40 CFR 89.326 - Engine intake air humidity measurement.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Engine intake air humidity measurement... Test Equipment Provisions § 89.326 Engine intake air humidity measurement. (a) Humidity conditioned air... type of intake air supply, the humidity measurements must be made within the intake air supply system...

Determination of tricresyl phosphate air contamination in aircraft.

Science.gov (United States)

Denola, G; Hanhela, P J; Mazurek, W

2011-08-01

Monitoring of tricresyl phosphate (TCP) contamination of cockpit air was undertaken in three types of military aircraft [fighter trainer (FT), fighter bomber (FB), and cargo transport (CT) aircraft]. The aircraft had a previous history of pilot complaints about cockpit air contamination suspected to originate from the engine bleed air supply through the entry of aircraft turbine engine oil (ATO) into the engine compressor. Air samples were collected in flight and on the ground during engine runs using sorbent tubes packed with Porapak Q and cellulose filters. A total of 78 air samples were analysed, from 46 different aircraft, and 48 samples were found to be below the limit of detection. Nine incidents of smoke/odour were identified during the study. The concentrations of toxic o-cresyl phosphate isomers were below the level of detection in all samples. The highest total TCP concentration was 51.3 μg m(-3), while most were generally found to be contamination of cabin/cockpit air has been the subject of much concern in aviation, quantitative data are sparse.

Combustion engine. [for air pollution control

Science.gov (United States)

Houseman, J. (Inventor)

1977-01-01

An arrangement for an internal combustion engine is provided in which one or more of the cylinders of the engine are used for generating hydrogen rich gases from hydrocarbon fuels, which gases are then mixed with air and injected into the remaining cylinders to be used as fuel. When heavy load conditions are encountered, hydrocarbon fuel may be mixed with the hydrogen rich gases and air and the mixture is then injected into the remaining cylinders as fuel.

A hot air driven thermoacoustic-Stirling engine

Energy Technology Data Exchange (ETDEWEB)

Tijani, M.E.H.; Spoelstra, S. [ECN Biomass and Energy Efficiency, Petten (Netherlands)

2012-09-15

Significant energy savings can be obtained by implementing a thermally driven heat pump into industrial or domestic applications. Such a thermally driven heat pump uses heat from a high-temperature source to drive the system which upgrades an abundantly available heat source (industrial waste heat, air, water, geothermal). A way to do this is by coupling a thermoacoustic engine with a thermoacoustic heat pump. The engine is driven by a burner and produces acoustic power and heat at the required temperature. The acoustic power is used to pump heat in the heat pump to the required temperature. This system is attractive since it uses a noble gas as working medium and has no moving mechanical parts. This paper deals with the first part of this system: the engine. In this study, hot air is used to simulate the flue gases originating from a gas burner. This is in contrast with a lot of other studies of thermoacoustic engines that use an electrical heater as heat source. Using hot air resembles to a larger extent the real world application. The engine produces about 300W of acoustic power with a performance of 41% of the Carnot efficiency at a hot air temperature of 620C.

Bleed water testing program for controlled low strength material

International Nuclear Information System (INIS)

Langton, C.A.

1996-01-01

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

Perimenopausal Bleeding and Bleeding After Menopause

Science.gov (United States)

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

40 CFR 90.309 - Engine intake air temperature measurement.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Engine intake air temperature measurement. 90.309 Section 90.309 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Emission Test Equipment Provisions § 90.309 Engine intake air temperature measurement. (a) The measurement...

Diesel engines and air pollution: facts and figures

International Nuclear Information System (INIS)

Chaaban, Farid

1998-01-01

Traffic densities and resulting air pollution, in any country are directly related to the degree of urbanization and the size and characteristics of the transportation sector. In Lebanon, the car ownership rate is among the highest in the world and its consequence is the drastic deterioration in ambient air quality in Greater Beirut and other organized regions. In this article, features of diesel engines are described. The environmental impacts of diesel engines, in relation of petrol engines are briefly presented. Pollutants provocated by diesel fuel, due to its contents in Carbon , Sulfur and gaseous emissions (noise level, smoke, Carbon Monoxide emissions, smell) as well as the economical aspects are given in comparison with petrol engines. Conclusion is given that diesel engines will help in reducing air pollution caused by transport sector in Lebanon, only if some required vehicles conditions are satisfied

Experimental studies of the air hybrid engine charging operation

OpenAIRE

Zhao, H; Ma, T; Lee, CY

2014-01-01

Over the last few years, theoretical and modelling studies have been carried out on the feasibility and potential of novel mild air hybrid engine concepts based on production components. These mild air hybrid concepts are able to convert vehicle brake energy into pneumatic energy in the form of compressed air stored in the air tank. The compressed air can then be used to crank-start the engine by either injecting and expanding in the cylinder or driving a production air starter. Thus, the reg...

Aircraft Recirculation Filter for Air-Quality and Incident Assessment.

Science.gov (United States)

Eckels, Steven J; Jones, Byron; Mann, Garrett; Mohan, Krishnan R; Weisel, Clifford P

The current research examines the possibility of using recirculation filters from aircraft to document the nature of air-quality incidents on aircraft. These filters are highly effective at collecting solid and liquid particulates. Identification of engine oil contaminants arriving through the bleed air system on the filter was chosen as the initial focus. A two-step study was undertaken. First, a compressor/bleed air simulator was developed to simulate an engine oil leak, and samples were analyzed with gas chromatograph-mass spectrometry. These samples provided a concrete link between tricresyl phosphates and a homologous series of synthetic pentaerythritol esters from oil and contaminants found on the sample paper. The second step was to test 184 used aircraft filters with the same gas chromatograph-mass spectrometry system; of that total, 107 were standard filters, and 77 were nonstandard. Four of the standard filters had both markers for oil, with the homologous series synthetic pentaerythritol esters being the less common marker. It was also found that 90% of the filters had some detectable level of tricresyl phosphates. Of the 77 nonstandard filters, 30 had both markers for oil, a significantly higher percent than the standard filters.

Aircraft Recirculation Filter for Air-Quality and Incident Assessment

Science.gov (United States)

Eckels, Steven J.; Jones, Byron; Mann, Garrett; Mohan, Krishnan R.; Weisel, Clifford P.

2015-01-01

The current research examines the possibility of using recirculation filters from aircraft to document the nature of air-quality incidents on aircraft. These filters are highly effective at collecting solid and liquid particulates. Identification of engine oil contaminants arriving through the bleed air system on the filter was chosen as the initial focus. A two-step study was undertaken. First, a compressor/bleed air simulator was developed to simulate an engine oil leak, and samples were analyzed with gas chromatograph-mass spectrometry. These samples provided a concrete link between tricresyl phosphates and a homologous series of synthetic pentaerythritol esters from oil and contaminants found on the sample paper. The second step was to test 184 used aircraft filters with the same gas chromatograph-mass spectrometry system; of that total, 107 were standard filters, and 77 were nonstandard. Four of the standard filters had both markers for oil, with the homologous series synthetic pentaerythritol esters being the less common marker. It was also found that 90% of the filters had some detectable level of tricresyl phosphates. Of the 77 nonstandard filters, 30 had both markers for oil, a significantly higher percent than the standard filters. PMID:25641977

System and method for conditioning intake air to an internal combustion engine

Science.gov (United States)

Sellnau, Mark C.

2015-08-04

A system for conditioning the intake air to an internal combustion engine includes a means to boost the pressure of the intake air to the engine and a liquid cooled charge air cooler disposed between the output of the boost means and the charge air intake of the engine. Valves in the coolant system can be actuated so as to define a first configuration in which engine cooling is performed by coolant circulating in a first coolant loop at one temperature, and charge air cooling is performed by coolant flowing in a second coolant loop at a lower temperature. The valves can be actuated so as to define a second configuration in which coolant that has flowed through the engine can be routed through the charge air cooler. The temperature of intake air to the engine can be controlled over a wide range of engine operation.

Working characteristics of variable intake valve in compressed air engine.

Science.gov (United States)

Yu, Qihui; Shi, Yan; Cai, Maolin

2014-01-01

A new camless compressed air engine is proposed, which can make the compressed air energy reasonably distributed. Through analysis of the camless compressed air engine, a mathematical model of the working processes was set up. Using the software MATLAB/Simulink for simulation, the pressure, temperature, and air mass of the cylinder were obtained. In order to verify the accuracy of the mathematical model, the experiments were conducted. Moreover, performance analysis was introduced to design compressed air engine. Results show that, firstly, the simulation results have good consistency with the experimental results. Secondly, under different intake pressures, the highest output power is obtained when the crank speed reaches 500 rpm, which also provides the maximum output torque. Finally, higher energy utilization efficiency can be obtained at the lower speed, intake pressure, and valve duration angle. This research can refer to the design of the camless valve of compressed air engine.

Working Characteristics of Variable Intake Valve in Compressed Air Engine

Science.gov (United States)

Yu, Qihui; Shi, Yan; Cai, Maolin

2014-01-01

A new camless compressed air engine is proposed, which can make the compressed air energy reasonably distributed. Through analysis of the camless compressed air engine, a mathematical model of the working processes was set up. Using the software MATLAB/Simulink for simulation, the pressure, temperature, and air mass of the cylinder were obtained. In order to verify the accuracy of the mathematical model, the experiments were conducted. Moreover, performance analysis was introduced to design compressed air engine. Results show that, firstly, the simulation results have good consistency with the experimental results. Secondly, under different intake pressures, the highest output power is obtained when the crank speed reaches 500 rpm, which also provides the maximum output torque. Finally, higher energy utilization efficiency can be obtained at the lower speed, intake pressure, and valve duration angle. This research can refer to the design of the camless valve of compressed air engine. PMID:25379536

Working Characteristics of Variable Intake Valve in Compressed Air Engine

Directory of Open Access Journals (Sweden)

Qihui Yu

2014-01-01

Full Text Available A new camless compressed air engine is proposed, which can make the compressed air energy reasonably distributed. Through analysis of the camless compressed air engine, a mathematical model of the working processes was set up. Using the software MATLAB/Simulink for simulation, the pressure, temperature, and air mass of the cylinder were obtained. In order to verify the accuracy of the mathematical model, the experiments were conducted. Moreover, performance analysis was introduced to design compressed air engine. Results show that, firstly, the simulation results have good consistency with the experimental results. Secondly, under different intake pressures, the highest output power is obtained when the crank speed reaches 500 rpm, which also provides the maximum output torque. Finally, higher energy utilization efficiency can be obtained at the lower speed, intake pressure, and valve duration angle. This research can refer to the design of the camless valve of compressed air engine.

Efficient energy recovering air inlet system for an internal combustion engine

NARCIS (Netherlands)

2011-01-01

An air inlet system (10) for an internal combustion engine (200) is provided. The air inlet system comprises an air intake port (20), an air output port (30) for providing air for a combustion chamber (202) of the combustion engine (200), and a turbine (40). The turbine (40) is situated in between

Efficient energy recovering air inlet system for an international combustion engine

NARCIS (Netherlands)

2013-01-01

An air inlet system (10) for an internal combustion engine (200) is provided. The air inlet system comprises an air intake port (20), an air output port (30) for providing air for a combustion chamber (202) of the combustion engine (200), and a turbine (40). The turbine (40) is situated in between

40 CFR 86.313-79 - Air flow measurement specifications; diesel engines.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 18 2010-07-01 2010-07-01 false Air flow measurement specifications... Procedures § 86.313-79 Air flow measurement specifications; diesel engines. (a) The air flow measurement... (CONTINUED) AIR PROGRAMS (CONTINUED) CONTROL OF EMISSIONS FROM NEW AND IN-USE HIGHWAY VEHICLES AND ENGINES...

Fuzzy logic speed control for the engine of an air-powered vehicle

OpenAIRE

Qihui Yu; Yan Shi; Maolin Cai; Weiqing Xu

2016-01-01

To improve the condition of air and eliminate exhaust gas pollution, this article proposes a compressed air power system. Instead of an internal combustion engine, the automobile is equipped with a compressed air engine, which transforms the energy of compressed air into mechanical motion energy. A prototype was built, and the compressed air engine was tested on an experimental platform. The output torque and energy efficiency were obtained from experimental results. When the supply pressure ...

Liquid air cycle engines

Science.gov (United States)

Rosevear, Jerry

1992-01-01

Given here is a definition of Liquid Air Cycle Engines (LACE) and existing relevant technologies. Heat exchanger design and fabrication techniques, the handling of liquid hydrogen to achieve the greatest heat sink capabilities, and air decontamination to prevent heat exchanger fouling are discussed. It was concluded that technology needs to be extended in the areas of design and fabrication of heat exchangers to improve reliability along with weight and volume reductions. Catalysts need to be improved so that conversion can be achieved with lower quantities and lower volumes. Packaging studies need to be investigated both analytically and experimentally. Recycling with slush hydrogen needs further evaluation with experimental testing.

Stirling engine with air working fluid

Science.gov (United States)

Corey, John A.

1985-01-01

A Stirling engine capable of utilizing air as a working fluid which includes a compact heat exchange module which includes heating tube units, regenerator and cooler positioned about the combustion chamber. This arrangement has the purpose and effect of allowing the construction of an efficient, high-speed, high power-density engine without the use of difficult to seal light gases as working fluids.

Experimental study on axisymmetric air intake for the supersonic transport; choonsokukiyo jikutaishogata air intake no jikken kenkyu

Energy Technology Data Exchange (ETDEWEB)

Sato, T. [Institute of the Space and Astronautical Science,Tokyo (Japan); Takagi, I. [Kawasaki Heavy Industries, Ltd., Kobe (Japan); Kojima, T.; Kobayashi, H. [The University of Tokyo, Tokyo (Japan)

1998-12-05

Mixed-compression type axisymmetric air intakes for ATREX engine have been tested in the supersonic wind tunnel from Mach 0.5 to 4 since 1993. The throat area of the intake can be variable with a translating center spike to accomplish starting and off-design operation since the ATREX intake must work well over the wide flight Mach number up to 6. Here are presented effects of the intake design Mach number, the air bleed from a center spike and/or a cowl around the throat, an angle of attack and blunt nose of the spike on the intake performance characteristics, that is total pressure recovery and mass capture ratio. It is found that bleeding from the center spike and the cowl influences mainly on total pressure recovery and mass capture ratio respectively. The advantage of rounding properly off the spike nose is confirmed. Small center spike cone angle and/or blunt nose is sensitive to the angle of attack. (author)

Comparison Based on Exergetic Analyses of Two Hot Air Engines: A Gamma Type Stirling Engine and an Open Joule Cycle Ericsson Engine

Directory of Open Access Journals (Sweden)

Houda Hachem

2015-10-01

Full Text Available In this paper, a comparison of exergetic models between two hot air engines (a Gamma type Stirling prototype having a maximum output mechanical power of 500 W and an Ericsson hot air engine with a maximum power of 300 W is made. Referring to previous energetic analyses, exergetic models are set up in order to quantify the exergy destruction and efficiencies in each type of engine. The repartition of the exergy fluxes in each part of the two engines are determined and represented in Sankey diagrams, using dimensionless exergy fluxes. The results show a similar proportion in both engines of destroyed exergy compared to the exergy flux from the hot source. The compression cylinders generate the highest exergy destruction, whereas the expansion cylinders generate the lowest one. The regenerator of the Stirling engine increases the exergy resource at the inlet of the expansion cylinder, which might be also set up in the Ericsson engine, using a preheater between the exhaust air and the compressed air transferred to the hot heat exchanger.

Heat exchanger design for hot air ericsson-brayton piston engine

Directory of Open Access Journals (Sweden)

Ďurčanský P.

2014-03-01

Full Text Available One of the solutions without negative consequences for the increasing energy consumption in the world may be use of alternative energy sources in micro-cogeneration. Currently it is looking for different solutions and there are many possible ways. Cogeneration is known for long time and is widely used. But the installations are often large and the installed output is more suitable for cities or industry companies. When we will speak about decentralization, the small machines have to be used. The article deals with the principle of hot-air engines, their use in combined heat and electricity production from biomass and with heat exchangers as primary energy transforming element. In the article is hot air engine presented as a heat engine that allows the conversion of heat into mechanical energy while heat supply can be external. In the contribution are compared cycles of hot-air engine. Then are compared suitable heat exchangers for use with hot air Ericsson-Brayton engine. In the final part is proposal of heat exchanger for use in closed Ericsson-Brayton cycle.

Heat exchanger design for hot air ericsson-brayton piston engine

Science.gov (United States)

Ďurčanský, P.; Lenhard, R.; Jandačka, J.

2014-03-01

One of the solutions without negative consequences for the increasing energy consumption in the world may be use of alternative energy sources in micro-cogeneration. Currently it is looking for different solutions and there are many possible ways. Cogeneration is known for long time and is widely used. But the installations are often large and the installed output is more suitable for cities or industry companies. When we will speak about decentralization, the small machines have to be used. The article deals with the principle of hot-air engines, their use in combined heat and electricity production from biomass and with heat exchangers as primary energy transforming element. In the article is hot air engine presented as a heat engine that allows the conversion of heat into mechanical energy while heat supply can be external. In the contribution are compared cycles of hot-air engine. Then are compared suitable heat exchangers for use with hot air Ericsson-Brayton engine. In the final part is proposal of heat exchanger for use in closed Ericsson-Brayton cycle.

Design type air engine Di Pietro

Directory of Open Access Journals (Sweden)

Zwierzchowski Jaroslaw

2017-01-01

Full Text Available The article presents a pneumatic engine constructed by Angelo Di Pietro. 3D solid models of pneumatic engine components were presented therein. A directional valve is a key element of the control system. The valve functions as a camshaft distributing air to particular engine chambers. The construction designed by Angelo Di Pietro is modern and innovative. A pneumatic engine requires low pressure to start rotary movement. With the use of CFD software, the fields of velocity vectors’ distribution were determined. Moreover, the author determined the distribution of pressure values in engine inlet and outlet channels. CFD model studies on engine operation were conducted for chosen stages of operating cycles. On the basis of simulation tests that were conducted, the values of flow rates for the engine were determined. The distribution of pressure values made it possible to evaluate the torque value on the rotating shaft.

