid bone (the Sistrunk procedure. The postoperative pathology report indicated thyroglossal duct remnants with no evidence of malignancy.

  5. A small solitary non-parasitic hepatic cyst causing an intra-hepatic bile duct stricture: a case report

    Directory of Open Access Journals (Sweden)

    Hong Taeho

    2010-08-01

    Full Text Available Abstract Introduction We report an unusual presentation of a small hepatic cyst causing cholangitis. Case presentation A 70-year-old Asian man was hospitalized for aggravated chronic pain in the right upper portion of his abdomen. Fever developed after admission. Laboratory tests revealed elevated hepatobiliary enzymes, inflammatory markers and carbohydrate antigen 19-9 without hyperbilirubinemia. Ultrasound and computed tomography demonstrated dilatation of the left intra-hepatic bile ducts. Endoscopic retrograde cholangiopancreatography showed that the right intra-hepatic bile ducts were normally filled with contrast medium, but the left intra-hepatic bile ducts were not seen in the confluence. A left hepatectomy was performed because a hidden malignancy could not be excluded. The surgical findings showed no tumor around the bile duct but rather a 2 cm cyst in segment four of Couinaud's category of the liver around the hilum. The pathology report was a solitary non-parasitic hepatic cyst compressing the bile duct. Conclusion A very small solitary hepatic cyst might cause hepatic duct stricture if it is located near the hepatic hilum, and should be considered in the differential diagnosis of a hepatic duct stricture.

  6. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases

    Science.gov (United States)

    Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo

    2015-01-01

    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial. PMID:25713806

  7. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases.

    Science.gov (United States)

    Beppu, Toru; Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo

    2015-02-01

    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial.

  8. Salivary Duct Cyst: Histo-pathologic Correlation

    Directory of Open Access Journals (Sweden)

    Divya Vinayachandran

    2013-01-01

    Full Text Available Non-neoplastic cysts of the salivary glands are uncommon and represent 2-5% of all salivary gland lesions. They are mainly mucoceles or salivary duct cysts. Unlike a mucocele, which is surrounded by granulation tissue, the salivary duct cyst is lined by epithelium. Salivary duct cysts are more common in the oral minor salivary glands and rarely occur in the major salivary glands, show a marked predilection for the superficial lobe of the parotid, and represent 10% of all salivary gland cysts. Neoplastic differentiation of the lining of the salivary duct cyst has been reported. We report a case of a salivary duct cyst of the left parotid gland, with a review of radiographic and histopathologic features.

  9. The pelvic kidney of male Ambystoma maculatum (Amphibia, urodela, ambystomatidae) with special reference to the sexual collecting ducts.

    Science.gov (United States)

    Siegel, Dustin S; Sever, David M; Aldridge, Robert D

    2010-12-01

    This study details the gross and microscopic anatomy of the pelvic kidney in male Ambystoma maculatum. The nephron of male Ambystoma maculatum is divided into six distinct regions leading sequentially away from a renal corpuscle: (1) neck segment, which communicates with the coelomic cavity via a ventrally positioned pleuroperitoneal funnel, (2) proximal tubule, (3) intermediate segment, (4) distal tubule, (5) collecting tubule, and (6) collecting duct. The proximal tubule is divided into a vacuolated proximal region and a distal lysosomic region. The basal plasma membrane is modified into intertwining microvillus lamellae. The epithelium of the distal tubule varies little along its length and is demarcated by columns of mitochondria with their long axes oriented perpendicular to the basal lamina. The distal tubule possesses highly interdigitating microvillus lamellae from the lateral membranes and pronounced foot processes of the basal membrane that are not intertwined, but perpendicular to the basal lamina. The collecting tubule is lined by an epithelium with dark and light cells. Light cells are similar to those observed in the distal tuble except with less mitochondria and microvillus lamellae of the lateral and basal plasma membrane. Dark cells possess dark euchromatic nuclei and are filled with numerous small mitochondria. The epithelium of the neck segment, pleuroperitoneal funnel, and intermediate segment is composed entirely of ciliated cells with cilia protruding from only the central portion of the apical plasma membrane. The collecting duct is lined by a highly secretory epithelium that produces numerous membrane bound granules that stain positively for neutral carbohydrates and proteins. Apically positioned ciliated cells are intercalated between secretory cells. The collecting ducts anastomose caudally and unite with the Wolffian duct via a common collecting duct. The Wolffian duct is secretory, but not to the extent of the collecting duct

  10. Factors affecting length of stay following colonic resection.

    Science.gov (United States)

    Schmelzer, Thomas M; Mostafa, Gamal; Lincourt, Amy E; Camp, Steven M; Kercher, Kent W; Kuwada, Timothy S; Heniford, B Todd

    2008-05-15

    In-hospital length of stay (LOS) has become a valuable measure of outcomes following any operation, which also directly impacts cost. The aim of this study was to identify the factors that affect LOS after colonic resection. A retrospective analysis was performed of adult patients who underwent colonic resection over an 8-y period at a tertiary institution. Data collected included demographics, American Society of Anesthesiologists (ASA) score, preoperative comorbidities and medications, operative management, postoperative morbidity and mortality, and LOS. Statistical analysis included descriptive statistics and multiple logistic regression to identify variables predictive of prolonged LOS. A total of 899 consecutive patients were identified. One hundred eighty-seven resections were performed urgently, and 712 were elective. Two-hundred forty-five cases were performed laparoscopically. Complications occurred in 205 cases (23%), and there were 32 deaths (4%). The median LOS was 7 d. Logistic analysis showed 15 variables to be predictive of prolonged LOS. These included advanced age, warfarin sodium use, ASA score >or=3, alcoholism, chronic obstructive pulmonary disease, end-stage renal disease, illicit drug use, total colectomy (versus segmental), open resections (versus laparoscopic), and postoperative complications. In addition, the presence of at least one postoperative complication was predictive of prolonged LOS (P = 0.0002, OR 2.4 95% CI 1.5-3.8). ASA score and the incidence of postoperative complications are the only significant categories of variables that predict prolonged LOS after colectomy. Laparoscopic approach and the extent of the resection are predictive as well.

  11. Pseudotumor of the distal common bile duct at endoscopic retrograde cholangiopancreatography

    Science.gov (United States)

    Tan, Justin H.; Coakley, Fergus V; Wang, Zhen J.; Poder, Liina; Webb, Emily; Yeh, Benjamin M.

    2010-01-01

    Background Prior studies have described a pseudocalculus appearance in the distal common bile duct as a normal variant at cholangiography. The objective of this study is to describe the occurrence of pseudotumor in the distal common bile duct at endoscopic retrograde cholangiopancreatography (ERCP). Methods Nine patients who underwent ERCP between May 2004 and July 2008 were identified as having a transient eccentric mural-based filling defect in the distal common bile duct. A single reader systematically reviewed all studies and recorded the imaging findings. Results The mean diameter of the filling defect was 9 mm (range, 5 to 11). Eight patients had resolution of the filling defect during the same ERCP or on a subsequent ERCP, and in 2 of these patients the inferior border of the filling defect was not well visualized. The other patient underwent surgical resection of a presumed tumor with no evidence of malignancy on surgical pathology. Conclusion An eccentric mural-based filling defect in the distal common bile duct can be artifactual in nature and may reflect transient contraction of the sphincter of Oddi. Recognition of this pseudotumor may help avoid unnecessary surgery. PMID:21724120

  12. Transition duct system with metal liners for delivering hot-temperature gases in a combustion turbine engine

    Energy Technology Data Exchange (ETDEWEB)

    Wiebe, David J.

    2017-04-11

    A transition duct system (10) for delivering hot-temperature gases from a plurality of combustors in a combustion turbine engine is provided. The system includes an exit piece (16) for each combustor. The exit piece may include a straight path segment (26) and an arcuate connecting segment (36). A respective straight metal liner (92) and an arcuate metal liner (94) may be each inwardly disposed onto a metal outer shell (38) along the straight path segment and the arcuate connecting segment (36) of the exit piece. Structural arrangements are provided to securely attach the respective liners in the presence of substantial flow path pressurization. Cost-effective serviceability of the transition duct systems is realizable since the liners can be readily removed and replaced as needed.

  13. Hepatic segmentectomy combined with major hepatic vein resection for preser ving remnant liver lobe

    Institute of Scientific and Technical Information of China (English)

    Xue Xing; Hong Li; Wei-Guo Liu

    2008-01-01

    BACKGROUND: Impairment of liver function is the most serious complication that occurs after liver resection or in cirrhotic liver. Postoperative hepatic failure, which is mainly preceded by insufifcient remnant liver function and/or postoperative septic complications, is the major cause of hospital mortality. This study was undertaken to evaluate hepatic segmentectomy combined with major hepatic vein (MHV) resection for preserving the remnant liver lobe in the treatment of resectable primary liver cancer. METHODS: From 1997 to 2007, six patients with primary liver cancer underwent hepatic segmentectomy with MHV resection, and three patients with hepatic vein injury had ligation of the MHV. The remnant liver lobe was preserved after hepatic segmentectomy combined with MHV resection or ligation. RESULTS: The preserved liver lobe with normal structure could maintain hepatic function and showed no evidence of atrophy or swelling after hepatic segmentectomy combined with MHV resection or ligation. CONCLUSIONS: After the right inferior hepatic vein is conifrmed, and the MHV is occluded experimentally before hepatic segmentectomy combined with MHV resection, progressively deteriorating congestion does not occur in the preserved segment. Ligation or resection of the two MHVs must be avoided in patients with hepatic cirrhosis who have to undergo hepatic segmentectomy combined with MHV resection. Ligation of the MHV in patients with juxtahepatic vein injury is a simple and effective therapeutic modality.

  14. The role of radiotherapy in the treatment of bile duct carcinoma.

    Science.gov (United States)

    Veeze-Kuijpers, B; Meerwaldt, J H; Lameris, J S; van Blankenstein, M; van Putten, W L; Terpstra, O T

    1990-01-01

    Forty-two patients with irresectable bile duct carcinoma (n = 31) or with microscopic evidence of tumor rest after aggressive surgery for bile duct carcinoma (n = 11) were given radiotherapy consisting intentionally of external-beam therapy and intraluminal 192Iridium (192Ir) wire application(s) following bile drainage procedures. The treatment was well tolerated; complications were mainly infectious and related to the success of the drainage. A median survival of 10 months was achieved for the group as a whole. Patients treated following microscopically incomplete resection survived longer than patients with an irresectable tumor (15 vs 8 months median survival, p = 0.06). Gross lymph node involvement also proved to be a prognostic factor.

  15. The role of radiotherapy in the treatment of bile duct carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Veeze-Kuijpers, B.; Meerwaldt, J.H.; Lameris, J.S.; van Blankenstein, M.; van Putten, W.L.; Terpstra, O.T. (Dr. Daniel den Hoed Cancer Center, Rotterdam (Netherland))

    1990-01-01

    Forty-two patients with irresectable bile duct carcinoma (n = 31) or with microscopic evidence of tumor rest after aggressive surgery for bile duct carcinoma (n = 11) were given radiotherapy consisting intentionally of external-beam therapy and intraluminal 192Iridium ({sup 192}Ir) wire application(s) following bile drainage procedures. The treatment was well tolerated; complications were mainly infectious and related to the success of the drainage. A median survival of 10 months was achieved for the group as a whole. Patients treated following microscopically incomplete resection survived longer than patients with an irresectable tumor (15 vs 8 months median survival, p = 0.06). Gross lymph node involvement also proved to be a prognostic factor.

  16. Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT

    Energy Technology Data Exchange (ETDEWEB)

    Phongkitkarun, S. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: rasih@mahidol.ac.th; Kobayashi, S. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Varavithya, V. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Huang, X. [Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Curley, S.A. [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Charnsangavej, C. [Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2005-06-01

    AIM: To describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data. METHODS: Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms and laboratory data. RESULTS: Bile duct abnormalities developed in 34 (57%) of cases either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade. CONCLUSION: Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis, and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes and guide appropriate treatment.

  17. Trends of surgical treatment of hilar bile duct cancer: clinical andexperimental perspectives

    Institute of Scientific and Technical Information of China (English)

    Zhi Qiang Huang; Ning Xin Zhou; Da Dong Wang; Jian Guo Lu; Ming Yi Chen

    2000-01-01

    AIM To summarize the experience of surgical treatment of hilar cholangiocarcinoma and the results of aseries of experiments.METHODS AND RESULTS Personal perspectives of surgical treatment of hilar cholangiocarcinoma werebased on the experience of a series of patients with hilar bile duct cancer treated in the General Hospital ofPLA, Beijing from 1986 to 1999. A total of 157 cases were treated surgically, with 106 (67.5%) resections ofthe tumor , 37.6% of the resections was proved to be radical. The 1-, 2-, 3-, and 5-year survival rate of theradical resection group was 96.7%, 40.0%, 23.3% and 13.3%, respectively. No patient of the palliativeresection group lived beyond 3 years postoperatively. The recent trends of surgical management of hilar bileduct cancer were discussed. Experiments were carried out for cooperative clinicopathological study toevaluate the perineural space involvement, the neural cell adhesion molecule expression, p16 geneexpression, and the 3-dimensional reconstruction of the bile duct cancer specimens. The pathogeneticrelationship of HBV and HCV with extrahepatic cholangiocarcinoma was evaluated by histochemical and IS-PCR methods. And an inquiry into the possibility of gene therapy was made.CONCLUSION Hilar bile duct cancer rarely runs a “benign” course. It is a regional disease rather than alocal affection and may be related to HBV and HCV infection in China. It possesses the metastasing abilityalong the perineural space by a “jumping” fashion, therefore, in most cases, conventional surgical excision isbound to be unradical in the region of the porta hepatis for anatomical reasons.

  18. Biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection.

    Science.gov (United States)

    Kaneya, Yohei; Yoshida, Hiroshi; Matsutani, Takeshi; Hirakata, Atsushi; Matsushita, Akira; Suzuki, Seiji; Yokoyama, Tadashi; Maruyama, Hiroshi; Sasajima, Koji; Uchida, Eiji

    2011-01-01

    Most hepatic cysts are asymptomatic, but complications occasionally occur. We describe a patient with biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection. A 60-year-old Japanese woman was admitted to our hospital because of a nontender mass in the right upper quadrant of the abdomen. Laboratory tests revealed the following: serum total bilirubin, 0.6 mg/dL; serum aspartate aminotransferase, 100 IU/L; serum alanine aminotransferase, 78 IU/L; serum alkaline phosphatase, 521 IU/L; and serum gamma glutamic transpeptidase, 298 IU/L. Abdominal computed tomography, ultrasonography, and magnetic resonance cholangiopancreatography revealed a huge hepatic cyst, 13 cm in diameter, at the hepatic hilum, accompanied by dilatation of the intrahepatic bile duct and obstruction of the common bile duct. We diagnosed biliary obstruction due to a huge hepatic cyst at the hepatic hilum, and laparoscopic surgery was performed. A huge hepatic cyst was seen at the hepatic hilum. After needle puncture of the huge cyst, the anterior wall of the cyst was unroofed, and cholecystectomy was done. Intraoperative cholangiography through a cystic duct revealed stenosis of the duct. Subsequent decapsulation of the cyst was performed in front of the common bile duct. After this procedure, cholangiography revealed that the stenosis of the common bile duct had resolved. Histopathological examination of the surgical specimen confirmed the hepatic cyst was benign. The postoperative course was uneventful, and the results of liver function tests normalized. The patient was discharged 7 days after operation. Computed tomography 3 months after operation revealed disappearance of the hepatic cyst and no dilatation of the intrahepatic bile duct.

  19. Clinical significance of main pancreatic duct dilation on computed tomography: Single and double duct dilation

    Institute of Scientific and Technical Information of China (English)

    Mark D Edge; Maarouf Hoteit; Amil P Patel; Xiaoping Wang; Deborah A Baumgarten; Qiang Cai

    2007-01-01

    AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases.METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records.RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer.CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful follow up since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.

  20. Bile Duct Adenoma with Oncocytic Features

    Directory of Open Access Journals (Sweden)

    E. J. Johannesen

    2014-01-01

    Full Text Available Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

  1. LAPAROSCOPIC RESECTION IN COLORECTAL CANCER

    Institute of Scientific and Technical Information of China (English)

    Reinhard Bittner

    2005-01-01

    @@ 1 Introduction The feasibility of colon resection using the laparoscope was demonstrated as early as 1991[1~3]. It was shown one year later that it is also possible to use the laparoscope in abdominoperineal resection of the rectum for rectal carcinoma[4, 5]. One year after this, the first study was reported in which the results of anterior resection with the laparoscope were compared with the conventional operation in a small number of patients with carcinoma of the rectum[6]. The first reports on the feasibility of total excision of the mesorectum in patients with carcinoma of the middle or lower third of the rectum were first published at the start of this century[7~9]. It can be stated in summary that resection of the colon or rectum using the laparoscope is not of disadvantage to the patient, given that the surgeon has appropriate experience and the patient has been properly selected.

  2. Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy.

    Science.gov (United States)

    Tappenden, Kelly A

    2014-05-01

    The human small intestine is organized with a proximal-to-distal gradient of mucosal structure and nutrient processing capacity. However, certain nutrients undergo site-specific digestion and absorption, such as iron and folate in the duodenum/jejunum vs vitamin B12 and bile salts in the ileum. Intestinal resection can result in short bowel syndrome (SBS) due to reduction of total and/or site-specific nutrient processing areas. Depending on the segment(s) of intestine resected, malabsorption can be nutrient specific (eg, vitamin B12 or fat) or sweeping, with deficiencies in energy, protein, and various micronutrients. Jejunal resections are generally better tolerated than ileal resections because of greater postresection adaptive capacity than that of the jejunum. Following intestinal resection, energy scavenging and fluid absorption become particularly important in the colon owing to loss of digestive and absorptive surface area in the resection portion. Resection-induced alterations in enteroendocrine cell abundance can further disrupt intestinal function. For example, patients with end jejunostomy have depressed circulating peptide YY and glucagon-like peptide 2 concentrations, which likely contribute to the rapid intestinal transit and blunted intestinal adaptation observed in this population. SBS-associated pathophysiology often extends beyond the gastrointestinal tract, with hepatobiliary disease, metabolic bone disease, D-lactic acidosis, and kidney stone formation being chronic complications. Clinical management of SBS must be individualized to account for the specific nutrient processing deficit within the remnant bowel and to mitigate potential complications, both inside and outside the gastrointestinal tract.

  3. [Intra-Abdominal Germ Cell Tumor in Persistent Mullerian Duct Syndrome].

    Science.gov (United States)

    Mishima, Takao; Harada, Jiro; Kawa, Gen; Sakurai, Takanori; Okada, Takuya

    2016-08-01

    A 46-year-old man was admitted to hospital presenting with a lower abdominal mass. The patient's testes were not palpable in the scrotum, and the levels of lactic dehydrogenase, α-fetoprotein and human chorionic gonadotropin were all elevated. Enhanced computed tomography revealed that the lumen of the mass had penetrated the prostate. Pathological analysis of biopsy tissue indicated that the mass was a seminoma. Residual tumor resection was performed after chemotherapy. On histological examination, the lumen proved to be a Mullerian structure. Our diagnosis was an intra-abdominal germ cell tumor and persistent Mullerian duct syndrome.

  4. Paraurethral Skene's duct cyst in a newborn

    Science.gov (United States)

    Moralioğlu, Serdar; Bosnalı, Oktav; Celayir, Ayşenur Cerrah; Şahin, Ceyhan

    2013-01-01

    Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene's duct cyst in a newborn which was treated by incision and drainage. PMID:24049387

  5. Variable-Depth Liner Evaluation Using Two NASA Flow Ducts

    Science.gov (United States)

    Jones, M. G.; Nark, D. M.; Watson, W. R.; Howerton, B. M.

    2017-01-01

    Four liners are investigated experimentally via tests in the NASA Langley Grazing Flow Impedance Tube. These include an axially-segmented liner and three liners that use reordering of the chambers. Chamber reordering is shown to have a strong effect on the axial sound pressure level profiles, but a limited effect on the overall attenuation. It is also shown that bent chambers can be used to reduce the liner depth with minimal effects on the attenuation. A numerical study is also conducted to explore the effects of a planar and three higher-order mode sources based on the NASA Langley Curved Duct Test Rig geometry. A four-segment liner is designed using the NASA Langley CDL code with a Python-based optimizer. Five additional liner designs, four with rearrangements of the first liner segments and one with a redistribution of the individual chambers, are evaluated for each of the four sources. The liner configuration affects the sound pressure level profile much more than the attenuation spectra for the planar and first two higher-order mode sources, but has a much larger effect on the SPL profiles and attenuation spectra for the last higher-order mode source. Overall, axially variable-depth liners offer the potential to provide improved fan noise reduction, regardless of whether the axially variable depths are achieved via a distributed array of chambers (depths vary from chamber to chamber) or a group of zones (groups of chambers for which the depth is constant).

  6. Transition duct assembly with modified trailing edge in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    McMahan, Kevin Weston; Schott, Carl Gerard; Ingram, Clint Luigie; Siden, Gunnar Leif; Pierre, Sylvain

    2016-10-04

    Transition duct assemblies for turbine systems and turbomachines are provided. In one embodiment, a transition duct assembly includes a plurality of transition ducts disposed in a generally annular array and comprising a first transition duct and a second transition duct. Each of the plurality of transition ducts includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of each transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct assembly further includes an aerodynamic structure defined by the passages of the first transition duct and the second transition duct. The aerodynamic structure includes a pressure side, a suction side, and a trailing edge, the trailing edge having a modified aerodynamic contour.

  7. Reference values of MRI measurements of the common bile duct and pancreatic duct in children

    Energy Technology Data Exchange (ETDEWEB)

    Gwal, Kriti; Bedoya, Maria A.; Patel, Neal; Darge, Kassa; Anupindi, Sudha A. [University of Pennsylvania Perelman School of Medicine, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Rambhatla, Siri J. [Beth Israel Medical Center, Department of Pediatrics, Newark, NJ (United States); Sreedharan, Ram R. [University of Pennsylvania, Departments of Gastroenterology, Hepatology and Nutrition, The Children' s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (United States)

    2015-08-15

    Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) is now an essential imaging modality for the evaluation of biliary and pancreatic pathology in children, but there are no data depicting the normal diameters of the common bile duct (CBD) and pancreatic duct. Recognition of abnormal duct size is important and the increasing use of MRCP necessitates normal MRI measurements. To present normal MRI measurements for the common bile duct and pancreatic duct in children. In this retrospective study we searched all children ages birth to 10 years in our MR urography (MRU) database from 2006 until 2013. We excluded children with a history of hepatobiliary or pancreatic surgery. We stratified 204 children into five age groups and retrospectively measured the CBD and the pancreatic duct on 2-D axial and 3-D coronal T2-weighted sequences. We performed statistical analysis, using logistic and linear regressions to detect the age association of the visibility and size of the duct measurements. We used non-parametric tests to detect gender and imaging plane differences. Our study included 204 children, 106 (52%) boys and 98 (48%) girls, with a median age of 33 months (range 0-119 months). The children were distributed into five age groups. The common bile duct was visible in all children in all age groups. The pancreatic duct was significantly less visible in the youngest children, group 1 (54/67, 80.5%; P = 0.003) than in the oldest children, group 5 (22/22, 100%). In group 2 the pancreatic duct was seen in 19/21 (90.4%), in group 3 52/55 (94.5%), and in group 4 39/39 (100%). All duct measurements increased with age (P < 0.001; r-value > 0.423), and the incremental differences between ages were significant. The measurement variations between the axial and coronal planes were statistically significant (P < 0.001); however these differences were fractions of millimeters. For example, in group 1 the mean coronal measurement of the CBD was 2.1 mm and the axial

  8. Transmission of wave energy in curved ducts

    Science.gov (United States)

    Rostafinski, W.

    1973-01-01

    A formation of wave energy flow was developed for motion in curved ducts. A parametric study over a range of frequencies determined the ability of circular bends to transmit energy for the case of perfectly rigid walls.

  9. Ducted propagation of chorus waves: Cluster observations

    Directory of Open Access Journals (Sweden)

    K. H. Yearby

    2011-09-01

    Full Text Available Ducted propagation of whistler waves in the terrestrial magnetosphere-ionosphere system was discussed and studied long before the first in-situ spacecraft measurements. While a number of implicit examples of the existence of ducted propagation have been found, direct observation of ducts has been hampered by the low sampling rates of measurements of the plasma density. The present paper is based on Cluster observations of chorus waves. The ability to use measurements of the spacecraft potential as a proxy for high time resolution electron density measurements is exploited to identify a number of cases when increased chorus wave power, observed within the radiation belts, is observed simultaneously with density enchantments. It is argued that the observation of ducted propagation of chorus implies modification of numerical models for plasma-wave interactions within the radiation belts.

  10. General Information about Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  11. Treatment Options for Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  12. Stages of Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  13. Treatment Option Overview (Extrahepatic Bile Duct Cancer)

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  14. INTERIOR DUCT SYSTEM DESIGN, CONSTRUCTION, AND PERFORMANCE

    Energy Technology Data Exchange (ETDEWEB)

    Janet E.R. Mcllvaine; David Beal; Philip Fairey

    2001-10-10

    By removing air distribution and conditioning equipment from unconditioned spaces, homeowners stand to benefit substantially with respect to both energy savings and indoor air quality. Duct leakage introduces: Greater heating and cooling loads from air at extreme temperatures and humidity levels; Outside air and air from unconditioned spaces that may contain air borne contaminants, combustion gases, pollen, mold spores, and/or particles of building materials; and Higher whole-house infiltration/exfiltration rates. Exemplary studies conducted since 1990 have demonstrated the prevalence of duct leakage throughout the United States and measured energy savings of approximately 20% during both heating and cooling seasons from leakage reduction. These all dealt with duct leakage to and/or from unconditioned spaces. In the building science community, leakage within the conditioned space is generally presumed to eliminate the negative consequences of duct leakage with the exception of possibly creating pressure imbalances in the house which relates to higher infiltration and/or exfiltration. The practical challenges of isolating ducts and air handlers from unconditioned spaces require builders to construct an air-tight environment for the ducts. Florida Solar Energy Center researchers worked with four builders in Texas, North Carolina, and Florida who build a furred-down chase located either in a central hallway or at the edges of rooms as an architectural detail. Some comparison homes with duct systems in attics and crawl spaces were included in the test group of more than 20 homes. Test data reveals that all of the duct/AHU systems built inside the conditioned space had lower duct leakage to unconditioned spaces than their conventional counterparts; however, none of the homes was completely free of duct leakage to unconditioned spaces. Common problems included wiring and plumbing penetrations of the chase, failure to treat the chase as an air tight space, and misguided

  15. Effect of shear on duct wall impedance.

    Science.gov (United States)

    Goldstein, M.; Rice, E.

    1973-01-01

    The solution to the equation governing the propagation of sound in a uniform shear layer is expressed in terms of parabolic cylinder functions. This result is used to develop a closed-form solution for acoustic wall impedance which accounts for both the duct liner and the presence of a boundary layer in the duct. The effective wall impedance can then be used as the boundary condition for the much simpler problem of sound propagation in uniform flow.

  16. Gas Explosions Mitigation by Ducted Venting

    OpenAIRE

    2007-01-01

    The mitigation of effects of gas and dust explosions within industrial equipment is effective if venting the combustion products to safe location. The presence of relief duct is however likely to increase the severity of the explosion with respect to equipment vented to open atmosphere, due to secondary explosions occurring in the initial sections of duct, frictional drag and inertia of the gas column, acoustic and Helmholtz oscillations. The weights of these phenomena on explosion e...

  17. Energy Conservation Through Duct Leakage Reduction

    Science.gov (United States)

    2004-02-26

    Energy Conservation Through Duct Leakage Reduction February 26, 2004 Rich Glatt – Lindab Inc. Report Documentation Page Form ApprovedOMB No. 0704...4. TITLE AND SUBTITLE Energy Conservation Through Duct Leakage Reduction 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...Wall – DW that installs like SW - easiest installing DW system on the market – Eliminates the need for costly flanged connections – SMACNA Leakage

  18. Intestinal growth adaptation and glucagon-like peptide 2 in rats with ileal--jejunal transposition or small bowel resection

    DEFF Research Database (Denmark)

    Thulesen, J; Hartmann, B; Kissow, Hannelouise;

    2001-01-01

    , and twofold in the distally resected group. Tissue GLP-2 levels were unchanged in resected rats. The data indicate that transposition of a distal part of the small intestine, and thereby exposure of L cells to a more nutrient-rich chyme, leads to intestinal growth. The adaptive intestinal growth is associated......Glucagon-like peptide 2 (GLP-2), produced by enteroendocrine L-cells, regulates intestinal growth. This study investigates circulating and intestinal GLP-2 levels in conditions with altered L-cell exposure to nutrients. Rats were allocated to the following experimental groups: ileal...... GLP-2 levels in the intestinal segments were unchanged. In resected rats with reduced intestinal capacity, adaptive small bowel growth was more pronounced following proximal resection than distal small bowel resection. Circulating GLP-2 levels increased threefold in proximally resected animals...

  19. A Comparison of Simulation Capabilities for Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Miller, William A [ORNL; Smith, Matt K [ORNL; Gu, Lixing [Florida Solar Energy Center (FSEC); New, Joshua Ryan [ORNL

    2014-11-01

    Typically, the cheapest way to install a central air conditioning system in residential buildings is to place the ductwork in the attic. Energy losses due to duct-attic interactions can be great, but current whole-house models are unable to capture the dynamic multi-mode physics of the interactions. The building industry is notoriously fragmented and unable to devote adequate research resources to solve this problem. Builders are going to continue to put ducts in the attic because floor space is too expensive to closet them within living space, and there are both construction and aesthetic issues with other approaches such as dropped ceilings. Thus, there is a substantial need to publicly document duct losses and the cost of energy used by ducts in attics so that practitioners, builders, homeowners and state and federal code officials can make informed decisions leading to changes in new construction and additional retrofit actions. Thus, the goal of this study is to conduct a comparison of AtticSim and EnergyPlus simulation algorithms to identify specific features for potential inclusion in EnergyPlus that would allow higher-fidelity modeling of HVAC operation and duct transport of conditioned air. It is anticipated that the resulting analysis from these simulation tools will inform energy decisions relating to the role of ducts in future building energy codes and standards.

  20. Double common bile duct: A case report

    Institute of Scientific and Technical Information of China (English)

    Srdjan P Djuranovic; Milenko B Ugljesic; Nenad S Mijalkovic; Viktorija A Korneti; Nada V Kovacevic; Tamara M Alempijevic; Slaven V Radulovic; Dragan V Tomic; Milan M Spuran

    2007-01-01

    Double common bile duct (DCBD) is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct (ACBD) opens in different parts of upper gastrointestinal tract (stomach, duodenum, ductus pancreaticus or septum). This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction (APBJ) and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APBJ with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APBJ and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.

  1. Cisto de colédoco em adulto: anomalia da junção do colédoco com o ducto pancreático submetido à ressecção do cisto e à derivação biliar e pancreática Common bile duct cyst in adult: anomaly of the common bile duct-pancreatic junction submitted to excision of the cyst and a biliary and pancreatic deviation

    Directory of Open Access Journals (Sweden)

    Manlio Basilio Speranzini

    2008-04-01

    Full Text Available Common bile duct cysts are rare congenital anomalies which have been diagnosed only in twenty per cent of adults. The etiology is uncertain, but many patients have an anomalous pancreatobiliary junction anatomy. We present a case of a young man with a type I Alonso-Lej/ Todani common bile duct cyst and an anomalous common bile duct-pancreatic junction anatomy. Because the common bile duct did not have a segment of normal caliber, to avoid compromising with the pancreatic channel after the excision of the cyst, we performed a Roux-en-Y anastomosis by anastomosing the biliary duct to the proximal excluded jejunal loop and the common duct-pancreatic junction to the same more distally loop.

  2. [Segmental neurofibromatosis].

    Science.gov (United States)

    Zulaica, A; Peteiro, C; Pereiro, M; Pereiro Ferreiros, M; Quintas, C; Toribio, J

    1989-01-01

    Four cases of segmental neurofibromatosis (SNF) are reported. It is a rare entity considered to be a localized variant of neurofibromatosis (NF)-Riccardi's type V. Two cases are male and two female. The lesions are located to the head in a patient and the other three cases in the trunk. No family history nor transmission to progeny were manifested. The rest of the organs are undamaged.

  3. Current status of laparoscopic liver resection for hepatocellular carcinoma.

    Science.gov (United States)

    Guro, Hanisah; Cho, Jai Young; Han, Ho-Seong; Yoon, Yoo-Seok; Choi, YoungRok; Periyasamy, Mohan

    2016-06-01

    Laparoscopic liver resection (LLR) is becoming widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic left lateral sectionectomy and minor laparoscopic liver resection are now considered standard approaches, especially for tumors located in the anterolateral segments of the liver. Laparoscopic left lateral sectionectomy in adult donors is also gaining acceptance for child liver transplantation in many centers. Major LLRs, including left hepatectomy and right hepatectomy, have been recently attempted. Laparoscopic donor hepatectomy is becoming more popular owing to increasing demand from young living donors who appreciate its minimal invasiveness and excellent cosmetic outcomes. Several centers have performed total laparoscopic donor right hepatectomy in adult-to-adult living donor liver transplantation. Many meta-analyses have shown that LLR is better than open liver resection in terms of short-term outcomes, principally cosmetic outcomes. Although no randomized control trials have compared LLR with open liver resection, the long-term oncologic outcomes were similar for both procedures in recent case-matched studies.

  4. Hypersexuality after Temporal Lobe Resection.

    Science.gov (United States)

    Baird, Amee D.; Wilson, Sarah J.; Bladin, Peter F.; Saling, Michael M.; Reutens, David C.

    2002-04-01

    Hypersexuality has occasionally been reported in patients with temporal lobe epilepsy following temporal lobe resection. The mechanism underlying this phenomenon is poorly understood. We describe seven patients who spontaneously reported dramatic postoperative changes in sexual behavior after unilateral temporal lobe resection. Five of the seven patients showed evidence of bilateral temporal lobe abnormalities. All of the patients had significant difficulties with postoperative psychosocial adjustment that preceded the onset of hypersexuality. Five of the patients were completely seizure-free and one reported postoperative auras. Recurrent complex partial seizures occurred at a reduced frequency in one patient after 6 months. In this patient, the period of seizure freedom did not directly correlate with the period of hypersexuality. These cases suggest that hypersexuality following unilateral temporal lobe resection is more likely to occur in the presence of psychosocial difficulties and contralateral temporal lobe abnormalities. Neurophysiological processes associated with seizure cessation alone do not appear to account for postoperative hypersexuality.

  5. Transduodenal exploration of the common bile duct in patients with nondilated ducts.

    Science.gov (United States)

    Ratych, R E; Sitzmann, J V; Lillemoe, K D; Yeo, C J; Cameron, J L

    1991-07-01

    Exploration of the small common bile duct can be technically difficult and is associated with a significant risk of ductal injury or late stricture, or both. Transduodenal common duct exploration after sphincteroplasty (TCDE/S) is an alternative method of duct exploration that avoids choledochotomy. Cholecystectomy followed by TCDE/S was performed upon 28 patients with nondilated ducts and suspected choledocholithiasis. Common duct stones were retrieved in 17 patients. Failure to retrieve stones in the remaining 11 patients was attributed to either false-positive results of cholangiography, forceful passage of stones into the duodenum during the initial insertion of a Fogarty catheter through the cystic duct or a false-negative finding at duct exploration. There was no perioperative mortality. Two patients had asymptomatic postoperative hyperamylasemia. One patient had postoperative pancreatitis, hyperbilirubinemia and cholangitis that resolved with antibiotic therapy by the eighth postoperative day. Other complications included wound infection, delayed gastric emptying, pneumonia and otitis media. The over-all morbidity rate was 28.6 per cent. Long term follow-up was obtained in all 28 patients. All patients in the follow-up group are free of recurrent biliary tract disease. TCDE/S appears to be a safe and effective method of exploring the nondilated common bile duct.