Design type air engine Di Pietro

Science.gov (United States)

Zwierzchowski, Jaroslaw

The article presents a pneumatic engine constructed by Angelo Di Pietro. 3D solid models of pneumatic engine components were presented therein. A directional valve is a key element of the control system. The valve functions as a camshaft distributing air to particular engine chambers. The construction designed by Angelo Di Pietro is modern and innovative. A pneumatic engine requires low pressure to start rotary movement. With the use of CFD software, the fields of velocity vectors' distribution were determined. Moreover, the author determined the distribution of pressure values in engine inlet and outlet channels. CFD model studies on engine operation were conducted for chosen stages of operating cycles. On the basis of simulation tests that were conducted, the values of flow rates for the engine were determined. The distribution of pressure values made it possible to evaluate the torque value on the rotating shaft.

Automotive engine air intake system with variable noise control

Science.gov (United States)

Moenssen, David J.; Hellie, Mark D.; Koston, John D.; Shaw, Christopher E.

2005-09-01

Engine air intake systems are routinely tasked with delivering a specific target sound which involves meeting an overall noise level and, in many cases, desired frequency content over the entire engine speed range. In order to meet these targets, it is generally necessary to incorporate one or more reactive tuning devices, such as Helmholtz resonators, into the intake system. Traditional devices provide deep attenuation at their designed frequency, but they also introduce undesirable sideband resonances at a higher and a lower frequency. Even after the addition of several devices, it may still not be possible to match the desired intake noise targets due to their deep attenuation and sideband amplification. The subject of this work is to introduce an electronically controlled variable noise control (VNC) device for engine air intake systems which is capable of adjusting the air intake system's frequency response as commanded by the engine operating conditions. The VNC device permits the desired amount of attenuation of peaks in the air intake noise without introducing undesirable sideband resonances. In addition, because the tuning is controlled electronically, the VNC device can deliver a target-specific response using the same hardware across multiple vehicle programs.

Gastrointestinal bleeding

Science.gov (United States)

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

Preliminary Data on the Effects of Inlet Pressure Distortions on the J57-P-1 Turbojet Engine

Science.gov (United States)

Wallner, Lewis E.; Lubick, Robert J.; Einstein, Thomas H.

1954-01-01

An investigation to determine the steady-state and surge characteristics of the J57-P-1 two-spool turbojet engine with various inlet air-flow distortions was conducted in the altitude wind tunnel at the NACA Lewis laboratory. Along with a uniform inlet total-pressure distribution, one circumferential and three radial pressure distortions were investigated. Data were obtained over a complete range of compressor speeds both with and without intercompressor air bleed at a flight Mach number of 0.8 and at altitudes of 35,000 and 50,000 feet. Total-pressure distortions of the magnitudes investigated had very little effect on the steady-state operating line for either the outer or inner compressor. The small radial distortions investigated also had engine over that obtained with the uniform inlet pressure distribution. The circumferential distortion, however, raised the minimum speed at which the engine could operate without encountering surge when the intercompressor bleeds were closed. This increase in minimum speed resulted in a substantial reduction in the operable speed range accompanied by a reduction in the altitude operating limit.

Intelligent energy management control of vehicle air conditioning system coupled with engine

International Nuclear Information System (INIS)

Khayyam, Hamid; Abawajy, Jemal; Jazar, Reza N.

2012-01-01

Vehicle Air Conditioning (AC) systems consist of an engine powered compressor activated by an electrical clutch. The AC system imposes an extra load to the vehicle's engine increasing the vehicle fuel consumption and emissions. Energy management control of the vehicle air conditioning is a nonlinear dynamic system, influenced by uncertain disturbances. In addition, the vehicle energy management control system interacts with different complex systems, such as engine, air conditioning system, environment, and driver, to deliver fuel consumption improvements. In this paper, we describe the energy management control of vehicle AC system coupled with vehicle engine through an intelligent control design. The Intelligent Energy Management Control (IEMC) system presented in this paper includes an intelligent algorithm which uses five exterior units and three integrated fuzzy controllers to produce desirable internal temperature and air quality, improved fuel consumption, low emission, and smooth driving. The three fuzzy controllers include: (i) a fuzzy cruise controller to adapt vehicle cruise speed via prediction of the road ahead using a Look-Ahead system, (ii) a fuzzy air conditioning controller to produce desirable temperature and air quality inside vehicle cabin room via a road information system, and (iii) a fuzzy engine controller to generate the required engine torque to move the vehicle smoothly on the road. We optimised the integrated operation of the air conditioning and the engine under various driving patterns and performed three simulations. Results show that the proposed IEMC system developed based on Fuzzy Air Conditioning Controller with Look-Ahead (FAC-LA) method is a more efficient controller for vehicle air conditioning system than the previously developed Coordinated Energy Management Systems (CEMS). - Highlights: ► AC interacts: vehicle, environment, driver components, and the interrelationships between them. ► Intelligent AC algorithm which uses

Pollution prevention for cleaner air: EPA's air and energy engineering research laboratory

International Nuclear Information System (INIS)

Shaver, E.M.

1992-01-01

The article discusses the role of EPA's Air and Energy Engineering Research Laboratory (AEERL) in pollution prevention research for cleaner air. For more than 20 years, AEERL has been conducting research to identify control approaches for the pollutants and sources which contribute to air quality problems. The Laboratory has successfully developed and demonstrated cost-effective sulfur dioxide, nitrogen oxides, and particulate control technologies for fossil fuel combustion sources. More recently, it has expanded its research activities to include indoor air quality, radon, organic control, stratospheric ozone depletion, and global warming. AEERL also develops inventories of air emissions of many types. Over the last several years, it has made substantial efforts to expand research on pollution prevention as the preferred choice for air emissions reduction

Variable speed gas engine-driven air compressor system

Science.gov (United States)

Morgan, J. R.; Ruggles, A. E.; Chen, T. N.; Gehret, J.

1992-11-01

Tecogen Inc. and Ingersoll-Rand Co. as a subcontractor have designed a nominal 150-hp gas engine-driven air compressor utilizing the TECODRIVE 8000 engine and the Ingersoll-Rand 178.5-mm twin screw compressor. Phase 1 included the system engineering and design, economic and applications studies, and a draft commercialization plan. Phase 2 included controls development, laboratory prototype construction, and performance testing. The testing conducted verified that the compressor meets all design specifications.

Vaginal Bleeding

Science.gov (United States)

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

Abnormal uterine bleeding

Science.gov (United States)

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

EXPERIMENTAL INVESTIGATION OF AN AIR CHARGED LOW POWERED STIRLING ENGINE

Directory of Open Access Journals (Sweden)

Can ÇINAR

2004-01-01

Full Text Available In this study, an air charged, low powered manufactured ? type Stirling engine was investigated experimentally. Tests were conducted at 800, 900 and 1000 °C hot source temperatures, 1, 1.5, 2, 2.5, 3, 3.5 bars air charge pressure. The variation of engine power depending on the charge pressure and hot source temperature for two different heat transfer area was investigated experimentally. Maximum output power was obtained at 1000 °C and 3 bars charge pressure as 58 W at 441 rpm. Engine speed was reached at 846 rpm without load.

Liquid air fueled open–closed cycle Stirling engine

International Nuclear Information System (INIS)

Xu, Weiqing; Wang, Jia; Cai, Maolin; Shi, Yan

2015-01-01

Highlights: • Energy of liquid air is divided into cryogenic energy and expansion energy. • Open–closed cycle Stirling mechanism is employed to improve efficiency. • The Schmidt theory is modified to describe temperature variation in cold space. - Abstract: An unconventional Stirling engine is proposed and its theoretical analysis is performed. The engine belongs to a “cryogenic heat engine” that is fueled by cryogenic medium. Conventional “cryogenic heat engine” employs liquid air as pressure source, but disregards its heat-absorbing ability. Therefore, its efficiency can only be improved by increasing vapor pressure, accordingly increasing the demand on pressure resistance and sealing. In the proposed engine, the added Stirling mechanism helps achieve its high efficiency and simplicity by utilizing the heat-absorbing ability of liquid air. On one hand, based on Stirling mechanism, gas in the hot space absorbs heat from atmosphere when expanding; gas in the cold space is cooled down by liquid air when compressed. Taking atmosphere as heat source and liquid air as heat sink, a closed Stirling cycle is formed. On the other hand, an exhaust port is set in the hot space. When expanding in the hot space, the vaporized gas is discharged through the exhaust port. Thus, an open cycle is established. To model and analyze the system, the Schmidt theory is modified to describe temperature variation in the cold space, and irreversible characteristic of regenerator is incorporated in the thermodynamic model. The results obtained from the model show that under the same working pressure, the efficiency of the proposed engine is potentially higher than that of conventional ones and to achieve the same efficiency, the working pressure could be lower with the new mechanism. Its efficiency could be improved by reducing temperature difference between the regenerator and the cold/hot space, increasing the swept volume ratio, decreasing the liquid–gas ratio. To keep

STUDY OF FLOW IN AIR-INTAKE SYSTEM FOR A SINGLE-CYLINDER GO-KART ENGINE

Directory of Open Access Journals (Sweden)

S. A. Sulaiman

2010-06-01

Full Text Available Intake-air manifolds have a major effect on a vehicle’s engine performance and emission of noise and pollutants. Differences in engine outputs and applications require different designs of intake-air manifolds in order to achieve the best volumetric efficiency and thus the best engine performance. In the present work, the flow characteristics of air flowing in various designs of air-intake manifold of a 200-cc four-stroke Go-Kart engine are studied. The study is done by three dimensional simulations of the flow of air within six designs of air-intake manifold into the combustion chamber by using commercial CFD software, Fluent version 6.2. The simulation results are validated by an experimental study performed using a flow bench. The study reveals that the variations in the geometry of the air-intake system can result in a difference of up to 20% in the mass flow rate of air entering the combustion chamber.

Deployable Engine Air-Brake for Drag Management Applications, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — ATA Engineering, Inc, proposes an SBIR program to demonstrate an innovative engine air-brake (EAB) technology that uses a deployable swirl vane mechanism to switch...

Deployable Engine Air-Brake for Drag Management Applications, Phase II

Data.gov (United States)

National Aeronautics and Space Administration — ATA Engineering, Inc., (ATA) proposes a Phase II SBIR program to demonstrate an innovative engine air-brake (EAB) technology that uses a deployable swirl vane...

Fuzzy logic speed control for the engine of an air-powered vehicle

Directory of Open Access Journals (Sweden)

Qihui Yu

2016-03-01

Full Text Available To improve the condition of air and eliminate exhaust gas pollution, this article proposes a compressed air power system. Instead of an internal combustion engine, the automobile is equipped with a compressed air engine, which transforms the energy of compressed air into mechanical motion energy. A prototype was built, and the compressed air engine was tested on an experimental platform. The output torque and energy efficiency were obtained from experimental results. When the supply pressure was set at 2 MPa and the speed was 420 r min−1, the output torque, the output power, and the energy efficiency were 56 N m, 1.93 kW, and 25%, respectively. To improve the efficiency of the system, a fuzzy logic speed control strategy is proposed and simulated. The experimental study verified that the theoretical evaluation of the system was reasonable, and this research can be referred to as the design and control of air-powered vehicles.

Acoustic Detection of Faults and Degradation in a High-Bypass Turbofan Engine during VIPR Phase III Testing

Science.gov (United States)

Boyle, Devin K.

2017-01-01

The Vehicle Integrated Propulsion Research (VIPR) Phase III project was executed at Edwards Air Force Base, California, by the National Aeronautics and Space Administration and several industry, academic, and government partners in the summer of 2015. One of the research objectives was to use external radial acoustic microphone arrays to detect changes in the noise characteristics produced by the research engine during volcanic ash ingestion and seeded fault insertion scenarios involving bleed air valves. Preliminary results indicate the successful acoustic detection of suspected degradation as a result of cumulative exposure to volcanic ash. This detection is shown through progressive changes, particularly in the high-frequency content, as a function of exposure to greater cumulative quantities of ash. Additionally, detection of the simulated failure of the 14th stage stability bleed valve and, to a lesser extent, the station 2.5 stability bleed valve, to their fully-open fail-safe positions was achieved by means of spectral comparisons between nominal (normal valve operation) and seeded fault scenarios.

Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

DEFF Research Database (Denmark)

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

2017-01-01

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

Analysis and simulation of mobile air conditioning system coupled with engine cooling system

International Nuclear Information System (INIS)

Qi, Zhao-gang; Chen, Jiang-ping; Chen, Zhi-jiu

2007-01-01

Many components of the mobile air conditioning system and engine cooling system are closely interrelated and make up the vehicle climate control system. In the present paper, a vehicle climate control system model including air conditioning system and engine cooling system has been proposed under different operational conditions. All the components have been modeled on the basis of experimental data. Based on the commercial software, a computer simulation procedure of the vehicle climate control system has been developed. The performance of the vehicle climate control system is simulated, and the calculational data have good agreement with experimental data. Furthermore, the vehicle climate control simulation results have been compared with an individual air conditioning system and engine cooling system. The influences between the mobile air conditioning system and the engine cooling system are discussed

The Sensitivity of Precooled Air-Breathing Engine Performance to Heat Exchanger Design Parameters

Science.gov (United States)

Webber, H.; Bond, A.; Hempsell, M.

The issues relevant to propulsion design for Single Stage To Orbit (SSTO) vehicles are considered. In particular two air- breathing engine concepts involving precooling are compared; SABRE (Synergetic Air-Breathing and Rocket Engine) as designed for the Skylon SSTO launch vehicle, and a LACE (Liquid Air Cycle Engine) considered in the 1960's by the Americans for an early generation spaceplane. It is shown that through entropy minimisation the SABRE has made substantial gains in performance over the traditional LACE precooled engine concept, and has shown itself as the basis of a viable means of realising a SSTO vehicle. Further, it is demonstrated that the precooler is a major source of thermodynamic irreversibility within the engine cycle and that further reduction in entropy can be realised by increasing the heat transfer coefficient on the air side of the precooler. If this were to be achieved, it would improve the payload mass delivered to orbit by the Skylon launch vehicle by between 5 and 10%.

Analysis of Air Force Civil Engineering Strategic Planning

National Research Council Canada - National Science Library

Mondo, Francis

2003-01-01

Several organizations within the Department of Defense, including the Air Force Civil Engineer, are actively engaged in strategic planning in an effort to create a roadmap for future capabilities and performance...

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

Science.gov (United States)

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

2015-12-01

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

Closed loop engine control for regulating NOx emissions, using a two-dimensional fuel-air curve

Science.gov (United States)

Bourn, Gary D.; Smith, Jack A.; Gingrich, Jess W.

2007-01-30

An engine control strategy that ensures that NOx emissions from the engine will be maintained at an acceptable level. The control strategy is based on a two-dimensional fuel-air curve, in which air manifold pressure (AMP) is a function of fuel header pressure and engine speed. The control strategy provides for closed loop NOx adjustment to a base AMP value derived from the fuel-air curve.

A Study of Performance Output of a Multivane Air Engine Applying Optimal Injection and Vane Angles

Directory of Open Access Journals (Sweden)

Bharat Raj Singh

2012-01-01

Full Text Available This paper presents a new concept of the air engine using compressed air as the potential power source for motorbikes, in place of an internal combustion engine. The motorbike is proposed to be equipped with an air engine, which transforms the energy of the compressed air into mechanical motion energy. A mathematical model is presented here, and performance evaluation is carried out on an air-powered novel air turbine engine. The maximum power output is obtained as 3.977 kW (5.50 HP at the different rotor to casing diameter ratios, optimal injection angle 60°, vane angle 45° for linear expansion (i.e., at minimum air consumption when the casing diameter is kept 100 mm, at injection pressure 6 bar (90 psi and speed of rotation 2500 rpm. A prototype air engine is built and tested in the laboratory. The experimental results are also seen much closer to the analytical values, and the performance efficiencies are recorded around 70% to 95% at the speed of rotation 2500–3000 rpm.

Air fuel ratio detector corrector for combustion engines using adaptive neurofuzzy networks

Directory of Open Access Journals (Sweden)

Nidhi Arora

2013-07-01

Full Text Available A perfect mix of the air and fuel in internal combustion engines is desirable for proper combustion of fuel with air. The vehicles running on road emit harmful gases due to improper combustion. This problem is severe in heavy vehicles like locomotive engines. To overcome this problem, generally an operator opens or closes the valve of fuel injection pump of locomotive engines to control amount of air going inside the combustion chamber, which requires constant monitoring. A model is proposed in this paper to alleviate combustion process. The method involves recording the time-varying flow of fuel components in combustion chamber. A Fuzzy Neural Network is trained for around 40 fuels to ascertain the required amount of air to form a standard mix to produce non-harmful gases and about 12 fuels are used for testing the network’s performance. The network then adaptively determines the additional/subtractive amount of air required for proper combustion. Mean square error calculation ensures the effectiveness of the network’s performance.

40 CFR 1065.125 - Engine intake air.

Science.gov (United States)

2010-07-01

... measurements at each intake, use an average value for verifying compliance to § 1065.520(b)(2). (2) Humidity. You may use a single shared humidity measurement for intake air as long as your equipment for handling... engines with multiple intakes with separate humidity measurements at each intake, use a flow-weighted...

Bleeding during Pregnancy

Science.gov (United States)

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

Clean Air Act Standards and Guidelines for Energy, Engines, and Combustion

Science.gov (United States)

This page contains the stationary sources of air pollution for the energy, engines, and combustion industries, and their corresponding air pollution regulations. To learn more about the regulations for each industry, just click on the links below.