  6. Diffuse-Type Caroli Disease with Characteristic Central Dot Sign Complicated by Multiple Intrahepatic and Common Bile Duct Stones.

    Science.gov (United States)

    Hwang, Moon Joo; Kim, Tae Nyeun

    2017-07-01

    Caroli disease (CD) is a rare congenital malformation of the liver characterized by non-obstructive, segmental, cystic dilatation of the intrahepatic bile ducts (IHDs). The clinical course is usually asymptomatic for the first 5-20 years, and symptoms may seldom occur throughout the patient's life. Bile stagnation leads to recurrent episodes of cholangitis, stone formation, or liver abscesses, and biliary cirrhosis usually occurs years later. Here we report on a 42-year-old man diagnosed with diffuse-type CD with a characteristic central dot sign, who had multiple intrahepatic and common bile duct (CBD) stones. CBD stones were treated successfully with endoscopic retrograde cholangiopancreatography (ERCP).

  7. Ultrasound appearance of chronic mammary duct ectasia

    Energy Technology Data Exchange (ETDEWEB)

    Duchesne, N. [Ottawa Hospital, Dept. of Radiology, Ottawa, Ontario (Canada)]. E-mail: nathalie_duchesne_22@yahoo.ca; Skolnik, S. [Univ. of Toronto, Dept. of Family Medicine, Toronto, Ontario (Canada); Bilmer, S. [Ottawa Hospital, Dept. of Radiology, Ottawa, Ontario (Canada)

    2005-12-15

    Mammary duct ectasia (MDE), also called periductal mastitis, mammary dysplasia, or plasma cell mastitis, is a benign condition of the mammary gland first described by Haagensen in 1951. The etiology of MDE is unknown and its pathogenesis still controversial; the periductal inflammation could be either the cause or the result of dilated damaged ducts. The process is usually bilateral and asymptomatic, with only a small percentage of patients presenting with symptoms that may include long course of tumour formation, usually subareolar breast lumps, nipple discharge, nipple retraction, mastalgia, and mammary abscess or fistulas. Mammographic presentation of MDE is well known; its features include periductal calcification, benign intraductal calcification, and retroareolar duct dilatation. The periductal calcification results from dystrophic calcification and forms calcified rings or very dense, oval, elongated calcifications, each with a central lucency representing the dilated duct. Intraductal calcifications of duct ectasia represent inspissated intraductal material and are typically of uniform high density, often needle-like, and occasionally branching. Occasionally, there are no mammographic findings, and the diagnosis must rely on sonographic features. Appearance of MDE on ultrasonography (US) depends on the stage of the disease and the contents of the dilated ducts. The acute presentation has been demonstrated in the literature more often than has its chronic counterpart. In the former, duct content can vary from anechoic to isoechoic with surrounding fatty tissue. In chronic MDE, episodes of inflammation are longer. This tends to result in secretions that have a more solid, cheesy texture, partly due to cholesterol crystals, foam cells, and inflammatory cells. For both types of MDE, the appearance can mimic high-grade ductal carcinoma in situ (DCIS) on US. In this essay, 2 chronic MDE cases are presented and their US appearance discussed. Our goal is to explore

  8. Parenteral Nutrition in Liver Resection

    Directory of Open Access Journals (Sweden)

    Carlo Chiarla

    2012-01-01

    Full Text Available Albeit a very large number of experiments have assessed the impact of various substrates on liver regeneration after partial hepatectomy, a limited number of clinical studies have evaluated artificial nutrition in liver resection patients. This is a peculiar topic because many patients do not need artificial nutrition, while several patients need it because of malnutrition and/or prolonged inability to feeding caused by complications. The optimal nutritional regimen to support liver regeneration, within other postoperative problems or complications, is not yet exactly defined. This short review addresses relevant aspects and potential developments in the issue of postoperative parenteral nutrition after liver resection.

  9. Does preoperative cross-sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm?

    Science.gov (United States)

    Barron, M R; Roch, A M; Waters, J A; Parikh, J A; DeWitt, J M; Al-Haddad, M A; Ceppa, E P; House, M G; Zyromski, N J; Nakeeb, A; Pitt, H A; Schmidt, C Max

    2014-03-01

    Main pancreatic duct (MPD) involvement is a well-demonstrated risk factor for malignancy in intraductal papillary mucinous neoplasm (IPMN). Preoperative radiographic determination of IPMN type is heavily relied upon in oncologic risk stratification. We hypothesized that radiographic assessment of MPD involvement in IPMN is an accurate predictor of pathological MPD involvement. Data regarding all patients undergoing resection for IPMN at a single academic institution between 1992 and 2012 were gathered prospectively. Retrospective analysis of imaging and pathologic data was undertaken. Preoperative classification of IPMN type was based on cross-sectional imaging (MRI/magnetic resonance cholangiopancreatography (MRCP) and/or CT). Three hundred sixty-two patients underwent resection for IPMN. Of these, 334 had complete data for analysis. Of 164 suspected branch duct (BD) IPMN, 34 (20.7%) demonstrated MPD involvement on final pathology. Of 170 patients with suspicion of MPD involvement, 50 (29.4%) demonstrated no MPD involvement. Of 34 patients with suspected BD-IPMN who were found to have MPD involvement on pathology, 10 (29.4%) had invasive carcinoma. Alternatively, 2/50 (4%) of the patients with suspected MPD involvement who ultimately had isolated BD-IPMN demonstrated invasive carcinoma. Preoperative radiographic IPMN type did not correlate with final pathology in 25% of the patients. In addition, risk of invasive carcinoma correlates with pathologic presence of MPD involvement.

  10. The "flying" bile duct: avulsion of the common bile duct in a plane crash survivor.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Blunt trauma is an unusual cause of extrahepatic bile duct injury. This is a case of a 51-year-old gentleman who sustained a significant seatbelt injury in a plane crash. Laparotomy, performed due to persistent abdominal pain, revealed that the common bile duct (CBD) was completely avulsed from the duodenum. Following insertion of drains and transfer to a hepatobiliary centre, the devascularised CBD was excised and replaced with a roux-en-y hepaticojejunostomy. Necrotic tissue was debrided from the pancreatic head. A persistent bile leak developed from the sub-hepatic drain. Repeat laparotomy revealed a bile leak from small ducts on the liver surface. Ligation of the ducts and bioglue sealing of the area were successfully performed. Subsequent to this a pancreatic fistula developed from the main pancreatic duct, which has since resolved. This unusual case illustrates the need for prompt recognition and early repair to optimise outcomes in traumatic CBD injury.

  11. Hepatocellular carcinoma in cirrhotic patients with portal hypertension: Is liver resection always contraindicated?

    Institute of Scientific and Technical Information of China (English)

    Andrea Ruzzenente; Alessandro Valdegamberi; Tommaso Campagnaro; Simone Conci; Silvia Pachera; Calogero Iacono,; Alfredo Guglielmi

    2011-01-01

    AIM: To analyze the outcome of hepatocellular carcinoma (HCC) resection in cirrhosis patients, related to presence of portal hypertension (PH) and extent of hepatectomy. METHODS: A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver resection. RESULTS: PH was present in 44 (32.5%) patients. Overall mortality and morbidity were 2.2% and 33.7%, respectively. Median survival time in patients with or without PH was 31.6 and 65.1 mo, respectively (P = 0.047); in the subgroup with Child-Pugh class A cirrhosis, median survival was 65.1 mo and 60.5 mo, respectively (P = 0.257). Survival for patients submitted to limited liver resection was not significantly different in presence or absence of PH. Conversely, median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo, respectively (P = 0.035). CONCLUSION: PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients, but resection of 2 or more segments should not be recommended in patients with PH.

  12. Mixed segmentation

    DEFF Research Database (Denmark)

    Bonde, Anders; Aagaard, Morten; Hansen, Allan Grutt

    This book is about using recent developments in the fields of data analytics and data visualization to frame new ways of identifying target groups in media communication. Based on a mixed-methods approach, the authors combine psychophysiological monitoring (galvanic skin response) with textual...... content analysis and audience segmentation in a single-source perspective. The aim is to explain and understand target groups in relation to, on the one hand, emotional response to commercials or other forms of audio-visual communication and, on the other hand, living preferences and personality traits...

  13. Salivary duct carcinoma of the parotid gland

    Directory of Open Access Journals (Sweden)

    Mona Mlika

    2012-01-01

    Full Text Available Salivary duct carcinoma of the parotid gland is an uncommon tumor, highly aggressive. About 200 cases have been reported in the English literature. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as "salivary duct carcinoma." The authors describe a new case of salivary duct carcinoma of the parotid gland. We present the case of a 50-year-old patient with progressive facial paralysis. The MRI examination of the head showed two ill-defined formations. A malignant tumor was strongly suspected, so that a total left parotidectomy with excision of the adjacent facial nerve and left lymph node dissection was performed. Microscopic examination concluded to a salivary duct carcinoma of the left parotid gland negative with Her2/neu antibody with lymph node metastasis. There were no recurrences or metastases within 3 years of follow-up. Salivary duct carcinoma of the parotid gland is a rare tumor with an aggressive behavior. This is due to its propensity to infiltrate distant organs. The diagnosis is based on microscopic examination. Treatment modalities are non-consensual, but some authors advocate the necessity of aggressive approach, especially in tumors negative with Heur2/neu antibody. This is due to the fact that the overexpression of this antigen was reported to be associated with a poor prognosis.

  14. Characterization of flow in a scroll duct

    Science.gov (United States)

    Begg, E. K.; Bennett, J. C.

    1985-01-01

    A quantitative, flow visualization study was made of a partially elliptic cross section, inward curving duct (scroll duct), with an axial outflow through a vaneless annular cutlet. The working fluid was water, with a Re(d) of 40,000 at the inlet to the scroll duct, this Reynolds number being representative of the conditions in an actual gas turbine scroll. Both still and high speed moving pictures of fluorescein dye injected into the flow and illuminated by an argon ion laser were used to document the flow. Strong secondary flow, similar to the secondary flow in a pipe bend, was found in the bottom half of the scroll within the first 180 degs of turning. The pressure field set up by the turning duct was strong enough to affect the inlet flow condition. At 90 degs downstream, the large scale secondary flow was found to be oscillatory in nature. The exit flow was nonuniform in the annular exit. By 270 degs downstream, the flow appeared unorganized with no distinctive secondary flow pattern. Large scale structures from the upstream core region appeared by 90 degs and continued through the duct to reenter at the inlet section.

  15. Numerical simulation of flow past circular duct

    Institute of Scientific and Technical Information of China (English)

    Ze-gao YIN; Xian-wei Cao; Hong-da SHI; Jian MA

    2010-01-01

    The Renormalization Group(RNG)k-ε turbulence model and Volume of Fluid(VOF)method were employed to simulate the flow past a circular duct in order to obtain and analyze hydraulic parameters.According to various upper and bottom gap ratios,the force on the duct was calculated.When the bottom gap ratio is 0,the drag force coefficient,lift force coefficient,and composite force reach their maximum values,and the azimuth reaches its minimum.With an increase of the bottom gap ratio from 0 to 1,the drag force coefficient and composite force decrease sharply,and the lift force coefficient does not decreases so much,but the azimuth increases dramatically.With a continuous increase of the bottom gap ratio from 1 upward,the drag force coefficient,lift force coefficient,composite force,and azimuth vary little.Thus,the bottom gap ratio is the key factor influencing the force on the circular duct.When the bottom gap ratio is less than 1,the upper gap ratio has a remarkable influence on the force of the circular duct.When the bottom gap ratio is greater than 1,the variation of the upper gap ratio has little influence on the force of the circular duct.

  16. Convolution seal for transition duct in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2015-05-26

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface feature for interfacing with an adjacent transition duct. The turbine system further includes a convolution seal contacting the interface feature to provide a seal between the interface feature and the adjacent transition duct.

  17. Radical resection of pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Alexander Koliopanos; C Avgerinos; Athanasios Farfaras; C Manes; Christos Dervenis

    2008-01-01

    BACKGROUND:Pancreatic adenocarcinoma (PCa) is a disease with dismal prognosis, and the only possibility of cure, albeit small, is based on the combination of complete resection with negative histopathological margins (R0 resection) with adjuvant treatment. Therefore, a lot of effort has been made during the last decade to assess the role of extensive surgery in both local recurrence and survival of patients with PCa. DATA SOURCES:Medline search and manual cross-referencing were utilized to identify published evidence-based data for PCa surgery between 1973 and 2006, with emphasis to feasibility, efifcacy, long-term survival, disease free survival, recurrence rates, pain relief and quality of life. RESULTS: Extended surgery is safe and feasible in high volume surgical centers with comparable short-term results. Organ preserving surgery is a main goal because of quality of life reasons and is performed whenever possible from the tumor extent. Concerning long-term survival major vein resection does not adversely affect outcome. To date, there are no changes in long-term survival attributed to the extended lymph node dissection. However, there is a beneift in locoregional control with fewer local recurrences and extended lymphadenectomy allows better staging for the disease. CONCLUSIONS:Extended PCa surgery is safe and feasible despite the inconclusive results in patient's survival beneift. In the future, appropriately powered randomized trials of standard vs. extended resections may show improved outcomes for PCa patients.

  18. [Liver resection by water jet].

    Science.gov (United States)

    Horie, T

    1989-01-01

    Major problem in resecting liver parenchyma is how to control the bleeding. Recently, resection of the liver by water jet has been reported. So, experimental and clinical studies were performed to investigate the usefulness of the water jet equipment. Ten pigs weighing around 17kg were used. The optimal pressure to resect the porcine liver was 7 to 15kg/cm2. By 4 weeks the cut surface was covered with fibrous capsule. Portal angiography showed no abnormality in the resected area. The water jet was also used in 30 human operations. The optimal pressure was 12 to 18kg/cm2 for non cirrhotic liver and 15 to 20kg/cm2 for cirrhotic liver. The surface immediately after jet cutting was more smooth than that of CUSA and histologically there was slight bleeding and necrosis. The volume of blood loss during dissection was not different between water jet group and CUSA group. No significant changes were found in the laboratory data. These results suggest that water jet is as useful as CUSA for cutting the liver parenchyma.

  19. Awake craniotomy for tumor resection

    Directory of Open Access Journals (Sweden)

    Mohammadali Attari

    2013-01-01

    Full Text Available Surgical treatment of brain tumors, especially those located in the eloquent areas such as anterior temporal, frontal lobes, language, memory areas, and near the motor cortex causes high risk of eloquent impairment. Awake craniotomy displays major rule for maximum resection of the tumor with minimum functional impairment of the Central Nervous System. These case reports discuss the use of awake craniotomy during the brain surgery in Alzahra Hospital, Isfahan, Iran. A 56-year-old woman with left-sided body hypoesthesia since last 3 months and a 25-year-old with severe headache of 1 month duration were operated under craniotomy for brain tumors resection. An awake craniotomy was planned to allow maximum tumor intraoperative testing for resection and neurologic morbidity avoidance. The method of anesthesia should offer sufficient analgesia, hemodynamic stability, sedation, respiratory function, and also awake and cooperative patient for different neurological test. Airway management is the most important part of anesthesia during awake craniotomy. Tumor surgery with awake craniotomy is a safe technique that allows maximal resection of lesions in close relationship to eloquent cortex and has a low risk of neurological deficit.

  20. Immediate reconstruction of the mandible after resection for aggressive odontogenic tumours: a cohort study

    NARCIS (Netherlands)

    Simon, E.N.; Merkx, M.A.W.; Kalyanyama, B.M.; Shubi, F.M.; Stoelinga, P.J.W.

    2013-01-01

    The results are reported of a clinical follow-up study on 32 selected but consecutive patients with mandibular ameloblastoma. They were all treated by a segmental resection and reconstructed, using two 2.3 mm reconstruction plates and an autogenous particulate bone graft, taken from the anterior

  1. Endoluminal compression clip : full-thickness resection of the mesenteric bowel wall in a porcine model

    NARCIS (Netherlands)

    Kopelman, Yael; Siersema, Peter D.; Nir, Yael; Szold, Amir; Bapaye, Amol; Segol, Ori; Willenz, Ehud P.; Lelcuk, Shlomo; Geller, Alexander; Kopelman, Doron

    2009-01-01

    Background: Performing a full-thickness intestinal wall resection Of a sessile polyp located on the mesenteric side with a compression clip may lead to compression of mesenteric vessels. The application of such a clip may therefore cause a compromised blood supply in the particular bowel segment, le

  2. Simultaneous laparoscopic anterior resection and left hepatic lobectomy for stage IV rectal cancer.

    Science.gov (United States)

    Casaccia, Marco; Famiglietti, Federico; Andorno, Enzo; Di Domenico, Stefano; Ferrari, Chiara; Valente, Umberto

    2010-01-01

    We report the case of a 68-year-old female patient affected by rectal cancer and a synchronous metastatic lesion measuring 8 cm in diameter in the left hepatic lobe. After a laparoscopic ultrasonography exploration of the liver to detect possible occult metastases, a simultaneous colorectal resection and a left hepatic lobectomy including a partial resection of segment IV were performed. Five ports were used for the entire procedure. The resected specimens were extracted through a Pfannenstiel incision. The procedure was completed laparoscopically. Total operative time was 455 minutes with negligible intraoperative blood loss. The postoperative hospital stay was 12 days. At 4-month follow-up, the patient recovered completely. A computed tomography scan performed at this time showed no signs of recurrent disease. This report confirms the feasibility of the laparoscopic approach to simultaneous hepatic and colorectal resections in stage IV rectal cancer. The known advantages of the miniinvasive approach could make such complex procedures more endurable.

  3. Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Chi-Liang Cheng; Yung-Kuan Tsou; Cheng-Hui Lin; Jui-Hsiang Tang; Chien-Fu Hung; Kai-Feng Sung; Ching-Song Lee

    2012-01-01

    AIM:To describe characteristics of a poorly expandable (PE) common bile duct (CBD) with stones on endoscopic retrograde cholangiography.METHODS:A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment.Between 2003 and 2006,endoscopic retrograde cholangiography (ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital.Patients with characteristic PE bile duct on ERC were identified from the database.Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS:A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study.The median patient age was 45 years (range,20 to 92 years); 66.7% of the patients were men.The diameters of the widest non-PE CBD segment,the PE segment,and the largest stone were 14.3 ± 4.9 mm,5.8 ± 1.6 mm,and 11.2 ± 4.7 mm,respectively.The length of the PE segment was 39.7±15.4 mm (range,12.3 mm to 70.9 mm).To remove the CBD stone(s) completely,mechanical lithotripsy was required in 25 (83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature.The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy.Post-ERC complications occurred in 4 cases:pancreatitis in 1,cholangitis in 2,and an impacted Dormia basket with cholangitis in 1.Two (6.7%)of the 28 patients developed recurrent CBD stones at follow-up (50 ± 14 mo) and were successfully managed with therapeutic ERC.CONCLUSION:Patients with a PE duct frequently require mechanical lithotripsy for stones extraction.To retrieve stones successfully and avoid complications,these patients should be identified during ERC.

  4. Disckectomy, Partial Adjacent Centrum Resection, Bone Graft with Titanium Mesh and Titanium Plate Fixation for the Treatment of Single Segment Cervical Disc Degeneration with Adjacent Vertebral Posterior Osteophyte%椎间盘及部分椎体切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴椎体后缘骨赘

    Institute of Scientific and Technical Information of China (English)

    孙继飞; 何强; 刘振利; 陈庆胜

    2012-01-01

    目的 评价颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘的疗效. 方法 应用颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘退变突出伴相邻椎体后缘骨赘22例.取颈椎前路手术切口,术中仅切除突出的椎间盘及相邻椎体的1/3~ 1/2,使脊髓得到彻底的减压.再用填满碎骨的钛网植于骨缺损处加用钛板螺丝钉内固定,固定范围仅限于相邻椎体.术前和术后通过神经功能JOA评分、颈部轴性症状、颈椎动态侧位片和颈椎MRI比较临床疗效. 结果 均获随访,平均15(6 ~24)个月,术后JOA评分优良率86.4%,颈部轴性症状减轻,脊髓功能明显得到恢复.颈椎活动度良好.X线检查见钛网植骨及钛板内固定良好,未见不稳现象.MRI示颈髓压迫解除. 结论 颈椎椎间盘及相邻椎体部分切除加钛网植骨钛板内固定术治疗单节段颈椎椎间盘突出伴相邻椎体骨赘效果显著,可最大限度地保留颈椎节段的活动度.%Objective To evaluate the clinical effects of disckectomy, partial adjacent centrum resection , bone graft with titanium mesh and titanium plate fixation for the treatment of single segment cervical disc degeneration with adjacent vertebral posterior osteophyte. Methods There were 22 cases received this kind of surgical procedure. By anterior cervical incision, the herniated disc and only 1/3 to 1/2 of the adjacent vertebral body were removed for the decompression of the spinal cord. Then the titanium mesh filled with the small bones was implanted in the bone defect followed by titanium screw fixation. The fixation was limited to the adjacent vertebral bodies. Preoperative and postoperative neurological functions of the JOA score, the cervical axial symptoms, the cervical dynamic radiographs and cervical spine MRI were used to compare the clinical

  5. Hybrid resection of duodenal tumors.

    Science.gov (United States)

    Poultsides, George A; Pappou, Emmanouil P; Bloom, George Peter; Orlando, Rocco

    2011-09-01

    The aim of this study was to review our experience with the hand-assisted laparoscopic management of duodenal tumors with no or low malignant potential and to compare this approach with published case reports of purely laparoscopic local duodenal resection. Eight cases of hand-assisted laparoscopic local duodenal resection performed from 2000 to 2008 were retrospectively reviewed. Hand-assistance was utilized for complete duodenal mobilization, and local duodenal resection was accomplished extracorporeally through the hand-access incision. Patient and tumor characteristics, operative time, length of stay, and complications were compared with 18 cases of totally laparoscopic local excision of duodenal tumors published since 1997. Patients with ampullary tumors were excluded. Compared with the purely laparoscopic approach, the hand-assisted technique was associated with shorter operative time (179 versus 131 minutes, P=.03) and was more commonly used for lesions located in the third portion of the duodenum (0% versus 37.5%, P=.02). Tumor size (2.9 cm versus 3.2 cm, P=.61) and length of hospital stay (5.9 versus 5.9 days, P=.96) were similar between the two groups. The rate of complications was also comparable (0% versus 12.5%, P=.31); 1 of 8 patients in the hand-assisted group developed an incisional hernia at the hand-access site. Hand-assisted laparoscopic local duodenal resection is a feasible, safe, and effective alternative to the totally laparoscopic approach. In addition to being associated with comparable length of hospital stay, hand-assistance can shorten operative time by facilitating duodenal mobilization as well as extracorporeal duodenal resection and closure.

  6. FLUID FLOW IN ROTATING HELICAL SQUARE DUCTS

    Institute of Scientific and Technical Information of China (English)

    Chen Hua-jun; Zhang Ben-zhao; Zhang Jin-suo

    2003-01-01

    A numerical study is made for a fully developed laminar flow in rotating helical pipes.Due to the rotation, the Coriolis force can also contribute to the secondary flow.The interaction between rotation, torsion, and curvature complicates the flow characteristics.The effects of rotation and torsion on the flow transitions are studied in details.The results show that there are obvious differences between the flow in rotating ducts and in helical ducts without rotation.Certain hitherto unknown flow patterns are found.The effects of rotation and torsion on the friction factor are also examined.Present results show the characteristics of the fluid flow in rotating helical square ducts.

  7. Acoustic energy in ducts - Further observations

    Science.gov (United States)

    Eversman, W.

    1979-01-01

    The transmission of acoustic energy in uniform ducts carrying uniform flow is investigated with the purpose of clarifying two points of interest. The two commonly used definitions of acoustic 'energy' flux are shown to be related by a Legendre transformation of the Lagrangian density exactly as in deriving the Hamiltonian density in mechanics. In the acoustic case the total energy density and the Hamiltonian density are not the same which accounts for two different 'energy' fluxes. When the duct has acoustically absorptive walls neither of the two flux expressions gives correct results. A reevaluation of the basis of derivation of the energy density and energy flux provides forms which yield consistent results for soft walled ducts.

  8. Segmented blockcopolymers with uniform amide segments

    NARCIS (Netherlands)

    Husken, D.; Krijgsman, J.; Gaymans, R.J.

    2004-01-01

    Segmented blockcopolymers based on poly(tetramethylene oxide) (PTMO) soft segments and uniform crystallisable tetra-amide segments (TxTxT) are made via polycondensation. The PTMO soft segments, with a molecular weight of 1000 g/mol, are extended with terephthalic groups to a molecular weight of 6000

  9. Xylometazoline hydrochloride nasal spray combined with laser artificial nasolacrimal duct implantation for nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Xiao-Zhao Yang

    2017-02-01

    Full Text Available AIM: To study the role of xylometazoline hydrochloride nasal spray in combination therapy of nasolacrimal duct obstruction and to investigate the effect of nasal inflammation on nasolacrimal duct obstruction. METHODS: Totally 279 patients with nasolacrimal duct obstruction were collected, who received lacrimal passage irrigation, CT angiography for lacrimal passage and nasal endoscope before treated by lacrimal laser forming and artificial nasolacrimal duct implantation combined with xylometazoline hydrochloride nasal spray. In group A, 137 patients were treated with antibiotic eye drop and non-steroidal anti-inflammatory drugs after operations. In group B, 142 patients were treated with xylometazoline hydrochloride nasal spray besides the same treatment for group A. RESULTS:In the 279 patients 217(77.8%, in which 105 cases(76.6%were in group A and 112 cases(78.9%were in group B, were suffered with nasal inflammation, including nasal mucosal hyperemia, inferior turbinate hypertrophy, middle turbinate hypertrophy. At 3mo after the ducts were drawn, efficacy of group B was 95.8%, which was significant better than that of group A(86.1%, PCONCLUSION: Nasal inflammation was an important factor in the incidence of nasolacrimal duct obstruction, which shoud pay more attention in the process of diagnosis and treatment. Combination therapy could improve the cure rate of nasolacrimal duct obstruction.

  10. Percutaneous treatment of benign bile duct strictures

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)]. E-mail: martin.kocher@seznam.cz; Cerna, Marie [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Havlik, Roman [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Kral, Vladimir [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Gryga, Adolf [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Duda, Miloslav [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)

    2007-05-15

    Purpose: To evaluate long-term results of treatment of benign bile duct strictures. Materials and methods: From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27-77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. Results: Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. Conclusion: Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.

  11. Classiifcation of iatrogenic bile duct injur y

    Institute of Scientific and Technical Information of China (English)

    Wan-Yee Lau; Eric C.H. Lai

    2007-01-01

    BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classiifcation systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords"bile duct injury", "cholecystectomy", and “classiifcation”. Additional papers were identiifed by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classiifed using the Bismuth's classiifcation. This classiifcation, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the ifnal outcome after surgical repair. However, the Bismuth's classiifcation does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classiifcation made Bismuth’s classiifcation much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classiifcation systems to complement the Bismuth's classiifcation. CONCLUSIONS:None of the classiifcation system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classiifcation system will be published in the near future.

  12. Minor-but-Complex Liver Resection: An Alternative to Major Resections for Colorectal Liver Metastases Involving the Hepato-Caval Confluence

    Science.gov (United States)

    Urbani, Lucio; Masi, Gianluca; Puccini, Marco; Colombatto, Piero; Vivaldi, Caterina; Balestri, Riccardo; Marioni, Antonio; Prosperi, Valerio; Forfori, Francesco; Licitra, Gabriella; Leoni, Chiara; Paolicchi, Adriana; Boraschi, Piero; Lunardi, Alessandro; Tascini, Carlo; Castagna, Maura; Buccianti, Piero

    2015-01-01

    Abstract Major hepatectomy (MH) is often considered the only possible approach for colorectal liver metastasis (CRLM) at the hepato-caval confluence (CC), but it is associated with high morbidity and mortality. With the aim to reduce MH, we developed the “minor-but-complex” (MbC) technique, which consists in the resection of less than 3 adjacent liver segments with exposure of the CC and preservation of hepatic outflow until spontaneous maturation of peripheral intrahepatic shunts between main hepatic veins. We have evaluated applicability and outcome of MbC resections for the treatment of CRLM involving the CC. In this retrospective cohort study, all consecutive liver resections (LR) performed for CRLM located in segments 1, 7, 8, or 4a were classified as MINOR – removal of <3 adjacent segments; MbC – removal of <3 adjacent segments with CC exposure; and MH – removal of ≥3 adjacent segments. The rate of avoided MH was obtained by the difference between the rate of potentially MH (PMH) plus potentially inoperable cases and the rate of the MH performed. Taking into account that postoperative mortality is mainly related to the amount of resected liver, MbC was compared with minor resections for safety, complexity, and outcome. Of the 59 LR analyzed, 29 (49.1%) were deemed PMH and 4 (6.8%) potentially inoperable. Eventually, MH was performed only in 8 (13.5%) with a decrease rate of 42.4%. Minor LR was performed in 23 (39.0%) and MbC LR in 28 (47.5%) patients. Among MbC cases, 32.1% had previous liver treatments, 39.3% required vascular reconstruction (no reconstructed vessel thrombosis occurred before maturation of peripheral intrahepatic shunts between main hepatic veins), and 7.1% had grade IIIb–IV complications, their median hospital stay was 9 days and 90-day mortality was 0%. After a median follow-up of 22.2 months, oncological results were comparable with those of minor resections. MbC hepatectomy lowers the need for MH and allows for the

  13. Nonlinear acoustic propagation in rectangular ducts

    Science.gov (United States)

    Nayfeh, A. H.; Tsai, M.-S.

    1974-01-01

    The method of multiple scales is used to obtain a second-order uniformly valid expansion for nonlinear acoustic wave propagation in a rectangular duct whose walls are treated with a nonlinear acoustic material. The wave propagation in the duct is characterized by the unsteady nonlinear Euler equations. The results show that nonlinear materials attenuate sound more than linear materials except at high acoustic frequencies. The nonlinear materials produce higher and combination tones which have higher attenuation rates than the fundamentals. Moreover, the attenuation rates of the fundamentals increase with increasing amplitude.

  14. Inverse potential scattering in duct acoustics.

    Science.gov (United States)

    Forbes, Barbara J; Pike, E Roy; Sharp, David B; Aktosun, Tuncay

    2006-01-01

    The inverse problem of the noninvasive measurement of the shape of an acoustical duct in which one-dimensional wave propagation can be assumed is examined within the theoretical framework of the governing Klein-Gordon equation. Previous deterministic methods developed over the last 40 years have all required direct measurement of the reflectance or input impedance but now, by application of the methods of inverse quantum scattering to the acoustical system, it is shown that the reflectance can be algorithmically derived from the radiated wave. The potential and area functions of the duct can subsequently be reconstructed. The results are discussed with particular reference to acoustic pulse reflectometry.

  15. Preconditioning the Helmholtz Equation for Rigid Ducts

    Science.gov (United States)

    Baumeister, Kenneth J.; Kreider, Kevin L.

    1998-01-01

    An innovative hyperbolic preconditioning technique is developed for the numerical solution of the Helmholtz equation which governs acoustic propagation in ducts. Two pseudo-time parameters are used to produce an explicit iterative finite difference scheme. This scheme eliminates the large matrix storage requirements normally associated with numerical solutions to the Helmholtz equation. The solution procedure is very fast when compared to other transient and steady methods. Optimization and an error analysis of the preconditioning factors are present. For validation, the method is applied to sound propagation in a 2D semi-infinite hard wall duct.

  16. Flow Investigation inside A Curved Square Duct

    Directory of Open Access Journals (Sweden)

    Dipyaman Gangopadhyay

    2017-05-01

    Full Text Available This paper presents the results of an experimental work with measurement of wall static pressure of 90°C shaped Curved duct. The test duct is made up of transparent perspex sheets to facilitate the flow visualization study. The duct has an inlet to exit area ratio of 1.0 with centerline distance of 750 mm. The inlet aspect ratio of the test duct has been fixed at 1.0. The velocities for the proposed investigations are to be measured by using a Pitot tube.Wall pressures are measured with the help of an inclinedmanometer with the inclination of 35°. The manometer had two tubes emanating from it: one left open to the atmosphere and the other connected to the steel pipes attached to the four walls of the curved duct. The difference in the readings helped us calculate the static pressure and thereby the normalized pressure. Wall pressure distribution along the curved and parallel walls of the duct at 0°, 22.5°, 45°, 67.5° and 90° measuring sections was measured. All the experimental data has been processed by an Intel i3 CPU, 3 GB RAM PC and analyzed to give the distribution of static pressure in the square duct.The main purpose of this investigation is to show the development of secondary flow which happens when the flow takes place through the bend in the curvature. This secondary flow arises as a result of a centrifugal force acting when the flow moves through the bend. The investigation is carried out at three different velocities 20 m/s, 40 m/s and 60 m/s. The distribution of normalized pressure which is the ratio of static pressure to the dynamic pressure is mapped and shown in the form of contours by using the software package SURFER.The trend of wall static pressure development on the walls of C shaped duct shows that as the flow proceeds towards the curvature, there exists a high pressure gradient between the outside face and inside face due the centrifugal force acting along the curvature. This shows the bulk shifting of flow towards

  17. Augmented reality in bone tumour resection

    Science.gov (United States)

    Park, Y. K.; Gupta, S.; Yoon, C.; Han, I.; Kim, H-S.; Choi, H.; Hong, J.

    2017-01-01

    Objectives We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. Methods We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice. Results The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137–143. PMID:28258117

  18. Learning endoscopic resection in the esophagus

    NARCIS (Netherlands)

    van Vilsteren, Frederike G. I.; Pouw, Roos E.; Herrero, Lorenza Alvarez; Bisschops, Raf; Houben, Martin; Peters, Frans T. M.; Schenk, B. E.; Weusten, Bas L. A. M.; Schoon, Erik J.; Bergman, Jacques J. G. H. M.

    2015-01-01

    Background: Endoscopic resection is the cornerstone of endoscopic management of esophageal early neoplasia. However, endoscopic resection is a complex technique requiring knowledge and expertise. Our aims were to identify the most important learning points in performing endoscopic resection in a tra

  19. Robotic-assisted minimally invasive liver resection

    Directory of Open Access Journals (Sweden)

    Yao-Ming Wu

    2014-04-01

    Conclusion: Robotic assistance increased the percentage of minimally invasive liver resections and the percentage of major minimally invasive liver resections with comparable perioperative results. Robotic-assisted minimally invasive liver resection is feasible, but its role needs more accumulated experience to clarify.

  20. [Congenital segmental duplication of the lumbar ureter (author's transl)].

    Science.gov (United States)

    Ponthieu, A; Anfossi, G; Guidicelli, C; Boutboul, R

    1977-03-01

    In a 23-year-old man attacks of nephritic colic led to the discovery of an obstruction on the left lumbar ureter. Segmental resection of the ureter was performed, removing 10 mm of malformed, obstructed ureter. This was an incomplete duplication, the two ureteral segments lying side-by-side, each with its own musculature, for a distance of 7mm. Above and below the anomaly, the ureter was normal. This exceptional malformation is compared with other internal obstructions of the ureter.

  1. Higher order mode propagation in nonuniform circular ducts

    Science.gov (United States)

    Cho, Y. C.; Ingard, K. U.

    1980-01-01

    This paper presents an analytical investigation of higher order mode propagation in a nonuniform circular duct without mean flow. An approximate wave equation is derived on the assumptions that the duct cross section varies slowly and that mode conversion is negligible. Exact closed form solutions are obtained for a particular class of converging-diverging circular duct which is here referred to as 'circular cosh duct'. Numerical results are presentd in terms of the transmission loss for the various duct shapes and frequencies. The results are applicable to studies of multimodal propagation as well as single mode propagation. The results are also applicable to studies of sound radiation from certain types of contoured inlet ducts, or of sound propagation in a converging-diverging duct of somewhat different shape from a cosh duct.

  2. Is spontaneous closure of a patent arterial duct common?

    Science.gov (United States)

    Hoffman, Julien I E

    2017-01-01

    As closing a patent arterial duct is relatively simple, safe, and successful, most children with a patent arterial duct have it closed soon after diagnosis. The larger ducts are closed to prevent congestive heart failure, pulmonary vascular disease, or aneurysmal dilatation of the ductus, and smaller ducts are closed to prevent infective endocarditis. Consequently, there is no opportunity to determine whether spontaneous closure or diminution in size of the patent arterial duct is common. If the duct does become smaller, flow through it may be so low that no murmur is produced - the silent ductus. The frequency and best management of the silent patent arterial duct are unknown, and we do not know whether these tiny ducts are the last stage before spontaneous closure.

  3. Algebraically growing waves in ducts with sheared mean flow

    Science.gov (United States)

    Nayfeh, A. H.; Telionis, D. P.

    1974-01-01

    Analysis of the behavior of standing and traveling acoustic waves in a smooth duct with a fluid flow having a sheared mean velocity profile, when the waves grow algebraically as they travel along the duct axis. It is shown that standing waves growing algebraically with the axial distance cannot exist in a smooth duct when the duct wall have a finite resistance. The existence of traveling waves subject to the same law of growth is also dismissed under realistic flow conditions.

  4. Modern technical approaches in resectional hepatic surgery.

    Science.gov (United States)

    Michalski, Christoph W; Billingsley, Kevin G

    2015-01-01

    Techniques in liver surgery have improved considerably during the last decades, allowing for liver resections with low morbidity and mortality. Preoperative patient selection, perioperative management, and intraoperative blood-sparing techniques are the cornerstones of modern liver surgery. Multimodal treatment of colorectal liver metastases has expanded the group of patients who are potential candidates for liver resection. Adjunctive techniques, including preoperative portal vein embolization and staged hepatectomy, have facilitated the safe performance of extensive liver resection. This article provides an overview of indications for liver resection and a systematic description of the technical approach to the most commonly performed resections.

  5. Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors.

    Science.gov (United States)

    Ichida, Hirofumi; Ishizawa, Takeaki; Tanaka, Masayuki; Terasawa, Muga; Watanabe, Genki; Takeda, Yoshinori; Matsuki, Ryota; Matsumura, Masaru; Hata, Taigo; Mise, Yoshinori; Inoue, Yosuke; Takahashi, Yu; Saiura, Akio

    2017-03-01

    The aim of this study was to demonstrate the detailed surgical techniques of laparoscopic hepatectomy using intercostal transthoracic trocars for subcapsular tumors located in segment VII or VIII. Intercostal transthoracic trocars were used in patients undergoing laparoscopic hepatectomy for tumors located in segment VII or VIII. Following establishment of pneumoperitoneum and placement of abdominal trocars, balloon-tipped trocars were inserted into the abdominal cavity from the intercostal space and through the pleural space and diaphragm. Upon placement of the intercostal trocars, the lung edge was confirmed by ultrasonography and laparoscopic examination. Following minimal mobilization of the right liver, hemispherical wedge resection of segment VII or VIII was performed using the intercostal trocars as a camera port or for the forceps of the surgeon's left hand. After the hepatectomy, the holes in the diaphragm were sutured closed. Among the 79 patients who underwent laparoscopic hepatectomy, intercostal trocars were used in 14 patients for resection of tumors located in segment VII (4 nodules) or VIII (10 nodules). The median (range) operation time and amount of blood loss for hepatectomy were 225 (109-477) min and 60 (20-310) mL, respectively. No postoperative complications associated with hepatectomy or the use of intercostal trocars occurred. Use of intercostal transthoracic trocars is safe and effective not only for complicated laparoscopic hepatectomy but also for hemispherical wedge resections of subcapsular hepatic tumors located in segment VII or VIII.

  6. Persistent Mullerian Duct Syndrome (PMDS With Large Intraabdominal Seminoma

    Directory of Open Access Journals (Sweden)

    Della Harigovind

    2017-07-01

    Full Text Available Persistent Mullerian Duct Syndrome, a form of male pseudohermaphroditism is characterized by the presence of the Mullerian duct derivatives in an otherwise phenotypically as well as genotypically normal male. We report a case of large intra abdominal seminoma in a male patient with cryptorchidism, along with persistence of Mullerian duct derivatives (uterus.

  7. A case of fascioliasis in common bile duct

    Energy Technology Data Exchange (ETDEWEB)

    Ham, Soo Youn; Park, Cheol Min; Chung, Kyu Byung; Lee, Chang Hong; Park, Seung Chul; Choi, Sang Yong; Lim, Han Jong [Korea University College of Medicine, Seoul (Korea, Republic of)

    1989-10-15

    A case of Fascioliasis of common bile duct is confirmed by visualization of adult fluke. Fascioliasis caused by Fasciola hepatica, is common parasitic disease in cattle and sheep. Human is an accidental host. ERCP demonstrated irregular linear conglomerated filling defects in common bile duct. Through surgical intervention, we found adult flukes of F. hepatica and adenomatous hyperplasia of common bile duct.

  8. Endolaryngeal laser resection of larynx

    Directory of Open Access Journals (Sweden)

    A. M. Mudunov

    2016-01-01

    Full Text Available Laryngeal cancer takes the leading position among malignant tumors of head and neck. Currently, endolaryngeal laser resection is the leading treatment option for localized processes (T1-T2. In the period from December 2014 to January 2016 such surgeries were performed in 76 patients in our clinic. Carcinoma in situ was detected in 19 (25 %, T1a in 27 (35 %, T1b in 24 (31 %, T2 in 6 (8 % patients. As result of the planned histological examination, in all cases surgical procedures had microscopically radical character. Endolaryngeal CO2 -laser resections allow to perform enough large radical surgical interventions with satisfactory functional and cosmetic results, without compromising long-term outcomes. 

  9. Molecular biomarkers in extrahepatic bile duct cancer patients undergoing chemoradiotherapy for gross residual disease after surgery

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Hyeon Kang; Kim, Kyu Bo; Chie, Eui Kyu; Ha, Sung W. [Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Hae Jin [Dept. of Radiation Oncology, Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2012-12-15

    To analyze the outcomes of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients who underwent R2 resection or bypass surgery and to identify prognostic factors affecting clinical outcomes, especially in terms of molecular biomarkers. Medical records of 21 patients with EHBD cancer who underwent R2 resection or bypass surgery followed by chemoradiotherapy from May 2001 to June 2010 were retrospectively reviewed. All surgical specimens were re-evaluated by immunohistochemical staining using phosphorylated protein kinase B (pAKT), CD24, matrix metalloproteinase 9 (MMP9), survivin, and {beta}-catenin antibodies. The relationship between clinical outcomes and immunohistochemical results was investigated. At a median follow-up of 20 months, the actuarial 2-year locoregional progression-free, distant metastasis-free and overall survival were 37%, 56%, and 54%, respectively. On univariate analysis using clinicopathologic factors, there was no significant prognostic factor. In the immunohistochemical staining, cytoplasmic staining, and nuclear staining of pAKT was positive in 10 and 6 patients, respectively. There were positive CD24 in 7 patients, MMP9 in 16 patients, survivin in 8 patients, and {beta}-catenin in 3 patients. On univariate analysis, there was no significant value of immunohistochemical results for clinical outcomes. There was no significant association between clinical outcomes of patients with EHBD cancer who received chemoradiotherapy after R2 resection or bypass surgery and pAKT, CD24, MMP9, survivin, and {beta}-catenin. Future research is needed on a larger data set or with other molecular biomarkers.

  10. Time-lapse imaging as a tool to investigate contractility of the epididymal duct--effects of cGMP signaling.

    Directory of Open Access Journals (Sweden)

    Andrea Mietens

    Full Text Available The well orchestrated function of epididymal smooth muscle cells ensures transit of spermatozoa through the epididymal duct during which spermatozoa acquire motility and fertilizing capacity. Relaxation of smooth muscle cells is mediated by cGMP signaling and components of this pathway are found within the male reproductive tract. Whereas contractile function of caudal parts of the rat epididymal duct can be examined in organ bath studies, caput and corpus regions are fragile and make it difficult to mount them in an organ bath. We developed an ex vivo time-lapse imaging-based approach to investigate the contractile pattern in these parts of the epididymal duct. Collagen-embedding allowed immobilization without impeding contractility or diffusion of drugs towards the duct and therefore facilitated subsequent movie analyses. The contractile pattern was made visible by placing virtual sections through the acquired image stack to track wall movements over time. By this, simultaneous evaluation of contractile activity at different positions of the observed duct segment was possible. With each contraction translating into a spike, drug-induced alterations in contraction frequency could be assessed easily. Peristaltic contractions were also detectable and throughout all regions in the proximal epididymis we found regular spontaneous contractile activity that elicited movement of intraluminal contents. Stimulating cGMP production by natriuretic peptide ANP or inhibiting degradation of cGMP by the phosphodiesterase 5 inhibitor sildenafil significantly reduced contractile frequency in isolated duct segments from caput and corpus. RT-PCR analysis after laser-capture microdissection localized the corresponding molecules to the smooth muscle layer of the duct. Our time-lapse imaging approach proved to be feasible to assess contractile function in all regions of the epididymal duct under near physiological conditions and provides a tool to evaluate acute

  11. Idea Bank: Duct Tape Note Twister

    Science.gov (United States)

    McHenry, Molly

    2008-01-01

    In this article, the author relates how she observed a middle school math teacher deliver a miserable class. She realized that she did the same thing to her music students. To engage her students, she developed "Note Twister," a music reading game using duct tape to form musical notes and the basic premise behind the game, "Twister." She finds…

  12. IDUS for Biliary and Pancreatic Duct Lesions

    Institute of Scientific and Technical Information of China (English)

    Takao ltoi

    2008-01-01

    @@ In the recent decade, wire-guided intraductal US(IDUS), which can be passed through the working channel of standard duodenoscopes to provide high-frequency ultrasound images, has been developed as a newly diagnostic tool for biliary and pancreatic duct lesions.

  13. Calcium influx pathways in rat pancreatic ducts

    DEFF Research Database (Denmark)

    Hug, M J; Pahl, C; Novak, I

    1996-01-01

    A number of agonists increase intracellular Ca2+ activity, [Ca2+]i, in pancreatic ducts, but the influx/efflux pathways and intracellular Ca2+ stores in this epithelium are unknown. The aim of the present study was to characterise the Ca2+ influx pathways, especially their pH sensitivity, in nati...

  14. Laser Beam Duct Pressure Controller System.

    Science.gov (United States)

    the axial flow of a conditioning gas within the laser beam duct, by matching the time rate of change of the pressure of the flowing conditioning gas...to the time rate of change of the pressure in the cavity of an operably associated laser beam turret.

  15. Familial occurrence of congenital bile duct dilatation

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Congenital bile duct dilatation (CBD) that developed in a parent and son is presented.Familial occurrence of CBD is rare,with only a few male cases having been reported.Since the initial report of CBD occurring in siblings in 1981,a total of 20 cases (10 pairs) have been published as of 2007.Clinical and genetic features of CBD are discussed.

  16. Vascular invasion of klatskin tumor : computed tomography vs digital subtraction angiography in determining resectability

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Joo Hee; Han, Joon Koo; Kim, Tae Kyoung; Sin, Sang Jun; Hong, Hye Sook; Park, Jae Hyung; Choi, Byung Ihn; Kim, Sun Whe [College of Medicine, the Institute of Radiation Medicine, Seoul National University, Seoul (Korea, Republic of); Song, Chi Sung [Borame Hospital, Seoul (Korea, Republic of)

    2000-02-01

    To compare the accuracy of computed tomography (CT) with that of digital subtraction angiography (DSA) in predicting the resectability of Klatskin tumor on the basis of vascular invasion. Twenty-five patients with Klatskin tumor who had undergone laparotomy were included in this study. In order to assess the surgical resectability of their tumors, the preoperative CT scans and DSA of these patients were retrospectively assessed in terms of vascular invasion. The criteria of unresectability were tumoral invasion of the proper hepatic artery or main portal vein, or simultaneous invasion of the hepatic artery on one side and the other side portal vein. Tumors were unresectable in 13 cases, and resectable in 12. CT and DSA predicted nine and three tumors as unresectable ones, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT in determining whether a tumor was unresectable were 61.5%, 91.7%, 88.9%, 68.8% and 76.0%, respectively. For DSA, the respective figures were 23.1%, 100%, 100%, 54.5%, and 60%. For the detection of vascular invasion without diameter change, CT was superior to DSA; for the evaluation of vascular anatomy, it was, however, less effective. CT failed to detect small hepatic metastasis (n=3D2), lymph node metastasis (n=3D1), variation of the bile duct (n=3D1), and the distal extent of tumor in the bile duct (n=3D1), factors which precluded surgical resection. CT is a reliable method for the detection of vascular invasion and tumor unresectability. For the detection of vascular anatomic variation, the combined use of CT and DSA would be helpful. (author)

  17. Liver resection over the last decade

    DEFF Research Database (Denmark)

    Wettergren, A.; Larsen, P.N.; Rasmussen, A.;

    2008-01-01

    of hepatic metastases from colorectal cancer and hepatocellular carcinoma in our institution. MATERIALS AND METHODS: The patients who underwent their primary liver resection from 1.1.1995-31.12.2004 in our institution were included. The surgical outcome was reviewed retrospectively and the five-year survival...... after resection of hepatic metastases from colorectal cancer and hepatocellular carcinoma was estimated. RESULTS: 141 patients (71M/70F), median age 58 years (1-78), underwent a liver resection in the ten-year period. The number of resections increased from two in 1995 to 32 in 2004. Median hospital......AIMS: The results after liver resection have improved over the last decade with an operative mortality rate of less than 5% in high-volume centres. The aim of the present study was to assess the perioperative outcome after hepatic resection and to assess the long-term survival after liver resection...

  18. DNA End Resection: Facts and

    Directory of Open Access Journals (Sweden)

    Ting Liu

    2016-06-01

    Full Text Available DNA double-strand breaks (DSBs, which arise following exposure to a number of endogenous and exogenous agents, can be repaired by either the homologous recombination (HR or non-homologous end-joining (NHEJ pathways in eukaryotic cells. A vital step in HR repair is DNA end resection, which generates a long 3′ single-stranded DNA (ssDNA tail that can invade the homologous DNA strand. The generation of 3′ ssDNA is not only essential for HR repair, but also promotes activation of the ataxia telangiectasia and Rad3-related protein (ATR. Multiple factors, including the MRN/X complex, C-terminal-binding protein interacting protein (CtIP/Sae2, exonuclease 1 (EXO1, Bloom syndrome protein (BLM/Sgs1, DNA2 nuclease/helicase, and several chromatin remodelers, cooperate to complete the process of end resection. Here we review the basic machinery involved in DNA end resection in eukaryotic cells.

  19. Intestinal adaptation after extensive small bowel resection: differential changes in growth and insulin-like growth factor system messenger ribonucleic acids in jejunum and ileum.

    Science.gov (United States)

    Ziegler, T R; Mantell, M P; Chow, J C; Rombeau, J L; Smith, R J

    1998-07-01

    The distal small bowel exhibits greater adaptive growth than proximal segments after partial small intestine resection. To explore this process, we evaluated adaptive cellularity, intestinal insulin-like growth factor (IGF) system messenger RNA (mRNA) transcripts, and effects of recombinant IGF-I treatment in jejunum and ileum of adult rats. Gastrostomy-fed animals underwent 80% jejuno-ileal resection or intestinal transection and reanastomosis without resection, followed by infusion of human recombinant IGF-I (2.4 mg/kgXday) or vehicle. After 7 days, resected rats demonstrated modest adaptive growth in jejunum and marked cell proliferation in ileum. Resection increased IGF-I mRNA in both jejunum (183%) and ileum (249%) and up-regulated IGFBP-4 mRNA levels in both tissues. IGFBP-3 mRNA fell significantly in ileum after resection. IGF-I infusion modestly increased ileal cellularity after resection, but had no effect in jejunum. IGF-I markedly increased IGFBP-3 mRNA levels in jejunum after both transection and resection. These data confirm that bowel resection induces greater adaptive growth in ileum than jejunum. IGF-I administration modestly increases ileal, but not jejunal, growth after resection. Increased levels of intestinal IGF-I and IGFBP-4 mRNA suggest roles for IGF-I and IGFBP-4 in mediating small bowel adaptation. Higher levels of jejunal IGFBP-3 mRNA may be related to limited jejunal vs. ileal growth after extensive jejuno-ileal resection.

  20. Heat Transfer in a Superelliptic Transition Duct

    Science.gov (United States)

    Poinsatte, Philip; Thurman, Douglas; Hippensteele, Steven

    2008-01-01

    Local heat transfer measurements were experimentally mapped using a transient liquid-crystal heat transfer technique on the surface of a circular-to-rectangular transition duct. The transition duct had a length-to-diameter ratio of 1.5 and an exit-plane aspect ratio of 3. The crosssectional geometry was defined by the equation of a superellipse. The cross-sectional area was the same at the inlet and exit but varied up to 15 percent higher through the transition. The duct was preheated to a uniform temperature (nominally 64 C) before allowing room temperature air to be suddenly drawn through it. As the surface cooled, the resulting isothermal contours on the duct surface were revealed using a surface coating of thermochromic liquid crystals that display distinctive colors at particular temperatures. A video record was made of the surface temperature and time data for all points on the duct surfaces during each test. Using this surface temperature-time data together with the temperature of the air flowing through the model and the initial temperature of the model wall, the heat transfer coefficient was calculated by employing the classic one-dimensional, semi-infinite wall heat transfer conduction model. Test results are reported for inlet diameter-based Reynolds numbers ranging from 0.4x106 to 2.4x106 and two grid-generated freestream turbulence intensities of about 1 percent, which is typical of wind tunnels, and up to 16 percent, which may be more typical of real engine conditions.

  1. Laparoscopic liver resection for hepatocellular carcinoma in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Jai Young Cho; Ho-Seong Han

    2016-01-01

    Hepatocellular carcinoma (HCC) is a common malignant tumor and many cases occur in patients with liver cirrhosis. Although liver transplantation is the most effective treatment option, hepatectomy is still the ifrst curative treatment option because liver transplantation is limited by the donors and high cost. In recent years, laparoscopic liver resection (LLR) has increasingly been performed in patients with liver cirrhosis, and has several advantages over open liver resection. Besides less pain and shorter hospital stay, LLR in patients with liver cirrhosis is also associated with lower incidences of postoperative liver failure and ascites because of greater preservation of collateral veins and less liver manipulation. With increasing experience, LLR for HCC located in segments 7 or 8 is now feasible, and anatomic LLR could be performed in patients with cirrhosis. Many comparative studies have shown that LLR is better than open liver resection in patients with liver cirrhosis in terms of a lower incidence of postoperative liver failure and similar patient survival. In conclusion, LLR is a promising treatment modality for HCC in patients with liver cirrhosis.

  2. Predicting postoperative exercise capacity after major lung resection.

    Science.gov (United States)

    Nagamatsu, Yoshinori; Sueyoshi, Susumu; Tsubuku, Tatsuji; Kawasaki, Masayuki; Akagi, Yoshito

    2015-12-01

    This study investigates whether postoperative exercise capacity can be predicted from preoperative lung perfusion scintigraphy and the number of subsegments resected. We studied 315 patients, with 158 being assigned odd numbers and 157 being assigned even numbers. In the 158 patients assigned odd numbers, the predicted postoperative VO2 max/m2 (ppo VO2 max/m2) was obtained from the results of lung perfusion scintigraphy and the number of subsegments scheduled for resection. We then examined correlations with the actual values, 2 weeks and 1 month postoperatively, to obtain a regression equation (Series 1). In the 157 patients assigned even numbers, the ppo VO2 max/m2 corrected by the regression equation derived from Series 1 (corrected-ppo VO2 max/m2) was compared with the actual values, 2 weeks and 1 month postoperatively, to establish whether the postoperative VO2 max/m2 could be predicted. The regression equation between the ppo VO2 max/m2 and its actual value was y = 0.83x + 103, 2 weeks postoperatively, and y = 0.923x + 82, 1 month postoperatively. The difference between the corrected-ppo VO2 max/m2 and the actual postoperative value was small. Calculating the residual [Formula: see text]o2 max/m2 preoperatively from the results of lung perfusion scintigraphy and the number of segments scheduled for resection is useful for predicting postoperative exercise capacity.

  3. 完全腹腔镜胆囊癌根治术的临床疗效%Clinical effect of totally laparoscopic radical resection for gallbladder cancer

    Institute of Scientific and Technical Information of China (English)

    徐鋆耀; 姜海; 喻志敏; 闵军; 陈亚进

    2016-01-01

    Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer.Methods The retrospective cross-sectional descriptive study was adopted.The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected.The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients,and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection.The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination.Observation indicators included (1) operation situations,including surgical procedures,operation time,volume of intraoperative blood loss and number of lymph node dissected,(2) postoperative situations,including time for outoff-bed activity,time for diet intake,time of drainage tube removal,occurrence of complications and duration of hospital stay,(3) results of postoperative pathological examination,including tumor stage and surgical margin,(4) postoperative adjuvant treatment,(5) follow-up situation including the survival of patients,tumor recurrence and metastasis.The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Count data were represented as average (range).Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection + lymph node dissection at N1 region.Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection + Roux-en-Y hepaticojejunostomy,without perioperative death.The average operation time,average volume of intraoperative

  4. Transition duct system with straight ceramic liner for delivering hot-temperature gases in a combustion turbine engine

    Energy Technology Data Exchange (ETDEWEB)

    Wiebe, David J.

    2017-05-16

    A transition duct system (10) for delivering hot-temperature gases from a plurality of combustors in a combustion turbine engine is provided. The system includes an exit piece (16) for each combustor. The exit piece may include a straight path segment (26) for receiving a gas flow from a respective combustor. A straight ceramic liner (40) may be inwardly disposed onto a metal outer shell (38) along the straight path segment of the exit piece. Structural arrangements are provided to securely attach the ceramic liner in the presence of substantial flow path pressurization. Cost-effective serviceability of the transition duct systems is realizable since the liner can be readily removed and replaced as needed.

  5. The effect of duct surface character on methane explosion propagation

    Institute of Scientific and Technical Information of China (English)

    LIN Bai-quan; YE Qing; JIAN Cong-guang; WU Hai-jin

    2007-01-01

    The effect of duct surface character on methane explosion propagation was experimentally studied and theoretically analyzed. The roughness has effect on methane explosion propagation. The flame propagation velocity and the peak value pressure of methane explosion in rough duct are larger than the parameters in smooth duct. The heat exchange of the surface has effect on methane explosion propagation. The propagation velocity of flame and strength of explosion wave in the duct covered by heat insulation material are larger than those in duct with good heat transmittability.

  6. Magnetic resonance imaging of extrahepatic bile duct disruption

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Yon-Cheong; Wang, Li-Jen; Chen, Chi-Jen [Department of Radiology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan); Chen, Ray-Jade [Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan)

    2002-10-01

    Blunt injury of the extrahepatic bile duct is rare and hence a large series of scientific study of its MRI is difficult to perform. We present the MRI and MR cholangiography of a case of blunt extrahepatic bile duct injury proven at surgery. The diagnosis could be established based on MRI findings of an abrupt tapering of the extrahepatic bile duct with a retracted end, a discordant small-caliber proximal duct, massive ascites, and a hematoma in proximity to the bile duct injury. This non-invasive MRI study is a promising imaging modality to evaluate biliary tract injury. (orig.)

  7. Performance Study and CFD Predictions of a Ducted Fan System

    Science.gov (United States)

    Abrego, Anita I.; Chang, I-Chung; Bulaga, Robert W.; Rutkowski, Michael (Technical Monitor)

    2002-01-01

    An experimental investigation was completed in the NASA Ames 7 by 10-Foot Wind Tunnel to study the performance characteristics of a ducted fan. The goal of this effort is to study the effect of ducted fan geometry and utilize Computational Fluid Dynamics (CFD) analysis to provide a baseline for correlation. A 38-inch diameter, 10-inch chord duct with a five-bladed fixed-pitch fan was tested. Duct performance data were obtained in hover, vertical climb, and forward flight test conditions. This paper will present a description of the test, duct performance results and correlation with CFD predictions.

  8. Transition duct with divided upstream and downstream portions

    Energy Technology Data Exchange (ETDEWEB)

    McMahan, Kevin Weston; LeBegue, Jeffrey Scott; Maldonado, Jaime Javier; Dillard, Daniel Jackson; Flanagan, James Scott

    2015-07-14

    Turbine systems are provided. In one embodiment, a turbine system includes a transition duct comprising an inlet, an outlet, and a duct passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The duct passage includes an upstream portion extending from the inlet and a downstream portion extending from the outlet. The turbine system further includes a rib extending from an outer surface of the duct passage, the rib dividing the upstream portion and the downstream portion.

  9. Preoperative segmental embolization of the proper hepatic artery prior to pylorus-preserving pancreaticoduodenectomy: A case report

    Directory of Open Access Journals (Sweden)

    Masanobu Taguchi

    2015-01-01

    Conclusion: Preoperative segmental embolization of the hepatic artery before PPPD for a patient with a replaced left hepatic artery encouraged the growth of collateral blood supply, allowing radical resection including the vessels and obviated the need for arterial reconstruction.

  10. Dispersion properties of ducted whistlers, generated by lightning discharge

    Directory of Open Access Journals (Sweden)

    D. L. Pasmanik

    2005-06-01

    Full Text Available Whistler-mode wave propagation in magnetospheric ducts of enhanced cold plasma density is studied. The case of the arbitrary ratio of the duct radius to the whistler wavelength is considered, where the ray-tracing method is not applicable. The set of duct eigenmodes and their spatial structure are analysed and dependencies of eigenmode propagation properties on the duct characteristics are studied. Special attention is paid to the analysis of the group delay time of one-hop propagation of the whistler wave packet along the duct. We found that, in contrast to the case of a wide duct, the group delay time in a rather narrow duct decreases as the eigenmode number increases. The results obtained are suggested for an explanation of some types of multi-component whistler signals.

  11. Curved Duct Noise Prediction Using the Fast Scattering Code

    Science.gov (United States)

    Dunn, M. H.; Tinetti, Ana F.; Farassat, F.

    2007-01-01

    Results of a study to validate the Fast Scattering Code (FSC) as a duct noise predictor, including the effects of curvature, finite impedance on the walls, and uniform background flow, are presented in this paper. Infinite duct theory was used to generate the modal content of the sound propagating within the duct. Liner effects were incorporated via a sound absorbing boundary condition on the scattering surfaces. Simulations for a rectangular duct of constant cross-sectional area have been compared to analytical solutions and experimental data. Comparisons with analytical results indicate that the code can properly calculate a given dominant mode for hardwall surfaces. Simulated acoustic behavior in the presence of lined walls (using hardwall duct modes as incident sound) is consistent with expected trends. Duct curvature was found to enhance weaker modes and reduce pressure amplitude. Agreement between simulated and experimental results for a straight duct with hard walls (no flow) was excellent.

  12. Rationale for Measuring Duct Leakage Flows in Large Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.; Diamond, Richard C.; Sherman, Max H.

    2005-07-01

    Industry-wide methods of assessing duct leakage are based on duct pressurization tests, and focus on ''high pressure'' ducts. Even though ''low pressure'' ducts can be a large fraction of the system and tend to be leaky, few guidelines or construction specifications require testing these ducts. We report here on the measured leakage flows from ten large commercial duct systems at operating conditions: three had low leakage (less than 5% of duct inlet flow), and seven had substantial leakage (9 to 26%). By comparing these flows with leakage flows estimated using the industry method, we show that the latter method by itself is not a reliable indicator of whole-system leakage flow, and that leakage flows need to be measured.

  13. Endovascular angioplasty before resection of a sphenoidal meningioma with vascular encasement.

    Science.gov (United States)

    Chivoret, N; Fontaine, D; Lachaud, S; Chau, Y; Sedat, J

    2011-09-01

    We describe a case of sphenoid wing meningioma presenting with cerebral infarction due to extended vascular encasement in which endovascular angioplasty was performed before surgery to avoid perioperative ischemia. A severe stenosis involved the intracranial internal carotid artery and the proximal segments of the middle and anterior cerebral arteries. Endovascular dilatation was followed by complete surgical resection. Preoperative mild aphasia and hemiparesia resolved completely after surgery. Endovascular angioplasty of arterial trunks and their branches can be proposed before the resection of skull base meningiomas encasing these arteries to decrease the risk of perioperative brain ischemia related to their surgical manipulation or vasospasm.

  14. Vascular resection and reconstruction at pancreatico-duodenectomy:technicalissues

    Institute of Scientific and Technical Information of China (English)

    Edward CS Lai

    2012-01-01

    BACKGROUND: With the improvement of perioperative management over the years, pancreatico-duodenectomy has become a safe operation despite its technical complexity. The presence of concomitant visceral artery occlusion unrelated to the underlying malignancy and concomitant major venous inifltration by tumor poses additional hazards to resection which could compromise the postoperative outcome. DATA SOURCES: A MEDLINE database search was performed to identify relevant articles using the key words"median arcuate ligament syndrome", "superior mesenteric artery", "replaced right hepatic artery", and "portal vein resection". Additional papers and book chapters were identiifed by a manual search of the references from the key articles. RESULTS:Computed tomography with 3-dimensional recon-struction of the vascular anatomy provides most key information on the potential vascular problems encountered during surgery. A trial clamping of the gastroduodenal artery provides a simple intraoperative assessment for the presence of any signiifcant visceral arterial occlusion. Depending on the timing of diagnosis, division of the median arcuate ligament, bypass or endovascular stenting should be considered. Portal and superior mesenteric vein resection had been used with increasing frequency and safety. The steps and methods taken to reconstruct the venous continuity vary with individual surgeons, and the anatomical variations encountered. With segmental loss of the portal vein, opinions differs with regard to the preservation of the splenic vein, and when divided, the necessity of restoring its continuity;source of the autologous vein graft when needed and whether the use of synthetic graft is a safe alternative. CONCLUSIONS: During a pancreatico-duodenectomy, images of computed tomography must be carefully studied to appreciate the changes and variation of vascular anatomy. Adequate preoperative preparation, acute awareness of the probable arterial and venous anatomical

  15. 肝切除术联合术中胆道镜治疗17例肝内胆管结石的疗效分析%The therapy experience of liver resection combined intraoperative choledochoscope for intrahepatic biliary calculi in 17 cases

    Institute of Scientific and Technical Information of China (English)

    赵本泉; 吴伟; 项建斌; 马中林

    2015-01-01

    目的:探讨肝切除术联合术中胆道镜治疗肝内胆管结石的临床疗效。方法回顾性分析该院肝胆外科2005~2014年行肝切除术联合术中胆道镜治疗肝内胆管结石17例患者的临床资料,根据肝内胆管结石的分布,其中左外叶6例,左半肝5例,右肝第Ⅵ段3例,第Ⅶ段1例,第Ⅷ段1例,左外叶合并右后叶下段1例。17例患者均采用传统肝叶或肝段切除术(单钳法联合第一肝门阻断技术),其中左外叶切除6例,左半肝切除5例,右肝第Ⅵ段切除3例,第Ⅶ段切除1例,第Ⅷ段切除1例,左外叶联合右后叶下段切除1例,同时行胆总管切开取石、T管引流附加手术10例,所有患者术中均常规行胆道镜检查。结果17例患者均治愈,无严重并发症,无远期结石复发。结论肝切除术联合术中胆道镜是治疗肝内胆管结石积极、有效、彻底的方法。%Objective To investigate the clinical efficacy of liver resection combined intraoperative choledochoscope for intra‐hepatic biliary calculi .Methods A retrospective analysis of clinical data in seventeen patients with intrahepatic biliary calculi ,who have been received liver resection combined intraoperative choledochoscope in the department of hepatobiliary surgery during 2005 to 2014 was conducted .According to the distribution of intrahepatic bile duct stones ,six cases located in left liver lobe ,five cases lo‐cated in left half liver ,three cases located in liver section Ⅵ ,one case located in liver section Ⅶ ,one case located in liver section Ⅷ , one case located in left liver lobe associated with right posterior lobe lower segment .Seventeen cases were treated with hepatolobec‐tomy or segmental liver resection (single clamp method combined first hilar occlusion) ,among which six cases received hepatic left lateral lobectomy ,five cases received left hemihepatectomy ,three cases received partial hepatic resection in

  16. Strategic market segmentation

    National Research Council Canada - National Science Library

    Maričić Branko R; Đorđević Aleksandar

    2015-01-01

    ..., requires segmented approach to the market that appreciates differences in expectations and preferences of customers. One of significant activities in strategic planning of marketing activities is market segmentation...

  17. Resectable pancreatic small cell carcinoma

    Directory of Open Access Journals (Sweden)

    Jordan M. Winter

    2011-01-01

    Full Text Available Primary pancreatic small cell carcinoma (SCC is rare, with just over 30 cases reported in the literature. Only 7 of these patients underwent surgical resection with a median survival of 6 months. Prognosis of SCC is therefore considered to be poor, and the role of adjuvant therapy is uncertain. Here we report two institutions’ experience with resectable pancreatic SCC. Six patients with pancreatic SCC treated at the Johns Hopkins Hospital (4 patients and the Mayo Clinic (2 patients were identified from prospectively collected pancreatic cancer databases and re-reviewed by pathology. All six patients underwent a pancreaticoduodenectomy. Clinicopathologic data were analyzed, and the literature on pancreatic SCC was reviewed. Median age at diagnosis was 50 years (range 27-60. All six tumors arose in the head of the pancreas. Median tumor size was 3 cm, and all cases had positive lymph nodes except for one patient who only had five nodes sampled. There were no perioperative deaths and three patients had at least one postoperative complication. All six patients received adjuvant therapy, five of whom were given combined modality treatment with radiation, cisplatin, and etoposide. Median survival was 20 months with a range of 9-173 months. The patient who lived for 9 months received chemotherapy only, while the patient who lived for 173 months was given chemoradiation with cisplatin and etoposide and represents the longest reported survival time from pancreatic SCC to date. Pancreatic SCC is an extremely rare form of cancer with a poor prognosis. Patients in this surgical series showed favorable survival rates when compared to prior reports of both resected and unresectable SCC. Cisplatin and etoposide appears to be the preferred chemotherapy regimen, although its efficacy remains uncertain, as does the role of combined modality treatment with radiation.

  18. [Baroreflex failure after chemodectoma resection].

    Science.gov (United States)

    Gómez Esteban, J C; Boyero, S; Fernández, C; Sagasta, A; Pérez, T; Velasco, F; Allue, I; Lezcano, E; Zarranz, J J

    2004-10-01

    Baroreflex failure after chemodectoma resection We present a case of baroreflex failure secondary to a unilateral injury of the glossopharyngeal nerve. The patient was operated for a left-sided chemodectoma in the carotid body. Some months after surgery she started to report presyncopal episodes exacerbated by mental stress and when standing up. During these episodes, the patient presented hypertensive crises and tachycardia. However, blood pressure was below normal ranges at rest. The diagnosis was baroreflex failure secondary to unilateral injury of the glossopharyngeal nerve. The case reported herein illustrates the fact that the presence of a bilateral injury is not essential for the occurrence of this disorder.

  19. Intraoperative simulation of remnant liver function during anatomic liver resection with indocyanine green clearance (LiMON) measurements.