Internal Bleeding

Science.gov (United States)

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

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

Science.gov (United States)

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

2014-01-01

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

Air and fuel supercharge in the performance of a diesel cycle engine

Directory of Open Access Journals (Sweden)

Marcelo Silveira de Farias

Full Text Available ABSTRACT: This paper aimed to evaluate the performance of a Diesel cycle engine, changing the configurations for the air and fuel supply system. Variables analyzed were torque, power, specific fuel consumption and thermal efficiency in four different engine configurations (aspirated, aspirated + service, turbocharged + service and turbocharged. For that, there were dynamometer experiments by power take-off of an agricultural tractor. The experimental outline used was entirely randomized, in a bifatorial design with three repetitions. Results indicated that the engine supercharge, compared to its original configuration, provided a significant increase of torque and power. Only the addition of turbo does not caused a significant effect in the engine performance. Application of turbocharger provides an improvement in the burning of the air/fuel mixture, which favors the increase of engine power and; consequently, reduced the specific fuel consumption.

Nonvariceal upper gastrointestinal bleeding

International Nuclear Information System (INIS)

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

2007-01-01

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

Nonvariceal upper gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

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

2007-07-15

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

Systems Engineering Management Training at Naval Air Systems Command

National Research Council Canada - National Science Library

Rebel, James

2000-01-01

Within the past few years, the Naval Air Systems Command (NAVAIR) has undergone several major changes including an engineering reorganization from a matrix organization to an Integrated Program Team/Competency Aligned Organization (IPT/CAO...

Theoretical and Experimental Investigations of Highly Uprated Diesel Engine with Temperature Regulator of Supercharging Air

Directory of Open Access Journals (Sweden)

G. A. Vershina

2005-01-01

Full Text Available Mathematical model of a highly uprated diesel engine with turbo-supercharging and intercooler of supercharging air is given in die paper. Theoretical study based on the model has made it possible to design and test an intercooler with a temperature regulator of supercharging air. Test results prove efficiency of temperature regulation of supercharging air in operation of an engine at low loads with excess air factor more than 3.2.

Air/fuel supply system for use in a gas turbine engine

Science.gov (United States)

Fox, Timothy A; Schilp, Reinhard; Gambacorta, Domenico

2014-06-17

A fuel injector for use in a gas turbine engine combustor assembly. The fuel injector includes a main body and a fuel supply structure. The main body has an inlet end and an outlet end and defines a longitudinal axis extending between the outlet and inlet ends. The main body comprises a plurality of air/fuel passages extending therethrough, each air/fuel passage including an inlet that receives air from a source of air and an outlet. The fuel supply structure communicates with and supplies fuel to the air/fuel passages for providing an air/fuel mixture within each air/fuel passage. The air/fuel mixtures exit the main body through respective air/fuel passage outlets.

Increasing the Air Charge and Scavenging the Clearance Volume of a Compression-Ignition Engine

Science.gov (United States)

Spanogle, J A; Hicks, C W; Foster, H H

1934-01-01

The object of the investigation presented in this report was to determine the effects of increasing the air charge and scavenging the clearance volume of a 4-stroke-cycle compression-ignition engine having a vertical-disk form combustion chamber. Boosting the inlet-air pressure with normal valve timing increased the indicated engine power in proportion to the additional air inducted and resulted in smoother engine operation with less combustion shock. Scavenging the clearance volume by using a valve overlap of 145 degrees and an inlet-air boost pressure of approximately 2 1/2 inches of mercury produced a net increase in performance for clear exhaust operation of 33 percent over that obtained with normal valve timing and the same boost pressure. The improved combustion characteristics result in lower specific fuel consumption, and a clearer exhaust.

Air mass flow estimation in turbocharged diesel engines from in-cylinder pressure measurement

Energy Technology Data Exchange (ETDEWEB)

Desantes, J.M.; Galindo, J.; Guardiola, C.; Dolz, V. [CMT - Motores Termicos, Universidad Politecnica de Valencia (Spain)

2010-01-15

Air mass flow determination is needed for the control of current internal combustion engines. Current methods are based on specific sensors (as hot wire anemometers) or indirect estimation through manifold pressure. With the availability of cylinder pressure sensors for engine control, methods based on them can be used for replacing or complementing standard methods. Present paper uses in cylinder pressure increase during the intake stroke for inferring the trapped air mass. The method is validated on two different turbocharged diesel engines and compared with the standard methods. (author)

Los Alamos PWR feed-and-bleed studies summary results and conclusions

International Nuclear Information System (INIS)

Boyack, B.E.; Henninger, R.J.; Lime, J.F.

1985-01-01

The adequacy of shutdown decay heat removal in pressurized water reactors (PWRs) is currently under investigation by the Nuclear Regulatory Commission. One part of this effort is review of feed-and-bleed procedures that could be used if the normal cooling mode through the steam generators was unavailable. Feed-and-bleed cooling is effected by manually activating the high-pressure injection (HPI) system and opening the power-operated relief valves (PORVs) to release the core decay energy. The feasibility of the feed-and-bleed concept as a diverse mode of heat removal has been evaluated at the Los Alamos National Laboratory. The TRAC-PF1 code has been used to predict the expected performances of the Oconee-1 and Calvert Cliffs-1 reactors of Babcock and Wilcox and Combustion Engineering, respectively, and the Zion-1 and H.B. Robinson-2 plants of Westinghouse. Feed and bleed was successfully applied in each of the four plants studied, provided it was initiated no later than the time of loss-of-secondary heat sink

Improving the performance of a compression ignition engine by directing flow of inlet air

Science.gov (United States)

Kemper, Carlton

1946-01-01

The object of this report is to present the results of tests performed by the National Advisory Committee for Aeronautics to determine the effect on engine performance of directing the flow of the inlet air to a 5-inch by 7-inch cylinder, solid injection, compression ignition engine, After a few preliminary tests, comparative runs were made at a speed of 1500 r.p.m. with and without directed air flow. It was found that directing the flow of the inlet air toward the fuel injection valve gave steadier engine operation, and an appreciable increase in power, and decreased fuel consumption. The results indicate the possibility of improving the performance of a given type of combustion chamber without changing its shape and with no change in valve timing. They would also seem to prove that directional turbulence, set up before the inlet valve of a four-stroke cycle engine, continues in the engine cylinder throughout the compression stroke.

A Source-Term Based Boundary Layer Bleed/Effusion Model for Passive Shock Control

Science.gov (United States)

Baurle, Robert A.; Norris, Andrew T.

2011-01-01

A modeling framework for boundary layer effusion has been developed based on the use of source (or sink) terms instead of the usual practice of specifying bleed directly as a boundary condition. This framework allows the surface boundary condition (i.e. isothermal wall, adiabatic wall, slip wall, etc.) to remain unaltered in the presence of bleed. This approach also lends itself to easily permit the addition of empirical models for second order effects that are not easily accounted for by simply defining effective transpiration values. Two effusion models formulated for supersonic flows have been implemented into this framework; the Doerffer/Bohning law and the Slater formulation. These models were applied to unit problems that contain key aspects of the flow physics applicable to bleed systems designed for hypersonic air-breathing propulsion systems. The ability of each model to predict bulk bleed properties was assessed, as well as the response of the boundary layer as it passes through and downstream of a porous bleed system. The model assessment was performed with and without the presence of shock waves. Three-dimensional CFD simulations that included the geometric details of the porous plate bleed systems were also carried out to supplement the experimental data, and provide additional insights into the bleed flow physics. Overall, both bleed formulations fared well for the tests performed in this study. However, the sample of test problems considered in this effort was not large enough to permit a comprehensive validation of the models.

Bleeding Disorders in Women

Science.gov (United States)

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

Vaginal bleeding in pregnancy

Science.gov (United States)

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

Upper gastrointestinal bleeding.

Science.gov (United States)

Feinman, Marcie; Haut, Elliott R

2014-02-01

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

Experimental characterization of mass, work and heat flows in an air cooled, single cylinder engine

International Nuclear Information System (INIS)

Perez-Blanco, H.

2004-01-01

Small air cooled engines, although large in numbers, receive scant attention in the literature. Experimental data for a four stroke, air cooled, single cylinder engine are presented in this report. Air to fuel ratios, indicated and output power, exhaust composition and heat loss are determined to result in suitable thermal and mechanical efficiencies. The data obtained are discussed with the perspective obtained from other literature references. Exhaust composition figures appear reasonable, but the measurement of the transient exhaust flows is still a concern. Based on the measurements, a graph illustrating the different energy transformations in the engine is produced. Undergraduate students in the curriculum routinely use the engine and the present work allows one to conclude that the measurement approach produces reasonable results. These results could be used by engine modelers and others interested in this wide field of technology

Study of transient in-cylinder air motion under motoring condition with diesel engine; Diesel engine no motoring ji no tonai ryudo kaiseki

Energy Technology Data Exchange (ETDEWEB)

Kitasei, T; Nakagawa, T [Mitsubishi Motors Co., Tokyo (Japan); Yamazumi, N [Ryoyu Keisan Co., Tokyo (Japan)

1997-10-01

The transient in-cylinder air motion have been investigated for reducing exhaust emissions and improving engine performance. A commercial CFD code was used for this purpose. For analyzing under engine motoring condition, the numerical model has a moving piston, intake and exhaust ports with moving valves. As result, exhaust port performance may be analyzed under steady condition, but intake port performance have to be analyzed under unsteady condition. Because transient in-cylinder air motion during intake process is different from steady in-cylinder air motion under influence of piston surface and air viscosity. 4 refs., 11 figs.

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

Directory of Open Access Journals (Sweden)

Lärfars Gerd

2010-09-01

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

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

OpenAIRE

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

2011-01-01

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

The International Bleeding Risk Score

DEFF Research Database (Denmark)

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

2017-01-01

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

AUTOMOTIVE DIESEL MAINTENANCE 1. UNIT II, MAINTAINING THE AIR SYSTEM--DETROIT DIESEL ENGINES.

Science.gov (United States)

Human Engineering Inst., Cleveland, OH.

THIS MODULE OF A 30-MODULE COURSE IS DESIGNED TO DEVELOP AN UNDERSTANDING OF THE OPERATION AND MAINTENANCE OF THE DIESEL ENGINE AIR SYSTEM. TOPICS ARE (1) OPERATION AND FUNCTION, (2) AIR CLEANER, (3) AIR SHUT-DOWN HOUSING, (4) EXHAUST SYSTEM, (5) BLOWER, (6) TURBOCHARGER, AND (7) TROUBLE-SHOOTING TIPS ON THE AIR SYSTEM. THE MODULE CONSISTS OF A…

Air Force-Wide Needs for Science, Technology, Engineering, and Mathematics (STEM) Academic Degrees

Science.gov (United States)

2014-01-01

anthropology (0190), mathematical statistics (1529), general math (AFIT faculty only), metallurgy (1321), and actuarial science (1510). 97 Tier II. Few...linking or frEE DownloAD At www.rand.org C O R P O R A T I O N Research Report Air Force–Wide Needs for Science , Technology, Engineering, and...00-00-2014 4. TITLE AND SUBTITLE Air Force-Wide Needs for Science , Technology, Engineering, and Mathematics (STEM) Academic Degrees 5a. CONTRACT

Buffer thermal energy storage for an air Brayton solar engine

Science.gov (United States)

Strumpf, H. J.; Barr, K. P.

1981-01-01

The application of latent-heat buffer thermal energy storage to a point-focusing solar receiver equipped with an air Brayton engine was studied. To demonstrate the effect of buffer thermal energy storage on engine operation, a computer program was written which models the recuperator, receiver, and thermal storage device as finite-element thermal masses. Actual operating or predicted performance data are used for all components, including the rotating equipment. Based on insolation input and a specified control scheme, the program predicts the Brayton engine operation, including flows, temperatures, and pressures for the various components, along with the engine output power. An economic parametric study indicates that the economic viability of buffer thermal energy storage is largely a function of the achievable engine life.

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

Science.gov (United States)

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

2017-04-01

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

Fluid flow and fuel-air mixing in a motored two-dimensional Wankel rotary engine

Science.gov (United States)

Shih, T. I.-P.; Nguyen, H. L.; Stegeman, J.

1986-01-01

The implicit-factored method of Beam and Warming was employed to obtain numerical solutions to the conservation equations of mass, species, momentum, and energy to study the unsteady, multidimensional flow and mixing of fuel and air inside the combustion chambers of a two-dimensional Wankel rotary engine under motored conditions. The effects of the following engine design and operating parameters on fluid flow and fuel-air mixing during the intake and compression cycles were studied: engine speed, angle of gaseous fuel injection during compression cycle, and speed of the fuel leaving fuel injector.

Bleeding esophageal varices

Science.gov (United States)

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

GI bleeding - slideshow

Science.gov (United States)

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

Scintigraphic evaluation of gastrointestinal bleeding

International Nuclear Information System (INIS)

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

1988-01-01

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

Liquid air fueled open-closed cycle Stirling engine and its exergy analysis

International Nuclear Information System (INIS)

Wang, Jia; Xu, Weiqing; Ding, Shuiting; Shi, Yan; Cai, Maolin; Rehman, Ali

2015-01-01

An unconventional Stirling engine is proposed and its theoretical analysis is performed. The engine belongs to a “cryogenic heat engine” that is fueled by cryogenic medium. Conventional “cryogenic heat engine” employs liquid air as a pressure source, but disregards its heat-absorbing ability. Therefore, its efficiency can only be improved by increasing vapor pressure, accordingly increasing the demand on pressure resistance and sealing. In the proposed engine, a closed cycle structure of Stirling engine is added to combine with the open cycle structure of a conventional cryogenic heat engine to achieve high efficiency and simplicity by utilizing the heat-absorbing ability of liquid air. Besides, the theoretical analysis of the proposed engine is performed. The Schmidt theory is modified to model temperature variation in the cold space of the engine, and irreversible characteristic of regenerator is incorporated in the thermodynamic model. The modeling results show that under the same working pressure, the efficiency of the proposed engine is potentially higher than that of conventional ones and to achieve the same efficiency, the working pressure could be lower with the new mechanism. Composition of exergy loss in the proposed engine is analyzed. - Highlights: • Cryogenic energy is better exploited by the open-closed cycle Stirling mechanism. • The Schmidt theory is modified to model temperature variation. • Irreversible characteristics are incorporated in the thermodynamic model. • Composition of exergy loss in proposed engine is analyzed.

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

Science.gov (United States)

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

2015-04-01

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

Air emissions inventory for the Idaho National Engineering Laboratory -- 1995 emissions report

International Nuclear Information System (INIS)

1996-06-01

This report presents the 1995 update of the Air Emission Inventory for the Idaho National Engineering Laboratory (INEL). The INEL Air Emission Inventory documents sources and emissions of non-radionuclide pollutants from operations at the INEL. The report describes the emission inventory process and all of the sources at the INEL, and provides non-radionuclide emissions estimates for stationary sources. The air contaminants reported include nitrogen oxides, sulfur oxides, carbon monoxide, volatile organic compounds, particulates, and hazardous air pollutants (HAPs)

Air emissions inventory for the Idaho National Engineering Laboratory -- 1995 emissions report

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-06-01

This report presents the 1995 update of the Air Emission Inventory for the Idaho National Engineering Laboratory (INEL). The INEL Air Emission Inventory documents sources and emissions of non-radionuclide pollutants from operations at the INEL. The report describes the emission inventory process and all of the sources at the INEL, and provides non-radionuclide emissions estimates for stationary sources. The air contaminants reported include nitrogen oxides, sulfur oxides, carbon monoxide, volatile organic compounds, particulates, and hazardous air pollutants (HAPs).

Vaginal or uterine bleeding - overview

Science.gov (United States)

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

Air Separation Using Hollow Fiber Membranes

Science.gov (United States)

Huang, Stephen E.

2004-01-01

The NASA Glenn Research Center in partnership with the Ohio Aerospace Institute provides internship programs for high school and college students in the areas of science, engineering, professional administrative, and other technical areas. During the summer of 2004, I worked with Dr. Clarence T. Chang at NASA Glenn Research Center s combustion branch on air separation using hollow fiber membrane technology. . In light of the accident of Trans World Airline s flight 800, FAA has mandated that a suitable solution be created to prevent the ignition of fuel tanks in aircrafts. In order for any type of fuel to ignite, three important things are needed: fuel vapor, oxygen, and an energy source. Two different ways to make fuel tanks less likely to ignite are reformulating the fuel to obtain a lower vapor pressure for the fuel and or using an On Board Inert Gas Generating System (OBIGGS) to inert the Central Wing Tank. goal is to accomplish the mission, which means that the Air Separation Module (ASM) tends to be bulky and heavy. The primary goal for commercial aviation companies is to transport as much as they can with the least amount of cost and fuel per person, therefore the ASM must be compact and light as possible. The plan is to take bleed air from the aircraft s engines to pass air through a filter first to remove particulates and then pass the air through the ASM containing hollow fiber membranes. In the lab, there will be a heating element provided to simulate the temperature of the bleed air that will be entering the ASM and analysis of the separated air will be analyzed by a Gas Chromatograph/Mass Spectrometer (GC/MS). The GUMS will separate the different compounds in the exit streams of the ASM and provide information on the performance of hollow fiber membranes. Hopefully I can develop ways to improve efficiency of the ASM. different types of jet fuel were analyzed and data was well represented on SAE Paper 982485. Data consisted of the concentrations of over

System Design and Analysis of a Directly Air-Assisted Turbocharged SI Engine with Camshaft Driven Valves

Directory of Open Access Journals (Sweden)

Lino Guzzella

2013-03-01

Full Text Available The availability of compressed air in combination with downsizing and turbocharging is a promising approach to improve the fuel economy and the driveability of internal combustion engines. The compressed air is used to boost and start the engine. It is generated during deceleration phases by running the engine as a piston compressor. In this paper, a camshaft-driven valve is considered for the control of the air exchange between the tank and the combustion chamber. Such a valve system is cost-effective and robust. Each pneumatic engine mode is realized by a separate cam. The air mass transfer in each mode is analyzed. Special attention is paid to the tank pressure dependence. The air demand in the boost mode is found to increase with the tank pressure. However, the dependence on the tank pressure is small in the most relevant operating region. The air demand of the pneumatic start shows a piecewise continuous dependence on the tank pressure. Finally, a tank sizing method is proposed which uses a quasi-static simulation. It is applied to a compact class vehicle, for which a tank volume of less than 10 L is sufficient. A further reduction of the tank volume is limited by the specifications imposed on the pneumatic start.