    Science.gov (United States)

    Thomas, Michael N; Weninger, Ernst; Angele, Martin; Bösch, Florian; Pratschke, Sebastian; Andrassy, Joachim; Rentsch, Markus; Stangl, Manfred; Hartwig, Werner; Werner, Jens; Guba, Markus

    2015-06-01

    Post-hepatectomy liver failure (PHLF) is the major cause of death following liver resection. The aim of this study was to evaluate the feasibility of an intraoperative simulation of post-resection liver function. Intraoperative liver function was measured by indocyanine green (ICG) clearance using the LiMON technology. In 20 patients undergoing anatomic liver resection, ICG plasma disappearance rate (PDR (%/min) and ICG retention at 15 min (R15 ) (%) were measured immediately after the induction of anaesthesia (t0 ), after selective arterial and portovenous inflow trial clamping (TC) of the resected liver segments (t1 ), after the completion of resection (t2 ) and before the closure of the abdominal cavity (t3 ). The median baseline (t0 ) PDR was 16.5%/min. Trial clamping of the inflow (t1 ) resulted in a significant reduction in PDR to 10.5%/min. Results under TC were similar to those obtained after resection (t2 ) (median PDR: 10.5%/min). Linear regression modelling showed that post-resection liver volume could be accurately predicted by TC of liver inflow (P < 0.0001), but not by determining the resected liver volume. Simulated post-resection liver function under TC correlated well with PHLF and length of hospital stay. Intraoperative ICG clearance measurements allow real-time monitoring of intraoperative liver function during surgery. Trial clamping of arterial and portovenous inflow accurately predicts immediate post-resection liver function. The intraoperative measurement of liver function and simulation of post-resection liver function may help to avoid PHLF. © 2015 International Hepato-Pancreato-Biliary Association.

  20. Acoustic Power Transmission Through a Ducted Fan

    Science.gov (United States)

    Envia, Ed

    2016-01-01

    For high-speed ducted fans, when the rotor flowfield is shock-free, the main contribution to the inlet radiated acoustic power comes from the portion of the rotor stator interaction sound field that is transmitted upstream through the rotor. As such, inclusion of the acoustic transmission is an essential ingredient in the prediction of the fan inlet noise when the fan tip relative speed is subsonic. This paper describes a linearized Euler based approach to computing the acoustic transmission of fan tones through the rotor. The approach is embodied in a code called LINFLUX was applied to a candidate subsonic fan called the Advanced Ducted Propulsor (ADP). The results from this study suggest that it is possible to make such prediction with sufficient fidelity to provide an indication of the acoustic transmission trends with the fan tip speed.

  1. Theoretical analysis of HVAC duct hanger systems

    Science.gov (United States)

    Miller, R. D.

    1987-01-01

    Several methods are presented which, together, may be used in the analysis of duct hanger systems over a wide range of frequencies. The finite element method (FEM) and component mode synthesis (CMS) method are used for low- to mid-frequency range computations and have been shown to yield reasonably close results. The statistical energy analysis (SEA) method yields predictions which agree with the CMS results for the 800 to 1000 Hz range provided that a sufficient number of modes participate. The CMS approach has been shown to yield valuable insight into the mid-frequency range of the analysis. It has been demonstrated that it is possible to conduct an analysis of a duct/hanger system in a cost-effective way for a wide frequency range, using several methods which overlap for several frequency bands.

  2. Extrahepatic bile duct neurilemmoma mimicking Klatskin tumor.

    Science.gov (United States)

    Kamani, Fereshteh; Dorudinia, Atosa; Goravanchi, Farhood; Rahimi, Farzaneh

    2007-04-01

    Neurilemmoma rarely develops in the biliary tree. Here, we report a 39-year-old Iranian woman with neurilemmoma in the extrahepatic bile duct presenting with progressively deepening jaundice. On the basis of clinical and radiological features, this tumor was initially suspected as Klatskin tumor. Histologically, the tumor was a typical neurilemmoma. Immunostaining showed that tumor cells were strongly and diffusely positive for S-100 protein, which supported the diagnosis of neurilemmoma. Neurilemmoma should be considered in the differential diagnosis of obstructive jaundice.

  3. IMP3 expression in lesions of the biliary tract: a marker for high-grade dysplasia and an independent prognostic factor in bile duct carcinomas.

    Science.gov (United States)

    Riener, Marc-Oliver; Fritzsche, Florian R; Clavien, Pierre-Alain; Pestalozzi, Bernhard C; Probst-Hensch, Nicole; Jochum, Wolfram; Kristiansen, Glen

    2009-10-01

    The oncofetal protein IMP3 (insulin-like growth factor II mRNA binding protein 3) is expressed during embryogenesis and carcinogenesis. Various tumor types have been analyzed for IMP3 expression, which was exclusively found in tumor cells and correlated with increased tumor aggressiveness and reduced overall survival. To our knowledge, IMP3 expression has not been investigated in bile duct carcinomas. Using large tissue sections from resection specimens of the extrahepatic biliary tract, we analyzed IMP3 in normal bile ducts (n = 36), bile ducts with acute inflammation and reactive epithelial changes (n = 26), low-grade dysplasia (n = 9), and high-grade dysplasia (n = 11). Furthermore, IMP3 expression was assessed in bile duct carcinoma (n = 115) using clinically well-characterized tissue microarrays. The findings were correlated with clinical-pathologic parameters including survival. High-grade dysplasia was strongly positive for IMP3 in all cases studied compared with no or weak expression in normal, inflamed, and low-grade dysplastic bile ducts. Of the bile duct carcinomas 58.3% (67/115) were strongly positive for IMP3, which was associated with a higher proliferation rate (P = .004) and p53 positivity (P = .022). Patients with strong IMP3 expression had significantly reduced overall survival (P = .037) similarly to the subgroup of pT3 carcinomas (P = .007). In multivariate analysis, IMP3 expression was an independent prognostic factor for overall survival (P = .040, RR = 1.809). This comprehensive study shows that IMP3 is an independent prognostic biomarker in bile duct carcinoma. In addition, it may be a marker for high-grade dysplasia in the extrahepatic biliary tract.

  4. Endoscopic management of bile duct stones.

    Science.gov (United States)

    Sivak, M V

    1989-09-01

    Endoscopic sphincterotomy is the procedure of choice for choledocholithiasis in patients who have had a cholecystectomy. The bile duct is cleared of stones in about 80 to 90 percent of patients. Available data, largely retrospective, suggest that surgery and endoscopic sphincterotomy are about equal with respect to removal of stones, morbidity, and mortality. Certain technical problems are discussed, including inability to insert the papillotome, the large stone, and problems relating to anatomy such as peripapillary diverticulum and prior gastrectomy. The treatment of patients with bile duct stones who have not had a cholecystectomy, with and without cholelithiasis, is controversial. Endoscopic sphincterotomy without subsequent cholecystectomy is adequate treatment for the majority of patients who are unfit for surgery, even if there are stones in the gallbladder, provided they are asymptomatic after endoscopic removal of stones from the bile ducts. Endoscopic sphincterotomy has been performed in the treatment of gallstone-induced pancreatitis, acute obstructive cholangitis, and sump syndrome. The complication rate for endoscopic sphincterotomy ranges from 6.5 to 8.7 percent, with a mortality rate of 0 to 1.3 percent. The most common serious complications are perforation, hemorrhage, acute pancreatitis, and sepsis.

  5. Endoscopic Management of Difficult Bile Duct Stones

    Directory of Open Access Journals (Sweden)

    Christian Ell

    1992-01-01

    Full Text Available More than 90% of all common bile duct concrements can be removed via the endoscopic retrograde route via endoscopic sphincterotomy, stone extraction by baskets and balloon catheters, or mechanical lithotripsy. Oversized, very hard or impacted stones, however, often still resist conventional endoscopic therapy. Promising new or improved approaches for the treatment of these stones are intracorporeal or extracorporeal shock wave lithotripsy. Shockwave lithotriptors for extracorporeal shockwave lithotripsy are currently available worldwide. However, for the waterbath first generation devices, general anesthesia is required since shockwaves are very painful. Furthermore, an x-ray localization system is essential to visualize the stones after having filled the bile duct over a nasobiliary catheter. An average of two shockwave treatments with additional two to four endoscopic sessions are required. ln tracorporeal lithotripsy promises more comfort and less effort for the patient. Shockwaves are generated either by means of the spark gap principle (electrohydraulic probes or by laser-induced plasma generation. Laser-induced shockwave lithotripsy appears to be more safer, since with dye and solid state lasers, athermal, well-controlled shockwaves can be generateJ without the risks for duct perfo ration (as described for the electrohydraulic system. Furthermore, a recently developed stone-tissue detection system integrated in a new dye laser system enchances the safety of laser-induced lithotripsy. ln consequence, lithotripsy without direct endoscopic control appears possible in selected cases.

  6. MRI of the biliary and pancreatic ducts

    Energy Technology Data Exchange (ETDEWEB)

    Pavone, P.; Laghi, A.; Catalano, C.; Panebianco, V.; Fabiano, S.; Passariello, R. [Dept. of Radiology II, Univ. of Rome ``La Sapienza`` (Italy)

    1999-10-01

    Magnetic resonance Cholangiopancreatography (MRCP) is a non-invasive imaging technique able to provide projectional images of the bile ducts. Different sequences, using both breath-hold and non-breath-hold acquisition techniques, have been employed in order to obtain MRCP images. The authors discuss technical aspects, considering both three-dimensional non-breath-hold techniques and two-dimensional breath-hold, multi-slice and thick slab sequences. Clinical applications of MRCP are evaluated, presenting data from both the literature and personal experience. The main indication for MRCP study is represented by the evaluation of common bile duct obstruction, with the aim of assessing the presence of the obstruction (accuracy 85-100 %) and, subsequently, its level (accuracy 91-100 %) and its cause. The utility of associating conventional MR images to MRCP in malignant strictures, in order to characterize and stage the malignant lesion, is also discussed. Finally, data are presented regarding the indications and the utility of MR-pancreatography in the evaluation of patients with pancreatic duct anomalies and chronic pancreatitis. (orig.) With 9 figs., 39 refs.

  7. [R1 resection of esophageal carcinoma].

    Science.gov (United States)

    Gockel, I; Wittekind, C

    2017-08-02

    The microscopic identification of residual tumor tissue in the oral or aboral resection margins (R1 resection) of esophageal specimens following oncologic esophageal resection, increases the risk of tumor recurrence and disease-related morbidity. Esophageal resection with its associated risks is only meaningful, if an R0 situation can be safely achieved. The relevance of microscopic involvement of the circumferential resection margin (CRM) in esophageal carcinoma in its different definitions by the British and the American Societies of Pathology has up to now never been investigated in a prospective study. According to the German S3 guideline, radiochemotherapy should be performed in a postoperatively proven R1 situation, which cannot be converted by a curative extended re-resection into an R0 situation or in unfavorable conditions for an extended re-resection, independent of neoadjuvant therapy. In the case of an R1 situation in the region of the CRM, an extended re-resection is not simply possible on account of the anatomical conditions with corresponding limitations by the aorta and the spinal column, in contrast to extensions of the re-resection orally or aborally.

  8. Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: A case report

    Institute of Scientific and Technical Information of China (English)

    Xiao-Wu Xu; Rong-Hua Li; Wei Zhou; Jie Wang; Ren-Chao Zhang; Ke Chen; Yi-Ping Mou

    2012-01-01

    We describe herein a 68-year-old woman who was diagnosed with a quite rare entity of intraductal papillary mucinous neoplasms (IPMNs) occurring simultaneously in the left lateral lobe of liver and the tail of pancreas.Abdominal computed tomography and magnetic resonance cholangiopancreatography showed a cystic dilatation of the pancreatic duct in the pancreatic tail,which suggested an IPMN,and multiple intrahepatic duct stones in the left lateral lobe.The patient underwent a laparoscopic left lateral hepatolobectomy and spleenpreserving distal pancreatectomy.Intra-operative finding of massive mucin in the dilated bile duct implied an intraductal mucinous tumor in the liver.The diagnosis of synchronous IPMNs in the liver and pancreas was confirmed by pathological examination.The patient was followed up for 6 mo without signs of recurrence.Although several cases of IPMN of liver without any pancreatic association have been reported,the simultaneous occurrence of IPMNs in the liver and pancreas is very rare.To the best of our knowledge,it is the first reported case treated by laparoscopic resection.

  9. Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: a case report.

    Science.gov (United States)

    Xu, Xiao-Wu; Li, Rong-Hua; Zhou, Wei; Wang, Jie; Zhang, Ren-Chao; Chen, Ke; Mou, Yi-Ping

    2012-11-28

    We describe herein a 68-year-old woman who was diagnosed with a quite rare entity of intraductal papillary mucinous neoplasms (IPMNs) occurring simultaneously in the left lateral lobe of liver and the tail of pancreas. Abdominal computed tomography and magnetic resonance cholangiopancreatography showed a cystic dilatation of the pancreatic duct in the pancreatic tail, which suggested an IPMN, and multiple intrahepatic duct stones in the left lateral lobe. The patient underwent a laparoscopic left lateral hepatolobectomy and spleen-preserving distal pancreatectomy. Intra-operative finding of massive mucin in the dilated bile duct implied an intraductal mucinous tumor in the liver. The diagnosis of synchronous IPMNs in the liver and pancreas was confirmed by pathological examination. The patient was followed up for 6 mo without signs of recurrence. Although several cases of IPMN of liver without any pancreatic association have been reported, the simultaneous occurrence of IPMNs in the liver and pancreas is very rare. To the best of our knowledge, it is the first reported case treated by laparoscopic resection.

  10. Arthroscopic resection of wrist ganglia.

    Science.gov (United States)

    Mathoulin, C; Hoyos, A; Pelaez, J

    2004-12-01

    The arthroscopic resection of synovial cysts of the wrist is a simple technique which is comfortable for the patient. We report on a series of 96 patients with dorsal synovial cysts (75 women, 21 men). All patients had undergone preliminary treatment which had been unsuccessful. We operated on 32 patients with a volar cyst (27 women, five men). All the patients were operated on as outpatients under local regional anaesthesia. For the dorsal cysts, after having precisely located the cyst, it is then resected after having inserted a shaver directly through the wall of the cyst starting with the capsule. For the volar cysts the arthroscope was inserted through a 3-4 portal and the shaver was inserted through a 1-2 radiocarpal portal. In all cases, there was no immobilisation and a range of motion was started the same day. For the dorsal cysts, our average follow-up was 34 months (range 12-46 months). There were no complications. We had four recurrences. For the palmar cysts, our average follow-up was 26 months (range 12-39 months). There have been no recurrences to date.

  11. Compact Buried Ducts in a Hot-Humid Climate House

    Energy Technology Data Exchange (ETDEWEB)

    Mallay, Dave [Home Innovation Research Labs, Upper Marlboro, MD (United States)

    2016-01-07

    "9A system of compact, buried ducts provides a high-performance and cost-effective solution for delivering conditioned air throughout the building. This report outlines research activities that are expected to facilitate adoption of compact buried duct systems by builders. The results of this research would be scalable to many new house designs in most climates and markets, leading to wider industry acceptance and building code and energy program approval. The primary research question with buried ducts is potential condensation at the outer jacket of the duct insulation in humid climates during the cooling season. Current best practices for buried ducts rely on encapsulating the insulated ducts with closed-cell spray polyurethane foam insulation to control condensation and improve air sealing. The encapsulated buried duct concept has been analyzed and shown to be effective in hot-humid climates. The purpose of this project is to develop an alternative buried duct system that performs effectively as ducts in conditioned space - durable, energy efficient, and cost-effective - in a hot-humid climate (IECC warm-humid climate zone 3A) with three goals that distinguish this project: 1) Evaluation of design criteria for buried ducts that use common materials and do not rely on encapsulation using spray foam or disrupt traditional work sequences; 2) Establishing design criteria for compact ducts and incorporate those with the buried duct criteria to further reduce energy losses and control installed costs; 3) Developing HVAC design guidance for performing accurate heating and cooling load calculations for compact buried ducts.

  12. Awake operative videothoracoscopic pulmonary resections.

    Science.gov (United States)

    Pompeo, Eugenio; Mineo, Tommaso C

    2008-08-01

    The authors' initial experience with awake videothoracoscopic lung resection suggests that these procedures can be easily and safely performed under sole thoracic epidural anesthesia with no mortality and negligible morbidity. One major concern was that operating on a ventilating lung would render surgical maneuvers more difficult because of the lung movements and lack of a sufficient operating space. Instead, the open pneumothorax created after trocar insertion produces a satisfactory lung collapse that does not hamper surgical maneuvers. These results contradict the accepted assumption that the main prerequisite for allowing successful thoracoscopic lung surgery is general anesthesia with one-lung ventilation. No particular training is necessary to accomplish an awake pulmonary resection for teams experienced in thoracoscopic surgery, and conversions to general anesthesia are mainly caused by the presence of extensive fibrous pleural adhesions or the development of intractable panic attacks. Overall, awake pulmonary resection is easily accepted and well tolerated by patients, as confirmed by the high anesthesia satisfaction score, which was better than in nonawake control patients. Nonetheless, thoracic epidural anesthesia has potential complications, including epidural hematoma, spinal cord injury, and phrenic nerve palsy caused by inadvertently high anesthetic level, but these never occurred in the authors' experience. Further concerns relate to patient participation in operating room conversations or risk for development of perioperative panic attacks. However, the authors have found that reassuring the patient during the procedure, explaining step-by-step what is being performed, and even showing the ongoing procedure on the operating video can greatly improve the perioperative wellness and expectations of patients, particularly if the procedure is performed for oncologic diseases. Panic attacks occurred in few patients and could be usually managed through

  13. Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma.

    Science.gov (United States)

    Park, Shin-Young; Park, Keun-Myoung; Shin, Woo Young; Choe, Yun-Mee; Hur, Yoon-Seok; Lee, Keon-Young; Ahn, Seung-Ik

    2017-07-01

    Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma is investigated.The medical records of 45 patients who had undergone radical resection for pancreatic adenocarcinoma from March 2010 to September 2013 were reviewed retrospectively. There were 34 patients in the pancreaticoduodenectomy (PD) group and 10 patients in the distal pancreatectomy (DP) group. One patient received total pancreatectomy. The endocrine function was measured using the glucose tolerance index (GTI), which was derived by dividing daily maximum serum glucose fluctuation by daily minimum glucose. Remnant pancreas volume (RPV) was estimated by considering pancreas body and tail as a column, and head as an ellipsoid, respectively. The pancreatic atrophic index (PAI) was defined as the ratio of pancreatic duct width to total pancreas width. Representative indices of each patient were compared before and after resection up to 2 years postoperatively.The area under receiver operating characteristic curve of GTI for diagnosing DM was 0.823 (95% confidence interval, 0.699-0.948, P < .001). Overall, GTI increased on postoperative day 1 (POD#1, mean ± standard deviation, 1.79 ± 1.40 vs preoperative, 1.02 ± 1.41; P = .001), and then decreased by day 7 (0.89 ± 1.16 vs POD#1, P < .001). In the PD group, the GTI on POD#14 became lower than preoperative (0.51 ± 0.38 vs 0.96 ± 1.37; P = .03). PAI in the PD group was significantly lower at 1 month postoperatively (0.22 ± 0.12 vs preoperative, 0.38 ± 0.18; P < .001). In the PD group, RPV was significantly lower at 1 month postoperatively (25.3 ± 18.3 cm vs preoperative, 32.4 ± 20.1 cm; P = .02), due to the resolution of pancreatic duct dilatation. RPV of the DP group showed no significant change. GTI was negatively related to RPV preoperatively (r = -0.317, P = .04), but this correlation disappeared postoperatively (r = -0

  14. Application of persistent methylene blue dyeing method for anatomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi%持久亚甲蓝染色法在肝细胞癌合并胆管癌栓解剖性肝切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    蔡守旺; 吕文平; 杨世忠; 曾建平; 徐立宁; 张文智; 董家鸿

    2012-01-01

    Objective To evaluate the role of anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method.Methods From January 2009 to February 2011,11 hepatocellular carcinoma patients with bile duct tumor thrombi underwent anantomic hepatotectomy with removal of the biliary tumor thrombus.There were 10 male and 1 female patients.The average age was 49 years ( ranging from 31 to 67 years).The initial symptom of 9 out of the 11 patients was jaundice. After anatomy and ligation of Glissonean pedicle of pre-resection segment,methylene blue was injected into its far-end portal vein in order to dye the segment,Results Persistent methylene blue dyeing method was successful in all patients. Primary foci were found in all patients.Hepatotectomy were performed,including 4 patients of segmentectomy,3 patients of subsegmentectomy,2 patients of hemihepatectomy,and 2 patients of hepatic sectorectomy.The mean operation time and blood loss was 137 minutes and 246 ml respectively.Severe complications such as liver function failure and sub-diaphragm abscess was avoided in all patients.No perioperative death.Post-operation radiotherapy was performed on 2 patients.Over a mean follow-up time of 14.6 months,liver cancer recurrence occured in 2 patients,abdomen seeding metastasis in 1 patient,bile duct tumor thrombi recurrence in 1 case,and 2 patients died.Conclusions Anantomic hepatotectomy of hepatocellular carcinoma with bile duct tumor thrombi by application of persistent methylene blue dyeing method can make resection more precise and improve curative effect.%目的 探讨持久亚甲蓝染色法在肝细胞癌合并胆管癌栓患者的解剖性肝切除术中的应用价值.方法 2009年1月至2011年2月对11例肝细胞癌合并胆管癌栓患者实施解剖性肝切除术和胆管取癌栓术.其中男性10例,女性1例;年龄31~67岁,平均年龄49岁.9例以黄疸为首

  15. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

    Energy Technology Data Exchange (ETDEWEB)

    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)

    2015-06-15

    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  16. Segmentation Similarity and Agreement

    CERN Document Server

    Fournier, Chris

    2012-01-01

    We propose a new segmentation evaluation metric, called segmentation similarity (S), that quantifies the similarity between two segmentations as the proportion of boundaries that are not transformed when comparing them using edit distance, essentially using edit distance as a penalty function and scaling penalties by segmentation size. We propose several adapted inter-annotator agreement coefficients which use S that are suitable for segmentation. We show that S is configurable enough to suit a wide variety of segmentation evaluations, and is an improvement upon the state of the art. We also propose using inter-annotator agreement coefficients to evaluate automatic segmenters in terms of human performance.

  17. Aberrant bile ducts, 'remnant surface bile ducts,' and peribiliary glands: descriptive anatomy, historical nomenclature, and surgical implications.

    Science.gov (United States)

    El Gharbawy, Ramadan M; Skandalakis, Lee J; Heffron, Thomas G; Skandalakis, John E

    2011-05-01

    The term "aberrant bile ducts" has been used to designate three heterogeneous groups of biliary structures: (1) bile ducts degenerating or disappearing (unknown etiology, diverse locations); (2) curious biliary structures in the transverse fissure; and (3) aberrant right bile ducts draining directly into the common hepatic duct. We report our observations on these three groups. Twenty-nine fresh human livers of stillborns and adults were injected differentially with colored latex and dissected. Adult livers showed portal venous and hepatic arterial branches, and bile ducts not associated with parenchyma, subjacent to and firmly adherent with the liver capsule: elements of ramifications of normal sheaths were present on the liver's surface. These ramifications, having lost parenchyma associated with them, then sequentially lost their portal branches, bile ducts and arterial branches. This process affected the ramifications of the sheaths in the left triangular ligament, adjacent to the inferior vena cava, in the gallbladder bed and anywhere else on the liver's surface and resulted in the presence of bile ducts accompanied by portal venous and/or hepatic arterial branches and not associated with parenchyma for a period of time. This first group represented normal bile ducts that do not meet the criteria of aberration and could be appropriately designated "remnant surface bile ducts." Such changes were not found in the transverse fissures and review of the literature revealed that the curious biliary structures are the microscopic peribiliary glands. The third group met the criteria of aberration and the anatomy of a representative duct is described.

  18. [ANALYSIS OF COMPLICATIONS POSTOPERATIVE CAUSES AND MORTALITY AFTER RADICAL TREATMENT FOR TUMORS OF THE LEFT ANATOMICAL SEGMENT OF THE PANCREAS].

    Science.gov (United States)

    Kopchak, V M; Kopchak, K V; Khomyak, I V; Duvalko, O V; Tkachuk, O S; Andronik, S V; Shevkolenko, H H; Khanenko, V V; Kvasivka, O O; Zubkov, O O

    2015-07-01

    Radical surgery for tumors of the left anatomical and surgical segment of the pancreas proved for distal resection in various versions, central resection and enucleation of tumors. The causes of early postoperative complications and mortality in 129 patients aged from 14 to 81 years, operated on for neoplastic lesions of the left anatomical segment of the pancreas in the period from 2009 to 2014 were analysed. The influence of various factors of risk of complications and mortality were studied in particular, extended resection, for tumor invasion of adjacent organs, and adjacent vessels.

  19. Lymphoscintigraphy SPECT/CT: Instrumental Navigator in Repair of Thoracic Duct Injury

    Energy Technology Data Exchange (ETDEWEB)

    Abaziz, Aini; Yusop, Syahrir M. [Universiti Kabangsaan Malaysia Medical Centre, Kuala Lumpur (Malaysia); Tahir, Mohd Fadzil Mohd; Lim, Yew Cheng [Gleneagles Intan Medical Centre, Kuala Lumpur (Malaysia); Gallowitsch, Hans-Jurgen [Nuclear Medicine and PETCT Centre, Klagenfurt (Australia)

    2016-06-15

    A 25-year-old female underwent resection of a large mediastinal tumour which was complicated by copious chylothorax, being worse on the left side. Minimally-in-vasive video-assisted thoracoscopic surgery (VATS) via a left-sided approach was performed and the severed ends of the thoracic duct were ligated. This only achieved temporary reduction of the amount of chylothorax, leading to a second attempt to repair the persistent leak. This prompted the surgeon to take a different approach from the previous two attempts. It was deemed too risky and potentially futile to further attempt to go after the leakage sites bilaterally. Hence, the surgeon performed a right thoracotomy to ligate the thoracic duct proximal to the leakage sites at the aortic hiatus. this successfully stopped the leak permanently. Planar lymphoscintigraphy lacks accurate anatomical depiction which SPECT-CT could offer. Conversely, anatomical imaging failed to locate the site of the leak. SPECT/CT Lymphoscintigraphy overcomes the limitation of either imaging alone, and has been reported to be valuable in documenting and depicting sites of injury. In this case, the SPECT-CT depiction and confirmation of bilateral leakage sites was pivotal in guiding the surgeon to take a different approach and achieve a permanent solution to the persistent chloroethoxy.

  20. A case of methicillin-resistant Staphylococcus aureus infection following bile duct stenting

    Institute of Scientific and Technical Information of China (English)

    Markus K Diener; Alexis Ulrich; Theresia Weber; Moritz N Wente; Markus W Büchler; Helmut Friess

    2005-01-01

    AIM: To present a case of methicillin-resistant Staphylococcus aureus (MRSA) infection following bile duct stenting in a patient with malignant biliary obstruction.METHODS: A 78-year-old male patient was admitted to a community hospital with progredient painless jaundice lasting over two weeks, weight loss and sweating at night.Whether a stent should be implanted pre-operatively in jaundiced patients or whether these patients should directly undergo surgical resection, was discussed.RESULTS: ERC and a biopsy from the papilla of Vater revealed an adenocarcinoma. In addition, a 7-Ch plastic stent was placed into the common bile duct. Persistent abdominal pain, increasing jaundice, weakness and indigestion led to the transfer of the patient to our hospital.A pylorus-preserving pancreatoduodenectomy wasperformed. Intraoperatively, bile leaked out of the transected choledochus andthe stent was found to be dislocated in the duodenum. A smear of the bile revealed an infection with MRSA, leading to post-operative isolation of the patient.CONCLUSION:As biliary stents can cause severe infection of the bile, the need for pre-operative placement of biliary stents should be carefully evaluated in each individual case.

  1. Perioperative nursing for laparoscopic liver resection

    Institute of Scientific and Technical Information of China (English)

    CHEN Li-jia; WEN Guo-fen

    2005-01-01

    Sir Run Run Shaw Hospital (SRRSH) has developed a form of laparoscopic hepatectomy, resecting by curettage and suction. Such resection has been carried out successfully in 6 patients who had liver tumors. The results are satisfactory. And after the operation, there is a very effective perioperative nursing ensuring the patient's recovery.

  2. Xanthogranulomatous Cystitis Treated by Transurethral Resection

    Directory of Open Access Journals (Sweden)

    Sachi Yamamoto

    2015-09-01

    Full Text Available Xanthogranulomatous cystitis (XC is a rare benign chronic inflammatory disease of unknown etiology. Curative treatment of XC requires surgical resection, and most of reported cases were treated by partial cystectomy. Here we describe a case with XC that was treated using transurethral resection.

  3. Climate analysis of evaporation ducts in the South China Sea

    OpenAIRE

    McKeon, Brian D.

    2013-01-01

    Approved for public release; distribution is unlimited. Evaporation ducts have important implications for U.S. Naval activities involving electromagnetic propagation. The presence of an evaporation duct can affect naval operations involving communications, surveillance, electronic warfare, and detection of low-flying missiles, surface ships, or submarine periscopes. We conducted a climate scale analysis of evaporation duct heights (EDH) in the northern South China Sea (SCS), including how ...

  4. Omphalomesenteric duct cyst with gastric mocosa: A case report

    OpenAIRE

    2006-01-01

    Persistance of the omphalomesenteric duct may lead to several anomalies including umblical sinus, umblical cyst, MeckeVs diverticulum or patent omphalomesenteric duct fistula. Clinical manifestations of umblical disorders are usually nonspecific; use of cross-sectional imaging can help identify most of these entities because of their typical locations and distributions in continuity with the other organs and guide therapy. A case of omphalomesenteric duct cyst are presented and analysed toget...

  5. Method for Observing Intravascular BongHan Duct

    CERN Document Server

    Jiang, X; Shin, H; Lee, B; Choi, C; Soh, K; Cheun, B; Baik, K; Soh, K; Jiang, Xiaowen; Kim, Hee-kyeong; Shin, Hak-soo; Lee, Byong-chon; Choi, Chunho; Soh, Kyung-soon; Cheun, Byeung-soo; Baik, Ku-youn; Soh, Kwang-sup

    2002-01-01

    A method for observing intra blood vessel ducts which are threadlike bundle of tubules which form a part of the BongHan duct system. By injecting 10% dextrose solution at a vena femoralis one makes the intravascular BongHan duct thicker and stronger to be easily detectable after incision of vessels. The duct is semi-transparent, soft and elastic, and composed of smaller tubules whose diameters are of 10$\\mu$m order, which is in agreement with BongHan theory.

  6. Biliary stenting for management of common bile duct stones.

    Science.gov (United States)

    Choudhuri, G; Sharma, B C; Saraswat, V A; Agarwal, D K; Baijal, S S

    1998-06-01

    Large and multiple common bile duct stones may defy extraction despite an adequate endoscopic papillotomy. We treated 65 patients with symptomatic bile duct stones with endoscopic stents after failed attempts at stone extraction. Of the 65 patients, bile duct stones were extracted in eight at a second attempt, 29 underwent elective surgery and 28 patients were followed with the stent in situ for 21-52 months (median 42 months). During follow up, two patients had recurrent pain and two required surgery. The remaining 24 patients remained asymptomatic. Biliary stenting is a safe and effective mode of treatment for common bile duct stones in patients who have failed stone extraction after endoscopic papillotomy.

  7. Flexible metallic seal for transition duct in turbine system

    Science.gov (United States)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2014-04-22

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface member for interfacing with a turbine section. The turbine system further includes a flexible metallic seal contacting the interface member to provide a seal between the interface member and the turbine section.

  8. Experimental investigation of a rapidly rotating turbulent duct flow

    Energy Technology Data Exchange (ETDEWEB)

    Maartensson, G.E.; Johansson, A.V. [Department of Mechanics, KTH, 10044 Stockholm (Sweden); Gunnarsson, J. [Bombardier Transportation, Vaesteraas (Sweden); Moberg, H. [Alfa Laval, 14780 Tumba (Sweden)

    2002-09-01

    Rapidly rotating duct flow is studied experimentally with Rotation numbers in the interval. To achieve this, in combination with relatively high Reynolds numbers (5,000-30,000 based on the hydraulic radius), water was used as the working medium. Square and rectangular duct cross-sections were used and the angle between the rotation vector and the main axis of the duct was varied. The influence of the rotation on the pressure drop in the duct was investigated and suitable scalings of this quantity were studied. (orig.)

  9. Leaf seal for transition duct in turbine system

    Science.gov (United States)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2013-06-11

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface member for interfacing with a turbine section. The turbine system further includes a leaf seal contacting the interface member to provide a seal between the interface member and the turbine section.

  10. CLINICAL AND MORPHOLOGICAL DIAGNOSTIC INTRAHEPATIC BILE DUCTS PAUCITY

    Directory of Open Access Journals (Sweden)

    O. E. Iryshkin

    2013-01-01

    Full Text Available Aim. To study the clinica-morphological features of syndromatic and nonsyndromatic paucity of intrahepatic bile ducts in pediatric liver transplant recipients. Methods and results. The clinical records were analyzed and histological studies of native livers of 20 children, who had suffered from paucity of intrahepatic bile ducts and to whom liver transplantation were made, were completed. The obtained data indicate higher levels of AST in patients with nonsyndromatic paucity of intrahepaticbile ducts (p = 0,023. Ductopenia was the more frequent indication of syndromatic form of paucity of intrahepatic bile ducts (p = 0,01, while ductular proliferations, which form «ductular structure», were discovered more often in nonsyndromatic paucity of intrahepaticbile ducts (p = 0,03. The extent of inflammatory-destructive changes was more expressed in nonsyndromatic pauci- ty of intrahepatic bile ducts (p = 0,01. Fibrosis or cirrhosis was formed more often in nonsyndromatic paucity of intrahepatic bile ducts (p = 0,008. Conclusion. Our results indicate more severe clinical and morphological manifestations in nonsyndromatic paucity of intrahepatic bile ducts. These findings may suggest about heavier liver condition in patient with nonsyndromatic form of paucity of intrahepatic bile ducts

  11. Duct injection technology prototype development: Evaluation of engineering data

    Energy Technology Data Exchange (ETDEWEB)

    1990-07-01

    The objective of the Duct Injection Technology Prototype Development Project is to develop a sound design basis for applying duct injection technology as a post-combustion SO{sub 2}emissions control method to existing coal-fired power plants. The necessary engineering design and scale-up criteria will be developed for the commercialization of duct injection technology for the control of SO{sub 2} emissions from coal-fired boilers in the utility industry. The primary focus of the analyses summarized in this Topical Report is the review of the known technical and economic information associated with duct injection technology. (VC)

  12. Convolution seal for transition duct in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2015-03-10

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface member for interfacing with a turbine section. The turbine system further includes a convolution seal contacting the interface member to provide a seal between the interface member and the turbine section.

  13. Colon resection for ovarian cancer: intraoperative decisions.

    Science.gov (United States)

    Hoffman, Mitchel S; Zervose, Emmanuel

    2008-11-01

    To discuss the benefits and morbidity of and indications for colon resection during cytoreductive operations for ovarian cancer. The history of cytoreductive surgery for ovarian cancer is discussed, with special attention to the incorporation of colon resection. Literature regarding cytoreductive surgery for ovarian cancer is then reviewed, again with attention to the role of colon resection. The focus of the review is directed at broad technical considerations and rationales, for both primary and secondary cytoreduction. Over the past 15 to 20 years the standard cytoreductive operation for ovarian cancer has shifted from an abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy to an en bloc radical resection of the pelvic tumor and an omentectomy, and more recently to include increasing use of extensive upper abdominal surgery. En bloc pelvic resection frequently includes rectosigmoid resection, almost always accompanied by a primary anastomosis. Other portions of the colon are at risk for metastatic involvement and sometimes require resection in order to achieve optimal cytoreduction. The data regarding colon resection for the purpose of surgical cytoreduction of ovarian cancer are conflicting (in terms of benefit) and all retrospective. However, the preponderance of information supports a benefit in terms of survival when cytoreduction is clearly optimal. Similar to primary surgery, benefit from secondary cytoreduction of ovarian cancer occurs when only a small volume of disease is left behind. The preponderance of data suggests that colon resection to achieve optimal cytoreduction has a positive impact on survival. In order to better understand the role of colon resection as well as other extensive cytoreductive procedures for ovarian cancer, it will be important to continue to improve our understanding of prognostic variables such as the nuances of metastatic bowel involvement in order to better guide appropriate surgical management.

  14. Pituitary Adenoma Segmentation

    CERN Document Server

    Egger, Jan; Kuhnt, Daniela; Freisleben, Bernd; Nimsky, Christopher

    2011-01-01

    Sellar tumors are approximately 10-15% among all intracranial neoplasms. The most common sellar lesion is the pituitary adenoma. Manual segmentation is a time-consuming process that can be shortened by using adequate algorithms. In this contribution, we present a segmentation method for pituitary adenoma. The method is based on an algorithm we developed recently in previous work where the novel segmentation scheme was successfully used for segmentation of glioblastoma multiforme and provided an average Dice Similarity Coefficient (DSC) of 77%. This scheme is used for automatic adenoma segmentation. In our experimental evaluation, neurosurgeons with strong experiences in the treatment of pituitary adenoma performed manual slice-by-slice segmentation of 10 magnetic resonance imaging (MRI) cases. Afterwards, the segmentations were compared with the segmentation results of the proposed method via the DSC. The average DSC for all data sets was 77.49% +/- 4.52%. Compared with a manual segmentation that took, on the...

  15. Pure Laparoscopic Liver Resection for Malignant Liver Tumor: Anatomic Resection Versus Nonanatomic Resection

    Institute of Scientific and Technical Information of China (English)

    Ya-Xi Chen; Dian-Rong Xiu; Chun-Hui Yuan; Bin Jiang; Zhao-Lai Ma

    2016-01-01

    Background: Laparoscopic liver resection (LLR) has been considered to be safe and feasible.However, few studies focused on the comparison between the anatomic and nonanatomic LLR.Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area.Methods: In this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected.Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter.All procedures were conducted by a single surgeon.Results: During nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included.Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively.Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group (4.77 ± 2.57 vs.2.87 ± 2.10 cm, P =0.001).Patients who underwent anatomic resection had longer operation time (364.09 ± 131.22 vs.252.00 ± 135.21 min, P < 0.001) but less blood loss per unit area (7.85 ± 7.17 vs.14.17 ± 10.43 ml/cm2,P =0.018).Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR.No mortality occurred during the hospital stay and 30 days after the operation.Moreover, there was no difference in the incidence of postoperative complications.The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups.Conclusions: Both anatomic and nonanatomic pure LLR are safe and feasible.Measuring the area ofparenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery

  16. Recurrence of inflammatory pseudotumor in the distal bile duct: Lessons learned from a single case and reported cases

    Institute of Scientific and Technical Information of China (English)

    EM López-Tomassetti Fernández; H Díaz Luis; A Martín Malagón; I Arteaga González; A Carrillo Pallarés

    2006-01-01

    Inflammatory myofibroblastic tumors (IMTs) or inflammatory pseudotumors (IPs) have been extensively discussed in the literature. They are usually found in the lung and upper respiratory tract. However, reporting of cases involving the biliopancreatic region has increased over recent years. Immunohistochemical study of these lesions limited to the pancreatic head or distal bile duct seems to be compatible with those observed in a new entity called autoimmune pancreatitis, but usually intense fibrotic reaction (zonation) predominates producing a mass. When this condition is limited to the pancreatic head, the common bile duct might be involved by the inflammatory process and jaundice may occur often resembling adenocarcinoma of the pancreas. We have previously reported a case of IMT arising from the bile duct associated with autoimmune pancreatitis which is an extremely rare entity. Four years after Kaush-Whipple resection, radiological examination on routine followup revealed a tumor mass, suggesting local recurrence.Ultrasound-guided FNA confirmed our suspicious diagnosis. This present case, as others, suggests that persistent follow-up is necessary in order to prevent irreversible liver damage at this specific location.

  17. Clinicodemographic aspect of resectable pancreatic cancer and prognostic factors for resectable cancer

    Directory of Open Access Journals (Sweden)

    Chiang Kun-Chun

    2012-05-01

    Full Text Available Abstract Background Pancreatic adenocarcinoma (PCA is one of the most lethal human malignancies, and radical surgery remains the cornerstone of treatment. After resection, the overall 5-year survival rate is only 10% to 29%. At the time of presentation, however, about 40% of patients generally have distant metastases and another 40% are usually diagnosed with locally advanced cancers. The remaining 20% of patients are indicated for surgery on the basis of the results of preoperative imaging studies; however, about half of these patients are found to be unsuitable for resection during surgical exploration. In the current study, we aimed to determine the clinicopathological characteristics that predict the resectability of PCA and to conduct a prognostic analysis of PCA after resection to identify favorable survival factors. Methods We retrospectively reviewed the medical files of 688 patients (422 men and 266 women who had undergone surgery for histopathologically proven PCA in the Department of Surgery at Chang Gung Memorial Hospital in Taiwan from 1981 to 2006. We compared the clinical characteristics of patients who underwent resection and patients who did not undergo resection in order to identify the predictive factors for successful resectability of PCA, and we conducted prognostic analysis for PCA after resection. Results A carbohydrate antigen 19–9 (CA 19–9 level of 37 U/ml or greater and a tumor size of 3 cm or more independently predicted resectability of PCA. In terms of survival after resection, PCA patients with better nutritional status (measured as having an albumin level greater than 3.5 g/dl, radical resection, early tumor stage and better-differentiated tumors were associated with favorable survival. Conclusions Besides traditional imaging studies, preoperative CA 19–9 levels and tumor size can also be used to determine the resectability of PCA. Better nutritional status, curative resection, early tumor stage and well

  18. Live 3D image overlay for arterial duct closure with Amplatzer Duct Occluder II additional size.

    Science.gov (United States)

    Goreczny, Sebstian; Morgan, Gareth J; Dryzek, Pawel

    2016-03-01

    Despite several reports describing echocardiography for the guidance of ductal closure, two-dimensional angiography remains the mainstay imaging tool; three-dimensional rotational angiography has the potential to overcome some of the drawbacks of standard angiography, and reconstructed image overlay provides reliable guidance for device placement. We describe arterial duct closure solely from venous approach guided by live three-dimensional image overlay.

  19. Effectiveness of duct sealing and duct insulation in multi-family buildings. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Karins, N.H.; Tuluca, A.; Modera, M.

    1997-07-01

    This research investigated the cost-effectiveness of sealing and insulating the accessible portions of duct systems exposed to unconditioned areas in multifamily housing. Airflow and temperature measurements were performed in 25 apartments served by 10 systems a 9 multi-family properties. The measurements were performed before and after each retrofit, and included apartment airflow (supply and return), duct system temperatures, system fan flow and duct leakage area. The costs for each retrofit were recorded. The data were analyzed and used to develop a prototypical multifamily house. This prototype was used in energy simulations (DOE-2.1E) and air infiltration simulations (COMIS 2.1). The simulations were performed for two climates: New York City and Albany. In each climate, one simulation was performed assuming the basement was tight, and another assuming the basement was leaky. Simulation results and average retrofit costs were used to calculate cost-effectiveness. The results of the analysis indicate that sealing leaks of the accessible ductwork is cost-effective under all conditions simulated (simple payback was between 3 and 4 years). Insulating the accessible ductwork, however, is only cost-effective for buildings with leaky basement, in both climates (simple paybacks were less than 5 years). The simple payback period for insulating the ducts in buildings with tight basements was greater than 10 years, the threshold of cost-effectiveness for this research. 13 refs., 5 figs., 27 tabs.

  20. Radiation of sound from unflanged cylindrical ducts

    Science.gov (United States)

    Hartharan, S. L.; Bayliss, A.

    1983-01-01

    Calculations of sound radiated from unflanged cylindrical ducts are presented. The numerical simulation models the problem of an aero-engine inlet. The time dependent linearized Euler equations are solved from a state of rest until a harmonic solution is attained. A fourth order accurate finite difference scheme is used and solutions are obtained from a fully vectorized Cyber-203 computer program. Cases of both plane waves and spin modes are treated. Spin modes model the sound generated by a turbofan engine. Boundary conditions for both plane waves and spin modes are treated. Solutions obtained are compared with experiments conducted at NASA Langley Research Center.

  1. NONLINEAR ELASTICITY OF BLOOD ARTERIAL DUCT

    Institute of Scientific and Technical Information of China (English)

    黄孟才; 顾忠; 沈俊; 唐复勇

    1991-01-01

    The paper deals with nonlinear elasticity of blood arterial duct, in which the artery is modeled to bea locally triclinic, transverse isotropic, incorapressible, axisymmetric and thickwalled tube with large deformations, The nonlinear coustitutive relationship of arterial tissues is based on the theorv of Green and Adkins. A nonlinear strain energy density function is introduced for nonlinear stress-strain relationship of second order, in which the coefficient of each term is expressed by means of a Lame’s constant, The elasticity constants are nqcessary to describe such a uonlinear finite strain etastieity of the second order, These constants are determined by means of the stress-strain increment theory.

  2. Classification and management of bile duct injuries

    OpenAIRE

    2011-01-01

    To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GI-1990-99 (33 cases...

  3. Predictors of prolonged postoperative endotracheal intubation in patients undergoing thoracotomy for lung resection.

    Science.gov (United States)

    Cywinski, Jacek B; Xu, Meng; Sessler, Daniel I; Mason, David; Koch, Colleen Gorman

    2009-12-01

    The aim of this study was to identify predictors of delayed endotracheal extubation defined as the need for postoperative ventilatory support after open thoracotomy for lung resection. An observational cohort investigation. A tertiary referral center. The study population consisted of 2,068 patients who had open thoracotomy for pneumonectomy, lobectomy, or segmental lung resection between January 1996 and December 2005. Not applicable. Preoperative and intraoperative variables were collected concurrently with the patient's care. Risk factors were identified using logistic regression with stepwise variable selection procedure on 1,000 bootstrap resamples, and a bagging algorithm was used to summarize the results. Intraoperative red blood cell transfusion, higher preoperative serum creatinine level, absence of a thoracic epidural catheter, more extensive surgical resection, and lower preoperative FEV(1) were associated with an increased risk of delayed extubation after lung resection. Most predictors of delayed postoperative extubation (ie, red blood cell transfusion, higher preoperative serum creatinine, lower preoperative FEV(1), and more extensive lung resection) are difficult to modify in the perioperative period and probably represent greater severity of underlying lung disease and more advanced comorbid conditions. However, thoracic epidural anesthesia and analgesia is a modifiable factor that was associated with reduced odds for postoperative ventilatory support. Thus, the use of epidural analgesia may reduce the need for post-thoracotomy mechanical ventilation.

  4. Elucidation of the molecular envenomation strategy of the cone snail Conus geographus through transcriptome sequencing of its venom duct

    Directory of Open Access Journals (Sweden)

    Hu Hao

    2012-06-01

    Full Text Available Abstract Background The fish-hunting cone snail, Conus geographus, is the deadliest snail on earth. In the absence of medical intervention, 70% of human stinging cases are fatal. Although, its venom is known to consist of a cocktail of small peptides targeting different ion-channels and receptors, the bulk of its venom constituents, their sites of manufacture, relative abundances and how they function collectively in envenomation has remained unknown. Results We have used transcriptome sequencing to systematically elucidate the contents the C. geographus venom duct, dividing it into four segments in order to investigate each segment’s mRNA contents. Three different types of calcium channel (each targeted by unrelated, entirely distinct venom peptides and at least two different nicotinic receptors appear to be targeted by the venom. Moreover, the most highly expressed venom component is not paralytic, but causes sensory disorientation and is expressed in a different segment of the venom duct from venoms believed to cause sensory disruption. We have also identified several new toxins of interest for pharmaceutical and neuroscience research. Conclusions Conus geographus is believed to prey on fish hiding in reef crevices at night. Our data suggest that disorientation of prey is central to its envenomation strategy. Furthermore, venom expression profiles also suggest a sophisticated layering of venom-expression patterns within the venom duct, with disorientating and paralytic venoms expressed in different regions. Thus, our transcriptome analysis provides a new physiological framework for understanding the molecular envenomation strategy of this deadly snail.

  5. Radical resection of giant chondrosarcoma of the anterior chest wall

    Directory of Open Access Journals (Sweden)

    Stanić Vojkan

    2008-01-01

    Full Text Available Background. Chondrosarcomas represent approximately 30% of primary malignant bone tumors, the most frequent of which is on anterior thoracic wall. Case report. We presented a case of 50-year-old man suffering from a slowgrowing, painless giant chondrosarcoma of the anterior chest wall. A wide resection was performed to excise the tumor including attached skin, right breast, ribs, sternum, soft tissues and parietal pleura. Mediastinum was not affected by the tumor. After resecting a 26 × 20 × 22 cm segment, the chest wall defect was reconstructed with a Marlex mesh and extensive latissimus dorsi myocutaneous flap pedicled on the right thoracodorsal vessels. Histopatology diagnosis was chondrosarcoma G 2−3. The mechanics of ventilation was not altered and respiratory function was normal from the immediate postoperative period. Three years after the operation postoperative results showed no local recurrence and excellent functional and aesthetic results were evident. Respiratory function remained unaltered. Conclusion. According to the results it can be concluded that the use of Marlex mash and myocutaneous flap is good method for stabilization of the chest wall and enough to avoid paradoxical respiratory movements in managing giant chondrosarcoma of the anterior chest wall.

  6. Small-Sized, Flat-Type Invasive Branch Duct Intraductal Papillary Mucinous Neoplasm: A Case Report

    Directory of Open Access Journals (Sweden)

    Koji Shindo

    2013-10-01

    Full Text Available Recent improvements in diagnostic modalities are increasing the frequency of detection of small-sized branch duct intraductal papillary mucinous neoplasms (BD-IPMNs. International consensus guidelines for IPMN recommend surveillance without immediate resection for small-sized (<3 cm BD-IPMNs without malignant features on imaging. Our patient is the first to have undergone resection of a small-sized BD-IPMN containing invasive cancer, but without malignant features on imaging. We herein report a case involving a 70-year-old man with a small cystic lesion in the pancreas head detected by health screening ultrasonography. Detailed examination revealed that the cystic lesion was a BD-IPMN measuring about 2 cm, with no malignant features. However, cytological examination of the pancreatic juice showed atypical cells with high-grade dysplasia storing intracytoplasmic mucin, indicating malignant BD-IPMN. Pathological examination of the resected specimen showed a BD-IPMN measuring 16 mm with an associated invasive carcinoma that invaded the pancreatic parenchyma over a distance of 11 mm. In this patient, invasive cancer was present within a small BD-IPMN with no high-risk stigmata on imaging. Cytological examination of the pancreatic juice allowed for the detection of pancreatic cancer in such a small-sized IPMN. Although routine endoscopic retrograde cholangiopancreatography (ERCP with cytology is not recommended in all patients with BD-IPMNs, ERCP may contribute to the detection of small pancreatic cancers in select cases. Accumulation of cases of pancreatic cancer within small BD-IPMNs may help establish the indications for ERCP with cytological examination for the purpose of early detection of small pancreatic cancer.

  7. Laparoscopic Colorectal Resection in the Obese Patient

    Science.gov (United States)

    Martin, Sean T.; Stocchi, Luca

    2011-01-01

    Laparoscopic colorectal surgery is an accepted alternative to conventional open resection in the surgical approach of both benign and malignant diseases of the colon and rectum. Well-described benefits of laparoscopic surgery include accelerated recovery of bowel function, decreased post-operative pain and shorter hospital stay; these advantages could be particularly beneficial to high-risk patient groups, such as obese patients. At present, data regarding the application of the laparoscopic approach to colorectal resection in the obese is equivocal. We evaluate the available evidence to support laparoscopic colorectal resection in the obese patient population. PMID:23204942

  8. Long-term survival case of a recurrent colon cancer owing to successful resection of a tumor at hepaticojejunostomy: report of a case.

    Science.gov (United States)

    Natsume, Seiji; Shimizu, Yasuhiro; Sano, Tsuyoshi; Senda, Yoshiki; Ito, Seiji; Komori, Koji; Abe, Tetsuya; Yanagisawa, Akio; Yamao, Kenji

    2015-12-01

    With advances in surgical procedures and perioperative management, hepato-biliary-pancreatic surgery, including hepatectomy and pancreaticoduodenectomy, has been employed for recurrent colon cancer. However, no report has described a case of major hepatectomy with the combined resection of hepaticojejunostomy following pancreaticoduodenectomy for locoregionally recurrent colon cancer. Here, such a case is reported. The patient, a 37-year-old woman, had undergone pancreaticoduodenectomy for lymph node recurrence along the extrahepatic bile duct from cecal cancer. Thirteen months later, a biliary stricture was found at the hepaticojejunostomy site and right hepatectomy was performed. The resected specimen showed a papillary tumor at the hepaticojejunostomy. Based on its histological features, the pathogenesis of this tumor was considered to be intramural recurrence via lymphatic vessels. Although she underwent resection of a lymph node recurrence at her mesentery 12 months later, she has remained well thereafter, without any sign of further recurrence during 5 years of follow-up after hepatectomy.

  9. GPS Control Segment

    Science.gov (United States)

    2015-04-29

    Luke J. Schaub Chief, GPS Control Segment Division 29 Apr 15 GPS Control Segment Report Documentation Page Form ApprovedOMB No. 0704-0188...00-2015 4. TITLE AND SUBTITLE GPS Control Segment 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...Center, GPS Control Segment Division,Los Angeles AFB, El Segundo,CA,90245 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S

  10. Sipunculans and segmentation

    DEFF Research Database (Denmark)

    Wanninger, Andreas; Kristof, Alen; Brinkmann, Nora

    2009-01-01

    Comparative molecular, developmental and morphogenetic analyses show that the three major segmented animal groups- Lophotrochozoa, Ecdysozoa and Vertebrata-use a wide range of ontogenetic pathways to establish metameric body organization. Even in the life history of a single specimen, different...... plasticity and potential evolutionary lability of segmentation nourishes the controversy of a segmented bilaterian ancestor versus multiple independent evolution of segmentation in respective metazoan lineages....

  11. Chloride and potassium conductances of cultured human sweat ducts

    DEFF Research Database (Denmark)

    Novak, I; Pedersen, P S; Larsen, Erik Hviid

    1992-01-01

    The purpose of this study was to characterize the ion conductances, in particular those for Cl- and K+, of human sweat duct cells grown in primary culture. Sweat duct cells from healthy individuals were grown to confluence on a dialysis membrane, which was then mounted in a mini-Ussing chamber...

  12. Bidirectional infrasonic ducts associated with sudden stratospheric warming events

    NARCIS (Netherlands)

    Assink, J.D.; Waxler, R.; Smets, P.S.M.; Evers, L.G.

    2014-01-01

    In January 2011, the state of the polar vortex in the midlatitudes changed significantly due to a minor sudden stratospheric warming event. As a result, a bidirectional duct for infrasound propagation developed in the middle atmosphere that persisted for 2 weeks. The ducts were due to two zonal wind

  13. Diverticular bile duct lesion in chronic active hepatitis

    DEFF Research Database (Denmark)

    Vyberg, M

    1989-01-01

    Liver needle biopsies from patients with non-A, non-B chronic active hepatitis and so-called abnormal bile duct epithelium were studied with a three-dimensional method. Photographs of bile duct structures in serial sections were transferred to acrylic plates. Five bile duct lesions of a not previ......Liver needle biopsies from patients with non-A, non-B chronic active hepatitis and so-called abnormal bile duct epithelium were studied with a three-dimensional method. Photographs of bile duct structures in serial sections were transferred to acrylic plates. Five bile duct lesions...... cells, but most were larger, with rounded nuclei, prominent nucleoli and abundant eosinophilic cytoplasm, sometimes with periodic acid-Schiff-positive, diastase-resistant granules. The lesions were only partly surrounded by a basement membrane. They were all embedded in a tight mononuclear inflammatory...... infiltrate associated with pronounced periportal piecemeal necrosis. In two cases, a germinal center was adjacent to the epithelium. The pathogenesis of the diverticular bile duct lesion is unknown, but the diverticuli probably represent Hering ducts and groups of periportal liver cells which have escaped...

  14. Cystic duct closure by sealing with bipolar electrocoagulation

    DEFF Research Database (Denmark)

    Schulze, S; Damgaard, B; Jørgensen, Lars Nannestad;

    2010-01-01

    BACKGROUND: Cystic duct leakage after cholecystectomy is not uncommon and is a potentially serious complication. The aim of this study was to assess a bipolar sealing system (LigaSure) for closure of the cystic duct. METHODS: The records from consecutive laparoscopic cholecystectomies performed i...

  15. Intracellular pH in rat pancreatic ducts

    DEFF Research Database (Denmark)

    Novak, I; Hug, M; Greger, R

    1997-01-01

    In order to study the mechanism of H+ and HCO3- transport in a HCO3- secreting epithelium, pancreatic ducts, we have measured the intracellular pH (pHi) in this tissue using the pH sensitive probe BCECF. We found that exposures of ducts to solutions containing acetate/acetic acid or NH4+/NH3 buff...

  16. Radiopaque intrahepatic duct stones in plain radiograph: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Young; Suh, Chang Hae; Park, Chan Sup; Chung, Won Kyun [College of Medicine, Inha University, Seongnam (Korea, Republic of)

    1994-04-15

    We experienced 3 cases of intrahepatic duct stones detected on plain radiographs. The patients had history of multiple episodes of recurrent cholangitis. Radiographic characteristics of these stones included multiple, round or rectangular radiopaque densities surrounded by calcified rim; these densities showed a branching pattern along the intrahepatic ducts.

  17. Sound waves in two-dimensional ducts with sinusoidal walls

    Science.gov (United States)

    Nayfeh, A. H.

    1974-01-01

    The method of multiple scales is used to analyze the wave propagation in two-dimensional hard-walled ducts with sinusoidal walls. For traveling waves, resonance occurs whenever the wall wavenumber is equal to the difference of the wavenumbers of any two duct acoustic modes. The results show that neither of these resonating modes could occur without strongly generating the other.

  18. Sound Radiation Characteristics of a Rectangular Duct with Flexible Walls

    Directory of Open Access Journals (Sweden)

    Praveena Raviprolu

    2016-01-01

    Full Text Available Acoustic breakout noise is predominant in flexible rectangular ducts. The study of the sound radiated from the thin flexible rectangular duct walls helps in understanding breakout noise. The current paper describes an analytical model, to predict the sound radiation characteristics like total radiated sound power level, modal radiation efficiency, and directivity of the radiated sound from the duct walls. The analytical model is developed based on an equivalent plate model of the rectangular duct. This model has considered the coupled and uncoupled behaviour of both acoustic and structural subsystems. The proposed analytical model results are validated using finite element method (FEM and boundary element method (BEM. Duct acoustic and structural modes are analysed to understand the sound radiation behaviour of a duct and its equivalence with monopole and dipole sources. The most efficient radiating modes are identified by vibration displacement of the duct walls and for these the radiation efficiencies have been calculated. The calculated modal radiation efficiencies of a duct compared to a simple rectangular plate indicate similar radiation characteristics.

  19. Laparoscopic colonic and rectal resection.

    Science.gov (United States)

    Velez, P M

    1993-12-01

    The technology that has permitted the rapid advance of minimal access surgery has now made it feasible to perform laparoscopically assisted colon resections safely. As the instrumentation improves, specimen removal problems are solved, surgeons' sewing skills improve, and other anastomotic methods are devised, an increasing amount of colonic surgery will be done using laparoscopy. It is clear that the techniques now in use are evolving, and will be substantially different a few years hence. Previously accepted surgical principles may continue to be challenged by new techniques, which must be evaluated under strict protocol before being widely accepted. These operations should be performed by surgeons who are able to achieve the same level of radical operation that they would achieve through a laparotomy. Special training in advanced laparoscopic techniques including microsurgical suturing is a distinct advantage in performing these operations successfully. It may be best for surgeons to start with palliative procedures or operations for benign diseases of the colon, to avoid the risk of jeopardizing an operation for cancer.

  20. Automatic Melody Segmentation

    NARCIS (Netherlands)

    Rodríguez López, Marcelo

    2016-01-01

    The work presented in this dissertation investigates music segmentation. In the field of Musicology, segmentation refers to a score analysis technique, whereby notated pieces or passages of these pieces are divided into “units” referred to as sections, periods, phrases, and so on. Segmentation analy

  1. Abdominoperineal Resection, Pelvic Exenteration, and Additional Organ Resection Increase the Risk of Surgical Site Infection after Elective Colorectal Surgery: An American College of Surgeons National Surgical Quality Improvement Program Analysis.

    Science.gov (United States)

    Kwaan, Mary R; Melton, Genevieve B; Madoff, Robert D; Chipman, Jeffrey G

    2015-12-01

    Determining predictors of surgical site infection (SSI) in a large cohort is important for the design of accurate SSI surveillance programs. We hypothesized that additional organ resection and pelvic exenterative procedures are associated independently with a higher risk of SSI. Patients in the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®; American College of Surgeons, Chicago, IL) database (2005-2012) were identified (n=112,282). Surgical site infection (superficial or deep SSI) at 30 d was the primary outcome. Using primary and secondary CPT® codes (American Medical Association, Chicago, IL) pelvic exenteration was defined and additional organ resection was defined as: bladder resection/repair, hysterectomy, partial vaginectomy, additional segmental colectomy, small bowel, gastric, or diaphragm resection. Univariable analysis of patient and procedure factors identified significant (p40 (OR: 2.51), pulmonary comorbidities (OR: 1.22), smoking (OR: 1.24), bowel obstruction (OR: 1.40), wound classification 3 or 4 (OR: 1.18), and abdominoperineal resection (OR: 1.58). Laparoscopic or laparoscopically assisted procedures offered a protective effect against incision infection (OR: 0.55). Additional organ resection (OR: 1.08) was also associated independently with SSI, but the magnitude of the effect was decreased after accounting for operative duration. In the analysis that excludes operative duration, pelvic exenteration is associated with SSI (OR: 1.38), but incorporating operative duration into the model results in this variable becoming non-significant. In addition to other factors, obesity, surgery for bowel obstruction, abdominoperineal resection, and additional organ resection are independently associated with a higher risk of SSI. Surgical site infection risk in pelvic exenteration and multiple organ resection cases appears to be mediated by prolonged operative duration. In these established high-risk sub-groups of

  2. Duct thermal performance models for large commercial buildings

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.

    2003-10-01

    Despite the potential for significant energy savings by reducing duct leakage or other thermal losses from duct systems in large commercial buildings, California Title 24 has no provisions to credit energy-efficient duct systems in these buildings. A substantial reason is the lack of readily available simulation tools to demonstrate the energy-saving benefits associated with efficient duct systems in large commercial buildings. The overall goal of the Efficient Distribution Systems (EDS) project within the PIER High Performance Commercial Building Systems Program is to bridge the gaps in current duct thermal performance modeling capabilities, and to expand our understanding of duct thermal performance in California large commercial buildings. As steps toward this goal, our strategy in the EDS project involves two parts: (1) developing a whole-building energy simulation approach for analyzing duct thermal performance in large commercial buildings, and (2) using the tool to identify the energy impacts of duct leakage in California large commercial buildings, in support of future recommendations to address duct performance in the Title 24 Energy Efficiency Standards for Nonresidential Buildings. The specific technical objectives for the EDS project were to: (1) Identify a near-term whole-building energy simulation approach that can be used in the impacts analysis task of this project (see Objective 3), with little or no modification. A secondary objective is to recommend how to proceed with long-term development of an improved compliance tool for Title 24 that addresses duct thermal performance. (2) Develop an Alternative Calculation Method (ACM) change proposal to include a new metric for thermal distribution system efficiency in the reporting requirements for the 2005 Title 24 Standards. The metric will facilitate future comparisons of different system types using a common ''yardstick''. (3) Using the selected near-term simulation approach

  3. Hepatocyte isolation from resected benign tissues: Results of a 5-year experience

    Science.gov (United States)

    Meng, Fan-Ying; Liu, Li; Liu, Jun; Li, Chun-You; Wang, Jian-Ping; Yang, Feng-Hui; Chen, Zhi-Shui; Zhou, Ping

    2016-01-01

    AIM To analyze retrospectively a 5-year experience of human hepatocyte isolation from resected liver tissues with benign disease. METHODS We established a method of modified four-step retrograde perfusion to isolate primary human hepatocytes. Samples were collected from the resected livers of patients with intrahepatic duct calculi (n = 7) and liver hemangioma (n = 17). Only the samples weighing ≥ 15 g were considered suitable for hepatocyte isolation. By using the standard trypan blue exclusion technique, hepatocyte viability and yield were immediately determined after isolation. RESULTS Twenty-four liver specimens, weighing 15-42 g, were immediately taken from the margin of the removed samples and transferred to the laboratory for hepatocyte isolation. Warm ischemia time was 5-35 min and cold ischemia time was 15-45 min. For the 7 samples of intrahepatic duct calculi, the method resulted in a hepatocyte yield of 3.49 ± 2.31 × 106 hepatocytes/g liver, with 76.4% ± 10.7% viability. The 17 samples of liver hemangioma had significantly higher yield of cells (5.4 ± 1.71 × 106 cells/g vs 3.49 ± 2.31 × 106 cells/g, P 0.05). We obtained a cell yield of 5.31 ± 1.87 × 106 hepatocytes/g liver when the samples weighed > 20 g. However, for the tissues weighing ≤ 20 g, a reduction in yield was found (3.08 ± 1.86 × 106 cells/g vs 5.31 ± 1.87 × 106 cells/g, P < 0.05). CONCLUSION Benign diseased livers are valuable sources for large-number hepatocyte isolation. Our study represents the largest number of primary human hepatocytes isolated from resected specimens from patients with benign liver disease. We evaluated the effect of donor liver characteristics on cell isolation, and we found that samples of liver hemangioma can provide better results than intrahepatic duct calculi, in terms of cell yield. Furthermore, the size of the tissues can affect the outcome of hepatocyte isolation. PMID:27688659

  4. Heat Transfer in Conical Corner and Short Superelliptical Transition Ducts

    Science.gov (United States)

    Poinsatte, Philip; Thurman, Douglas; Hippensteele, Steven

    2008-01-01

    Local surface heat transfer measurements were experimentally mapped using a transient liquid-crystal heat-transfer technique on the surface of two circular-to-rectangular transition ducts. One has a transition cross section defined by conical corners (Duct 1) and the other by an elliptical equation with changing coefficients (Duct 2). Duct 1 has a length-to-diameter ratio of 0.75 and an exit plane aspect ratio of 1.5. Duct 2 has a length-to-diameter ratio of 1.0 and an exit plane aspect ratio of 2.9. Test results are reported for various inlet-diameter-based Reynolds numbers ranging from 0.45 106 to 2.39 106 and two freestream turbulence intensities of about 1 percent, which is typical of wind tunnels, and up to 16 percent, which may be more typical of real engine conditions.

  5. Hepatobiliary Scan in Infantile Spontaneous Perforation of Common Bile Duct

    Energy Technology Data Exchange (ETDEWEB)

    Zeon, Seok Kil; Ryu, Jong Gul; Lee, Eun Young [Keimyung University School of Medicine, Taegu (Korea, Republic of); Lee, Jong Gil [Taegu Fatima Hospital, Taegu (Korea, Republic of)

    1996-03-15

    Spontaneous perforation of CBD in infant is a rare but fatal disease. We report a case of bile leakage from common bile duct in 11 months old girl with progressive abdominal distension and vomiting, preoperatively diagnosed by hepatobiliary scan with Tc-99m-DISIDA, which was confirmed by surgery. Operative cholangiogram showed a small perforation at the confluence of cystic duct and common bile duct with mild fusiform dilatation, and no definite abnormality in confluence of the common bile duct and pancreatic duct. Simple drainage of the free peritoneal bilous fluid and T-tube drainage were performed without any evidence of the complication. Patient was inevitable for 6 months OPD follow-up examination.

  6. Extravasation Mucocele Arising from a Lingual Thyroglossal Duct Remnant

    Directory of Open Access Journals (Sweden)

    Mitsuhiko Nakahira

    2015-01-01

    Full Text Available Although a thyroglossal duct cyst is a congenital anomaly, it can also appear in adults. Despite the presence of embryological remnants, it is still unclear why the cyst should suddenly develop later in life. We report a case of a 46-year-old male with an extravasation mucocele arising from a long-standing lingual thyroglossal duct remnant. MRI demonstrated a lingual cystic lesion near the hyoid bone associated with a suprahyoid tract-like structure masquerading as a thyroglossal duct cyst. However, histopathological examination demonstrated a mucocele secondary to a rupture of a thyroglossal duct remnant with numerous intramural heterotopic salivary glands. We propose a new mechanism of an acquired cystic formation of this congenital disease that excessive production of mucus from heterotopic salivary glands and a physical trauma such as swallowing may lead to extravasation of mucus from the thyroglossal duct.

  7. Cystic duct remnant mucocele in a liver transplant recipient

    Energy Technology Data Exchange (ETDEWEB)

    Ahlawat, Sushil K. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ (United States); Fishbien, Thomas M. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); Haddad, Nadim G. [Georgetown University Hospital, Department of Surgery, Division of Transplant Surgery, Washington, DC (United States)

    2008-08-15

    Cystic duct remnant mucocele is an extremely rare complication of liver transplantation in children. Surgical correction is usually required for cystic duct remnant mucocele when it causes biliary obstruction. We describe a 14-month-old liver transplant recipient who presented with biliary obstruction 1 month after orthotopic liver transplantation with an end-to-end choledochocholedocal biliary anastomosis for hepatoblastoma. US, CT and cholangiography findings were consistent with mucocele of the allograft cystic duct remnant. Surgery was not needed in our patient because the mucocele and biliary obstruction had resolved on repeat imaging most likely due to guidewire manipulation during cholangiography, resulting in opening of the cystic duct remnant orifice and drainage into the common duct. (orig.)

  8. [A Case of Repeat Liver Resection after Laparoscopic Resection of a Synchronous Liver Metastasis of Colon Cancer].

    Science.gov (United States)

    Miyazawa, Kotaro; Yoshioka, Shigeru; Shiobara, Masayuki; Wakatsuki, Kazuo; Kataoka, Masaaki; Arai, Syuka; Suda, Kosuke; Oeda, Yoshio; Takagi, Takashi

    2015-11-01

    A 44-year-old woman with subileus was diagnosed with advanced sigmoid colon cancer with a synchronous liver metasta- sis (segmanet 5/8). Laparoscopic anterior resection was performed, and histological diagnosis was sigmoid colon cancer, 55×40 mm, type 2, tub2>por2, pT3, ly2, v2, pN1, M1a, Stage Ⅳ (Japanese Classification of Colorectal Carcinoma, Eighth edition). Four courses of neoadjuvant chemotherapy (FOLFIRI plus panitumumab) shrank the liver metastasis. Laparoscopic partial liver resection was performed for 285 minutes, with 350 g of blood loss. The patient was discharged 9 days after the operation. Two courses of oral adjuvant chemotherapy (S-1) was performed but discontinued owing to side effects. Seven months after the surgery, computed tomography revealed 2 small liver metastasis (segment 8). Although the sizes were 35 and 5 mm, respectively, the larger mass was closed to the middle and right hepatic vein. Therefore, open hepatectomy was performed for 285 minutes, with 525 g of blood loss. The patient was discharged 9 days after the operation without complication. The patient had no recurrence for 1 year after the last surgery.

  9. Robotic resection of huge presacral tumors: case series and comparison with an open resection.

    Science.gov (United States)

    Oh, Jae Keun; Yang, Moon Sool; Yoon, Do Heum; Rha, Koon Ho; Kim, Keung Nyun; Yi, Seong; Ha, Yoon

    2014-06-01

    Clinical case series and analysis. The purpose of the present study is to evaluate the advantages and disadvantages of robotic presacral tumor resection compared with conventional open approach. Conventional open approach for huge presacral tumors in the retroperitoneal space often demands excessive hospitalization and poor cosmesis. Furthermore, narrow surgical field sometimes interrupt delicate procedures. Nine patients with huge (diameter >10 cm) presacral tumors underwent surgery. Five patients among them had robotic procedure and the others had open transperitoneal tumor resection. Operation time, blood loss, hospitalization, and complications were analyzed. Robotic presacral tumor resection showed shorter operation time, less bleeding, and shorter hospitalization. Moreover, there was no complication related to abdominal adhesion. Although robotic resection for presacral tumor still has limitations technically and economically, robotic resection for huge presacral tumors demonstrated advantages over open resection specifically for benign neurogenic tumors.