Simulation of a hot air engine for a generation of electricity using biogas for Tanzania rural application

International Nuclear Information System (INIS)

Mkiramweni, L.L.N.; Msaki, P.; Mshoro, I.B.

2007-01-01

At the moment, about 80% of the rural population in Tanzania lacks grid electricity. As a result, up to 90% of energy requirements in rural areas are met by firewood and hence causing deforestation. In the present paper, the authors are advocating the application of biogas to generate electricity in rural areas to minimise deforestation. Preliminary study conducted has shown that the power required in rural areas is about 10kW for household and small economic activities. As such, the authors have investigated the possibility of applying a hot air engine using biogas as a source of energy to generate electricity. The study involved simulation of hot air engine using a Stirling Numerical Analysis Program (SNAP) with use modifiable code. In the exercise, the performance of the simulated engine was assessed with helium, hydrogen and air as working media. Reheat loss and pressure losses were also assessed for varies range of engine power and efficiency. It has been observed that with helium and hydrogen as working gas, the power output could easily reach 10kW, which is sufficient for rural household application. However, with air the engine could realise only 4kW under similar conditions. It has further been observed that air has bigger and more viscous molecular with lower thermal conductivity and heat capacity, which results in higher losses. This implies that a relatively bigger engine need be employed for running with air. However, high initial cost will be offset by the reduction in operating cost, since air is freely available. For proper operation of the engine heater temperature should be maintained above 630(deg)C, which is realizable with biogas having a flame temperature of about 870(deg)C. (author)

Adaptive individual-cylinder thermal state control using intake air heating for a GDCI engine

Science.gov (United States)

Roth, Gregory T.; Sellnau, Mark C.

2016-08-09

A system for a multi-cylinder compression ignition engine includes a plurality of heaters, at least one heater per cylinder, with each heater configured to heat air introduced into a cylinder. Independent control of the heaters is provided on a cylinder-by-cylinder basis. A combustion parameter is determined for combustion in each cylinder of the engine, and control of the heater for that cylinder is based on the value of the combustion parameter for combustion in that cylinder. A method for influencing combustion in a multi-cylinder compression ignition engine, including determining a combustion parameter for combustion taking place in a cylinder of the engine and controlling a heater configured to heat air introduced into that cylinder, is also provided.

Performance of a Compression-ignition Engine with a Precombustion Chamber Having High-Velocity Air Flow

Science.gov (United States)

Spanogle, J A; Moore, C S

1931-01-01

Presented here are the results of performance tests made with a single-cylinder, four stroke cycle, compression-ignition engine. These tests were made on a precombustion chamber type of cylinder head designed to have air velocity and tangential air flow in both the chamber and cylinder. The performance was investigated for variable load and engine speed, type of fuel spray, valve opening pressure, injection period and, for the spherical chamber, position of the injection spray relative to the air flow. The pressure variations between the pear-shaped precombustion chamber and the cylinder for motoring and full load conditions were determined with a Farnboro electric indicator. The combustion chamber designs tested gave good mixing of a single compact fuel spray with the air, but did not control the ensuing combustion sufficiently. Relative to each other, the velocity of air flow was too high, the spray dispersion by injection too great, and the metering effect of the cylinder head passage insufficient. The correct relation of these factors is of the utmost importance for engine performance.

Upper GI Bleeding in Children

Science.gov (United States)

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

Model Predictive Engine Air-Ratio Control Using Online Sequential Relevance Vector Machine

Directory of Open Access Journals (Sweden)

Hang-cheong Wong

2012-01-01

Full Text Available Engine power, brake-specific fuel consumption, and emissions relate closely to air ratio (i.e., lambda among all the engine variables. An accurate and adaptive model for lambda prediction is essential to effective lambda control for long term. This paper utilizes an emerging technique, relevance vector machine (RVM, to build a reliable time-dependent lambda model which can be continually updated whenever a sample is added to, or removed from, the estimated lambda model. The paper also presents a new model predictive control (MPC algorithm for air-ratio regulation based on RVM. This study shows that the accuracy, training, and updating time of the RVM model are superior to the latest modelling methods, such as diagonal recurrent neural network (DRNN and decremental least-squares support vector machine (DLSSVM. Moreover, the control algorithm has been implemented on a real car to test. Experimental results reveal that the control performance of the proposed relevance vector machine model predictive controller (RVMMPC is also superior to DRNNMPC, support vector machine-based MPC, and conventional proportional-integral (PI controller in production cars. Therefore, the proposed RVMMPC is a promising scheme to replace conventional PI controller for engine air-ratio control.

Potential benefits of oxygen-enriched intake air in a vehicle powered by a spark-ignition engine

Science.gov (United States)

Ng, H. K.; Sekar, R. R.

1994-04-01

A production vehicle powered by a spark-ignition engine (3.1-L Chevrolet Lumina, model year 1990) was tested. The test used oxygen-enriched intake air containing 25 and 28% oxygen by volume to determine (1) if the vehicle would run without difficulties and (2) if emissions benefits would result. Standard Federal Test Procedure (FTP) emissions test cycles were run satisfactorily. Test results of catalytic converter-out emissions (emissions out of the converter) showed that both carbon monoxide and hydrocarbons were reduced significantly in all three phases of the emissions test cycle. Test results of engine-out emissions (emissions straight out of the engine, with the converter removed) showed that carbon monoxide was significantly reduced in the cold phase. All emission test results were compared with those for normal air (21% oxygen). The catalytic converter also had an improved carbon monoxide conversion efficiency under the oxygen-enriched-air conditions. Detailed results of hydrocarbon speciation indicated large reductions in 1,3-butadiene, formaldehyde, acetaldehyde, and benzene from the engine with the oxygen-enriched air. Catalytic converter-out ozone was reduced by 60% with 25%-oxygen-content air. Although NO(x) emissions increased significantly, both for engine-out and catalytic converter-out emissions, we anticipate that they can be ameliorated in the near future with new control technologies. The automotive industry currently is developing exhaust-gas control technologies for an oxidizing environment; these technologies should reduce NO(x) emissions more efficiently in vehicles that use oxygen-enriched intake air. On the basis of estimates made from current data, several production vehicles that had low NO(x) emissions could meet the 2004 Tier 2 emissions standards with 25%-oxygen-content air.

Air Emission Inventory for the Idaho National Engineering Laboratory: 1992 emissions report

Energy Technology Data Exchange (ETDEWEB)

Stirrup, T.S.

1993-06-01

This report presents the 1992 Air Emission Inventory for the Idaho National Engineering Laboratory. Originally, this report was in response to the Environmental Oversight and Monitoring Agreement in 1989 between the State of Idaho and the Department of Energy Idaho Field Office, and a request from the Idaho Air Quality Bureau. The current purpose of the Air Emission Inventory is to provide the basis for the preparation of the INEL Permit-to-Operate (PTO) an Air Emission Source Application, as required by the recently promulgated Title V regulations of the Clean Air Act. This report includes emissions calculations from 1989 to 1992. The Air Emission Inventory System, an ORACLE-based database system, maintains the emissions inventory.

Air Emission Inventory for the Idaho National Engineering Laboratory: 1992 emissions report

International Nuclear Information System (INIS)

Stirrup, T.S.

1993-06-01

This report presents the 1992 Air Emission Inventory for the Idaho National Engineering Laboratory. Originally, this report was in response to the Environmental Oversight and Monitoring Agreement in 1989 between the State of Idaho and the Department of Energy Idaho Field Office, and a request from the Idaho Air Quality Bureau. The current purpose of the Air Emission Inventory is to provide the basis for the preparation of the INEL Permit-to-Operate (PTO) an Air Emission Source Application, as required by the recently promulgated Title V regulations of the Clean Air Act. This report includes emissions calculations from 1989 to 1992. The Air Emission Inventory System, an ORACLE-based database system, maintains the emissions inventory

Dysfunctional Uterine Bleeding (DUB) (For Teens)

Science.gov (United States)

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

Air Emission Inventory for the Idaho National Engineering Laboratory, 1993 emissions report

International Nuclear Information System (INIS)

1994-06-01

This report presents the 1993 update of the Air Emission Inventory for the Idaho National Engineering Laboratory (INEL). The purpose of the Air Emission Inventory is to commence the preparation of the permit to operate application for the INEL, as required by the recently promulgated Title V regulations of the Clean Air Act. The report describes the emission inventory process and all of the sources at the INEL and provides emissions estimates for both mobile and stationary sources

Air Emission Inventory for the Idaho National Engineering Laboratory, 1993 emissions report

Energy Technology Data Exchange (ETDEWEB)

1994-06-01

This report presents the 1993 update of the Air Emission Inventory for the Idaho National Engineering Laboratory (INEL). The purpose of the Air Emission Inventory is to commence the preparation of the permit to operate application for the INEL, as required by the recently promulgated Title V regulations of the Clean Air Act. The report describes the emission inventory process and all of the sources at the INEL and provides emissions estimates for both mobile and stationary sources.

Trends in air-breathing engines for super high speed aircraft engine system and its task

Energy Technology Data Exchange (ETDEWEB)

Nose, Hiroyuki

1988-06-10

The second generation of space plane is under active development as the world only space plane, the Space Shuttle of U.S. will not be able to satisfy the demands in 2000 even if its flight is resumed. Conceptual study was completed in the NASP project of U.S. and the test flight of experimental plane X-30 is scheduled in mid-90's. A variety of proposals have been made by U.K, West Germany and France and the European Space Agency (ESA) is adjusting them. The mini-shuttle is under planning in Japan, which will employ H-2 rocket. Typical air-breathing engines for space planes are: Super-sonic variable cycle turbofan engine, turbo-ram jet engine, and scram jet engine, which reduces the static temperature by making the flow velocity in combustion chamber to be supersonic to fire fuels. (29 figs, 3 tabs, 9 refs)

Cost/benefit analysis of adding a feed-and-bleed capability to Combustion Engineering pressurized-water reactors

International Nuclear Information System (INIS)

Gallup, D.R.; Gahan, E.; Cherdack, R.; Skala, G.

1983-08-01

This report presents the results of a cost/benefit analysis for the addition of a feed-and-bleed capability to the San Onofre Nuclear Generating Station, Unit 2, (SONGS 2). Two cases of feed-and-bleed capability were investigated: 1) adding power-operated relief valves (PORVs) to the pressurizer for depressurization and using the present high-pressure safety-injection (HPSI) system for reactor-coolant-system (RCS) inventory make-up and 2) adding an independent single-train feed-and-bleed system. For the first case, it is estimated that the core-melt frequency would be incrementally reduced by 4.0E-6 per year, a factor of 1.3, at a cost of $2.5 M to $4.3 M depending on when the equipment is installed. For the second case, it is estimated that the core-melt frequency would be incrementally reduced by 1.2E-5 per year, a factor of 3, at a cost of $7.0 M to $10.3 M

40 CFR 89.414 - Air flow measurement specifications.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Air flow measurement specifications... Emission Test Procedures § 89.414 Air flow measurement specifications. (a) The air flow measurement method... incorporates devices that affect the air flow measurement (such as air bleeds) that result in understated...

Management of severe perioperative bleeding

DEFF Research Database (Denmark)

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

2017-01-01

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

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

International Nuclear Information System (INIS)

Asgher, S.; Saleem, M.K.

2015-01-01

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

Engine Cycle Analysis of Air Breathing Microwave Rocket with Reed Valves

International Nuclear Information System (INIS)

Fukunari, Masafumi; Komatsu, Reiji; Yamaguchi, Toshikazu; Komurasaki, Kimiya; Arakawa, Yoshihiro; Katsurayama, Hiroshi

2011-01-01

The Microwave Rocket is a candidate for a low cost launcher system. Pulsed plasma generated by a high power millimeter wave beam drives a blast wave, and a vehicle acquires impulsive thrust by exhausting the blast wave. The thrust generation process of the Microwave Rocket is similar to a pulse detonation engine. In order to enhance the performance of its air refreshment, the air-breathing mechanism using reed valves is under development. Ambient air is taken to the thruster through reed valves. Reed valves are closed while the inside pressure is high enough. After the time when the shock wave exhausts at the open end, an expansion wave is driven and propagates to the thrust-wall. The reed valve is opened by the negative gauge pressure induced by the expansion wave and its reflection wave. In these processes, the pressure oscillation is important parameter. In this paper, the pressure oscillation in the thruster was calculated by CFD combined with the flux through from reed valves, which is estimated analytically. As a result, the air-breathing performance is evaluated using Partial Filling Rate (PFR), the ratio of thruster length to diameter L/D, and ratio of opening area of reed valves to superficial area α. An engine cycle and predicted thrust was explained.

Heat exchanger operation in the externally heated air valve engine with separated settling chambers

International Nuclear Information System (INIS)

Kazimierski, Zbyszko; Wojewoda, Jerzy

2014-01-01

The crucial role in the externally heated air valve engine is played by its heat exchangers which work in a closed cycle. These are: a heater and a cooler and they are subject to a numerical analysis in the paper. Both of them are equipped with fixed volumes that are separate settling chambers causing that heat exchangers behave as almost stationary recuperators and analysis of the stationary behaviour is the main goal of the paper. Power and efficiency of the engine must be not lower than their averaged values for the same engine working in unsteady conditions. The results of calculations confirm such a statement. The pressure drop in the exchanger is another natural phenomenon presented. It has been overcome by use of additional blowers and the use of them is an additional focus of the presented analysis. A separation of settling chambers and additional blowers is a novelty in the paper. There is also a pre-heater applied in the engine which does not differ from well-known heat exchangers met in energy generation devices. The main objective of the paper is to find the behaviour of the engine model under stationary conditions of the heat exchangers and compare it with the non-stationary ones. - Highlights: • Externally heated air engine combined with forced working gas flow (supercharging). • Separate settling chambers allow for achieving stable and constant heat exchange parameters. • Pressure drop in heat exchangers overcome by additional blowers. • Reciprocating piston air engine, cam governing system, standard lubrication for externally heated engine. • Different fuels: oil, coal, gas, biomass also solar or nuclear energy

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

Science.gov (United States)

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

2018-01-01

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

Air emission inventory for the Idaho National Engineering Laboratory: 1994 emissions report

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-07-01

This report Presents the 1994 update of the Air Emission inventory for the Idaho National Engineering Laboratory (INEL). The INEL Air Emission Inventory documents sources and emissions of non-radionuclide pollutants from operations at the INEL. The report describes the emission inventory process and all of the sources at the INEL, and provides non-radionuclide emissions estimates for stationary sources.

Air emission inventory for the Idaho National Engineering Laboratory: 1994 emissions report

International Nuclear Information System (INIS)

1995-07-01

This report Presents the 1994 update of the Air Emission inventory for the Idaho National Engineering Laboratory (INEL). The INEL Air Emission Inventory documents sources and emissions of non-radionuclide pollutants from operations at the INEL. The report describes the emission inventory process and all of the sources at the INEL, and provides non-radionuclide emissions estimates for stationary sources

In-Cabin Air Quality during Driving and Engine Idling in Air-Conditioned Private Vehicles in Hong Kong.

Science.gov (United States)

Barnes, Natasha Maria; Ng, Tsz Wai; Ma, Kwok Keung; Lai, Ka Man

2018-03-27

Many people spend lengthy periods each day in enclosed vehicles in Hong Kong. However, comparably limited data is available about in-cabin air quality in air-conditioned private vehicles, and the car usage that may affect the air quality. Fifty-one vehicles were tested for particulate matter (PM 0.3 and PM 2.5 ), total volatile organic compounds (TVOCs), carbon monoxide (CO), carbon dioxide (CO₂), airborne bacteria, and fungi levels during their routine travel journey. Ten of these vehicles were further examined for PM 0.3 , PM 2.5 , TVOCs, CO, and CO₂ during engine idling. In general, during driving PM 2.5 levels in-cabin reduced overtime, but not PM 0.3 . For TVOCs, 24% vehicles exceeded the recommended Indoor Air Quality (IAQ) level in offices and public places set by the Hong Kong Environmental Protection Department. The total volatile organic compounds (TVOC) concentration positively correlated with the age of the vehicle. Carbon monoxide (CO) levels in all of the vehicles were lower than the IAQ recommendation, while 96% vehicles exceeded the recommended CO₂ level of 1000 ppmv; 16% vehicles >5000 ppmv. Microbial counts were relatively low. TVOCs levels at idle engine were higher than that during driving. Although the time we spend in vehicles is short, the potential exposure to high levels of pollutants should not be overlooked.

In-Cabin Air Quality during Driving and Engine Idling in Air-Conditioned Private Vehicles in Hong Kong

Directory of Open Access Journals (Sweden)

Natasha Maria Barnes

2018-03-01

Full Text Available Many people spend lengthy periods each day in enclosed vehicles in Hong Kong. However, comparably limited data is available about in-cabin air quality in air-conditioned private vehicles, and the car usage that may affect the air quality. Fifty-one vehicles were tested for particulate matter (PM0.3 and PM2.5, total volatile organic compounds (TVOCs, carbon monoxide (CO, carbon dioxide (CO2, airborne bacteria, and fungi levels during their routine travel journey. Ten of these vehicles were further examined for PM0.3, PM2.5, TVOCs, CO, and CO2 during engine idling. In general, during driving PM2.5 levels in-cabin reduced overtime, but not PM0.3. For TVOCs, 24% vehicles exceeded the recommended Indoor Air Quality (IAQ level in offices and public places set by the Hong Kong Environmental Protection Department. The total volatile organic compounds (TVOC concentration positively correlated with the age of the vehicle. Carbon monoxide (CO levels in all of the vehicles were lower than the IAQ recommendation, while 96% vehicles exceeded the recommended CO2 level of 1000 ppmv; 16% vehicles >5000 ppmv. Microbial counts were relatively low. TVOCs levels at idle engine were higher than that during driving. Although the time we spend in vehicles is short, the potential exposure to high levels of pollutants should not be overlooked.