  10. Bile duct emptying in response to fat: a validation study.

    Science.gov (United States)

    Hunt, D R; Scott, A J

    1990-11-01

    Fatty meal sonography has been suggested to assess patients with biliary pain after cholecystectomy, but the effects of gallbladder removal on biliary dynamics has not been studied prospectively. Before elective cholecystectomy, 25 patients had their common hepatic ducts' diameter measured by ultrasonography before and after a fat stimulus. In 23, tests were repeated 1 month, 1 year, and 5 years after surgery. In preoperative studies, 5 patients showed dilatation after fat and 2 of these had stones in the common bile duct. However, another 4 patients with stones or sludge in the duct did not show dilatation, so that the response to fat was a poor indicator of patients requiring common bile duct exploration. No patient had major symptoms after surgery. At 1 month and 12 months, the response to fat was variable with more than half of those tested showing no decrease in duct size. A more consistent pattern emerged at 5 years, when 14 of 18 patients tested showed a decrease in common hepatic duct after fat; 3 were unchanged and 1 increased by 1 mm. The response to fat was less consistent and more difficult to measure in the common bile duct, even 5 years after operation. It was concluded that not all patients with indications for exploration of the common bile duct on operative cholangiography show a dilatation response to fat on preoperative testing. Also, fatty meal sonography should be used with caution because the response to fat in asymptomatic patients soon after operation is unpredictable, with occasional patients showing dilation without apparent obstruction. Measurement of common hepatic duct is preferred to common bile duct and increases in diameter of 1 mm are probably not significant.

  11. Lacrimal Duct Occlusion Is Associated with Infectious Keratitis

    Science.gov (United States)

    Li, Guigang; Guo, Jingmin; Liu, Rong; Hu, Weikun; Xu, Lingjuan; Wang, Juan; Cai, Subo; Zhang, Hong; Zhu, Yingting

    2016-01-01

    Background: To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis. Methodology/Principle Findings: The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing. Conclusions: Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction

  12. A Plug-and-Play Duct System Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Beach, Robert [IBACOS, Inc., Pittsburgh, PA (United States); Dickson, Bruce [IBACOS, Inc., Pittsburgh, PA (United States); Grisolia, Anthony [IBACOS, Inc., Pittsburgh, PA (United States); Poerschke, Andrew [IBACOS, Inc., Pittsburgh, PA (United States); Rapport, Ari [IBACOS, Inc., Pittsburgh, PA (United States)

    2017-07-10

    This report describes an air distribution system composed of a series of uniformly-sized ducts that terminate in rooms throughout the home and return to a central manifold, similar in fashion to a “home-run” cross-linked polyethylene plumbing system. With a well-designed manifold, each duct receives an equal static pressure potential for airflow from the air handling unit, and the number of needed ducts for each room are simply attached to fittings located on the manifold; in this sense, the system is plug-and-play (PnP). As indicated, all ducts in the PnP system are identical in size and small enough to fit in the ceiling and wall cavities of a house (i.e., less than 3.5-in. outer diameter). These ducts are also more appropriately sized for the lower airflow requirements of modern, energy-efficient homes; therefore, the velocity of the air moving through the duct is between that of conventional duct systems (approximately 700 ft/min) and high-velocity systems (more than 1,500 ft/min) on the market today. The PnP duct system uses semi-rigid plastic pipes, which have a smooth inner wall and are straightforward to install correctly, resulting in a system that has minimal air leakage. However, plastic ducts are currently not accepted by code for use in residential buildings; therefore, the project team considered other duct materials for the system that are currently accepted by code, such as small-diameter, wirehelix, flexible ductwork.

  13. A Plug-and-Play Duct System Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    R. Beach, B. Dickson, A. Grisolia, A. Poerschke, A. Rapport

    2017-07-01

    This report describes an air distribution system composed of a series of uniformly-sized ducts that terminate in rooms throughout the home and return to a central manifold, similar in fashion to a “home-run” cross-linked polyethylene plumbing system. With a well-designed manifold, each duct receives an equal static pressure potential for airflow from the air handling unit, and the number of needed ducts for each room are simply attached to fittings located on the manifold; in this sense, the system is plug-and-play (PnP). As indicated, all ducts in the PnP system are identical in size and small enough to fit in the ceiling and wall cavities of a house (i.e., less than 3.5-in. outer diameter). These ducts are also more appropriately sized for the lower airflow requirements of modern, energy-efficient homes; therefore, the velocity of the air moving through the duct is between that of conventional duct systems (approximately 700 ft/min) and high-velocity systems (more than 1,500 ft/min) on the market today. The PnP duct system uses semi-rigid plastic pipes, which have a smooth inner wall and are straightforward to install correctly, resulting in a system that has minimal air leakage. However, plastic ducts are currently not accepted by code for use in residential buildings; therefore, the project team considered other duct materials for the system that are currently accepted by code, such as small-diameter, wirehelix, flexible ductwork.

  14. Optimizing Adjuvant Therapy for Resected Pancreatic Cancer

    Science.gov (United States)

    In this clinical trial, patients with resected pancreatic head cancer will be randomly assigned to receive either gemcitabine with or without erlotinib for 5 treatment cycles. Patients who do not experience disease progression or recurrence will then be r

  15. Segmental dilatation of the ileum in a healthy adolescent

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Akash D.; Kovanlikaya, Arzu; Brill, Paula W. [New York Presbyterian Hospital-Weill Cornell Medical Center, Department of Radiology, New York, NY (United States); Beneck, Debra [New York Presbyterian Hospital-Weill Cornell Medical Center, Department of Pathology, New York, NY (United States); Spigland, Nitsana [New York Presbyterian Hospital-Weill Cornell Medical Center, Department of Surgery, New York, NY (United States)

    2009-12-15

    Segmental intestinal dilatation is a rare entity presenting overwhelmingly in infants and young children with congenital malformations, anemia, or history of gastrointestinal pathology, characterized by a focally distended segment of bowel with abrupt transition points without an obstructing barrier. We present a 16-year-old girl with no significant medical history who presented with bowel obstruction clinically. Segmental dilatation of the ileum was evident on a CT scan and small bowel series. Following surgical resection, pathologic examination of the segment revealed the presence of heterotopic gastric mucosa. The girl's symptoms resolved after surgery. Awareness of the imaging presentation of this entity can inform the evaluation of older children with nonspecific symptoms mimicking bowel obstruction. (orig.)

  16. [Laparoscopic distal resection of the pancreas].

    Science.gov (United States)

    Gürlich, R; Sixta, B; Oliverius, M; Kment, M; Rusina, R; Spicák, J; Sváb, J

    2005-09-01

    During the last two years, reports on laparoscopic procedures of the pancreas have been on increase. Laparoscopic resection of the pancreatic cauda is indicated, primarily, for benign cystic lesions of the cauda of the pancreas and for neuroendocrine tumors of the pancreas (mainly insulinomas). We have not recorded any report on the above procedure in the Czech literature. Therefore, in our case review, we have described laparoscopic distal resection of the pancreas with splenectomy for a pseudopapillary tumor of the pancreas.

  17. Conformal radiotherapy of locally advanced bile duct carcinoma; Radiotherapie conformationnelle des cholangiocarcinomes de la voie biliaire principale localement evolues

    Energy Technology Data Exchange (ETDEWEB)

    Bouras, N.; Caudry, M.; Bonnel, C.; Trouette, R.; Demeaux, H.; Maire, J.P. [Centre Hospitalier Universitaire, Hopital Saint-Andre, Service de Radiotherapie, 33 - Bordeaux (France); Saric, J.; Rullier, E. [Centre Hospitalier Universitaire, Hopital Saint-Andre, Service de Chirurgie Viscerale et de Transplantation Hepatique, 33 - Bordeaux (France)

    2002-02-01

    Purpose. - Retrospective study of 23 patients treated with conformal radiotherapy for a locally advanced bile duct carcinoma. Patients and methods. - Eight cases were irradiated after a radical resection (RO), because they were N+; seven after microscopically incomplete resection (R1) ; seven were not resected (R2). A dose of 45 of 50 Gy was delivered, followed by a boost up to 60 Gy in R1 and R2 groups. Concomitant chemotherapy was given in 15 cases. Results.-Late toxicity included a stenosis of the duodenum, and one of the biliary anastomosis. Two patients died from cholangitis, the mechanism of which remains unclear. Five patients are in complete remission, six had a local relapse, four developed a peritoneal carcinosis, and six distant metastases. Actuarial survival rate is 75%, 28% and 7% at 1, 3 and 5 years, respectively (median: 16.5 months). Seven patients are still alive with a 4 to 70 months follow-up. Survival is similar in the 3 small subgroups. The poor local control among RON+ cases might be related to the absence of a boost to the 'tumor bed'. In R1 patients, relapses were mainly distant metastases, where'as local and peritoneal recurrences predominated in R2. Conclusion. - Conformal radio-chemotherapy delivering 60 Gy represents a valuable palliative approach in locally advanced biliary carcinoma. (authors)

  18. What is a segment?

    Science.gov (United States)

    Hannibal, Roberta L; Patel, Nipam H

    2013-12-17

    Animals have been described as segmented for more than 2,000 years, yet a precise definition of segmentation remains elusive. Here we give the history of the definition of segmentation, followed by a discussion on current controversies in defining a segment. While there is a general consensus that segmentation involves the repetition of units along the anterior-posterior (a-p) axis, long-running debates exist over whether a segment can be composed of only one tissue layer, whether the most anterior region of the arthropod head is considered segmented, and whether and how the vertebrate head is segmented. Additionally, we discuss whether a segment can be composed of a single cell in a column of cells, or a single row of cells within a grid of cells. We suggest that 'segmentation' be used in its more general sense, the repetition of units with a-p polarity along the a-p axis, to prevent artificial classification of animals. We further suggest that this general definition be combined with an exact description of what is being studied, as well as a clearly stated hypothesis concerning the specific nature of the potential homology of structures. These suggestions should facilitate dialogue among scientists who study vastly differing segmental structures.

  19. Management of borderline resectable pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Amit; Mahipal; Jessica; Frakes; Sarah; Hoffe; Richard; Kim

    2015-01-01

    Pancreatic cancer is the fourth most common cause of cancer death in the United States. Surgery remains the only curative option; however only 20% of the patients have resectable disease at the time of initialpresentation. The definition of borderline resectable pancreatic cancer is not uniform but generally denotes to regional vessel involvement that makes it unlikely to have negative surgical margins. The accurate staging of pancreatic cancer requires triple phase computed tomography or magnetic resonance imaging of the pancreas. Management of patients with borderline resectable pancreatic cancer remains unclear. The data for treatment of these patients is primarily derived from retrospective single institution experience. The prospective trials have been plagued by small numbers and poor accrual. Neoadjuvant therapy is recommended and typically consists of chemotherapy and radiation therapy. The chemotherapeutic regimens continue to evolve along with type and dose of radiation therapy. Gemcitabine or 5-fluorouracil based chemotherapeutic combinations are administered. The type and dose of radiation vary among different institutions. With neoadjuvant treatment, approximately 50% of the patients are able to undergo surgical resections with negative margins obtained in greater than 80% of the patients. Newer trials are attempting to standardize the definition of borderline resectable pancreatic cancer and treatment regimens. In this review, we outline the definition, imaging requirements and management of patients with borderline resectable pancreatic cancer.

  20. Fast-track rehabilitation following video-assisted pulmonary sublobar wedge resection: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Christos Asteriou

    2016-01-01

    Full Text Available Background: Postoperative morbidity and inhospital length of stay are considered major determinants of total health care expenditure associated with thoracic operations. The aim of this study was to prospectively evaluate the role of video-assisted thoracic surgery (VATS compared to mini-muscle-sparing thoracotomy in facilitating early recovery and hospital discharge after pulmonary sublobar wedge resections. Patients and Methods: A total number of 120 patients undergoing elective pulmonary sublobar wedge resection were randomly assigned to VATS (n = 60 or mini-muscle-sparing thoracotomy (n = 60. The primary endpoint was time to hospital discharge. Postoperative complications, cardiopulmonary morbidity and 30-day mortality served as secondary endpoints. Results: Patients' baseline demographic and clinical data did not differ among study arms as well as the number of pulmonary segments resected and the morphology of the nodular lesions. Total hospital stay was significantly shorter in patients assigned to the thoracoscopic technique as opposed to those who were operated using the mini-muscle-sparing thoracotomy approach (4 ± 0.6 versus 4.4 ± 0.6 days respectively, P = 0.006. Multivariate analysis revealed that VATS approach was inversely associated with longer inhospital stay whereas the number of resected segments was positively associated with an increased duration of hospitalization. Patients in the VATS group were less likely to develop atelectasis (≥1 lobe compared to those who underwent thoracotomy (0% versus 6.7% respectively, P = 0.042. Kaplan-Meier analysis revealed similar 30-day mortality rates in both study arms (Log-rank P = 0.560. Conclusion: VATS was associated with shorter duration of hospitalization positively affecting the patients' quality of life and satisfaction. Significant suppression of the total cost of recovery after thoracoscopic pulmonary resections is expected.

  1. Metastatic Pulmonary Adenocarcinoma 6 Years After Curative Resection for Ampullary Adenocarcinoma. Metastatic Disease from Initial Primary or Metachronous Tumour?

    Directory of Open Access Journals (Sweden)

    Alexandros Giakoustidis

    2011-01-01

    Full Text Available Context With patients surviving longer after pancreatic resection, the challenges now is the management of the unresolved longerterm issues. Case report A 53-year-old woman with painless obstructive jaundice, underwent a pylorous preserving pancreaticoduodenectomy for a pT3N0M0 ampullary adenocarcinoma in 2001 (patchy chronic pancreatitis with mucinous metaplasia of background pancreatic duct epithelium and acinar atrophy were noted. Despite adjuvant chemotherapy, at month 54 she required a pulmonary wedge resection for metastatic adenocarcinoma, followed by a pulmonary relapse at 76 months when she underwent 6 neoadjuvant cycles of gemcitabine/capecitabine and a left pneumonectomy. Finally 7 years after the initial Whipple’s, a single 18F fluorodeoxyglucose (FDG avid pancreatic tail lesion led to completion pancreatectomy for a well-differentiated ductal adenocarcinoma with clear resection margins albeit peripancreatic adipose tissue infiltration. On review all resected tumour cells had identical immunophenotype (CK7+/CK20-/MUC1+/MUC2- as that of the primary. She is currently asymptomatic on follow-up. Conclusions These findings suggest that in selected cases even in the presence of pulmonary metastasis, repeat resections could result in long-term survival of patients with metachronous ampullary cancer. Second, even ampullary tumours maybe should be regarded as index tumors in the presence of ductal precursor lesions in the resection specimen. Three distant metastases, particularly if long after the initial tumour, should instigate a search for metachronous tumour, especially in the presence of field change in the initial specimen. Risk-adapted follow-up protocols with recognition of such factors could result in cost-effective surveillance and potentially improved outcomes.

  2. "Three-Grade Criteria" of Radical Resection for Primary Liver Cancer

    Institute of Scientific and Technical Information of China (English)

    Zengchen Ma; Jia Fan; Zhenggang Ren; Jinglin Xia; Liwen Huang; Zhaoyou Tang; Xinda Zhou; Zhiying Lin; Lunxiu Qin; Qinghai Ye; Huichuan Sun; Zhiquan Wu

    2005-01-01

    OBJECTIVE The present study was designed to develop the "ThreeGrade Criteria" for radical resection of primary liver cancer (PLC) and to evaluate its clinical significance.METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ: on or the primary branches of the portal vein, the common hepatic duct or its dition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level (with positive AFP before surgery)within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the "Three-Grade Criteria" these patients were divided into 6 groups: Grade Ⅰ radical group,Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group,Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups.RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment (P<0.01). Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%,51.2% and 64.4%, respectively (P<0.01).CONCLUSION The "Three-Grade Criteria" may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used,the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.

  3. Altered collecting duct adenylyl cyclase content in collecting duct endothelin-1 knockout mice

    Directory of Open Access Journals (Sweden)

    Kohan Donald E

    2007-05-01

    Full Text Available Abstract Background Endothelin-1 (ET-1 inhibition of vasopressin (AVP-stimulated water reabsorption by the inner medullary collecting duct (IMCD is associated with reduced cAMP accumulation. To determine the effect of ET-1 deficiency, AVP-stimulated cAMP responsiveness was assessed in IMCD from mice with collecting duct-specific deletion of ET-1 (CD ET-1 KO and from control animals. Methods Cyclic AMP production, adenylyl cyclase (AC mRNA, and AC protein were measured in acutely isolated IMCD. Results CD ET-1 KO IMCD had enhanced AVP-stimulated cAMP accumulation. Inhibition of calcium-stimulated AC using BAPTA did not prevent enhanced AVP responsiveness in CD ET-1 KO IMCD. Factors known to be modified by ET-1, including nitric oxide, cyclooxygenase metabolites, and superoxide did not affect the increased AVP responsiveness of CD ET-1 KO IMCD. Differential V2 receptor or G-protein activity was not involved since CD ET-1 KO IMCD had increased cAMP accumulation in response to forskolin and/or cholera toxin. CD ET-1 KO did not affect mRNA or protein levels of AC3, one of the major known collecting duct AC isoforms. However, the other known major collecting duct AC isoform (AC5/6 did have increased protein levels in CD ET-1 KO IMCD, although AC5 (weak signal and 6 mRNA levels were unchanged. Conclusion ET-1 deficiency increases IMCD AC5/6 content, an effect that may synergize with acute ET-1 inhibition of AVP-stimulated cAMP accumulation.

  4. Transcatheter stenting of arterial duct in duct-dependent congenital heart disease

    Directory of Open Access Journals (Sweden)

    Đukić Milan

    2013-01-01

    Full Text Available Introduction. Critical congenital heart diseases (CHD are mostly duct-dependent and require stable systemic-pulmonary communication. In order to maintain patency of the ductus arteriosus (DA, the first line treatment is Prostaglandin E1 and the second step is the surgical creation of aortic-pulmonary shunt. To reduce surgical risk in neonates with the critical CHD, transcatheter stenting of DA can be performed in selected cases. Case Outline. A four-month old infant was diagnosed with the pulmonary artery atresia with ventricular septal defect (PAA/VSD. The left pulmonary artery was perfused from DA, and the right lung through three major aortopulmonary collaterals (MAPCAs. A coronary stent was placed in the long and critically stenotic DA, with final arterial duct diameter of 3.5 mm, and significantly increased blood supply to the left lung. After the procedure, the infant’s status was improved with regard to arterial oxygen saturation, feeding and weight gain. During the follow-up, one year later, aortography revealed in-stent stenosis. The left pulmonary artery, as well as the branches, was well-developed and the decision was made to proceed with further surgical correction. Conclusion. Stenting of DA can be an effective alternative to primary surgical correction in selected patients with duct-dependent CHD.

  5. Toward real-time tumor margin identification in image-guided robotic brain tumor resection

    Science.gov (United States)

    Hu, Danying; Jiang, Yang; Belykh, Evgenii; Gong, Yuanzheng; Preul, Mark C.; Hannaford, Blake; Seibel, Eric J.

    2017-03-01

    For patients with malignant brain tumors (glioblastomas), a safe maximal resection of tumor is critical for an increased survival rate. However, complete resection of the cancer is hard to achieve due to the invasive nature of these tumors, where the margins of the tumors become blurred from frank tumor to more normal brain tissue, but in which single cells or clusters of malignant cells may have invaded. Recent developments in fluorescence imaging techniques have shown great potential for improved surgical outcomes by providing surgeons intraoperative contrast-enhanced visual information of tumor in neurosurgery. The current near-infrared (NIR) fluorophores, such as indocyanine green (ICG), cyanine5.5 (Cy5.5), 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX), are showing clinical potential to be useful in targeting and guiding resections of such tumors. Real-time tumor margin identification in NIR imaging could be helpful to both surgeons and patients by reducing the operation time and space required by other imaging modalities such as intraoperative MRI, and has the potential to integrate with robotically assisted surgery. In this paper, a segmentation method based on the Chan-Vese model was developed for identifying the tumor boundaries in an ex-vivo mouse brain from relatively noisy fluorescence images acquired by a multimodal scanning fiber endoscope (mmSFE). Tumor contours were achieved iteratively by minimizing an energy function formed by a level set function and the segmentation model. Quantitative segmentation metrics based on tumor-to-background (T/B) ratio were evaluated. Results demonstrated feasibility in detecting the brain tumor margins at quasi-real-time and has the potential to yield improved precision brain tumor resection techniques or even robotic interventions in the future.

  6. 瞳孔缘环行切除术对葡萄膜炎并发白内障术后眼前节的影响研究%Study on effect of Anterior segment after the pupillary margin circulator resection surgery on uveitis complicated cataract

    Institute of Scientific and Technical Information of China (English)

    罗向霞; 刘永民; 苏莉; 樊莹; 王亦山; 刘永红; 李媛; 毛倩

    2013-01-01

    目的:探讨葡萄膜炎并发的白内障处理瞳孔膜闭的较好术式。方法临床纳入40例(40眼)葡萄膜炎并发白内障瞳孔膜闭患者,随机分为两组,每组20例(20眼),分别采用瞳孔缘环行切除虹膜约0.5mm和传统机械性扩大处理瞳孔膜闭,观察术前、术后7d、1m及3m术眼最佳矫正视力、角膜、瞳孔直径、前房炎性反应。结果两组术后7天视力>0.5者观察组占35%,对照组占15%,P<0.05,两组比较差异有统计学意义,观察组视力优于对照组;术后自然光线下两组瞳孔状态比较,观察组瞳孔规则呈圆形、直径<4mm者占95%、90%,对照组55%、45%,两组差异具有统计学意义;术后角膜水肿术后7天及1月两组角膜水肿程度分级比较,两者组比较差异无统计学意义;术后3d、7d房水反应 Tyndall征强阳性对照组分别占90%、55%,与观察组70%、25%差异比较差异具有统计学意义,术后1月两组房水闪辉差异比较差异无统计学意义。结论采用瞳孔缘环形切除进行瞳孔成型后瞳孔大小及形态接近正常生理状态,有效减轻术后虹膜反应,避免了瞳孔过大畏光及对视力影响,可以作为葡萄膜炎并发的白内障手术治疗的较好术式。%Objective To explore the better technique for uveitis complicated cataract with pupillary membrane closed .Methods 40 cases(40 eye)with uveitis cataract were randomly divided into 2 groups ,the ring of the pupillary margin resection and conventional mechanical to be used in two groups ,respectively ,To observe correction vision ,cornea ,pupil diameter ,aqueous humor ,anterior chamber inflammatory reaction , before surgery ,after 1 week ,1 month and 3month .Results The correction vision>0 .5 ,after 7 days ,35% of the observation group ,15% of the control group ,P<0 .05 ,significant difference between the two groups ,the observation group vision is better than

  7. Development of a new duct leakage test: DeltaQ

    Energy Technology Data Exchange (ETDEWEB)

    Walker,I.S.; Sherman,M.H.; Wempen, J.; Wang, D.; McWilliams, J.A.; Dickerhoff, D.J.

    2001-08-01

    Duct leakage is a key factor in determining energy losses from forced air heating and cooling systems. Several studies (Francisco and Palmiter 1997 and 1999, Andrews et al. 1998, and Siegel et al. 2001) have shown that the duct system efficiency cannot be reliably determined without good estimates of duct leakage. Specifically, for energy calculations, it is the duct leakage air flow to outside at operating conditions that is required. Existing test methods either precisely measure the size of leaks (but not the flow through them at operating conditions), or measure these flows with insufficient accuracy. The DeltaQ duct leakage test method was developed to provide improved estimates of duct leakage during system operation. In this study we developed the analytical calculation methods and the test procedures used in the DeltaQ test. As part of the development process, we have estimated uncertainties in the test method (both analytically and based on field data) and designed automated test procedures to increase accuracy and reduce the contributions of operator errors in performing field tests. In addition, the test has been evaluated in over 100 houses by several research teams to show that it can be used in a wide range of houses and to aid in finding limits or problems in field applications. The test procedure is currently being considered by ASTM as an update of an existing duct leakage standard.

  8. Mechanical properties of the porcine bile duct wall

    Directory of Open Access Journals (Sweden)

    Andersen Helle

    2004-07-01

    Full Text Available Abstract Background and Aim The function of the common bile duct is to transport bile from the liver and the gall bladder to the duodenum. Since the bile duct is a distensible tube consisting mainly of connective tissue, it is important to obtain data on the passive mechanical wall properties. The aims of this study were to study morphometric and biomechanical wall properties during distension of the bile duct. Methods Ten normal porcine common bile ducts were examined in vitro. A computer-controlled volume ramp infusion system with concomitant pressure recordings was constructed. A video camera provided simultaneous measurement of outer dimensions of the common bile duct. Wall stresses and strains were computed. Results The common bile duct length increased by 25% from 24.4 ± 1.8 mm at zero pressure to 30.5 ± 2.0 mm at 5 kPa (p (βε - 1. The circumferential stress-strain curve was shifted to the left when compared to the longitudinal stress-strain curve, i.e. the linear constants (α values were different (p 0.5. Conclusion The porcine bile duct exhibited nonlinear anisotropic mechanical properties.

  9. Magnetic Resonance Sialography Findings of Submandibular Ducts Imaging

    Directory of Open Access Journals (Sweden)

    Nezahat Karaca Erdoğan

    2013-01-01

    Full Text Available Purpose. We aimed to assess the problem solving capability of magnetic resonance sialography (MR sialography, a noninvasive method for imaging submandibular gland ducts and determining duct-related pathologies, by comparing diseased and healthy cases. Materials and Methods. We conducted radiological assessment on a total of 60 submandibular glands (mean age 44.7 in 20 cases and 10 volunteers. MR sialography examinations were conducted with single-shot fast spin-echo sequence by using a surface coil placed on the submandibular gland. Each gland was evaluated in terms of the length, width and stricture of the main duct, as well as the difference between the intraparenchymal duct width, and the main duct width. Statistical analysis was performed. Results. In the MR sialography the primary duct mean length was determined as 51 mm (40–57 mm in all submandibular glands. On the MR sialography imaging, the visualization ratio of the ductal system of submandibular gland was evaluated in the cases and volunteers. Conclusion. MR sialography is an effective and a noninvasive method in imaging submandibular gland ducts, demonstrating the presence, location and degree of stricture/dilatation, and elucidating the disease etiology.

  10. Flow Development through a Duct and a Diffuser Using CFD

    Directory of Open Access Journals (Sweden)

    Prasanta K.Sinha

    2017-01-01

    Full Text Available In the present paper an extensive study of rectangular cross-sectioned C-duct and C-diffuser is made by the help of 2-D mean velocity contours. Study of flow characteristics through constant area duct is a fundamental research area of basic fluid mechanics since the concepts of potential flow and frictional losses in conduit flow were established. C-ducts are used in aircraft intakes, combustors, internal cooling systems of gas turbines, ventilation ducts, wind tunnels etc., while diffuser is mechanical device usually made in the form of a gradual conical expander intended to raise the static pressure of the fluid flowing through it. Flow through curved ducts is more complex compared to straight duct due to the curvature of the duct axis and centrifugal forces are induced on the flowing fluid resulting in the development of secondary motion (normal to the primary flow direction which is manifested in the form of a pair of contra-rotating vortices. For a diffuser in addition to the secondary flow, the diverging flow passage, which causes an adverse stream wise pressure gradient, can lead to flow separation. The combined effect may result n non uniformity of total pressure and total pressure loss at the exit. A comparative study of different turbulent models available in the Fluent using y  as guidance in selecting the appropriate grid configuration and turbulence models are done. Standard k-ε model and RSM models are used to solve the closure problem for both the constant area duct and the diffuser. It has been observed that the Standard k-e model predicts the flow through the constant area duct and the diffuser within a reasonable domain ofthe y  range.

  11. [Results after laparoscopic liver resection: an appropriate option in malignant disease].

    Science.gov (United States)

    Cugat Andorrà, Esteban; Herrero Fonollosa, Eric; García Domingo, María Isabel; Camps Lasa, Judith; Carvajal López, Fernando; Rodríguez Campos, Aurora; Cirera Nogueras, Lluís; Fernández Plana, Julen; de Marcos Izquierdo, José Ángel; Paraira Beser, Marta; San Martín Elizaincín, Marta

    2013-10-01

    The laparoscopic approach is not yet widely used in liver surgery, but has proven to be safe and feasible in selected patients even in malignant disease. The experience and results of a hepato-pancreato-biliary (HPB) surgery unit in the treatment of malignant liver disease by laparoscopic approach is presented. Between February 2002 and May 2011, 71 laparoscopic liver resections were performed, 43 for malignant disease (only patients with more than one year of follow-up were included). Mean age was 63 years old and 58% of the patients were male. Forty-nine per cent of the lesions were located in segments ii-iii. Thirty segmentectomies were performed, 7 limited resections and 6 major hepatectomies. The median operative time was 163 min. There were 3 conversions. Five cases (11%) required blood transfusion. The oral intake began at 32 h and the median hospital stay was 6.7 days. There were no reoperations and there was one case of mortality. Nine patients (21%) had postoperative complications. The mean number of resected lesions was 1.2, with an average size of 3.5 cm. All resections were R0. The median survival after resection of colorectal liver metastases (CLM) was 69% and 43.5% at 36 and 60 months, respectively, and 89% and 68% at 36 and 60 months, respectively, in hepatocellular carcinoma (HCC). The laparoscopic liver resection in malignant disease is feasible and safe in selected patients. The same oncological rules as for open surgery should be followed. In selected patients it offers similar long-term oncological results as open surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  12. Flow in Idealised Compliant Human Cystic Duct Models

    Science.gov (United States)

    Al-Atabi, M.; Chin, S. B.; Beck, S.; Luo, X. Y.

    The functions of the cystic duct and the role of its complicated geometry (in particular the valves of Heister), in the delivery of bile flow have always been a subject of speculation. This paper reports on an experimental investigation of the flow in idealised, compliant cystic duct models. The valves of Heister were idealised using eight semi-circular alternating baffles fitted inside the compliant tubes. These tubes were arranged in configurations representing the anatomical configurations of real cystic ducts. Models both with and without baffles were tested for comparison. The results show that the valves of Heister seem to play a role in facilitating both the filling and emptying of the gallbladder.

  13. Finite-amplitude waves in cylindrical lined ducts

    Science.gov (United States)

    Nayfeh, A. H.; Tsai, M.-S.

    1974-01-01

    A second-order uniformly valid expansion is obtained for nonlinear waves propagating in a cylindrical duct lined with a point-reacting acoustic material that consists of a porous sheet followed by honey-comb cavities and backed by the impervious walls of the duct. The effect of the liner is taken into account by coupling the waves in the duct with those in the liner. As in the two-dimensional case, the nonlinearity increases the attenuation rate at all frequencies except in narrow bandwidths around the resonant frequencies, irrespective of the geometrical dimensions of the liner or the acoustic properties of the porous sheet.

  14. Spontaneous common bile duct perforation due to periampullary growth

    Directory of Open Access Journals (Sweden)

    Pandiaraja Javabal

    2014-06-01

    Full Text Available Spontaneous common bile duct perforations are an unusual cause of acute abdomen. In spontaneous common bile duct perforation, malignant growth is even rare. It is a rare entity usually reported in infants and children due to congenital anomalies. It is rarely reported in adults. In this case report, a 55 - year - old male patient who was diagnosed as a duodenal perforation in the pre - operative period, but the intra - operative findings was common bile duct perforation due to periampullary growth, is reported

  15. EFFECT OF AIRFLOW AND HEAT INPUT RATES ON DUCT EFFICIENCY.

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.W.

    2003-05-28

    Reducing the airflow and heat input rates of a furnace that is connected to a duct system in thermal contact with unconditioned spaces can significantly reduce thermal distribution efficiency. This is a straightforward theoretical calculation based on the increased residence time of the air in the duct at the lower flow rate, which results in greater conduction losses. Experimental tests in an instrumented residential-size duct system have confirmed this prediction. Results are compared with the heat-loss algorithm in ASHRAE Standid 152P. The paper concludes with a discussion of possible remedies for this loss of efficiency in existing systems and optional design strategies in new construction.

  16. Paraurethral Skene′s duct cyst in a newborn

    Directory of Open Access Journals (Sweden)

    Serdar Moralioglu

    2013-01-01

    Full Text Available Paraurethral or Skene′s duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene′s duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene′s duct cyst in a newborn which was treated by incision and drainage.

  17. [Inadvertent thoracic duct puncture during right axially central venous cannulation].

    Science.gov (United States)

    Kawashima, Shingo; Itagaki, Taiga; Adachi, Yushi; Ishii, Yasuhiro; Taniguchi, Midzuki; Doi, Matsuyuki; Sato, Shigehito

    2010-10-01

    A case of inadvertent thoracic duct puncture during right axially central venous cannulation is reported. The catheterization was performed under the real time ultrasound guidance technique and the coronal view image was continuously displayed. After confirming the feelings of venous puncture, clear yellow fluid was aspired into the connected syringe to the needle. Initially, an accidental thoracic puncture with subsequent pleural fluid aspiration was suspected;however, no finding of pleural effusion was observed with ultrasound imaging and computed tomography. Thus, an accidental thoracic duct puncture and the subsequent lymph fluid aspiration were suspected. Even in a right side approach for central venous catheterization, thoracic duct injury might ensure.

  18. BACTERIOLOGICAL INVESTIGATION ON Fasciola hepatica AND CATTLE BILIARY DUCTS

    Directory of Open Access Journals (Sweden)

    A. Panebianco

    2009-03-01

    Full Text Available The aim of this work was to investigate the occurrence of bacteria in Fasciola hepatica and into cattle biliary ducts containing the parasite. A total of 24 liver and 58 F. hepatica samples were analysed. In all biliary ducts and in 62,06% of parasite Enterobacteriaceae were isolated. The bacterial specie more frequently isolated from parasite were Citrobacter freundii (34%, Proteus mirabilis (18%, Providencia rettgeri (12%, Staphylococcus spp. (18%, Enterobacter spp. (12%. There doesn’t appear to be a correlation between bacterial specie from parasite and ducts. The Authors conclude with some related inspective consideration.

  19. Transition duct with late injection in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    LeBegue, Jeffrey Scott; Pentecost, Ronnie Ray; Flanagan, James Scott; Kim, Won -Wook; McMahan, Kevin Weston

    2015-09-15

    A system for supplying an injection fluid to a combustor is disclosed. The system includes a transition duct comprising an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The passage defines a combustion chamber. The system further includes a tube providing fluid communication for the injection fluid to flow through the transition duct and into the combustion chamber.

  20. Comparison of nerve graft integration after segmentar resection versus epineural burying in crushed rat sciatic nerves

    Directory of Open Access Journals (Sweden)

    Cunha Marco Túlio Rodrigues da

    1997-01-01

    Full Text Available The aim of the present paper is to compare and correlate the take of nerve segments in a severely crushed nerve. Forty adult Wistar rats had their right sciatic nerve by a "Péan-Murphy" forceps for 40 minutes. In Group 1 (n=20, a segmentar serection in the crushed sciatic nerve was made. A sural nerve segment from the opposite hindpaw was placed in the gap. In Group 2 (n=20, a lontudinal insision in the epineurium of the lesioned sciatic nerve was made. A sural nerve segment was buried underneath the epineurium. The crushed sciatic nerves undergone Wallerian degeneration and endoneurial fibrosis. Sciatic nerves from Group 2 had significant better histological aspects than those from Group 1. Sural nerve grafts presented better degrees of regeneration than crushed sciatic nerves. Sural nerve grafts from Group 2 (burying method integrated as well as those from Group 1 (segmentar resection.

  1. Resection after preoperative chemotherapy versus synchronous liver resection of colorectal cancer liver metastases

    Science.gov (United States)

    Kim, Chan W.; Lee, Jong L.; Yoon, Yong S.; Park, In J.; Lim, Seok-Byung; Yu, Chang S.; Kim, Tae W.; Kim, Jin C.