Bleeding into the skin

Science.gov (United States)

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

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

Science.gov (United States)

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

2018-03-01

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

Heavy Menstrual Bleeding (Menorrhagia)

Science.gov (United States)

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

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

DEFF Research Database (Denmark)

Guo, Yutao; Zhu, Hang; Chen, Yundai

2018-01-01

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

An experimental setup for the study of the steady air flow in a diesel engine chamber

Directory of Open Access Journals (Sweden)

Montanero José María

2012-04-01

Full Text Available We present an experimental setup for studying the steady air flow in a diesel engine chamber. An engine block containing the inlet manifold was placed on a test bench. A steady air stream crossed the inlet manifold and entered a glass chamber driven by a fan. A PIV system was set up around the bench to measure the in-chamber flow. An air spray gun was used as seed generator to producing sub-millimeter droplets, easily dragged by the air stream. Images of the in-flow chamber were acquired in the course of the experiments, and processed to measure the velocity field. The pressure drop driven the air current and the mass flow rate were also measured.

The use of 111In-labelled platelets for scintigraphic localization of gastrointestinal bleeding with special reference to occult bleeding

International Nuclear Information System (INIS)

Gjerloeff Schmidt, K.; Waever Rasmussen, J.; Grove, O.; Andersen, D.

1986-01-01

Gamma-camera imaging of the abdomen after injection of autologous 111 In-labelled platelets was applied for localization of gastrointestinal bleeding in a study of 22 patients. In 15 studies showing scintigraphic signs of bleeding, the clinical presentation included occult bleeding in 6, melaena in 4, and bloody stools in 5 patients. Scintigraphy could be done repeatedly for up to 1 week after a single tracer injection. The time interval between the injection and scintigraphic visualization of bleeding ranged from 10 min to 68 h, being longest in cases of occult bleeding. In most cases the scintigraphic findings were supported by other diagnostic modalities, including surgical removal of presumed sources of bleeding. In seven studies without scintigraphic signs of bleeding, a probable source of bleeding was identified by other means in one patient. The 111 In-platelet method seems to be a promising method for localization of gastrointestinal bleeding which may prove particularly useful in cases of occult or recurrent bleeding

Vaginal bleeding between periods

Science.gov (United States)

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

Simulation, experimental validation and kinematic optimization of a Stirling engine using air and helium

International Nuclear Information System (INIS)

Bert, Juliette; Chrenko, Daniela; Sophy, Tonino; Le Moyne, Luis; Sirot, Frédéric

2014-01-01

A Stirling engine with nominal output power of 1 kW is tested using air and helium as working gases. The influence of working pressure, engine speed and temperature of the hot source is studied, analyzing instantaneous gas pressure as well as instantaneous and stationary temperature at different positions to derive the effective power. A zero dimensional finite-time thermodynamic, three zones model of a generic Stirling engine is developed and successfully validated against experimental gas temperature and pressure in each zone, providing the effective power. This validation underlines the interest of different working gases as well as different geometric configurations for different applications. Furthermore, the validated model allows parametric studies of the engine, with regard to geometry, working gas and engine kinematics. It is used in order to optimize the kinematic of a Stirling engine for different working points and gases. - Highlights: • A Stirling engine of 1 kW is tested using air and helium as working gas. • Effects of working pressure, speed and temperature on power are studied. • A zero dimensional finite-time thermodynamic, three zones model of it is validated. • The validated model is used for parametric studies and optimization of the engine

Value of Adjusted Blood Requirement Index in determining failure to control bleed in patients with variceal bleeding.

Science.gov (United States)

Abid, Shahab; Khalid, Abdullah B; Awan, Safia; Shah, Hasnain A; Hamid, Saeed; Jafri, Wasim

2015-03-01

Variceal bleeding is a serious complication in patients with cirrhosis. Among the criteria that were proposed in Baveno conferences, the Adjusted Blood Requirement Index (ABRI) has not been validated prospectively in clinical practice. We therefore aim to evaluate the measurement of ABRI as a marker of failure to control bleeding and to evaluate the consistency of ABRI in relation to other criteria of failure to control variceal bleeding. All patients with variceal bleeding who presented to Aga Khan University Hospital from January 2010 to December 2012 who were administered transfusion of packed red blood cells were included after obtaining informed consent. All patients were managed as per the standard protocol with intravenous terlipressin along with band ligation and injection of cyanoacrylate in cases of esophageal and fundal varices, respectively. Hemoglobin and hematocrit were measured every 6 h for 48 h and then every 12 h until 5 days of index bleed in each patient. Packed cells were transfused if hemoglobin decreased below 8 g/dl. The number of blood units transfused, change in hemoglobin values, and ABRI were calculated after each unit of blood transfusion till 120 h. In patients in whom bleed could not be controlled, an ABRI value of 0.75 or more was compared with other Baveno IV-based parameters that define failure to control variceal bleeding. During the study period, 137 eligible patients with variceal bleed were admitted. The mean age of the patients was 52±12 years. The majority of patients (50.4%) were in Child-Pugh class B, followed by 38% in Child-Pugh class C. According to the Baveno IV criteria, overall failure to control acute variceal bleeding occurred in 52 (37.9%) patients. Excluding ABRI, failure to control bleeding was found in 22/137 (16%) patients, whereas ABRI-based criteria showed that in 34/137 (24.8%) patients, bleeding could not be controlled. There were only four (2.9%) patients with variceal bleeding in whom ABRI and

Abnormal Uterine Bleeding FAQ

Science.gov (United States)

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

Automated registration of tail bleeding in rats.

Science.gov (United States)

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

2008-05-01

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

The influence of air-fuel ratio on mixture parameters in port fuel injection engines

Directory of Open Access Journals (Sweden)

Adrian Irimescu

2008-10-01

Full Text Available Nowadays, research in the internal combustion engine field is focusing on detailed understanding of the processes that take place in certain parts of the aggregate, and can have a great influence on the engine’s performance and pollution levels. Such research is developed in this paper, in which using a numerical method based on the i-x air-fuel diagram, one can simulate a series of values for pressure, temperature and intake air humidity before and after mixture formation takes place in a spark ignition engine inlet port. The aim is to evaluate the final temperature of the air-fuel mixture near the inlet valve and evaluating the main factors of influence on the homogeneity of the mixture.

Management of acute gastric varices bleeding

Directory of Open Access Journals (Sweden)

Chen-Jung Chang

2013-10-01

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

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

Science.gov (United States)

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

2016-07-01

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

Severe Bleeding: First Aid

Science.gov (United States)

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

Recurrent Bleeding After Perimesencephalic Hemorrhage.

Science.gov (United States)

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

2017-12-01

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

Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

International Nuclear Information System (INIS)

Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M.; Al-Wafai, I.; Vallgren, S.

1989-01-01

The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of 99m Tc-DTPA, 99m Tc-RBCs and 99m Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both 99m Tc-DTPA and 99m Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only 99m Tc-DTPA was successful in detecting the bleeding site. The results indicate that 99m Tc-DTPA is the most useful 99m Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.) [de

Potentiometric surfaces of the Arnold Engineering Development Complex Area, Arnold Air Force Base, Tennessee, May and September 2011

Science.gov (United States)

Haugh, Connor J.; Robinson, John A.

2016-01-29

Arnold Air Force Base occupies about 40,000 acres in Coffee and Franklin Counties, Tennessee. The primary mission of Arnold Air Force Base is to provide risk-reduction information in the development of aerospace products through test and evaluation. This mission is achieved in part through test facilities at Arnold Engineering Development Complex (AEDC), which occupies about 4,000 acres in the center of Arnold Air Force Base. Arnold Air Force Base is underlain by gravel and limestone aquifers, the most productive of which is the Manchester aquifer. Several volatile organic compounds, primarily chlorinated solvents, have been identified in the groundwater at Arnold Air Force Base. In 2011, the U.S. Geological Survey, in cooperation with the U.S. Air Force, Arnold Air Force Base, completed a study of groundwater flow focused on the Arnold Engineering Development Complex area. The Arnold Engineering Development Complex area is of particular concern because within this area (1) chlorinated solvents have been identified in the groundwater, (2) the aquifers are dewatered around below-grade test facilities, and (3) there is a regional groundwater divide.

[Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

Science.gov (United States)

Belanová, Veronika; Gřiva, Martin

2015-12-01

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

Prospective analysis of delayed colorectal post-polypectomy bleeding.

Science.gov (United States)

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

2018-01-17

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

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

NARCIS (Netherlands)

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

2014-01-01

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

Development of an Engine Air-Brake for Quiet Drag Applications, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — A novel quiet engine air-brake is proposed in response to NASA's solicitation for concepts for active and passive control of noise sources for conventional and...

Comparison of detectable bleeding rates of radiopharmaceuticals for localization of gastrointestinal bleeding in sheep using a closed system

Energy Technology Data Exchange (ETDEWEB)

Owunwanne, A.; Sadek, S.; Yacoub, T.; Awdeh, M.; Abdel-Dayem, H.M. (Kuwait Univ. (Kuwait). Dept. of Nuclear Medicine); Al-Wafai, I.; Vallgren, S. (Kuwait Univ. (Kuwait). Dept. of Surgery)

1989-06-01

The closed experimental animal model system was used to compare the detectable gastrointestinal (GI) bleeding rates of {sup 99m}Tc-DTPA, {sup 99m}Tc-RBCs and {sup 99m}Tc tin colloid in sheep. The three radiopharmaceuticals were used to detect the upper GI bleeding sites at rates of 0.57 and 0.25 ml/min. At the lower bleeding rate of 0.1 ml/min, both {sup 99m}Tc-DTPA and {sup 99m}Tc-RBCs were successful in detecting the bleeding site. At the lowest rate of 0.07 ml/min only {sup 99m}Tc-DTPA was successful in detecting the bleeding site. The results indicate that {sup 99m}Tc-DTPA is the most useful {sup 99m}Tc radiopharmaceutical for detecting the upper GI bleeding site at the slowest bleeding rate studied. (orig.).

Computer Model to Estimate Reliability Engineering for Air Conditioning Systems

International Nuclear Information System (INIS)

Afrah Al-Bossly, A.; El-Berry, A.; El-Berry, A.

2012-01-01

Reliability engineering is used to predict the performance and optimize design and maintenance of air conditioning systems. Air conditioning systems are expose to a number of failures. The failures of an air conditioner such as turn on, loss of air conditioner cooling capacity, reduced air conditioning output temperatures, loss of cool air supply and loss of air flow entirely can be due to a variety of problems with one or more components of an air conditioner or air conditioning system. Forecasting for system failure rates are very important for maintenance. This paper focused on the reliability of the air conditioning systems. Statistical distributions that were commonly applied in reliability settings: the standard (2 parameter) Weibull and Gamma distributions. After distributions parameters had been estimated, reliability estimations and predictions were used for evaluations. To evaluate good operating condition in a building, the reliability of the air conditioning system that supplies conditioned air to the several The company's departments. This air conditioning system is divided into two, namely the main chilled water system and the ten air handling systems that serves the ten departments. In a chilled-water system the air conditioner cools water down to 40-45 degree F (4-7 degree C). The chilled water is distributed throughout the building in a piping system and connected to air condition cooling units wherever needed. Data analysis has been done with support a computer aided reliability software, this is due to the Weibull and Gamma distributions indicated that the reliability for the systems equal to 86.012% and 77.7% respectively. A comparison between the two important families of distribution functions, namely, the Weibull and Gamma families was studied. It was found that Weibull method performed for decision making.

Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model

International Nuclear Information System (INIS)

Thorne, D.A.; Datz, F.L.; Remley, K.; Christian, P.E.

1987-01-01

Proponents of [/sup 99m/Tc]sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with [/sup 99m/Tc]sulfur colloid. Since similar data in the dog model were unavailable for /sup 99m/Tc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with /sup 99m/Tc using an in vitro technique. Venous blood was then withdrawn and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that /sup 99m/Tc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for [/sup 99m/Tc]sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate

Ignition Study on a Rotary-valved Air-breathing Pulse Detonation Engine

Science.gov (United States)

Wu, Yuwen; Han, Qixiang; Shen, Yujia; Zhao, Wei

2017-05-01

In the present study, the ignition effect on detonation initiation was investigated in the air-breathing pulse detonation engine. Two kinds of fuel injection and ignition methods were applied. For one method, fuel and air was pre-mixed outside the PDE and then injected into the detonation tube. The droplet sizes of mixtures were measured. An annular cavity was used as the ignition section. For the other method, fuel-air mixtures were mixed inside the PDE, and a pre-combustor was utilized as the ignition source. At firing frequency of 20 Hz, transition to detonation was obtained. Experimental results indicated that the ignition position and initial flame acceleration had important effects on the deflagration-to-detonation transition.

Pneumatic hybridization of a diesel engine using compressed air storage for wind-diesel energy generation

International Nuclear Information System (INIS)

Basbous, Tammam; Younes, Rafic; Ilinca, Adrian; Perron, Jean

2012-01-01

In this paper, we are studying an innovative solution to reduce fuel consumption and production cost for electricity production by Diesel generators. The solution is particularly suitable for remote areas where the cost of energy is very high not only because of inherent cost of technology but also due to transportation costs. It has significant environmental benefits as the use of fossil fuels for electricity generation is a significant source of GHG (Greenhouse Gas) emissions. The use of hybrid systems that combine renewable sources, especially wind, and Diesel generators, reduces fuel consumption and operation cost and has environmental benefits. Adding a storage element to the hybrid system increases the penetration level of the renewable sources, that is the percentage of renewable energy in the overall production, and further improves fuel savings. In a previous work, we demonstrated that CAES (Compressed Air Energy Storage) has numerous advantages for hybrid wind-diesel systems due to its low cost, high power density and reliability. The pneumatic hybridization of the Diesel engine consists to introduce the CAES through the admission valve. We have proven that we can improve the combustion efficiency and therefore the fuel consumption by optimizing Air/Fuel ratio thanks to the CAES assistance. As a continuation of these previous analyses, we studied the effect of the intake pressure and temperature and the exhaust pressure on the thermodynamic cycle of the diesel engine and determined the values of these parameters that will optimize fuel consumption. -- Highlights: ► Fuel economy analysis of a simple pneumatic hybridization of the Diesel engine using stored compressed air. ► Thermodynamic analysis of the pneumatic hybridization of diesel engines for hybrid wind-diesel energy systems. ► Analysis of intake pressure and temperature of compressed air and exhaust pressure on pressure/temperature during Diesel thermodynamic cycle. ► Direct admission of

Postpartum bleeding: efficacy of endovascular management

International Nuclear Information System (INIS)

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

2003-01-01

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

Postpartum bleeding: efficacy of endovascular management

Energy Technology Data Exchange (ETDEWEB)

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

2003-06-01

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

Upper gastrointestinal bleeding in patients with CKD.

Science.gov (United States)

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

2014-08-07

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

An Investigation of the Composition of the Flow in and out of a Two-Stroke Diesel Engine and Air Consumption Ratio

Directory of Open Access Journals (Sweden)

Mirko Grljušić

2017-06-01

Full Text Available The aim of this research was to investigate the mass, substance and energy flow through two-stroke low speed Diesel engines. For this reason, a zero-dimensional model of the combustion in the engine was developed with a calculated amount and composition of exhaust gases. Due to the large amount of oxygen in the exhaust gases, a ratio of real air consumption and stoichiometric amount of air required for combustion of injected fuel was set. The calculated ratio showed that the engine consumed four times more air than needed for combustion in AFRstoich. In this work, this was called the Air Consumption Factor or Ratio, and has not previously been mentioned in scientific literature. The air consumption ratio is defined as a factor of dry or humid air. To be more comprehensive, a modified diagram of the composition of the flow in and out of a two-stroke fuel injection engine and the cylinder was made.

The usefulness of MDCT in acute intestinal bleeding

International Nuclear Information System (INIS)

Kim, Kum Rae; Park, Won Kyu; Kim, Jae Woon; Chang, Jay Chun; Jang, Han Won

2006-01-01

We wanted to evaluate the usefulness of MDCT for localizing a bleeding site and for helping make a decision on further management for acute intestinal bleeding. We conducted a retrospective review of 17 consecutive patients who presented with acute intestinal bleeding and who also underwent MDCT before angiography or surgery. The sensitivity of MDCT for detecting acute intestinal bleeding was assessed and compared with that of conventional angiography. The sensitivity of MDCT for the detection of acute intestinal bleeding was 77% (13 or 17), whereas that of angiography was 46% (6 or 13). All the bleeding points that were subsequently detected on angiography were visualized on MDCT. In three cases, the bleeding focus was detected on MDCT and not on angiography. In four cases, both MDCT and angiography did not detect the bleeding focus; for one of these cases, CT during SMA angiography was performed and this detected the active bleeding site. In patients with acute intestinal bleeding, MDCT is a useful image modality to detect the bleeding site and to help decide on further management before performing angiography or surgery. When tumorous lesions are detected, invasive angiography can be omitted

Early lactate clearance for predicting active bleeding in critically ill patients with acute upper gastrointestinal bleeding: a retrospective study.

Science.gov (United States)

Wada, Tomoki; Hagiwara, Akiyoshi; Uemura, Tatsuki; Yahagi, Naoki; Kimura, Akio

2016-08-01

Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding.

The role of endoscopy in pediatric gastrointestinal bleeding

Science.gov (United States)

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

2016-01-01

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

Endoscopic management of bleeding peptic ulcers

International Nuclear Information System (INIS)

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

2001-01-01

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

Scintigraphic detection and localization of gastrointestinal bleeding sites

International Nuclear Information System (INIS)

Alavi, A.

1988-01-01

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

Development and Testing of a Rotating Detonation Engine Run on Hydrogen and Air

Science.gov (United States)

2012-03-22

Jay Rutledge (Member) Date v AFIT/GAE/ENY/12-M36 Abstract Rotating detonation engines ( RDEs ) have the potential for greater...efficiencies over conventional engines by utilizing pressure gain combustion. A new modular RDE (6 in diameter) was developed and successfully run on...hydrogen and standard air. The RDE allows for variation of injection scheme and detonation channel widths. Tests provided the operational space of the

Synergistic shortening of the bleeding time by desmopressin and ethamsylate in patients with various constitutional bleeding disorders.

Science.gov (United States)

Kobrinsky, N L; Israels, E D; Bickis, M G

1991-01-01

Desmopressin and ethamsylate were evaluated for possible synergistic effects on the bleeding time. The drugs were administered individually and together to 12 patients with markedly prolonged bleeding times known to be relatively or absolutely unresponsive to desmopressin alone. The bleeding disorders studied included Glanzmann's thrombasthenia (one), other disorders of platelet function (four), pseudo-von Willebrand disease (one), and von Willebrand disease type I (three), type II (two), and type III (one). Desmopressin alone shortened the bleeding time from 23.9 +/- 1.5 to 19.5 +/- 2.3 min (p = 0.03). Ethamsylate alone was without effect. Desmopressin and ethamsylate together shortened the bleeding time to 11.2 +/- 1.4 min (p less than 0.01 compared to baseline, p = 0.02 compared to desmopressin alone). The combination was ineffective in three patients, with Glanzmann's thrombasthenia (one), and von Willebrand disease type I (one) and type III (one). Toxic effects of the drugs were not observed. Five patients received desmopressin and ethamsylate prior to dental work with mandibular block (one), heart surgery requiring cardiopulmonary bypass (two), and adenotonsillectomy surgery (two). Normal hemostasis was achieved in each case. A synergistic shortening of the bleeding time was observed with the combination of desmopressin and ethamsylate in a wide range of bleeding disorders.

Helical CT in acute lower gastrointestinal bleeding

International Nuclear Information System (INIS)

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

2003-01-01

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

Vibration survey of internal combustion engines for use on unmanned air vehicles

International Nuclear Information System (INIS)

Duanis, B.

1998-01-01

This paper describes the method, the procedure and data results of engine vibration test which is carried out on engines for use on unmanned air vehicles. The paper focuses on the testing of rotating propulsion systems powered by an internal combustion engine which is composed of main rotating components such as the alternator, gearbox, propeller , dampers and couplings. Three measurement methods for measuring torsional and lateral vibrations are presented: a. Gear tooth pulse signal. b. Shaft Strain Gage. c. Laser Displacement Sensors The paper also presents data from tests which were performed using each method and discusses the applications, the advantages and disadvantages of each method

Particles and emissions from a diesel engine equipped with a humid air motor system

Energy Technology Data Exchange (ETDEWEB)

Nord, Kent; Zurita, Grover; Tingvall, Bror; Haupt, Dan [Luleaa Univ. of Technology (Sweden). Div. of Environmental Technology

2002-02-01

A system for reduction of NO{sub x}, humid air motor system (HAM), has been connected to an eleven liters diesel engine. Earlier studies have demonstrated the system's capacity to lower NO{sub x}-emissions from diesel engines. The present study is directed to investigate their influence of the system on the emissions of particles, aldehydes and noise while at the same time monitoring essential engine parameters, water consumption and verifying the NO{sub x} reducing ability. The system has been tested under the various conditions stated in 13-mode cycle ECE R-49. Additional tests have been necessary for sampling and measurements of particles and noise. The results show that HAM caused a large reduction of the NO{sub x} emissions while the engine performance was almost unaffected. Average reduction of NO{sub x} during the different modes of ECE R-49 was 51,1%. The reduction was directly related to the humidity of the inlet air and a further reduction can be anticipated with higher humidity. Samples have also been taken for acetaldehydes and formaldehyde. The results suggest a large reduction of aldehydes, in the range of 78 to 100%, when using HAM. Unfortunately it cannot be excluded that the results obtained are a result of a combination of high air humidity and the sampling technique used. The influence of the system on the emission of hydrocarbons was negligible while a moderate increase in the emission of carbon monoxide was noticed. No confident relationship between air humidity and the observed effects could be detected. Particle number concentrations and size distribution have also been measured. The measurements showed that the particle number concentrations was usually increased when HAM was coupled to the engine. The increase in particle number concentration, observed in five out of six running modes, varied between 46 and 148%. There was no trend indicating a shift in mean particle diameter when using HAM. Noise level and cylinder pressure have also

Adaptive critic learning techniques for engine torque and air-fuel ratio control.

Science.gov (United States)

Liu, Derong; Javaherian, Hossein; Kovalenko, Olesia; Huang, Ting

2008-08-01

A new approach for engine calibration and control is proposed. In this paper, we present our research results on the implementation of adaptive critic designs for self-learning control of automotive engines. A class of adaptive critic designs that can be classified as (model-free) action-dependent heuristic dynamic programming is used in this research project. The goals of the present learning control design for automotive engines include improved performance, reduced emissions, and maintained optimum performance under various operating conditions. Using the data from a test vehicle with a V8 engine, we developed a neural network model of the engine and neural network controllers based on the idea of approximate dynamic programming to achieve optimal control. We have developed and simulated self-learning neural network controllers for both engine torque (TRQ) and exhaust air-fuel ratio (AFR) control. The goal of TRQ control and AFR control is to track the commanded values. For both control problems, excellent neural network controller transient performance has been achieved.

Vaginal bleeding in late pregnancy

Science.gov (United States)

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

Prediction of cold start hydrocarbon emissions of air cooled two wheeler spark ignition engines by simple fuzzy logic simulation

Directory of Open Access Journals (Sweden)

Samuel Raja Ayyanan

2014-01-01

Full Text Available The cold start hydrocarbon emission from the increasing population of two wheelers in countries like India is one of the research issues to be addressed. This work describes the prediction of cold start hydrocarbon emissions from air cooled spark ignition engines through fuzzy logic technique. Hydrocarbon emissions were experimentally measured from test engines of different cubic capacity, at different lubricating oil temperature and at different idling speeds with and without secondary air supply in exhaust. The experimental data were used as input for modeling average hydrocarbon emissions for 180 seconds counted from cold start and warm start of gasoline bike engines. In fuzzy logic simulation, member functions were assigned for input variables (cubic capacity and idling rpm and output variables (average hydrocarbon emission for first 180 seconds at cold start and warm start. The knowledge based rules were adopted from the analyzed experimental data and separate simulations were carried out for predicting hydrocarbon emissions from engines equipped with and without secondary air supply. The simulation yielded the average hydrocarbon emissions of air cooled gasoline engine for a set of given input data with accuracy over 90%.

Preliminary Results of the Determination of Inlet-Pressure Distortion Effects on Compressor Stall and Altitude Operating Limits of the J57-P-1 Turbojet Engine

Science.gov (United States)

Wallner, L. E.; Lubick, R. J.; Chelko, L. J.

1955-01-01

During an investigation of the J57-P-1 turbojet engine in the Lewis altitude wind tunnel, effects of inlet-flow distortion on engine stall characteristics and operating limits were determined. In addition to a uniform inlet-flow profile, the inlet-pressure distortions imposed included two radial, two circumferential, and one combined radial-circumferential profile. Data were obtained over a range of compressor speeds at an altitude of 50,000 and a flight Mach number of 0.8; in addition, the high- and low-speed engine operating limits were investigated up to the maximum operable altitude. The effect of changing the compressor bleed position on the stall and operating limits was determined for one of the inlet distortions. The circumferential distortions lowered the compressor stall pressure ratios; this resulted in less fuel-flow margin between steady-state operation and compressor stall. Consequently, the altitude operating Limits with circumferential distortions were reduced compared with the uniform inlet profile. Radial inlet-pressure distortions increased the pressure ratio required for compressor stall over that obtained with uniform inlet flow; this resulted in higher altitude operating limits. Likewise, the stall-limit fuel flows required with the radial inlet-pressure distortions were considerably higher than those obtained with the uniform inlet-pressure profile. A combined radial-circumferential inlet distortion had effects on the engine similar to the circumferential distortion. Bleeding air between the two compressors eliminated the low-speed stall limit and thus permitted higher altitude operation than was possible without compressor bleed.

Treatment of acute variceal bleeding

DEFF Research Database (Denmark)

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

2008-01-01

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

Management of patients with ulcer bleeding.

Science.gov (United States)

Laine, Loren; Jensen, Dennis M

2012-03-01

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

Non-self-sustained microwave discharge and the concept of a microwave air jet engine

International Nuclear Information System (INIS)

Batanov, G M; Gritsinin, S I; Kossyi, I A

2002-01-01

A new type of microwave discharge - near-surface non-self-sustained discharge (NSND) - has been realized and investigated. A physical model of this discharge is presented. For the first time NSND application for microwave air jet engines has been proposed. Measurements under laboratory conditions modelling the microwave air jet engine operation shows the qualitative agreement between the model of NSND and actual processes near the target irradiated by a powerful microwave beam. Characteristic dependences of recoil momentum of target on the background pressure and microwave pulse duration obtained in experiments are presented. Measured cost of thrust produced by the NSND is no more than 3.0 kW N -1 , which is close to the predicted values

Serendipity in scintigraphic gastrointestinal bleeding studies

International Nuclear Information System (INIS)

Goergen, T.G.

1983-01-01

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

Management of Patients with Acute Lower Gastrointestinal Bleeding

Science.gov (United States)

Strate, Lisa L.; Gralnek, Ian M.

2016-01-01

This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal hemorrhage. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based upon clinical parameters should be performed to help distinguish patients at high and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper GI bleeding source and thus warrants an upper endoscopy. In the majority of patients, colonoscopy should be the initial diagnostic procedure and should be performed within 24 hours of patient presentation after adequate colon preparation. Endoscopic hemostasis therapy should be provided to patients with high risk endoscopic stigmata of bleeding including active bleeding, non-bleeding visible vessel, or adherent clot. The endoscopic hemostasis modality used (mechanical, thermal, injection or combination) is most often guided by the etiology of bleeding, access to the bleeding site, and endoscopist experience with the various hemostasis modalities. Repeat colonoscopy, with endoscopic hemostasis performed if indicated, should be considered for patients with evidence of recurrent bleeding. Radiographic interventions (tagged red blood cell scintigraphy, CT angiography, angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation, and who are unlikely to tolerate bowel preparation and colonoscopy. Strategies to prevent recurrent bleeding should be considered. NSAID use should be avoided in patients with a history of acute lower GI bleeding particularly if secondary to diverticulosis or angioectasia. In patients with established cardiovascular disease who require aspirin (secondary prophylaxis), aspirin should not be discontinued. The exact timing depends on the severity of bleeding, perceived adequacy of hemostasis and the risk of a thromboembolic event. Surgery

Vitamin K deficiency bleeding of the newborn

Science.gov (United States)

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

Risk of bleeding with dabigatran in atrial fibrillation.

Science.gov (United States)

Hernandez, Inmaculada; Baik, Seo Hyon; Piñera, Antonio; Zhang, Yuting

2015-01-01

It remains unclear whether dabigatran etexilate mesylate is associated with higher risk of bleeding than warfarin sodium in real-world clinical practice. To compare the risk of bleeding associated with dabigatran and warfarin using Medicare data. In this retrospective cohort study, we used pharmacy and medical claims in 2010 to 2011 from a 5% random sample of Medicare beneficiaries. We identified participants as those newly diagnosed as having atrial fibrillation from October 1, 2010, through October 31, 2011, and who initiated dabigatran or warfarin treatment within 60 days of initial diagnosis. We followed up patients until discontinued use or switch of anticoagulants, death, or December 31, 2011. Dabigatran users (n = 1302) and warfarin users (n = 8102). We identified any bleeding events and categorized them as major and minor bleeding by anatomical site. Major bleeding events included intracranial hemorrhage, hemoperitoneum, and inpatient or emergency department stays for hematuria, gastrointestinal, or other hemorrhage. We used a propensity score weighting mechanism to balance patient characteristics between 2 groups and Cox proportional hazards regression models to evaluate the risk of bleeding. We further examined the risk of bleeding for 4 subgroups of high-risk patients: those 75 years or older, African Americans, those with chronic kidney disease, and those with more than 7 concomitant comorbidities. Dabigatran was associated with a higher risk of bleeding relative to warfarin, with hazard ratios of 1.30 (95% CI, 1.20-1.41) for any bleeding event, 1.58 (95% CI, 1.36-1.83) for major bleeding, and 1.85 (95% CI, 1.64-2.07) for gastrointestinal bleeding. The risk of intracranial hemorrhage was higher among warfarin users, with a hazard ratio of 0.32 (95% CI, 0.20-0.50) for dabigatran compared with warfarin. Dabigatran was consistently associated with an increased risk of major bleeding and gastrointestinal hemorrhage for all subgroups analyzed. The risk of

Causes of lower gastrointestinal bleeding on colonoscopy

International Nuclear Information System (INIS)

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

2017-01-01

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

Scintigraphic pattern of small bowel bleeding

International Nuclear Information System (INIS)

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

2004-01-01

Introduction: Small intestine is the longest part of gastrointestinal tract. Intra-luminal haemorrhage occurring anywhere in its long and tortuous course is difficult to trace. It is relatively inaccessible to endoscopic evaluation. Upper GI endoscopy can see only up to distal duodenum, whereas colonoscope can view maximum of 30 centimeters of terminal ileum after negotiating the scope through ileo-caecal valve. Hence, localization of bleeding source from small bowel remains a difficult clinical problem. This group of patients can be evaluated with scintigraphy for localizing the site of bleeding before undergoing either angiography or surgery. To our best of knowledge, there is no study, which has utilized scintigraphy for evaluation of small bowel bleed exclusively. The present study has been designed to know the efficacy of 99mTc-RBC scintigraphy in detecting small bowel bleed and to know whether it can differentiate between jejunal and ileal bleeding ? Materials and methods: Thirteen patients presenting with lower gastrointestinal bleeding (malena) were enrolled for the study. In all cases, upper GI endoscopy (UGIE) was unremarkable. Colonoscopic examination was either negative or suspected bleeding occurring proximal to ileo-caecal valve. Thus, in these patients, it is presumed clinically that bleeding is originating from small bowel. Barium meal follow through (BMFT) studies, however, could not delineate any etiological lesion in these patients. There were 8 men and 5 women (mean age 48 years). All patients were anemic (Hb- 6 gm%) and mean 3 units of blood were transfused.These patients were subjected to Tc-99m labeled red blood cells scintigraphy (15 mci, in-vivo method) for localization of source of bleeding. The scintiscan was acquired in two phases. A first pass phase acquired at a rate of 2 seconds per frame for 60 seconds followed by acquisition of static abdominal images (500 K, 256 x 256 matrix) at 5 minutes intervals up to 90 minutes on LFOV gamma

Risk management of low air void asphalt concrete mixtures.

Science.gov (United States)

2013-07-01

Various forms of asphalt pavement distress, such as rutting, shoving and bleeding, can be attributed, in many cases, to low air voids in : the mixtures during production and placement. The occurrence of low air void contents during plant production m...

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

Science.gov (United States)

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

2014-04-01

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

[Related factors to re-bleeding and mortality in cirrhotic patients with acute variceal bleeding at Hipolito Unanue Hospital, Lima, Peru].

Science.gov (United States)

Parra Pérez, Víctor Felipe; Raymundo Cajo, Roxana Magali; Gutiérrez de Aranguren, Constantino Fernando

2013-01-01

To determine related factors to 5 days re-bleeding and 6 week-mortality of an episode of variceal bleeding in cirrhotic patients. Observational, descriptive, co relational, retrospective study. In this study were included the cirrhotic patients who entered to Hipolito Unanue Hospital, Lima, Peru, between January 2006 and February 2012 with suspicion of variceal bleeding. Were excluded patients who bled from nonvariceal origin, or that did not have the data in clinical history to calculate the Child Pugh score, the Model for terminal diseases of the liver (MELD), or the endoscopic report detailing the bleeding source and the presence of esophageal and/or gastric varices. We include 63 patients, 35 (55.6%) were men. The median of age was of 64 years. 26 of them (41.3%) were Child Pugh C, where as the median of MELD score was 9. The multivariate analysis found that the Child Pugh score was related to 6 weeks-mortality (p=0,003), where as the presence of active bleeding during endoscopy (p=0.012) and the value of creatinine (p=0.012) were related to 5 days re-bleeding. The Child Pugh score was related to 6 weeks-mortality in cirrhotic patients with variceal bleeding. Active bleeding during endoscopy and the value of creatinine were related to 5 days re-bleeding.

Angiographic diagnosis and treatment of gastrointestinal bleeding

International Nuclear Information System (INIS)

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

1986-01-01

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

Angiographic diagnosis and treatment of gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

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

1986-02-15

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

Radiological diagnosis of gastrointestinal bleeding

International Nuclear Information System (INIS)

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

1990-01-01

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

A Piston Geometry and Nozzle Spray Angle Investigation in a DI Diesel Engine by Quantifying the Air-Fuel Mixture

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Pavlos Dimitriou

2015-03-01

Full Text Available Low temperature diesel combustion has been widely investigated over the last few years for reducing in-cylinder emissions of Direct Injection (DI diesel engines without sacrificing efficiency and fuel consumption. The spatial distribution of the fuel within the combustion chamber and the air-fuel mixing quality are the key factors affecting temperature generation within the cylinder. Avoiding fuel rich areas within the cylinder can significantly reduce the local high temperatures resulting in low NOx formation. This paper investigates the effects of the combustion chamber geometry and spray angle on the air-fuel mixing and emissions formation of a DI diesel engine. A new quantitative factor measuring the air-fuel mixing quality has been adopted in order to analyze and compare air-fuel mixing quality for different piston geometries. The results have shown that pistons with a narrow entrance and a deep combustion re-entrant chamber benefit from increased air-fuel mixtures due to the significantly higher swirl generated within the cylinder. However, the improved air-fuel mixing does not consequently lead to a reduced NOx generation, which is highly affected by the combustion efficiency of the engine.

A rare case of bleeding disorder: Glanzmann's thrombasthenia.