    2017-01-01

    Abstract This study aimed to determine the prognostic effects of preoperative chemotherapy for colorectal cancer liver metastasis (CLM). We retrospectively evaluated 2 groups of patients between January 2006 and August 2012. A total of 53 patients who had ≥3 hepatic metastases underwent resection after preoperative chemotherapy (preoperative chemotherapy group), whereas 96 patients who had ≥3 hepatic metastases underwent resection with a curative intent before chemotherapy for CLM (primary resection group). A propensity score (PS) model was used to compare the both groups. The 3-year disease-free survival (DFS) rates were 31.7% and 20.4% in the preoperative chemotherapy and primary resection groups, respectively (log-rank = 0.015). Analyzing 32 PS matched pairs, we found that the DFS rate was significantly higher in the preoperative chemotherapy group than in the primary resection group (3-year DFS rates were 34.2% and 16.8%, respectively [log-rank = 0.019]). Preoperative chemotherapy group patients had better DFSs than primary resection group patients in various multivariate analyses, including crude, multivariable, average treatment effect with inverse probability of treatment weighting model and PS matching. Responses to chemotherapy are as important as achieving complete resection in cases of multiple hepatic metastases. Preoperative chemotherapy may therefore be preferentially considered for patients who experience difficulty undergoing complete resection for multiple hepatic metastases. PMID:28207557

  2. Angiotensin I conversion to angiotensin II stimulates cortical collecting duct sodium transport.

    Science.gov (United States)

    Komlosi, Peter; Fuson, Amanda L; Fintha, Attila; Peti-Peterdi, János; Rosivall, Laszlo; Warnock, David G; Bell, Phillip Darwin

    2003-08-01

    Angiotensin (Ang) II directly stimulates epithelial sodium channel activity in the rabbit cortical collecting duct. Because Ang I and converting enzyme analogues might be present in the distal nephron, this raises the possibility of intraluminal generation of Ang II. Conversion of Ang I to Ang II was monitored by Ang II-dependent changes in intracellular sodium concentration as a reflection of sodium transport across the apical membrane. This involved imaging-based fluorescence microscopy with sodium-binding benzofuran isophthalate in isolated, perfused, cortical collecting-duct segments from rabbit kidney. Principal and intercalated cells were differentiated by rhodamine-conjugated peanut lectin. Control principal cell intracellular sodium concentration, during perfusion with 25 mmol/L NaCl and zero sodium in the bath plus monensin (10(-5) mol/L) averaged 5.8+/-0.14 mmol/L (n=156). The increase in intracellular sodium concentration, when luminal NaCl was increased from 25 to 150 mmol/L, was elevated by 3.5-fold in the presence of intraluminal Ang I (10(-6) mol/L). Also, the effects of Ang I on sodium transport were not significantly different from the effects of Ang II (10(-9) mol/L). Ang I was used in micromolar concentrations to ensure that there was sufficient substrate available for conversion to Ang II. Inhibition of the angiotensin-converting enzyme with captopril reduced the stimulatory effect of Ang I. These results suggest that intraluminal conversion of Ang I to Ang II can occur in the cortical collecting duct, resulting in enhanced apical sodium entry.

  3. Experimental study on inhibitory effect of bridgy duct of hepatic artery on apoptosis of liver and bile duct cells

    Institute of Scientific and Technical Information of China (English)

    Hongwei Lu; Yiming Li; Hong Ji; Jinkai Xu

    2006-01-01

    Objective: To investigate whether the method of bridgy duct established between the recipient's spleen artery and the donor's gastroduodenal artery could inhibit the apoptosis of liver and bile duct cells caused by hepatic artery ischemia.Methods: Twenty-four mongrel dogs from Xi'an area were used to establish simplified models of dog orthotopic liver transplantation and divided into three groups randomly: HAI group (hepatic artery ischemia group),BBB group (bypassing the blood by a bridgy duct) and control group. After cold perfusion, The samples were collected from liver and bile duct in each group at different time and fixed in glutaraldehyde and 4% polyformaldehyde respectively. At last, the apoptosis of liver and bile duct cells were observed and the apoptotic indexes were calculated. Results: Two hours after cold perfusion, apoptotic phenomenon was common in HAI group, rare in BBB group, while no apoptotic phenomenon was observed in control group. TUNEL staining showed that there was no significant difference in apoptotic index among the three groups immediately after cold perfusion. However, with time going, the apoptotic cells were increased in three groups, and the difference in apoptotic index was significant among three groups (P < 0.01 ). Conclusion: Bridgy duct of hepatic artery can inhibit the apoptosis of liver and bile duct cells caused by HAI significantly.

  4. Keypoint Transfer Segmentation

    OpenAIRE

    Wachinger, C.; Toews, M.; Langs, G.; Wells, W.; Golland, P.

    2015-01-01

    We present an image segmentation method that transfers label maps of entire organs from the training images to the novel image to be segmented. The transfer is based on sparse correspondences between keypoints that represent automatically identified distinctive image locations. Our segmentation algorithm consists of three steps: (i) keypoint matching, (ii) voting-based keypoint labeling, and (iii) keypoint-based probabilistic transfer of organ label maps. We introduce generative models for th...

  5. Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, C.; Pavone, P.; Laghi, A.; Panebianco, V.; Scipioni, A.; Fanelli, F.; Brillo, R.; Passariello, R. [Department of Radiology, University of Rome ``La Sapienza`` (Italy)

    1998-03-27

    The purpose of this study was to determine the possibility of integrating MR cholangiopancreatography (MRCP) and MR angiography (MRA) to conventional MR images in the diagnosis and assessment of resectability of pancreatic adenocarcinoma. Twenty-three patients with pancreatic adenocarcinoma were prospectively examined with MR. Conventional MR images were acquired in all patients. Three-dimensional MRCP and MRA images were acquired in all patients with suspected biliary and vascular involvement. Acquisition time was less than 45 min in all cases. Images were independently evaluated by two radiologists, with final reading decided by consensus among readers. Diagnosis was confirmed with surgery in 16 patients and with percutaneous biopsy in 7. Concordance among readers was high with a kappa value of 0.83. Pancreatic adenocarcinoma was observed in all patients. Correct assessment of unresectability due to vascular involvement was found in 22 of 23 patients. Biliary obstruction was evident in 13 patients, involving the biliary and pancreatic ducts in 9 and the biliary ducts only in 4. Technical advances permit extensive use of MRI in the evaluation of abdominal pathologies. The combination of MR imaging, MRCP, and MRA can provide sufficient information for the diagnosis and assessment of resectability of pancreatic adenocarcinoma, which otherwise would require three different exams. (orig.) With 5 figs., 2 tabs., 23 refs.

  6. Universal Numeric Segmented Display

    CERN Document Server

    Azad, Md Abul kalam; Kamruzzaman, S M

    2010-01-01

    Segmentation display plays a vital role to display numerals. But in today's world matrix display is also used in displaying numerals. Because numerals has lots of curve edges which is better supported by matrix display. But as matrix display is costly and complex to implement and also needs more memory, segment display is generally used to display numerals. But as there is yet no proposed compact display architecture to display multiple language numerals at a time, this paper proposes uniform display architecture to display multiple language digits and general mathematical expressions with higher accuracy and simplicity by using a 18-segment display, which is an improvement over the 16 segment display.

  7. Resection for secondary malignancy of the pancreas.

    Science.gov (United States)

    Hung, Jui-Hsia; Wang, Shin-E; Shyr, Yi-Ming; Su, Cheng-Hsi; Chen, Tien-Hua; Wu, Chew-Wun

    2012-01-01

    This study tried to clarify the role of pancreatic resection in the treatment of secondary malignancy with metastasis or local invasion to the pancreas in terms of surgical risk and survival benefit. Data of secondary malignancy of the pancreas from our 19 patients and cases reported in the English literature were pooled together for analysis. There were 329 cases of resected secondary malignancy of the pancreas, including 241 cases of metastasis and 88 cases of local invasion. The most common primary tumor metastatic to the pancreas and amenable to resection was renal cell carcinoma (RCC) (73.9%). More than half (52.3%) of the primary cancers with local invasion to the pancreas were colon cancer, and nearly half (40.9%) were stomach cancer. The median metastatic interval was 84 months (7 years) for overall primary tumors and 108 months (9 years) for RCC. The 5-year survival for secondary malignancy of the pancreas after resection was 61.1% for metastasis and 58.9% for local invasion, with 72.8% for RCC metastasis, 69.0% for colon cancer, and 43.8% for stomach cancer with local invasion to the pancreas. Pancreatic resection should not be precluded for secondary malignancy of the pancreas because long-term survival could be achieved with acceptable surgical risk in selected patients.

  8. Combined radical retropubic prostatectomy and rectal resection.

    Science.gov (United States)

    Klee, L W; Grmoljez, P

    1999-10-01

    To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

  9. ß-adrenergic regulation of ion transport in pancreatic ducts: Patch-clamp study of isolated rat pancreatic ducts

    DEFF Research Database (Denmark)

    Novak, I

    1998-01-01

    much smaller effects. At comparable concentrations, it depolarized Vm by a few millivolts. Neither agonist had significant effects on intracellular Ca2+. CONCLUSIONS: This study provides the first direct evidence that adrenergic stimulation, namely, that of beta-adrenoceptors, controls ion transport....... METHODS: Small intralobular ducts were isolated from rat pancreas and studied in vitro by the whole-cell patch clamp technique. Cell membrane voltages and currents were indicators of cellular ion transport. In some ducts, intracellular Ca2+ activity was measured by fluorescence optical methods. RESULTS...... in pancreatic ducts. Similar to secretin, isoproterenol stimulation leads to opening of luminal Cl- channels, and HCO3- enters the lumen in exchange for Cl-....

  10. Practical approaches to effective management of intestinal radiation injury: Benefit of resectional surgery

    Institute of Scientific and Technical Information of China (English)

    Nikolaos Perrakis; Evangelos Athanassiou; Dimitra Vamvakopoulou; Maria Kyriazi; Haris Kappos; Nikolaos C Vamvakopoulos; Iakovos Nomikos

    2011-01-01

    AIM: To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.METHODS: During a 7-year period we operated on 17 cases (5 male, 12 female) admitted to our surgical department with intestinal radiation injury (IRI). They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy. During follow-up, they developed radiation enteritis requiring surgical treatment due to failure of conservative management.RESULTS: IRI was located in the terminal ileum in 12 patients, in the rectum in 2 patients, in the descending colon in 2 patients, and in the cecum in one patient. All patients had resection of the affected region(s). There were no postoperative deaths, while 3 cases presented with postoperative complications (17.7%). All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range, 6-96 mo).CONCLUSION: We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

  11. Feasibility of the mini-open vertebral column resection for severe thoracic kyphosis.

    Science.gov (United States)

    Chou, Dean; Lau, Darryl; Roy, Esha

    2014-05-01

    Severe thoracic kyphosis caused by pathologic fractures often needs to be corrected by resection of the collapsed vertebral body, reconstruction of the anterior spinal column, and correction of the kyphosis with long-segment fixation. The resection of this pathologic bone functions essentially as a vertebral column resection. With the advent of minimally invasive technology, the powerful corrective forces afforded in open cases can be applied using a less invasive approach. In this article, we describe a mini-open posterior technique for thoracic kyphosis via a vertebrectomy and cantilever technique. Two patients underwent kyphosis correction via mini-open vertebrectomy. One patient was corrected from 92 degrees to 65 degrees, and the second patient was corrected from 70 degrees to 53 degrees. Both patients underwent a mini-open approach. Cantilever correction was accomplished over an expandable cage with a minimally invasive pedicle screw system. We describe our technique of mini-open vertebral column resection and kyphosis correction in the thoracic spine.

  12. Anomalous pancreatico-biliary ductal union with cystic dilatation of the bile duct.

    Science.gov (United States)

    Richer, J P; Faure, J P; Morichau-Beauchant, M; Dugue, T; Maillot, N; Kamina, P; Carretier, M

    1998-01-01

    We report, in an adult, an asymptomatic association between cystic dilation of the bile duct (type IV A in Todani's classification) and anomalous pancreatico-biliary ductal union (APBD) with stones in a long common channel. In APBD, the connection between the common bile duct and the main pancreatic duct is located outside the duodenal wall andis therefore not under the influence of the sphincter of Boyden. An abnormally long common channel is in excess of 15 mm. Two types of convergence anomalies are defined according to whether the bile duct opens into the main pancreatic duct (BP) or the main pancreatic duct into the bile duct (PB). In APBD, there is probably a reverse pressure gradient between the bile and pancreatic ducts, with regurgitation of pancreatic juice into the bile duct, repeated attacks of cholangitis, stenosis and cystic dilatation. A long common channel is associated with a higher incidence of carcinoma of the gall bladder of the bile duct.

  13. Heat Transfer Augmentation in Developing Flow Through a Ribbed Square Duct

    Institute of Scientific and Technical Information of China (English)

    Khan R K; Ali M.A.T; Akhanda M.A.R

    2006-01-01

    An experimental study is conducted to investigate the heat transfer augmentation in developing turbulent flow through a ribbed square duct. The duct is made of 16mm thick bakelite sheet. The bottom surface of the ribbed wall having rib pitch to height ratio of 10 is heated by passing a c current to the heater placed under it. The uniform heating is controlled using a digital temperature controller and a variac. The results of ribbed duct are compared with the results of a smooth duct under the same experimental conditions. It is observed that the heat transfer augmentation in ribbed duct is better than that of the smooth duct. At Re=5.0 × 104 , the mean temperature of air flowing through the ribbed duct increases by 2.45 percent over the smooth duct, whereas in the ribbed duct Nusselt number increases by 15.14 percent than that of the smooth duct with a 6 percent increase in pressure drop.

  14. Molecular basis of potassium channels in pancreatic duct epithelial cells

    DEFF Research Database (Denmark)

    Hayashi, M.; Novak, Ivana

    2013-01-01

    Potassium channels regulate excitability, epithelial ion transport, proliferation, and apoptosis. In pancreatic ducts, K channels hyperpolarize the membrane potential and provide the driving force for anion secretion. This review focuses on the molecular candidates of functional K channels...

  15. Sound transmission through ducts and aircraft noise prediction, volume 1

    Science.gov (United States)

    Schauer, J. J.; Datko, J. T.; Guyton, R. W.

    1982-01-01

    Aircraft engine acoustical lining impedance models, ray acoustics, hydrodynamic modes, and transient analysis of sound propagation in variable area duct studies were applied to aircraft noise prediction. The effects of several duct lining configurations in a TF33 P5 and a CFM56 engined KC-135B aircraft were predicted. The prediction was based on a model corrected to fit flight noise data and modified by including theoretical duct noise attenuation predictions. The transient solution of variable area ducts permitted the prediction of sound propgation in bullet nose inlets for no low and was moderately successful when a potential flow was included with low Mach numbers. Volume 1 contains the technical report and analysis. Volume 2 contains the user's manuals and listings of the computer codes developed.

  16. Scattering matrices in non-uniformly lined ducts

    Science.gov (United States)

    Demir, Ahmet

    2017-02-01

    Sudden area expansion and sudden area contraction in an infinitely long duct with discontinuous locally reacting lining are defined by respective mixed boundary value problems. In the absence of a sudden area change, a separate problem with an infinite duct having bifid lining on its wall is described. Introducing Fourier transform along the duct axis boundary value problems is solved by the well-known Wiener-Hopf technique, and then, corresponding scattering matrices are constructed. To show the proper use of scattering matrices in the case of several discontinuities and also validation and comparison purposes, transmitted field in a duct with an inserted expansion chamber whose walls are treated by acoustically absorbent material is derived by the help of the relevant scattering matrices. A perfect agreement is observed when the transmitted fields are compared numerically with a similar work exists in the literature.

  17. ATP release, generation and hydrolysis in exocrine pancreatic duct cells

    DEFF Research Database (Denmark)

    Kowal, Justyna Magdalena; Yegutkin, G.G.; Novak, Ivana

    2015-01-01

    Extracellular adenosine triphosphate (ATP) regulates pancreatic duct function via P2Y and P2X receptors. It is well known that ATP is released from upstream pancreatic acinar cells. The ATP homeostasis in pancreatic ducts, which secrete bicarbonate-rich fluid, has not yet been examined. First, our...... aim was to reveal whether pancreatic duct cells release ATP locally and whether they enzymatically modify extracellular nucleotides/sides. Second, we wished to explore which physiological and pathophysiological factors may be important in these processes. Using a human pancreatic duct cell line, Capan......-1, and online luminescence measurement, we detected fast ATP release in response to pH changes, bile acid, mechanical stress and hypo-osmotic stress. ATP release following hypo-osmotic stress was sensitive to drugs affecting exocytosis, pannexin-1, connexins, maxi-anion channels and transient...

  18. Nasolacrimal duct mucocele: case report and literature review.

    Science.gov (United States)

    Britto, Fernanda Carneiro Corujeira de; Rosier, Vitor Veloso; Luz, Tovar Vicente; Verde, Raquel Crisóstomo Lima; Lima, Clara Mônica Figueiredo de; Lessa, Marcus Miranda

    2015-01-01

    Introduction Mucoceles are benign expansive cystic formations, composed of a mucus-secreting epithelium (respiratory or pseudostratified epithelium). Nasolacrimal mucocele occurs in a small proportion of children with nasolacrimal duct obstruction and is characterized by a cystic mass in the medial canthus with dilation of the nasolacrimal duct; although dacryocystoceles are rare in adults, they have been reported in patients with trachoma. Objective Discuss clinical aspects, diagnosis, and therapeutic management of mucocele of nasolacrimal duct based on literature review. Resumed Report The authors report a case of bilateral congenital nasolacrimal duct cysts in a 30-year-old man, identified as a tumor in the topography of both lacrimal sacs since birth without associated symptoms. The patient underwent successive surgical treatments, leading to recurrence of the tumor at the right side and recurrent local infections. Conclusion Endoscopic dacryocystorhinostomy has been increasingly used with good results and success rates similar to the external access.

  19. Design requirement on KALIMER control rod assembly duct

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, W.; Kang, H. Y.; Nam, C.; Kim, J. O.; Kim, Y. J

    1998-03-01

    This document establishes the design guidelines which are needs for designing the control rod assembly duct of the KALIMER as design requirements. it describes control rod assembly duct of the KALIMER and its requirements that includes functional requirements, performance requirements, interfacing systems, design limits and strength requirements, seismic requirements, structural requirements, environmental requirements, reliability and safety requirements, standard and codes, QA programs, and other requirements. The control rod system consists of three parts, which are drive mechanism, drive-line, and absorber bundle. This report deals with the absorber bundle and its outer duct only because the others are beyond the scope of fuel system design. The guidelines for design requirements intend to be used for an improved design of the control rod assembly duct of the KALIMER. (author). 19 refs.

  20. Nasolacrimal Duct Mucocele: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Britto, Fernanda Carneiro Corujeira de

    2014-02-01

    Full Text Available Introduction Mucoceles are benign expansive cystic formations, composed of a mucus-secreting epithelium (respiratory or pseudostratified epithelium. Nasolacrimal mucocele occurs in a small proportion of children with nasolacrimal duct obstruction and is characterized by a cystic mass in the medial canthus with dilation of the nasolacrimal duct; although dacryocystoceles are rare in adults, they have been reported in patients with trachoma. Objective Discuss clinical aspects, diagnosis, and therapeutic management of mucocele of nasolacrimal duct based on literature review. Resumed Report The authors report a case of bilateral congenital nasolacrimal duct cysts in a 30-year-old man, identified as a tumor in the topography of both lacrimal sacs since birth without associated symptoms. The patient underwent successive surgical treatments, leading to recurrence of the tumor at the right side and recurrent local infections. Conclusion Endoscopic dacryocystorhinostomy has been increasingly used with good results and success rates similar to the external access.

  1. Iatrogenic nasolacrimal duct obstruction following tooth extraction in a cat.

    Science.gov (United States)

    Paiva, Sávia Calline C S; Froes, Tilde R; Lange, Rogério Ribas; Machado, Marcello; Pachaly, José Ricardo; Montiani-Ferreira, Fabiano

    2013-01-01

    A 10-year-old DSH cat was referred for a dental evaluation and extraction procedure. Subsequently, the animal developed an acute onset of ocular discharge. Ophthalmologic examination revealed presence of unilateral ocular mucoid discharge leading to a diagnosis of epiphora secondary to nasolacrimal duct obstruction. Dacryocystorhinography was performed and confirmed the presence of a nasolacrimal duct obstruction, presumably acquired after an invasive dental procedure. Additionally, a vinyl cast in situ study of the nasolacrymal apparatus was performed to demonstrate the route of the nasolacrimal duct in the cat and its relationship to oral dental structures. This report documents an unusual case in which excessive inflammation/edema following tooth extraction caused acute epiphora secondary to extraluminal compression of the distal nasolacrimal duct.

  2. Low Cost/Low Noise Variable Pitch Ducted Fan Project

    Data.gov (United States)

    National Aeronautics and Space Administration — ACI proposes a design for a Propulsor (Low Cost/Low Noise Variable Pitch Ducted Fan) that has wide application in all sectors of Aviation. Propulsor hardware of this...

  3. Molecular basis of potassium channels in pancreatic duct epithelial cells

    DEFF Research Database (Denmark)

    Hayashi, M.; Novak, Ivana

    2013-01-01

    Potassium channels regulate excitability, epithelial ion transport, proliferation, and apoptosis. In pancreatic ducts, K channels hyperpolarize the membrane potential and provide the driving force for anion secretion. This review focuses on the molecular candidates of functional K channels in pan...

  4. Measure Guideline: Buried and/or Encapsulated Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Shapiro, C. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Zoeller, W. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Mantha, P. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States)

    2013-08-01

    Buried and/or encapsulated ducts (BEDs) are a class of advanced, energy-efficiency strategies intended to address the significant ductwork thermal losses associated with ducts installed in unconditioned attics. BEDs are ducts installed in unconditioned attics that are covered in loose-fill insulation and/or encapsulated in closed cell polyurethane spray foam insulation. This Measure Guideline covers the technical aspects of BEDs as well as the advantages, disadvantages, and risks of BEDs compared to other alternative strategies. This guideline also provides detailed guidance on installation of BEDs strategies in new and existing homes through step-by-step installation procedures. Some of the procedures presented here, however, require specialized equipment or expertise. In addition, some alterations to duct systems may require a specialized license.

  5. Hepatic Resection Using a Water Jet Dissector

    Science.gov (United States)

    Stain, S. C.; Guastella, T.; Maddern, G. J.; Blumgart, L. H.

    1993-01-01

    The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure, high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty-seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The results showed no difference in operative duration (p = .499). The mean estimated blood loss using the water jet was 1386 ml, and tissue fracture technique 2450 ml (p = .217). Transfusion requirements were less in the water jet group (mean 2.0 units) compared to the tissue fracture group (mean 5.2 units); (p = .023). Results obtained with the new water dissector are encouraging. The preliminary results suggest that blood loss may be diminished. PMID:8387808

  6. DNA End Resection:Facts and Mechanisms

    Institute of Scientific and Technical Information of China (English)

    Ting Liu; a Jun Huang; b

    2016-01-01

    DNA double-strand breaks (DSBs), which arise following exposure to a number of endogenous and exogenous agents, can be repaired by either the homologous recombination (HR) or non-homologous end-joining (NHEJ) pathways in eukaryotic cells. A vital step in HR repair is DNA end resection, which generates a long 30 single-stranded DNA (ssDNA) tail that can invade the homologous DNA strand. The generation of 30 ssDNA is not only essential for HR repair, but also promotes activation of the ataxia telangiectasia and Rad3-related protein (ATR). Multiple fac-tors, including the MRN/X complex, C-terminal-binding protein interacting protein (CtIP)/Sae2, exonuclease 1 (EXO1), Bloom syndrome protein (BLM)/Sgs1, DNA2 nuclease/helicase, and several chromatin remodelers, cooperate to complete the process of end resection. Here we review the basic machinery involved in DNA end resection in eukaryotic cells.

  7. Acoustic propagation in partially choked converging-diverging ducts

    Science.gov (United States)

    Kelly, J. J.; Nayfeh, A. H.; Watson, L. T.

    1982-01-01

    A computer model based on the wave-envelope technique is used to study acoustic propagation in converging-diverging hard walled and lined circular ducts carrying near sonic mean flows. The influences of the liner admittance, boundary layer thickness, spinning mode number, and mean Mach number are considered. The numerical results indicate that the diverging portion of the duct can have a strong reflective effect for partially choked flows.

  8. Compact Buried Ducts in a Hot-Humid Climate House

    Energy Technology Data Exchange (ETDEWEB)

    Mallay, D. [Home Innovation Research Labs, Upper Marlboro, MD (United States)

    2016-01-01

    A system of compact, buried ducts provides a high-performance and cost-effective solution for delivering conditioned air throughout the building. This report outlines research activities that are expected to facilitate adoption of compact buried duct systems by builders. The results of this research would be scalable to many new house designs in most climates and markets, leading to wider industry acceptance and building code and energy program approval.

  9. Surgical versus endoscopic treatment of bile duct stones

    DEFF Research Database (Denmark)

    Martin, D J; Vernon, D R; Toouli, J

    2006-01-01

    10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery.......10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP) or open or laparoscopic surgery....

  10. Bile duct hamar tomas-the von Meyenburg complex

    Institute of Scientific and Technical Information of China (English)

    Valdemir José Alegre Salles; Alexandre Marotta; Jorge Miguel Kather Netto; Manlio Basílio Speranzini; Marcos Roberto Martins

    2007-01-01

    Hamartomas of the bile duct (von Meyenburg complex) are benign neoplasms of the liver, constituted histologically cystic dilatations of the bile duct, encompassed by ifbrous stroma. We report a 42-year-old female patient with symptomatic cholecystitis, whose gross and ultrasonic appearance suggestive of multiple liver metastases. Magnetic resonance imaging and liver biopsy are the gold standards for diagnosis of this rare hepatobiliary condition.

  11. A case report of hepatocellular carcinoma in common hepatic duct

    Energy Technology Data Exchange (ETDEWEB)

    Song, Chi Sung; Park, In Ae; Choi, Sang Woon; Chung, Jung Kee [YongDeungPo City Hospital, Seoul (Korea, Republic of)

    1989-08-15

    We experienced a rare case of intraductal (common hepatic duct) hepatocellular carcinoma. Review of the literature disclosed 30 cases or less in which common duct involvement was a predominant clinical feature. Well demarcated, ovoid filling defect mass in CHD without parenchymal tumor mass was noted in ultrasound, PTC and CT study. The liver was cirrhotic, but {alpha}-fetoprotein level was normal. Differential diagnosis especially with Klatskin tumor is important and thought to be possible.

  12. BETTER DUCT SYSTEMS FOR HOME HEATING AND COOLING.

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.

    2001-01-01

    This is a series of six guides intended to provide a working knowledge of residential heating and cooling duct systems, an understanding of the major issues concerning efficiency, comfort, health, and safety, and practical tips on installation and repair of duct systems. These guides are intended for use by contractors, system designers, advanced technicians, and other HVAC professionals. The first two guides are also intended to be accessible to the general reader.

  13. Female form of persistent mullerian duct syndrome: Rare entity

    Directory of Open Access Journals (Sweden)

    Shailesh Solanki

    2015-01-01

    Full Text Available Persistent Mullerian duct syndrome (PMDS is a rare form of Disorder of sex development in which Mullerian duct derivatives (fallopian tubes, uterus and the proximal vagina are present in an otherwise normally differentiated 46 XY male. In the majority of cases, PMDS is a surprise finding either during orchidopexy or during inguinal hernia repair. We report a case of 4 year child with female type (Type III PMDS. We are discussing the presentation, management and review of the literature.

  14. EXPERIMENTAL INVESTIGATION OF A VARIABLE GEOMETRY DUCTED PROPELLER

    Directory of Open Access Journals (Sweden)

    Tomasz Muszyński

    2013-03-01

    Full Text Available The paper presents preliminary results of experimental research on the variable geometry of a ducted propeller. The purpose of this work is explore the area of ​​application of the ducted propellers of variable geometry. The paper contains the description of a test station and a model, initial tests’ results of some selected geometries intakes and exit vents in comparison with an open propeller.

  15. HVAC; Heating, Ventilation, Air Conditioning - Aerosol Duct Sealant

    Science.gov (United States)

    2016-09-01

    Approved for public release: distribution unlimited TDS-NAVFAC-EXWC-PW-1603 Sep 2016 HVAC ; Heating, Ventilation, Air Conditioning - Aerosol...energy consumption, depending on the HVAC system type and the location of the ducts that were sealed. The cost effectiveness of the technology is...Although several studies have been done on the effectiveness of sealing leaky HVAC ductwork with aerosol duct sealant, few studies have been done on

  16. A case of peribiliary cysts accompanying bile duct carcinoma

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Miura; Tadahiro Takada; Hodaka Amano; Masahiro Yoshida; Takahiro Isaka; Naoyuki Toyota; Keita Wada; Kenji Takagi; Kenichiro Karo

    2006-01-01

    A rare case of peribiliary cysts accompaying bile duct carcinoma is presented. A 54-year-old man was diagnosed as having lower bile duct carcinoma and peribiliary cysts by diagnostic imaging. He underwent pylorus preserving pancreatoduodenectomy. As for the peribiliary cysts, a course of observation was taken.Over surgery due to misdiagnosis of patients with biliary malignancy accompanied by peribiliary cysts should be avoided.

  17. Renal Collecting Duct Cancer: a Report of 2 Cases

    Institute of Scientific and Technical Information of China (English)

    Shiying Zhou

    2005-01-01

    @@ Renal collecting duct cancer is a rare malignant tumor, which accounts for 1% to 2% of epithelial kidney tumors,[1] Its pathological appearance has been easily misdiagnosed as a mammilliform renal cell carcinoma or as other tumors. The malignancy of renal collecting duct cancer is high, with early metastasis and poor prognosis. The clinical data for 2 cases of the tumor are discussed in this report, including reports on the histopathology and the changes in immunohistochemistry.

  18. Development and regression of the thyroglossal duct in mice.

    Science.gov (United States)

    Inoue, Katsuyuki; Bando, Yasuhiko; Sakiyama, Koji; Takizawa, Shota; Sakashita, Hideaki; Kondo, Hisatake; Amano, Osamu

    2015-07-01

    The thyroid anlage develops in the foramen caecum area of the tongue, and migrates through the anterior neck towards its final position in front of the laryngeal cartilages. During migration, the thyroglossal duct, a temporary structure connecting the thyroid anlage and the foramen caecum, is recognized. In the present study, chronological changes and apoptosis in the thyroglossal duct of mice were investigated histochemically using an antibody against Nkx2-1, initially identified as a thyroid transcription factor 1 (TTF1), and the TUNEL reaction in consecutive serial sagittal sections. At embryonic day 10.00 (E10.00), the thyroid anlage was Nkx2-1-immunoreactive and located just below the foramen caecum. As the thyroid anlage descended, the thyroglossal duct was formed at E10.25, being less than 10μm in diameter. By E10.75, the Nkx2-1-positive thyroglossal duct had progressively elongated up to 100μm. At E11.00 the thyroglossal duct began to disappear, beginning in its mid-portion, and finally became invisible at E11.50. At E11.00-12.00, apoptotic cells were found in an area where the thyroglossal duct was partially discontinuous. After E12.00, cartilaginous tissue of the hyoid bone anlage developed in the mid-portion of the area where the thyroglossal duct had regressed. Immunoreactivity for thyroglobulin, a marker of differentiated thyroid endocrine cells, was detected at E13.00. These results strongly suggest that the mouse thyroglossal duct disappears as a result of apoptosis before differentiation of the endocrine thyroid.

  19. On One-dimensional Sound Analysis of a Duct Network with Helmholtz Resonators

    OpenAIRE

    寺尾, 道仁; Terao, Michihito; 関根, 秀久; Sekine, Hidehisa; 大川, 真平; Okawa, Shinpei; 林, 大志; Hayashi, Daiji

    2002-01-01

    The outer orifice correction for Helmholtz resonators attached to the sidewall ofcircular ducts was studied. For the outer orifice correction when the axis direction ofthe orifice coincides with that of the duct, .explicit expressions were given by Ingard and Rschevkin. But their application to duct sections with duct-sidewall resonators is beyond their premise. An explicit expression ofthe outer orifice correction for duct-sidewall resonators was derived by conducting three-dimensionalbounda...

  20. Note on reflection and transmission coefficients for converging-diverging ducts

    Science.gov (United States)

    Durbin, P. A.

    1981-09-01

    Simple formulas for calculating acoustic reflection and transmission coefficients for converging-diverging ducts are derived; they extend the method of Cho and Ingard to arbitrary, slowly varying ducts. These formulas involve two parameters. The first is a function of duct shape and the second is the ratio of the duct radius downstream of the throat to that upstream of the throat to the upstream of the throat. An extension of the method to include mean flow is made for symmetric ducts.

  1. From interpretation to segmentation

    NARCIS (Netherlands)

    Koning, A.R.; Lier, R.J. van

    2005-01-01

    In visual perception, part segmentation of an object is considered to be guided by image-based properties, such as occurrences of deep concavities in the outer contour. However, object-based properties can also provide information regarding segmentation. In this study, outer contours and interpretat

  2. Segmentation, advertising and prices

    NARCIS (Netherlands)

    Galeotti, Andrea; Moraga González, José

    This paper explores the implications of market segmentation on firm competitiveness. In contrast to earlier work, here market segmentation is minimal in the sense that it is based on consumer attributes that are completely unrelated to tastes. We show that when the market is comprised by two

  3. Segmentation, advertising and prices

    NARCIS (Netherlands)

    Galeotti, Andrea; Moraga González, José

    2008-01-01

    This paper explores the implications of market segmentation on firm competitiveness. In contrast to earlier work, here market segmentation is minimal in the sense that it is based on consumer attributes that are completely unrelated to tastes. We show that when the market is comprised by two consume

  4. Benign segmental bronchial obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Loercher, U.

    1988-09-01

    The benigne segmental bronchial obstruction - mostly discovered on routine chest films - can well be diagnosed by CT. The specific findings in CT are the site of the bronchial obstruction, the mucocele and the localized empysema of the involved segment. Furthermore CT allows a better approach to the underlying process.

  5. Hospital benefit segmentation.

    Science.gov (United States)

    Finn, D W; Lamb, C W

    1986-12-01

    Market segmentation is an important topic to both health care practitioners and researchers. The authors explore the relative importance that health care consumers attach to various benefits available in a major metropolitan area hospital. The purposes of the study are to test, and provide data to illustrate, the efficacy of one approach to hospital benefit segmentation analysis.

  6. Natural convection heat transfer along vertical rectangular ducts

    Science.gov (United States)

    Ali, M.

    2009-12-01

    Experimental investigations have been reported on steady state natural convection from the outer surface of vertical rectangular and square ducts in air. Seven ducts have been used; three of them have a rectangular cross section and the rest have square cross section. The ducts are heated using internal constant heat flux heating elements. The temperatures along the vertical surface and the peripheral directions of the duct wall are measured. Axial (perimeter averaged) heat transfer coefficients along the side of each duct are obtained for laminar and transition to turbulent regimes of natural convection heat transfer. Axial (perimeter averaged) Nusselt numbers are evaluated and correlated using the modified Rayleigh numbers for laminar and transition regime using the vertical axial distance as a characteristic length. Critical values of the modified Rayleigh numbers are obtained for transition to turbulent. Furthermore, total overall averaged Nusselt numbers are correlated with the modified Rayleigh numbers and the area ratio for the laminar regimes. The local axial (perimeter averaged) heat transfer coefficients are observed to decrease in the laminar region and increase in the transition region. Laminar regimes are obtained at the lower half of the ducts and its chance to appear decreases as the heat flux increases.

  7. [From Langenbuch to Strasberg: the spectrum of bile duct injuries].