Science.gov (United States)

Swathi, Jami; Gowrishankar, A; Jayakumar, S A; Jain, Karun

2017-01-01

Glanzmann's thrombasthenia (GT) is a rare bleeding disorder, which is characterized by a lack of platelet aggregation. It is characterized by qualitative or quantitative abnormalities of the platelet membrane glycoprotein IIb/IIIa. Physiologically, this platelet receptor normally binds several adhesive plasma proteins, and this facilitates attachment and aggregation of platelets to ensure thrombus formation at sites of vascular injury. The lack of resultant platelet aggregation in GT leads to mucocutaneous bleeding whose manifestation may be clinically variable, ranging from easy bruising to severe and potentially life-threatening hemorrhages. To highlight this rare but potentially life-threating disorder, GT. We report a case of GT that was first detected because of the multiple episodes of gum bleeding. The patient was an 18-year-old girl who presented with a history of repeated episodes of gum bleeding since childhood. Till the first visit to our hospital, she had not been diagnosed with GT despite a history of bleeding tendency, notably purpura in areas of easy bruising, gum bleeding, and prolonged bleeding time after abrasions and insect stings. GT was diagnosed on the basis of prolonged bleeding time, lack of platelet aggregation with adenosine di phosphate, epinephrine and collagen. GT should always be considered as differential diagnosis while evaluating any case of bleeding disorder.

Photocoagulation in the treatment of bleeding peptic ulcer

Science.gov (United States)

Otto, Wlodzimierz; Paczkowski, Pawel M.

1996-03-01

The authors present their experience in the endoscopic laser photocoagulation of bleeding peptic ulcer. From 1991 to June 1995, 203 patients admitted for UGI bleeding from peptic ulcer have been treated by this method. The source of bleeding was confirmed by endoscopy. The patients were divided into two groups: actively bleeding peptic ulcer (group IA and IB according to Forrest's classification) and ulcer with stigmata of recent bleeding (group IIA/IIB). The former group consisted of 106 patients, among whom over 40 percent (45 patients) presented signs of hypovolemic shock on admission. Nd:YAG laser (Surgical Laser Technologies) was used in a continuous mode with a contact (8 - 20 watts) or non-contact (over 50 watts) method of coagulation. In actively bleeding patients photocoagulation resulted in stopping the hemorrhage in 95 (90%). Recurrent bleeding occurred in 16 cases; in 9 of them it was stopped by repeated photocoagulation. In this group 18 patients required surgical intervention. The mortality was of 10.3% (11 patients). In 97 patients with recent bleeding stigmata photocoagulation provoked heavy hemorrhage in 3 (in 2 cases stopped by prolonged coagulation). In 9 of the remaining 94 patients recurrent bleeding occurred. Nine patients required surgical intervention. Mortality in this group was of 6%.

AUTOMOTIVE DIESEL MAINTENANCE 1. UNIT XIV, I--MAINTAINING THE AIR SYSTEM, CUMMINS DIESEL ENGINE, II--UNIT REMOVAL--TRANSMISSION.

Science.gov (United States)

Human Engineering Inst., Cleveland, OH.

THIS MODULE OF A 30-MODULE COURSE IS DESIGNED TO DEVELOP AN UNDERSTANDING OF THE OPERATING PRINCIPLES AND MAINTENANCE OF THE DIESEL ENGINE AIR SYSTEM AND THE PROCEDURES FOR TRANSMISSION REMOVAL. TOPICS ARE (1) DEFINITION OF TERMS RELATED TO THE DIESEL AIR SYSTEM, (2) PRNCIPLES OF DIESEL AIR COMPRESSORS, (3) PRINCIPLES OF AIR STARTING MOTORS, (4)…

Air-fuel ratio control of a lean burn Si engine using fuzzy self tuning method

International Nuclear Information System (INIS)

Akhlaghi, M.; Bakhtiari Nejad, F.; Azadi, S.

2000-01-01

Reducing the exhaust emission of an spark ignition engine by means of engine modifications requires consideration of the effects of these modifications on the variations of crankshaft torque and the engine roughness respectively. Only if the roughness does not exceed a certain level the vehicle do not begin to surge. This paper presents a method for controlling the air-fuel ratio for a lean burn engine. Fuzzy rules and reasoning are utilized on-line to determine the control parameters. The main advantages of this method are simple structure and robust performance in a wide range of operating conditions. A non-linear model of an Si engine with the engine torque irregularity simulation is used in this study

Exergy Analysis of the Revolving Vane Compressed Air Engine

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Alison Subiantoro

2016-01-01

Full Text Available Exergy analysis was applied to a revolving vane compressed air engine. The engine had a swept volume of 30 cm3. At the benchmark conditions, the suction pressure was 8 bar, the discharge pressure was 1 bar, and the operating speed was 3,000 rev·min−1. It was found that the engine had a second-law efficiency of 29.6% at the benchmark conditions. The contributors of exergy loss were friction (49%, throttling (38%, heat transfer (12%, and fluid mixing (1%. A parametric study was also conducted. The parameters to be examined were suction reservoir pressure (4 to 12 bar, operating speed (2,400 to 3,600 rev·min−1, and rotational cylinder inertia (0.94 to 2.81 g·mm2. The study found that a higher suction reservoir pressure initially increased the second-law efficiency but then plateaued at about 30%. With a higher operating speed and a higher cylinder inertia, second-law efficiency decreased. As compared to suction pressure and operating speed, cylinder inertia is the most practical and significant to be modified.

The analysis of the causes of uterine bleeding occurred after cesarean section and the evaluation of interventional therapy for bleeding

International Nuclear Information System (INIS)

Hu Peng; Li Yuwei; Li Yunhui; Luo Bin; Wen Wen; Yang Bo

2011-01-01

Objective: to analyze the causes of uterine hemorrhage occurred after cesarean section and to investigate the value of angiography and transcatheter artery embolization (TAE) in the diagnosis and treatment of postpartum hemorrhage after cesarean section. Methods: During the period from Jan. 2001 to Dec. 2011, a total of 65 cases suffering from uterine bleeding after cesarean section had underwent uterine arteriography to clarify the diagnosis, which was followed by transcatheter uterine artery embolization (TUAE). The clinical data, the causes of bleeding and the angiographic features were retrospectively analyzed. Results: The causes of uterine bleeding after cesarean section included uterine artery pseudoaneurysm (n=26), uterine atony (n=18), placental factors (n=11), gestational hypertension (n=8), coexisting uterine fibroids (n=1) and uterine bleeding of unknown reason (n=1). Uterine artery angiography revealed contrast extravasation in all patients except one patient. The angiographic findings confirmed the diagnosis of uterine artery bleeding after cesarean section. The bleeding stopped after TUAE, and the patients were in stable condition. No serious complications occurred. Conclusion: Pseudoaneurysm is the primary cause of postpartum uterine hemorrhage after cesarean section. Transcatheter uterine artery angiography can promptly and reliably determine the causes of bleeding, and, at the same time, embolization therapy can be carried out to effectively stop the bleeding. (authors)

THROMBIN GENERATION AND BLEEDING IN HEMOPHILIA A

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

2012-01-01

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

Some failure analyses of South African Air Force aircraft engine and airframe components

CSIR Research Space (South Africa)

Benson, JM

1998-06-01

Full Text Available Failure analyses of various engine and airframe components from South African Air Force aircraft have been performed by the Division of Materials Science and Technology over several years and these have ranged from crash investigations to minor...

Monitoring and treatment of acute gastrointestinal bleeding.

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

2012-01-01

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

Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

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Biecker, Erwin

2013-01-01

Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

[The causes of recurrent ulcerative gastroduodenal bleeding].

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

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

Measurement of horizontal air showers with the Auger Engineering Radio Array

Science.gov (United States)

Kambeitz, Olga

2017-03-01

The Auger Engineering Radio Array (AERA), at the Pierre Auger Observatory in Argentina, measures the radio emission of extensive air showers in the 30-80 MHz frequency range. AERA consists of more than 150 antenna stations distributed over 17 km2. Together with the Auger surface detector, the fluorescence detector and the underground muon detector (AMIGA), AERA is able to measure cosmic rays with energies above 1017 eV in a hybrid detection mode. AERA is optimized for the detection of air showers up to 60° zenith angle, however, using the reconstruction of horizontal air showers with the Auger surface array, very inclined showers can also be measured. In this contribution an analysis of the AERA data in the zenith angle range from 62° to 80° will be presented. CoREAS simulations predict radio emission footprints of several km2 for horizontal air showers, which are now confirmed by AERA measurements. This can lead to radio-based composition measurements and energy determination of horizontal showers in the future and the radio detection of neutrino induced showers is possible.

Transcatheter arterial embolization for traumatic bleeding control

International Nuclear Information System (INIS)

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

1989-01-01

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

Transcatheter emboilization therapy of massive colonic bleeding

International Nuclear Information System (INIS)

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

1996-01-01

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

ENDOSCOPIC DIAGNOSIS AND TREATMENT OF UPPER GASTROINTESTINAL BLEEDING

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Daniela Benedeto-Stojanov

2015-06-01

Full Text Available Upper gastrointestinal bleeding (UGB is a common medical emergency problem with significant morbidity and mortality. The aim of this paper is to establish the incidence of upper gastrointestinal bleeding in relation to sex and age, determine the prevalence of bleeding lesions and perform analysis of bleeding peptic ulcer in relation to the location, age, gender, Forrest classification and the need for endoscopic hemostasis. Thе prospective study included 70 patients with UGB, 42 men and 28 women, mean age 68.64±13.66 years. The diagnosis of bleeding lesions was made exclusively by means of esophagogastroduodenoscopy. Forrest classification was used in the evaluation of the activity of bleeding ulcers of the stomach and duodenum. The largest number of bleeding patients was of male sex (60%. Bleeding most commonly occurred in patients older than 60 years (84.29%. Statistically, female patients were significantly older than patients of male gender (p=0.001. The most common cause of bleeding was peptic ulcer (65.71%. The average age of patients with gastric ulcer was 70.57±15.68 years, with a duodenal ulcer 63.78±16.70 years. In the duodenum, Forrest Ib, IIa and IIb ulcers were usually confirmed, whereas Forrest IIc ulcers were identified in the stomach. Endoscopic hemostasis was required in 55.56% of patients with duodenal and in 23.81% of patients with gastric ulcer. The incidence of UGB is higher in men and it increases with age. The most common cause of bleeding is ulcer disease. Patients with gastric ulcer are older than patients with duodenal ulcer, while both gastric and duodenal ulcers are found in the oldest patients. Duodenal ulcers cause serious bleeding and more often require endoscopic hemostasis.

Estimation of Engine Intake Air Mass Flow using a generic Speed-Density method

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Vojtíšek Michal

2014-10-01

Full Text Available Measurement of real driving emissions (RDE from internal combustion engines under real-world operation using portable, onboard monitoring systems (PEMS is becoming an increasingly important tool aiding the assessment of the effects of new fuels and technologies on environment and human health. The knowledge of exhaust flow is one of the prerequisites for successful RDE measurement with PEMS. One of the simplest approaches for estimating the exhaust flow from virtually any engine is its computation from the intake air flow, which is calculated from measured engine rpm and intake manifold charge pressure and temperature using a generic speed-density algorithm, applicable to most contemporary four-cycle engines. In this work, a generic speed-density algorithm was compared against several reference methods on representative European production engines - a gasoline port-injected automobile engine, two turbocharged diesel automobile engines, and a heavy-duty turbocharged diesel engine. The overall results suggest that the uncertainty of the generic speed-density method is on the order of 10% throughout most of the engine operating range, but increasing to tens of percent where high-volume exhaust gas recirculation is used. For non-EGR engines, such uncertainty is acceptable for many simpler and screening measurements, and may be, where desired, reduced by engine-specific calibration.

USNRC regulatory guidance for engineered safety feature air cleaning systems

International Nuclear Information System (INIS)

Bellamy, R.R.

1991-01-01

The need for clear, technically appropriate, and easily implementable guidance for the design, testing, and maintenance of nuclear air cleaning systems has long been recognized. Numerous industry consensus standards have been issued and revised over the last 30 years. Guidance has also been published by the US Nuclear Regulatory Commission in the form of regulations, regulatory guides, standard review plans, NUREG documents, and information notices. This paper will summarize the latest revisions to these documents and emphasize Regulatory Guide 1.52, Design, Testing, and Maintenance Criteria for Post-Accident Engineered-Safety-Feature Atmosphere Cleanup System Air Filtration and Adsorption Units of Light-Water-Cooled Nuclear Power Plants, which was last revised in 1978. The USNRC has undertaken a project to revise this regulatory guide, and the status of that revision is highlighted

Managing Chemotherapy Side Effects: Bleeding Problems

Science.gov (United States)

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

Statistical Engineering in Air Traffic Management Research

Science.gov (United States)

Wilson, Sara R.

2015-01-01

NASA is working to develop an integrated set of advanced technologies to enable efficient arrival operations in high-density terminal airspace for the Next Generation Air Transportation System. This integrated arrival solution is being validated and verified in laboratories and transitioned to a field prototype for an operational demonstration at a major U.S. airport. Within NASA, this is a collaborative effort between Ames and Langley Research Centers involving a multi-year iterative experimentation process. Designing and analyzing a series of sequential batch computer simulations and human-in-the-loop experiments across multiple facilities and simulation environments involves a number of statistical challenges. Experiments conducted in separate laboratories typically have different limitations and constraints, and can take different approaches with respect to the fundamental principles of statistical design of experiments. This often makes it difficult to compare results from multiple experiments and incorporate findings into the next experiment in the series. A statistical engineering approach is being employed within this project to support risk-informed decision making and maximize the knowledge gained within the available resources. This presentation describes a statistical engineering case study from NASA, highlights statistical challenges, and discusses areas where existing statistical methodology is adapted and extended.

Bleeding in cancer patients and its treatment: a review.

Science.gov (United States)

Johnstone, Candice; Rich, Shayna E

2017-12-18

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

Postpolypectomy lower GI bleeding: descriptive analysis

NARCIS (Netherlands)

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

2000-01-01

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

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

Science.gov (United States)

Bennett, Alyssa R; Gray, Susan H

2014-08-01

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

Scintigraphic demonstration of acute gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Alavi, A.

1980-01-01

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

Air Force Civil Engineer, Volume 9, Number 2, Summer 2001

Science.gov (United States)

2001-01-01

and massive concrete slabs with protruding steel segments were partially hidden by an overgrowth of vegetation . The three-story structure, which was...terms of the job you get afterward. Capt Bill Kale came to AFIT from Lajes Field, Azores, where he was the base architect with the 65th CES. Q. Why did...meet Air Force civil engineer needs. Speaking of AFIT � Capt Manuel Fernandez Capt Bill Kale Capt Laurie Richter Interviews with current and former

Abnormal Uterine Bleeding: American College of Nurse-Midwives.

Science.gov (United States)

2016-07-01

Variations in uterine bleeding, termed abnormal uterine bleeding, occur commonly among women and often are physiologic in nature with no significant consequences. However, abnormal uterine bleeding can cause significant distress to women or may signify an underlying pathologic condition. Most women experience variations in menstrual and perimenstrual bleeding in their lifetimes; therefore, the ability of the midwife to differentiate between normal and abnormal bleeding is a key diagnostic skill. A comprehensive history and use of the PALM-COEIN classification system will provide clear guidelines for clinical management, evidence-based treatment, and an individualized plan of care. The purpose of this Clinical Bulletin is to define and describe classifications of abnormal uterine bleeding, review updated terminology, and identify methods of assessment and treatment using a woman-centered approach. © 2016 by the American College of Nurse-Midwives.

Anti-factor IXa/X bispecific antibody ACE910 prevents joint bleeds in a long-term primate model of acquired hemophilia A

Science.gov (United States)

Yoshihashi, Kazutaka; Takeda, Minako; Kitazawa, Takehisa; Soeda, Tetsuhiro; Igawa, Tomoyuki; Sampei, Zenjiro; Kuramochi, Taichi; Sakamoto, Akihisa; Haraya, Kenta; Adachi, Kenji; Kawabe, Yoshiki; Nogami, Keiji; Shima, Midori; Hattori, Kunihiro

2014-01-01

ACE910 is a humanized anti-factor IXa/X bispecific antibody mimicking the function of factor VIII (FVIII). We previously demonstrated in nonhuman primates that a single IV dose of ACE910 exerted hemostatic activity against hemophilic bleeds artificially induced in muscles and subcutis, and that a subcutaneous (SC) dose of ACE910 showed a 3-week half-life and nearly 100% bioavailability, offering support for effective prophylaxis for hemophilia A by user-friendly SC dosing. However, there was no direct evidence that such SC dosing of ACE910 would prevent spontaneous bleeds occurring in daily life. In this study, we newly established a long-term primate model of acquired hemophilia A by multiple IV injections of an anti-primate FVIII neutralizing antibody engineered in mouse-monkey chimeric form to reduce its antigenicity. The monkeys in the control group exhibited various spontaneous bleeding symptoms as well as continuous prolongation of activated partial thromboplastin time; notably, all exhibited joint bleeds, which are a hallmark of hemophilia. Weekly SC doses of ACE910 (initial 3.97 mg/kg followed by 1 mg/kg) significantly prevented these bleeding symptoms; notably, no joint bleeding symptoms were observed. ACE910 is expected to prevent spontaneous bleeds and joint damage in hemophilia A patients even with weekly SC dosing, although appropriate clinical investigation is required. PMID:25274508

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

DEFF Research Database (Denmark)

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

2011-01-01

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

[Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

Science.gov (United States)

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

2015-07-01

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

Bleeding spectrum in children with moderate or severe von Willebrand disease: Relevance of pediatric-specific bleeding

NARCIS (Netherlands)

Sanders, Yvonne V.; Fijnvandraat, Karin; Boender, Johan; Mauser-Bunschoten, Evelien P.; van der Bom, Johanna G.; de Meris, Joke; Smiers, Frans J.; Granzen, Bernd; Brons, Paul; Tamminga, Rienk Y. J.; Cnossen, Marjon H.; Leebeek, Frank W. G.

2015-01-01

The bleeding phenotype of children with von Willebrand disease (VWD) needs to be characterized in detail to facilitate diagnosis during childhood and aid in the planning and assessment of treatment strategies. The objective was to evaluate the occurrence, type, and severity of bleeding in a large

Thermodynamic analysis of an absorption refrigeration system used to cool down the intake air in an Internal Combustion Engine

International Nuclear Information System (INIS)

Novella, R.; Dolz, V.; Martín, J.; Royo-Pascual, L.