    Science.gov (United States)

    Mercado, Miguel Angel

    2004-01-01

    Bile duct injuries are the main serious complication of laparoscopy cholecystectomy. The frequency of this type of injuries rangers, between 1 to 3 in 1,000 cases and although this rate remains stables, their frequency has increased because of the increasing expansion of the indication of cholecystectomy. Each lesion is the individual in it's features as well as the scenario in which the surgeon faces it. Several classifications have been developed, but that developed by Strasberg most used nowadays. Intraoperative cholangiography has shown evidence in meta analytic studies that diminishes the frequency of lesions but does not abolish them. Conversion from laparoscope's to the open approach with ample and convincent dissection is probably the best maneuver to reduce the frequency of lesions, when any anatomical or technical doubt appears. No patient should be operated in critical condition. In this situation, biliary reconstruction has a secondary role and only drainage of the ducts (percutaneous or surgical) is indicated. Roux en Y hepatoyeyunostomy is the procedure of choice for almost all cases, leaving other types of procedures for selected cases. Transhepatic transanastomotical stents should be used according to the individual status of the patient when small, scared or inflamed ducts are found. High quality anastomosis is obtained when proper ducts are found. Sometimes high dissection of the ducts is needed in order to obtain adequate ducts. Nine of each ten cases are completely rehabilitated, obtaining a good quality of life.

  8. WAVE PROPAGATION in the HOT DUCT of VHTR

    Energy Technology Data Exchange (ETDEWEB)

    Richard Schultz; Jim C. P. Liou

    2013-07-01

    In VHTR, helium from the reactor vessel is conveyed to a power conversion unit through a hot duct. In a hypothesized Depressurized Conduction Cooldown event where a rupture of the hot duct occurs, pressure waves will be initiated and reverberate in the hot duct. A numerical model is developed to quantify the transients and the helium mass flux through the rupture for such events. The flow path of the helium forms a closed loop but only the hot duct is modeled in this study. The lower plum of the reactor vessel and the steam generator are treated as specified pressure and/or temperature boundary to the hot duct. The model is based on the conservation principles of mass, momentum and energy, and on the equations of state for helium. The numerical solution is based on the method of characteristics with specified time intervals with a predictor and corrector algorithm. The rupture sub-model gives reasonable results. Transients induced by ruptures with break area equaling 20%, 10%, and 5% of the duct cross-sectional area are described.

  9. Energy efficient engine: Turbine transition duct model technology report

    Science.gov (United States)

    Leach, K.; Thurlin, R.

    1982-01-01

    The Low-Pressure Turbine Transition Duct Model Technology Program was directed toward substantiating the aerodynamic definition of a turbine transition duct for the Energy Efficient Engine. This effort was successful in demonstrating an aerodynamically viable compact duct geometry and the performance benefits associated with a low camber low-pressure turbine inlet guide vane. The transition duct design for the flight propulsion system was tested and the pressure loss goal of 0.7 percent was verified. Also, strut fairing pressure distributions, as well as wall pressure coefficients, were in close agreement with analytical predictions. Duct modifications for the integrated core/low spool were also evaluated. The total pressure loss was 1.59 percent. Although the increase in exit area in this design produced higher wall loadings, reflecting a more aggressive aerodynamic design, pressure profiles showed no evidence of flow separation. Overall, the results acquired have provided pertinent design and diagnostic information for the design of a turbine transition duct for both the flight propulsion system and the integrated core/low spool.

  10. An evaporation duct prediction model coupled with the MM5

    Institute of Scientific and Technical Information of China (English)

    JIAO Lin; ZHANG Yonggang

    2015-01-01

    Evaporation duct is an abnormal refractive phenomenon in the marine atmosphere boundary layer. It has been generally accepted that the evaporation duct prominently affects the performance of the electronic equipment over the sea because of its wide distribution and frequent occurrence. It has become a research focus of the navies all over the world. At present, the diagnostic models of the evaporation duct are all based on the Monin-Obukhov similarity theory, with only differences in the flux and character scale calculations in the surface layer. These models are applicable to the stationary and uniform open sea areas without considering the alongshore effect. This paper introduces the nonlinear factorav and the gust wind itemwg into the Babin model, and thus extends the evaporation duct diagnostic model to the offshore area under extremely low wind speed. In addition, an evaporation duct prediction model is designed and coupled with the fifth generation mesoscale model (MM5). The tower observational data and radar data at the Pingtan island of Fujian Province on May 25–26, 2002 were used to validate the forecast results. The outputs of the prediction model agree with the observations from 0 to 48 h. The relative error of the predicted evaporation duct height is 19.3% and the prediction results are consistent with the radar detection.

  11. Measure Guideline: Buried and/or Encapsulated Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Shapiro, C.; Zoeller, W.; Mantha, P.

    2013-08-01

    Buried and/or encapsulated ducts (BEDs) are a class of advanced, energy-efficiency strategies intended to address the significant ductwork thermal losses associated with ducts installed in unconditioned attics. BEDs are ducts installed in unconditioned attics that are covered in loose-fill insulation and/or encapsulated in closed cell polyurethane spray foam insulation. This Measure Guideline covers the technical aspects of BEDs as well as the advantages, disadvantages, and risks of BEDs compared to other alternative strategies. This guideline also provides detailed guidance on installation of BEDs strategies in new and existing homes through step-by-step installation procedures. This Building America Measure Guideline synthesizes previously published research on BEDs and provides practical information to builders, contractors, homeowners, policy analysts, building professions, and building scientists. Some of the procedures presented here, however, require specialized equipment or expertise. In addition, some alterations to duct systems may require a specialized license. Persons implementing duct system improvements should not go beyond their expertise or qualifications. This guideline provides valuable information for a building industry that has struggled to address ductwork thermal losses in new and existing homes. As building codes strengthen requirements for duct air sealing and insulation, flexibility is needed to address energy efficiency goals. While ductwork in conditioned spaces has been promoted as the panacea for addressing ductwork thermal losses, BEDs installations approach - and sometimes exceed - the performance of ductwork in conditioned spaces.

  12. Anaesthetic management in thoracoscopic distal tracheal resection.

    Science.gov (United States)

    Acosta Martínez, J; Beato López, J; Domínguez Blanco, A; López Romero, J L; López Villalobos, J L

    2017-03-01

    Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Laparoscopic resection for incidentally detected Meckel diverticulum

    Institute of Scientific and Technical Information of China (English)

    Davide Bona; Luigi Stefano Schipani; Marco Nencioni; Barbara Rubino; Luigi Bonavina

    2008-01-01

    The management of Meckel diverticulum found un-expectedly during an abdominal operation remains controversial.Most published reports have included only patients undergoing diverticulectomy or bowel resection through laparotomy.We report a case of a carcinoid tumor in a Meckel's diverticulum which was incidentally detected and removed during laparoscopic inguinal hernia repair.Although there is no compelling evidence in the literature to recommend prophylactic diverticulectomy,laparoscopic stapled resection represents a viable and safe approach in healthy individuals undergoing elective surgery for other purposes.

  14. Measure Guideline: Summary of Interior Ducts in New Construction, Including an Efficient, Affordable Method to Install Fur-Down Interior Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Beal, D. [BA-PIRC, Cocoa, FL (United States); McIlvaine, J. [BA-PIRC, Cocoa, FL (United States); Fonorow, K. [BA-PIRC, Cocoa, FL (United States); Martin, E. [BA-PIRC, Cocoa, FL (United States)

    2011-11-01

    This document illustrates guidelines for the efficient installation of interior duct systems in new housing, including the fur-up chase method, the fur-down chase method, and interior ducts positioned in sealed attics or sealed crawl spaces.

  15. Survival benefit in patients after palliative resection vs non-resection colon cancer surgery

    Institute of Scientific and Technical Information of China (English)

    A Beham; M Rentsch; K Püllmann; L Mantouvalou; H Spatz; HJ Schlitt; A Obed

    2006-01-01

    AIM: To evaluate survival in patients undergoing palliative resection versus non-resection surgery for primary colorectal cancer in a retrospective analysis.METHODS: Demographics, TNM status, operating details and survival were reviewed for 67 patients undergoing surgery for incurable colorectal cancer. Palliative resection of the primary tumor was performed in 46 cases in contrast to 21 patients with non-resection of the primary tumor and bypass surgery. Risk factors for postoperative mortality and poor survival were analyzed with univariate and multivariate analyses.RESULTS: The two groups were comparable in terms of age, gender, preoperative presence of ileus and tumor stage. Multivariate analysis showed that median survival was significantly higher in patients with palliative resection surgery (544 vs 233 d). Differentiation of the tumor and tumor size were additional independent factors that were associated with a significantly poorer survival rate.CONCLUSION: Palliative resection surgery for primary colorectal cancer is associated with a higher median survival rate. Also, the presence of liver metastasis and tumor size are associated with poor survival. Therefore,resection of the primary tumor should be considered in patients with non-curable colon cancer.

  16. Cystic dilatation of the common bile duct in adults: report of five cases and review of literature

    Directory of Open Access Journals (Sweden)

    Arruda Pedro Carlos Loureiro de

    2000-01-01

    Full Text Available The authors report five cases of cystic dilatation of the common bile duct Type I (Todani?s classification in adults patients, in Division of General Surgery of a University Hospital, treated over a- 25-year- period from 1974 to 1999, among 16.057 operations, and not previously published. Diagnosis was obtained by operative cholangiogram (OC in the first case, percutaneous transhepatic cholangiogram on the second one (PTHC and by ultrasonography (US, endoscopic retrograde cholangiopancreatography (ERCP, and operative cholangiogram (OC, respectively, on the last three cases. The second patient had an adenocarcinoma arising in the cystic wall associated with peritoneal metastasis. The first two cases were treated by internal drainage and the last three by excision of the cysts and bilioenteric anastomoses. Classification, incidence, etiology, diagnosis, malignization and surgical treatment of biliary cystic disease (BCD were revised, with the conclusion that resection must be the preferable method of treatment, when possible, especially due to the concern of malignization.

  17. 22例腮腺导管损伤手术治疗疗效分析%Clinical analysis of 22 cases with parotid gland duct injury

    Institute of Scientific and Technical Information of China (English)

    蒋勇联; 杨沛蕾; 刘国元

    2011-01-01

    PURPOSE: To discuss the early diagnosis and treatment of injury to the parotid duct. METHODS Segmental epidural catheter was used to repair the injured parotid duct, if the broken ends of the parotid duct can't b< anastomized end to end, facial vein transplantation and fascia parotideomasseterica flap were used for reconstruction RESULTS: In 22 cases, one case was lost to follow-up, nineteen cases had successful reconstruction of the parotid due with good parotid secretions. Two cases had atrophy of the parotid gland. CONCLUSIONS: Early diagnosis is critical fo treatment of injury of parotid duct. The efficacy of segmental epidural catheter is excellent for repair of parotid duct defect%目的:探讨腮腺导管损伤的早期诊断及手术治疗方法.方法:利用硬膜外麻醉导管做支架,修复损伤的腮腺导管;如导管因缺损无法端端吻合,选用面前静脉移植术和腮腺嚼肌筋膜瓣再造术.结果:本组22例患者1例失访,随访的21例中,19例腮腺导管通畅,腮腺分泌功能正常;2例腮腺腺体萎缩,无分泌功能.结论:腮腺导管损伤的早诊断有利于手术治疗,支架支撑修复损伤的腮腺导管效果良好.

  18. Concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis for synchronous carcinoma.

    Science.gov (United States)

    Jafari Giv, M; Ho, Y H

    2007-03-01

    An extensive large bowel resection with a single anastomosis is the accustomed management option for widely spaced synchronous colorectal neoplasms. We report a successful case of concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis in an 85-year-old man with synchronous cancers of the hepatic flexure and lowrectum. This surgical technique is advantageous for elderly patients as it provides the benefits of multiple segmental resection and laparoscopic surgery while potentially reducing mortality, time of procedure, postoperative pain, ileus, length of hospitalization and direct cost of care, and improving independence at discharge. The technique for efficient multiple extractions of specimens and effective reconstitution of pneumoperitoneum for a multistaged procedure is discussed.

  19. Total extraperitoneal (TEP) hernioplasty with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia.

    Science.gov (United States)

    Ginestà, Cesar; Saavedra-Perez, David; Valentini, Mauro; Vidal, Oscar; Benarroch, Guerson; García-Valdecasas, Juan Carlos

    2013-06-01

    We describe the first clinical case of a total extraperitoneal hernioplasty combined with intestinal resection assisted by laparoscopy for a strangulated Richter femoral hernia. The patient was a 94-year-old woman admitted to the emergency room with signs and symptoms of acute small bowel obstruction. Diagnosis of a strangulated left Richter femoral hernia was only possible during the initial exploratory laparoscopy. The extraperitoneal approach for mesh positioning was performed gaining access through an infraumbilical 12 mm trocar incision, and assistance of two 5 mm laparoscopic ports at the hipogastrium and right flank. Laparoscopy was resumed and segmental intestinal resection with primary anastomosis was performed. The patient recovered without complications and was discharged home at the fourth postoperative day. The total extraperitoneal approach for acute hernia repair was successful in our particular case. However, factors such as laparoscopic surgical experience, careful patient selection, and correct preoperative diagnosis must be considered before studies in the emergency setting.

  20. Intercalated duct cell is starting point in development of pancreatic ductal carcinoma?

    Directory of Open Access Journals (Sweden)

    Yamaguchi Toshikazu

    2005-01-01

    Full Text Available Abstract Background Although it is well known that the pancreatic ductal carcinoma may develop having a relationship to the mucous gland hyperplasia (MGH with atypia (PanIN-1B by PanIN system, the starting point of this atypical MGH is unclear. To know it, we examined the pancreas tissue using many methods described below. Methods 1. Twenty-seven surgically resected pancreas tissue specimens, including pancreatic ductal carcinomas (PDC, chronic pancreatitis and normal pancreas, were investigated using immunohistochemical stainings for MUC1, MUC6, 45M1, Ki67 and p53. 2. DNA extraction and analysis of K-ras mutation at codon 12 using microdissection method: The paraffin blocks with 16 regions including the intercalated duct cell (IC adjacant to the atypical MGH were prepared for DNA extraction. Mutation of K-ras codon 12 was analized and compared in enriched polymerase chain reaction-enzyme-linked minisequence assay (PCR-ELMA. Results 1. In the normal pancreas, although no positive cell was seen in 45M1, p53, Ki67, the cytoplasm of IC were always positive for MUC1 and sometimes positive for MUC6. In the pancreas with fibrosis or inflammation, MGH was positive for MUC6 and 45M1. And atypical MGH was positive for MUC1, MUC6 and 45M1. Some IC adjacent to the atypical MGH was positive for Ki67 as well as atypical MGH. The carcinoma cells in all cases of PDC were diffusely positive for MUC1, 45M1, p53 and Ki67, and focally positive for MUC6. 2. In K-ras mutation, we examined the regions including IC adjacent to the atypical MGH, because the immunohistochemical apomucin stainings of these regions resembled those of PDC as decribed above. And K-ras mutation was confirmed in 12 of 16 regions (75%. All mutations were a single mutation, in 6 regions GTT was detected, in 4 regions GAT was detected and in 2 region AGT was detected. Conclusion Some intercalated duct cell may be the starting point of the pancreatic ductal carcinoma, because the exhibitions of

  1. Immunohistochemical identification of kidney nephron segments in the dog, rat, mouse, and cynomolgus monkey.

    Science.gov (United States)

    Bauchet, Anne-Laure; Masson, Regis; Guffroy, Magali; Slaoui, Mohamed

    2011-12-01

    Kidney is a major target organ in preclinical studies. In recent years, intense research has been undertaken to characterize novel renal toxicity biomarkers. In this context, we studied nephron segment specific antibodies against aquaporin-1 (AQP-1), α-glutathione-S-transferase (alpha-GST), Tamm-Horsfall protein (TH), calbindin-D(28K) (CalD), and aquaporin-2 (AQP-2), using an immunoperoxidase method on formalin-fixed paraffin-embedded kidney tissues of dogs, rats, mice, and Cynomolgus monkeys. AQP-1 was specific for proximal tubules and thin descending limbs of Henle's loops and AQP-2 for connecting and collecting ducts in dogs, rats, mice, and Cynomolgus monkeys. Alpha-GST stained the straight part of proximal tubules in dogs and proximal convoluted tubule and straight part of proximal tubules in rats. TH was specific for thick ascending limbs of Henle's loops in mice, rats, dogs, and Cynomolgus monkeys and stained additionally scattered cells in cortical connecting/collecting ducts of dogs. CalD was found in distal convoluted tubules and cortical connecting and collecting ducts of dogs, rats, and mice and in distal convoluted tubules, connecting ducts, and cortical and medullary collecting ducts of Cynomolgus monkey. This panel of antibodies may be a helpful tool to identify renal tubules by light microscopy in preclinical studies and to validate new biomarkers of renal toxicity.

  2. Renal histopathology and crystal deposits in patients with small bowel resection and calcium oxalate stone disease.

    Science.gov (United States)

    Evan, Andrew P; Lingeman, James E; Worcester, Elaine M; Bledsoe, Sharon B; Sommer, Andre J; Williams, James C; Krambeck, Amy E; Philips, Carrie L; Coe, Fredric L

    2010-08-01

    We present here the anatomy and histopathology of kidneys from 11 patients with renal stones following small bowel resection, including 10 with Crohn's disease and 1 resection in infancy for unknown cause. They presented predominantly with calcium oxalate stones. Risks of formation included hyperoxaluria (urine oxalate excretion greater than 45 mg per day) in half of the cases, and acidic urine of reduced volume. As was found with ileostomy and obesity bypass, inner medullary collecting ducts (IMCDs) contained crystal deposits associated with cell injury, interstitial inflammation, and papillary deformity. Cortical changes included modest glomerular sclerosis, tubular atrophy, and interstitial fibrosis. Randall's plaque (interstitial papillary apatite) was abundant, with calcium oxalate stone overgrowth similar to that seen in ileostomy, idiopathic calcium oxalate stone formers, and primary hyperparathyroidism. Abundant plaque was compatible with the low urine volume and pH. The IMCD deposits all contained apatite, with calcium oxalate present in three cases, similar to findings in patients with obesity bypass but not an ileostomy. The mechanisms for calcium oxalate stone formation in IMCDs include elevated urine and presumably tubule fluid calcium oxalate supersaturation, but a low calcium to oxalate ratio. However, the mechanisms for the presence of IMCD apatite remain unknown.

  3. Application of autogenous artery to repair parotid duct defect%自体动脉在腮腺导管重建中的应用

    Institute of Scientific and Technical Information of China (English)

    池宇峰; 王维; 谭锡涛

    2013-01-01

    目的:利用自体动脉重建腮腺导管缺损,并探讨其临床效果.方法:用硬膜外麻醉导管做支架,截取一段颞浅动脉,重建缺损的腮腺导管;术后1个月、3个月、半年、1年复诊,检查患者腮腺局部有无肿胀、涎瘘,导管是否通畅.结果:6例患者腮腺局部无肿胀,无涎瘘,腮腺导管通畅,腮腺分泌功能正常.结论:以硬膜外麻醉导管做支架,采用自体动脉重建腮腺导管缺损效果良好.%PURPOSE:To use autogenous artery to repair parotid duct defect,and to investigate the clinical effect.METHODS:Anesthesia epidural catheter was used to support the parotid duct and a segment of superficial temporal artery was harvested to reconstruct the defect of the parotid duct.The patients were asked to revisit 1 month,3 months,half a year and one year postoperatively.RESULTS:No swelling and salivary fistula was noted.The parotid ducts were successfully reconstructed with good patency and normal secretion.CONCLUSIONS:Using anesthesia epidural catheter to support the parotid duct,autogenous artery is excellent for repair of parotid duct defect.

  4. Diagnosis and surgical treatments of hepatocellular carcinoma with tumor thrombosis in bile duct:Experience of 34 patients

    Institute of Scientific and Technical Information of China (English)

    Lun-Xiu Qin; Zeng-Chen Ma; Zhi-Quan Wu; Jia Fan; Xin-Da Zhou; Hui-Chuan Sun; Qing-Hai Ye; Lu Wang; Zhao-You Tang

    2004-01-01

    AIM: Hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDT) is a rare event. The prognosis of this type of patients is very dismal. The aim of this study was to share the experience in the diagnosis and treatment of HCC with BDT, to further improve the prognosis of these patients.METHODS: Thirty-four patients of HCC with BDT received surgical treatment in authors' institute from July 1987 to January 2003 were reviewed retrospectively. The experience in the diagnosis and treatment, and the outcome of this type of HCC patients were summarized.RESULTS: Thirty of the 34 patients (88.2%) were positive for alpha-fetoprotein (AFP) (>20 μg/L), and 12 patients (35.3%) were found having obstructive jaundice before operation, 18 cases were suspected of "obstruction of bile duct" preoperatively. The primary tumors were frequently located at the left medial (13 cases) or right anterior lobe (14 cases). Thirty-one patients received liver resections and removal of BDT, while the other 3 patients received removal of BDT combined with hepatic artery ligation and cannulation (HAL+HAI), or only removal of BDT because their liver function reservation and general condition could not tolerate the primary tumor resection. The 1-year survival rate was 71.4%(20/28). The longest disease-free survival was over 15 years. The intrahepatic tumor recurrence within 1 year after operation was found in 14 patients (14/28, 50.0%).CONCLUSION: Surgical removal of primary tumors and BDTis safe and beneficial to the HCC patients with BDT. Early detection, diagnosis, and surgical treatment are the key points to prolong the survival time of patients.

  5. Management of traumatic bile duct injury%外伤性胆道损伤的处理

    Institute of Scientific and Technical Information of China (English)

    张剑; 王剑明; 杨彦; 刘颜; 何俊闯; 齐卫鹏; 钱亚伟; 付阳

    2014-01-01

    patients with type Ⅳ received bile duct repair + T tube drainage,1 patient with type Ⅳ received end-to-end bile duct anastomosis + T tube drainage,1 patient with type Ⅳ received biliojejunostomy and 1 patient with type Ⅳ received quadrate lobectomy + hilar bile duct reshaping + hepatojejunostomy; 3 patients with type Ⅴ received biliojejunostomy.Eleven patients additionally received repair of the liver or hepatectomy,1 received splenectomy,5 received nephrectomy,4 received partial small bowel resection + endto-end anastomosis.One patient died of hemorrhagic shock perioperatively; 3 patients were complicated with bile leakage,1 with incisional infection,and they were cured by symptomatic treatment.Twenty-five patients were followed up at postoperative month 1,3,6,12,and no patient was complicated with delayed bile leakage and biliary stricture recurrence.Conclusions Traumatic bile duct injury is often diagnosed during the operation.Patients with traumatic bile duct are often combined with shock and other organs injury.As for the treatment,laparotomy should be applied as soon as possible on the base of anti-shock treatment,and the appropriate method for biliary reconstruction should be selected according to the site and degree of injury.

  6. Keypoint Transfer Segmentation.

    Science.gov (United States)

    Wachinger, C; Toews, M; Langs, G; Wells, W; Golland, P

    2015-01-01

    We present an image segmentation method that transfers label maps of entire organs from the training images to the novel image to be segmented. The transfer is based on sparse correspondences between keypoints that represent automatically identified distinctive image locations. Our segmentation algorithm consists of three steps: (i) keypoint matching, (ii) voting-based keypoint labeling, and (iii) keypoint-based probabilistic transfer of organ label maps. We introduce generative models for the inference of keypoint labels and for image segmentation, where keypoint matches are treated as a latent random variable and are marginalized out as part of the algorithm. We report segmentation results for abdominal organs in whole-body CT and in contrast-enhanced CT images. The accuracy of our method compares favorably to common multi-atlas segmentation while offering a speed-up of about three orders of magnitude. Furthermore, keypoint transfer requires no training phase or registration to an atlas. The algorithm's robustness enables the segmentation of scans with highly variable field-of-view.

  7. Pancreas and cyst segmentation

    Science.gov (United States)

    Dmitriev, Konstantin; Gutenko, Ievgeniia; Nadeem, Saad; Kaufman, Arie

    2016-03-01

    Accurate segmentation of abdominal organs from medical images is an essential part of surgical planning and computer-aided disease diagnosis. Many existing algorithms are specialized for the segmentation of healthy organs. Cystic pancreas segmentation is especially challenging due to its low contrast boundaries, variability in shape, location and the stage of the pancreatic cancer. We present a semi-automatic segmentation algorithm for pancreata with cysts. In contrast to existing automatic segmentation approaches for healthy pancreas segmentation which are amenable to atlas/statistical shape approaches, a pancreas with cysts can have even higher variability with respect to the shape of the pancreas due to the size and shape of the cyst(s). Hence, fine results are better attained with semi-automatic steerable approaches. We use a novel combination of random walker and region growing approaches to delineate the boundaries of the pancreas and cysts with respective best Dice coefficients of 85.1% and 86.7%, and respective best volumetric overlap errors of 26.0% and 23.5%. Results show that the proposed algorithm for pancreas and pancreatic cyst segmentation is accurate and stable.

  8. Segmentation of consumer's markets and evaluation of market's segments

    OpenAIRE

    ŠVECOVÁ, Iveta

    2013-01-01

    The goal of this bachelor thesis was to explain a possibly segmentation of consumer´s markets for a chosen company, and to present a suitable goods offer, so it would be suitable to the needs of selected segments. The work is divided into theoretical and practical part. First part describes marketing, segmentation, segmentation of consumer's markets, consumer's market, market's segments a other terms. Second part describes an evaluation of questionnaire survey, discovering of market's segment...

  9. Single incision laparoscopic colorectal resection: Our experience

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu

    2012-01-01

    Full Text Available Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum. There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years. The average operating time was 130 min (range 90-210 min. The average incision length was 3.2 cm (2.5-4.0 cm. There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days. Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes. Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.

  10. Parabolic resection for mitral valve repair.

    Science.gov (United States)

    Drake, Daniel H; Drake, Charles G; Recchia, Dino

    2010-02-01

    Parabolic resection, named for the shape of the cut edges of the excised tissue, expands on a common 'trick' used by experienced mitral surgeons to preserve tissue and increase the probability of successful repair. Our objective was to describe and clinically analyze this simple modification of conventional resection. Thirty-six patients with mitral regurgitation underwent valve repair using parabolic resection in combination with other techniques. Institution specific mitral data, Society of Thoracic Surgeons data and preoperative, post-cardiopulmonary bypass (PCPB) and postoperative echocardiography data were collected and analyzed. Preoperative echocardiography demonstrated mitral regurgitation ranging from moderate to severe. PCPB transesophageal echocardiography demonstrated no regurgitation or mild regurgitation in all patients. Thirty-day surgical mortality was 2.8%. Serial echocardiograms demonstrated excellent repair stability. One patient (2.9%) with rheumatic disease progressed to moderate regurgitation 33 months following surgery. Echocardiography on all others demonstrated no or mild regurgitation at a mean follow-up of 22.8+/-12.8 months. No patient required mitral reintervention. Longitudinal analysis demonstrated 80% freedom from cardiac death, reintervention and greater than moderate regurgitation at four years following repair. Parabolic resection is a simple technique that can be very useful during complex mitral reconstruction. Early and intermediate echocardiographic studies demonstrate excellent results.

  11. What Keeps Postpulmonary Resection Patients in Hospital?

    Directory of Open Access Journals (Sweden)

    T Bardell

    2003-01-01

    Full Text Available BACKGROUND: Prolonged air leak (longer than three days was hypothesized to be the primary cause of extended hospital stays following pulmonary resection. Its effect on length of stay (LOS was compared with that of suboptimal pain control, nausea and vomiting, and other causes. Predictors of prolonged LOS and of prolonged air leaks were investigated.

  12. Laparoscopic resection of retroperitoneal benign neurilemmoma

    Science.gov (United States)

    Park, Joon Seong; Kang, Chang Moo; Yoon, Dong Sup; Lee, Woo Jung

    2017-01-01

    Purpose The aim of this study was to verify that laparoscopic resection for treating retroperitoneal benign neurilemmoma (NL) is expected to be favorable for complete resection of tumor with technical feasibility and safety. Methods We retrospectively analyzed 47 operations for retroperitoneal neurogenic tumor at Yonsei University College of Medicine, Severance Hospital and Gangnam Severance Hospital between January 2005 and September 2015. After excluding 21 patients, the remaining 26 were divided into 2 groups: those who underwent open surgery (OS) and those who underwent laparoscopic surgery (LS). We compared clinicopathological features between the 2 groups. Results There was no significant difference in operation time, estimated blood loss, transfusion, complication, recurrence, or follow-up period between 2 groups. Postoperative hospital stay was significantly shorter in the LS group versus the OS group (OS vs. LS, 7.00 ± 3.43 days vs. 4.50 ± 2.16 days; P = 0.031). Conclusion We suggest that laparoscopic resection of retroperitoneal benign NL is feasible and safe by obtaining complete resection of the tumor. LS for treating retroperitoneal benign NL could be useful with appropriate laparoscopic technique and proper patient selection.

  13. Radical Carinal Resection for a Glomic Tumor.

    Science.gov (United States)

    Bellier, Jocelyn; Sage, Edouard; Gonin, François; Longchampt, Elisabeth; Chapelier, Alain

    2016-08-01

    We report the case of a 33-year-old woman who presented with increasing dyspnea secondary to a tumor arising from the carina. After desobstruction by bronchoscopy, the pathologic analysis revealed a glomic tumor. Carinal resection and reconstruction were performed with venoarterial extracorporeal membrane oxygenation support. The patient's postoperative course was uneventful, and the long-term result was excellent.

  14. Postoperative omental infarction following colonic resection

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, S.F., E-mail: skerr44@doctors.org.uk [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Hyland, R.; Rowbotham, E.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2012-02-15

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution's electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  15. Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: An open, randomized, prospective, multicenter, parallel-group trial

    DEFF Research Database (Denmark)

    Fischer, Lars; Seiler, Christoph M.; Broelsch, Christoph E.

    2011-01-01

    surgical trial with 2 parallel groups. Patients were eligible for intra-operative randomization after elective resection of ≥1 liver segment and primary hemostasis. The primary end point was the time to hemostasis after starting the randomized intervention to obtain secondaty hemostasis. Secondary end...

  16. Non-functioning well-differentiated neuroendocrine tumor of the extrahepatic bile duct:an unusual suspect?

    Institute of Scientific and Technical Information of China (English)

    Harsheet Sethi; Mansoor Madanur; Parthi Srinivasan; Bernard Portmann; Nigel Heaton; Mohamed Rela

    2007-01-01

    BACKGROUND: Neuroendocrine tumors (NETs) arising in the biliary tree are extremely rare, and 37 cases were identiifed in the English literature. METHODS: A well-differentiated NET was found arising from the junction of the cystic and common hepatic ducts, in a 51-year-old male presenting with pedal edema and weight loss with abnormal liver enzymes and a normal serum bilirubin level. No mass was seen on radiological imaging and biopsy of the liver was suggestive of an early cholangiopathy. A bile leak complicating the liver biopsy led to an ERCP that demonstrated a iflling defect suggestive of a mass in the common bile duct (CBD). RESULTS: He underwent a successful excision of the tumor with a Roux-en-Y hepaticojejunostomy. The diagnosis of NET was made on histological and immunohistochemical analysis of the resected specimen. He remains well and disease free 22 months after surgery. CONCLUSIONS: Recognition of biliary NET continues to be a challenge and an increased awareness of these tumors in rare sites will result in optimal management of these tumors.

  17. The laparoscopic enucleation for branch duct type intraductal papillary mucinous neoplasms located at the body of pancreas: A case report

    Directory of Open Access Journals (Sweden)

    Stevanović Dejan

    2015-01-01

    Full Text Available Introduction. Intraductal papillary mucinous neoplasms (IPMN are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8Ч5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2, which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

  18. Multiple MR Imaging Techniques in the Diagnosis and Assessment of Resectability in Pancreatic Carcinoma

    Institute of Scientific and Technical Information of China (English)

    LONGYu; KONGXiangquan; XUHaibo; LIUDingxi; YANGFan; XIONGYin; YUQun; FENGZhenjun

    2003-01-01

    Objective: To study the value of multiple MR imaging techniques in the diagnosis of pancreatic carcinoma and the assessment of resectbility of the lesion. Methods: MR imaging was performed in 18 pa-tients with surgically and/or pathologically proven pancreatic carcinoma. GRE T1WI, TSE T2WI, GRE T1WI with fat suppression, delayed enhancement GRE T1WI, MRCP and 3D DCE MRA were used in MR scanning. Tumor involvement of the celiac trunk and its main branches, superior mesenteric artery,the portal, splenic and superior mesenteric veins were prospectively graded on a 0-4 scale based on cir-cumferential contiguity of tumor to vessel. Results: On GRE T1WI and TSE T2WI all the lesions showed slightly hypointense and hyperintense, respectively; On GRE T1WI with fat suppression, all the tumors obviously appeared hypointense; On delayed enhancement GRE T1WI, the lesions displayed irregularly circular enhancement in 14 patients and well-distributed enhancement in 4 patients. MRCP showed exten-sive bile and main pancreatic duct dilatation with typical "double-duct" sign in 8 patients. On 3D DCE MRA, we thought it was unresectable with more than half circumferential involvement of tumor to vessel,so that the portal, splenic and superior mesenteric veins were involved with 56% (10/18), 39% (7/18)and 67% (12/18), respectively. The celiac trunk and its main branches and superior mesenteric arteries were involved with 22% (4/18) and 17% (3/18), respectively. The pancreatic lesions in 2 cases could be completely resected in the evaluation of MR imaging, which was fitted to the findings of operation by pan-creatoduodenectomy. The pancreatic lesions in other 2 cases were partly, resected because there was tumor extension to superior mesenteric vein and/or artery. The tumors in the remaining 14 patients were too large and involved peripancreatic vessels or there were stomach or liver metastases, so these patients were only treated by choledochojejunostomy and gastrojejunstomy. Conclusion

  19. ATP release, generation and hydrolysis in exocrine pancreatic duct cells.

    Science.gov (United States)

    Kowal, J M; Yegutkin, G G; Novak, I

    2015-12-01

    Extracellular adenosine triphosphate (ATP) regulates pancreatic duct function via P2Y and P2X receptors. It is well known that ATP is released from upstream pancreatic acinar cells. The ATP homeostasis in pancreatic ducts, which secrete bicarbonate-rich fluid, has not yet been examined. First, our aim was to reveal whether pancreatic duct cells release ATP locally and whether they enzymatically modify extracellular nucleotides/sides. Second, we wished to explore which physiological and pathophysiological factors may be important in these processes. Using a human pancreatic duct cell line, Capan-1, and online luminescence measurement, we detected fast ATP release in response to pH changes, bile acid, mechanical stress and hypo-osmotic stress. ATP release following hypo-osmotic stress was sensitive to drugs affecting exocytosis, pannexin-1, connexins, maxi-anion channels and transient receptor potential cation channel subfamily V member 4 (TRPV4) channels, and corresponding transcripts were expressed in duct cells. Direct stimulation of intracellular Ca(2+) and cAMP signalling and ethanol application had negligible effects on ATP release. The released ATP was sequentially dephosphorylated through ecto-nucleoside triphosphate diphosphohydrolase (NTPDase2) and ecto-5'-nucleotidase/CD73 reactions, with respective generation of adenosine diphosphate (ADP) and adenosine and their maintenance in the extracellular medium at basal levels. In addition, Capan-1 cells express counteracting adenylate kinase (AK1) and nucleoside diphosphate kinase (NDPK) enzymes (NME1, 2), which contribute to metabolism and regeneration of extracellular ATP and other nucleotides (ADP, uridine diphosphate (UDP) and uridine triphosphate (UTP)). In conclusion, we illustrate a complex regulation of extracellular purine homeostasis in a pancreatic duct cell model involving: ATP release by several mechanisms and subsequent nucleotide breakdown and ATP regeneration via counteracting nucleotide

  20. Prematurity reduces functional adaptation to intestinal resection in piglets

    DEFF Research Database (Denmark)

    Aunsholt, Lise; Thymann, Thomas; Qvist, Niels

    2015-01-01

    Background: Necrotizing enterocolitis and congenital gastrointestinal malformations in infants often require intestinal resection, with a subsequent risk of short bowel syndrome (SBS). We hypothesized that immediate intestinal adaptation following resection of the distal intestine with placement ...