2017-01-01

Highlights: • Enough power in the exhaust gases is available to operate the absorption cycle. • Three engine operating points are presented in the article. • Improvement potential up to 4% is possible in the engine indicated efficiency. • Engine indicated efficiency benefit was experimentally confirmed by direct testing. - Abstract: This paper deals with the thermodynamic analysis of an absorption refrigeration cycle used to cool down the temperature of the intake air in an Internal Combustion Engine using as a heat source the exhaust gas of the engine. The solution of ammonia-water has been selected due to the stability for a wide range of operating temperatures and pressures and the low freezing point. The effects of operating temperatures, pressures, concentrations of strong and weak solutions in the absorption refrigeration cycle were examined to achieve proper heat rejection to the ambient. Potential of increasing Internal Combustion Engine efficiency and reduce pollutant emissions was estimated by means of theoretical models and experimental tests. In order to provide boundary conditions for the absorption refrigeration cycle and to simulate its effect on engine performance, a 0D thermodynamic model was used to reproduce the engine performance when the intake air is cooled. Furthermore, a detailed experimental work was carried out to validate the results in real engine operation. Theoretical results show how the absorption refrigeration system decreases the intake air flow temperature down to a temperature around 5 °C and even lower by using the bottoming waste heat energy available in the exhaust gases in a wide range of engine operating conditions. In addition, the theoretical analysis estimates the potential of the strategy for increasing the engine indicated efficiency in levels up to 4% also at the operating conditions under evaluation. Finally, this predicted benefit in engine indicated efficiency has been experimentally confirmed by direct

COMBUSTION SIMULATION IN A SPARK IGNITION ENGINE CYLINDER: EFFECTS OF AIR-FUEL RATIO ON THE COMBUSTION DURATION

Directory of Open Access Journals (Sweden)

Nureddin Dinler

2010-01-01

Full Text Available Combustion is an important subject of internal combustion engine studies. To reduce the air pollution from internal combustion engines and to increase the engine performance, it is required to increase combustion efficiency. In this study, effects of air/fuel ratio were investigated numerically. An axisymmetrical internal combustion engine was modeled in order to simulate in-cylinder engine flow and combustion. Two dimensional transient continuity, momentum, turbulence, energy, and combustion equations were solved. The k-e turbulence model was employed. The fuel mass fraction transport equation was used for modeling of the combustion. For this purpose a computational fluid dynamics code was developed by using the finite volume method with FORTRAN programming code. The moving mesh was utilized to simulate the piston motion. The developed code simulates four strokes of engine continuously. In the case of laminar flow combustion, Arrhenius type combustion equations were employed. In the case of turbulent flow combustion, eddy break-up model was employed. Results were given for rich, stoichiometric, and lean mixtures in contour graphs. Contour graphs showed that lean mixture (l = 1.1 has longer combustion duration.

Novel techniques of oxygen bleeding for polymer electrolyte fuel cells under impure anode feeding and poisoning condition: A computational study using OpenFOAM®

International Nuclear Information System (INIS)

Hafttananian, M.; Ramiar, A.; Ranjbar, A.A.

2016-01-01

Highlights: • Oxygen bleeding as a treatment of poisoned fuel cells is simulated. • Oxygen bleeding, depended on impurity concentration, has an optimize range. • Three novel techniques of oxygen bleeding are introduced. • The OBME parameter is introduced to compare oxygen bleeding methods. • Pulsating and sinusoidal methods lead to 2.74 and 1.74 effectiveness, respectively. - Abstract: PEM fuel cells fed by steam methane reformate (SMR) and water gas shift reformate (WGSR) are always subjected to catalyst poisoning due to trace amounts of carbon monoxide in the fuel stream. Air or oxygen bleeding are the most common, cost-effective and easy-to-implement methods of mitigation for such conditions. In the present work, important restrictions of oxygen bleeding and disadvantages of continuous constant O_2 bleeding are introduced. In order to simulating the problem, a mathematical model containing reaction kinetics, governing equations, boundary conditions and constitutive relations are presented and according to these, a comprehensive OpenFOAM transient multicomponent solver having the capability of simulating anode side of PEM fuel cell is developed, introduced and validated with existing experimental data. In addition, three novel methods of oxygen bleeding: namely pulsating, exponential and sinusoidal methods are introduced which are practical for both open-end and dead-end fuel cells. A quantitative criterion, Oxygen Bleeding Method Effectiveness (OBME), is also introduced to attain comparability of novel methods with continuous constant O_2 bleeding as common method. Results showed up to more than 5% increase in recovery ratio accompanied with up to 63% save in oxygen consumption.

Effects of diluent admissions and intake air temperature in exhaust gas recirculation on the emissions of an indirect injection dual fuel engine

Energy Technology Data Exchange (ETDEWEB)

Abd-Alla, G.H.; Soliman, H.A.; Badr, O.A.; Abd-Rabbo, M.F. [Zagazig University, Cairo (Egypt). Shoubra Faculty of Engineering

2001-05-01

The operation of Diesel engines on gaseous fuels, commonly known as dual fuel engines, uses Diesel fuel as the pilot fuel and gaseous fuel (methane and sometimes propane in the present work) as the main fuel. The gaseous fuel was inducted in the intake manifold to mix with the intake air. The investigation was conducted on a high speed indirect injection (Ricardo-E6) dual fuel engine and was concerned with the effects of exhaust gas recirculation (EGR) on the dual fuel engine combustion and emissions, in particular, the effects of intake air temperature and diluent admissions (N{sub 2} and CO{sub 2}) on combustion and emissions. The use of diluents to displace oxygen (O{sub 2}) in the intake air resulted in a reduction in the O{sub 2} supplied to the engine, increased the inlet charge thermal capacity (thermal effect) and, potentially, CO{sub 2} and N{sub 2} participated in the combustion process (chemical effect). In a separate series of tests, the temperature of the engine inlet charge was raised gradually in order to simulate the effect of mixing hot EGR with the engine inlet gaseous fuel air mixture. It was found that the admission of diluents resulted in reductions in the exhaust oxides of nitrogen (NO{sub x}). Higher inlet charge temperature increases the exhaust NO{sub x} but reduces the unburned hydrocarbon emissions. Finally, when carbon dioxide was added to the inlet gaseous fuel air charge, large reductions in NO{sub x} were observed. (author)

Ambient air cooling arrangement having a pre-swirler for gas turbine engine blade cooling

Science.gov (United States)

Lee, Ching-Pang; Tham, Kok-Mun; Schroeder, Eric; Meeroff, Jamie; Miller, Jr., Samuel R; Marra, John J

2015-01-06

A gas turbine engine including: an ambient-air cooling circuit (10) having a cooling channel (26) disposed in a turbine blade (22) and in fluid communication with a source (12) of ambient air: and an pre-swirler (18), the pre-swirler having: an inner shroud (38); an outer shroud (56); and a plurality of guide vanes (42), each spanning from the inner shroud to the outer shroud. Circumferentially adjacent guide vanes (46, 48) define respective nozzles (44) there between. Forces created by a rotation of the turbine blade motivate ambient air through the cooling circuit. The pre-swirler is configured to impart swirl to ambient air drawn through the nozzles and to direct the swirled ambient air toward a base of the turbine blade. The end walls (50, 54) of the pre-swirler may be contoured.

The role of nuclear medicine in acute gastrointestinal bleeding

International Nuclear Information System (INIS)

Robinson, P.

1993-01-01

In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. 99 Tc m -sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. 99 Tc m -labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author)

The role of nuclear medicine in acute gastrointestinal bleeding

Energy Technology Data Exchange (ETDEWEB)

Robinson, P. (Saint James' s Hospital, Leeds (United Kingdom). Dept. of Radiology)

1993-10-01

In most patients with upper gastrointestinal (GI) bleeding, endoscopy will locate the site and cause of bleeding, and also provide an opportunity for local therapy. The cause of lower GI bleeding is often difficult to attribute, even when pathology is found by colonoscopy or barium enema. Nuclear medicine techniques can be used to identify the site of bleeding in those patients in whom the initial diagnostic procedures are negative or inconclusive. Methods using transient labelling of blood (e.g. [sup 99]Tc[sup m]-sulphur colloid) produce a high target-to-background ratio in positive cases, give quick results and localize bleeding sites accurately, but depend upon bleeding being active at the time of injection. Techniques using stable blood labelling (e.g. [sup 99]Tc[sup m]-labelled red blood cells) may be positive even with intermittent bleeding but may take several hours to produce a result and are less precise in localization. The most useful application is in patients with recurrent or prolonged bleeding, those with inconclusive endoscopy or barium studies, and those who are high-risk surgical candidates. (author).

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

Science.gov (United States)

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

2014-09-01

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

Transfusion strategy for acute upper gastrointestinal bleeding.

Science.gov (United States)

Handel, James; Lang, Eddy

2015-09-01

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

Analysis of the Perceived Adequacy of Air Force Civil Engineering Prime Beef Training

Science.gov (United States)

1985-09-01

hands-on portion is sufficient. The apparent positive effect of the classroom training is encouraging to note for educators, but must be balanced with...Gains Through Worklife Improvements. New York: Harcourt Brace Jovanovich, 1976. 19. Hains III, Major Paul W. "IMAGE," Air Force Engineering and Services

The prevalence of underlying bleeding disorders in patients with heavy menstrual bleeding with and without gynecologic abnormalities

NARCIS (Netherlands)

Knol, H. Marieke; Mulder, Andre; Bogchelman, Dick H.; Kluin-Nelemans, Hanneke C.; van der Zee, Ate G. J.; Meijer, Karina

OBJECTIVE: The purpose of this study was to assess the prevalence of underlying bleeding disorders in women with heavy menstrual bleeding (HMB) with and without gynecologic abnormalities. STUDY DESIGN: We performed a single-center prospective cohort study of 112 consecutive patients who were

Intracranial hemorrhage in congenital bleeding disorders.

Science.gov (United States)

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

2018-01-01

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

Pelvic artery embolization in gynecological bleeding

International Nuclear Information System (INIS)

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

2002-01-01

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

Upper gastrointestinal bleeding in irbid, jordan

International Nuclear Information System (INIS)

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

2007-01-01

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

Acquired bleeding disorders

African Journals Online (AJOL)

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

Immunosuppressive agents are associated with peptic ulcer bleeding.

Science.gov (United States)

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

2017-05-01

Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ 2 tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ 2 , and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P=0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P=0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at

Evaluation of rectal bleeding factors associated with prostate brachytherapy

International Nuclear Information System (INIS)

Aoki, Manabu; Miki, Kenta; Sasaki, Hiroshi; Kido, Masato; Shirahama, Jun; Takagi, Sayako; Kobayashi, Masao; Honda, Chikara; Kanehira, Chihiro

2009-01-01

The purpose of this study was to analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding. The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB+EBRT (44-46 Gy). Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P=0.0049) and higher percentage of grade 2 bleeding (P=0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 >130 Gy. Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade. (author)

Treatment Modalities in Adolescents Who present With Heavy Menstrual Bleeding.

Science.gov (United States)

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

2018-03-07

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

Gastric ulcer bleeding: diagnosis by computed tomography

Energy Technology Data Exchange (ETDEWEB)

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

1999-06-01

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

Gastric ulcer bleeding: diagnosis by computed tomography

International Nuclear Information System (INIS)

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

1999-01-01

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

Air Emission Inventory for the Idaho National Engineering and Environmental Laboratory - Calendar Year 1999 Emission Report

Energy Technology Data Exchange (ETDEWEB)

Zohner, S.K.

2000-05-30

This report presents the 1999 calendar year update of the Air Emission Inventory for the Idaho National Engineering and Environmental Laboratory (INEEL). The INEEL Air Emission Inventory documents sources and emissions of nonradionuclide pollutants from operations at the INEEL. The report describes the emission inventory process and all of the sources at the INEEL, and provides nonradionuclide emissions estimates for stationary sources.

Air Emission Inventory for the Idaho National Engineering and Environmental Laboratory - Calendar Year 1998 Emissions Report

Energy Technology Data Exchange (ETDEWEB)

S. K. Zohner

1999-10-01

This report presents the 1998 calendar year update of the Air Emission Inventory for the Idaho National Engineering and Environmental Laboratory (INEEL). The INEEL Air Emission Inventory documents sources and emissions of nonradionuclide pollutants from operations at the INEEL. The report describes the emission inventory process and all of the sources at the INEEL, and provides nonradiological emissions estimates for stationary sources.

Bleeding disorders in dental practice: A diagnostic overview

Directory of Open Access Journals (Sweden)

Abhirup Goswami

2014-01-01

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

Abnormal Bleeding during Menopause Hormone Therapy: Insights for Clinical Management

Directory of Open Access Journals (Sweden)

Sebastião Freitas De Medeiros

2013-01-01

Full Text Available Objective Our objective was to review the involved mechanisms and propose actions for controlling/treating abnormal uterine bleeding during climacteric hormone therapy. Methods A systemic search of the databases SciELO, MEDLINE, and Pubmed was performed for identifying relevant publications on normal endometrial bleeding, abnormal uterine bleeding, and hormone therapy bleeding. Results Before starting hormone therapy, it is essential to exclude any abnormal organic condition, identify women at higher risk for bleeding, and adapt the regimen to suit eachwoman's characteristics. Abnormal bleeding with progesterone/progestogen only, combined sequential, or combined continuous regimens may be corrected by changing the progestogen, adjusting the progestogen or estrogen/progestogen doses, or even switching the initial regimen to other formulation. Conclusion To diminish the occurrence of abnormal bleeding during hormone therapy (HT, it is important to tailor the regimen to the needs of individual women and identify those with higher risk of bleeding. The use of new agents as adjuvant therapies for decreasing abnormal bleeding in women on HT awaits future studies.

Timing of onset of gastrointestinal bleeding in the ICU

DEFF Research Database (Denmark)

Granholm, A; Lange, T; Anthon, C T

2018-01-01

BACKGROUND: Critically ill patients are at risk of gastrointestinal bleeding, but clinically important gastrointestinal bleeding is rare. The majority of intensive care unit (ICU) patients receive stress ulcer prophylaxis (SUP), despite uncertainty concerning the balance between benefit and harm....... For approximately half of ICU patients with gastrointestinal bleeding, onset is early, ie within the first two days of the ICU stay. The aetiology of gastrointestinal bleeding and consequently the balance between benefit and harm of SUP may differ between patients with early vs late gastrointestinal bleeding...... will describe baseline characteristics and assess the time to onset of the first clinically important episode of GI bleeding accounting for survival status and allocation to SUP or placebo. In addition, we will describe differences in therapeutic and diagnostic procedures used in patients with clinically...

77 FR 74125 - Airworthiness Directives; General Electric Company Turbofan Engines

Science.gov (United States)

2012-12-13

... Company Turbofan Engines AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of proposed... Company (GE) CF34-8C and CF34-8E turbofan engines with certain part numbers (P/N) of operability bleed... received reports of three failure events of OBV ring lock fuel fittings on GE CF34-8C turbofan engines. Two...

78 FR 19983 - Airworthiness Directives; General Electric Company Turbofan Engines

Science.gov (United States)

2013-04-03

... Airworthiness Directives; General Electric Company Turbofan Engines AGENCY: Federal Aviation Administration (FAA... Electric Company (GE) CF34-8C and CF34-8E turbofan engines with certain part numbers (P/N) of operability...-8E6, and CF34-8E6A1 turbofan engines, with an operability bleed valve (OBV) part number (P/N...

Clinical endoscopic management and outcome of post-endoscopic sphincterotomy bleeding.

Directory of Open Access Journals (Sweden)

Wei-Chen Lin

Full Text Available Post-endoscopic sphincterotomy bleeding is a common complication of biliary sphincterotomy, and the incidence varies from 1% to 48%. It can be challenging to localize the bleeder or to administer various interventions through a side-viewing endoscope. This study aimed to evaluate the risk factors of post-endoscopic sphincterotomy bleeding and the outcome of endoscopic intervention therapies. We retrospectively reviewed the records of 513 patients who underwent biliary sphincterotomy in Mackay Memorial Hospital between 2011 and 2016. The blood biochemistry, comorbidities, indication for sphincterotomy, severity of bleeding, endoscopic features of bleeder, and type of endoscopic therapy were analyzed. Post-endoscopic sphincterotomy bleeding occurred in 65 (12.6% patients. Forty-five patients had immediate bleeding and 20 patients had delayed bleeding. The multivariate analysis of risk factors associated with post-endoscopic sphincterotomy bleeding were liver cirrhosis (P = 0.029, end-stage renal disease (P = 0.038, previous antiplatelet drug use (P<0.001, and duodenal ulcer (P = 0.023. The complications of pancreatitis and cholangitis were higher in the bleeding group, with statistical significance. Delayed bleeding occurred within 1 to 7 days (mean, 2.5 days, and 60% (12/20 of the patients received endoscopic evaluation. In the delayed bleeding group, the successful hemostasis rate was 71.4% (5/7, and 65% (13/20 of the patients had ceased bleeding without endoscopic hemostasis therapy. Comparison of different therapeutic modalities showed that cholangitis was higher in patients who received epinephrine spray (P = 0.042 and pancreatitis was higher in patients who received epinephrine injection and electrocoagulation (P = 0.041 and P = 0.039 respectively. Clinically, post-endoscopic sphincterotomy bleeding and further endoscopic hemostasis therapy increase the complication rate of pancreatitis and cholangitis. Realizing the effectiveness of each

ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding.

Science.gov (United States)

Gerson, Lauren B; Fidler, Jeff L; Cave, David R; Leighton, Jonathan A

2015-09-01

Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended

[Management of intractable epistaxis and bleeding points localization].

Science.gov (United States)

Yang, Da-Zhang; Cheng, Jing-Ning; Han, Jun; Shu, Ping; Zhang, Hua

2005-05-01

To investigate the common nasal bleeding points and the management of intractable epistaxis. The bleeding points and its correlation with age distribution, surgical techniques as well as its effects were studied retrospectively in 92 patients, in whom the bleeding points were not found by routine nasal endoscopy and the hemorrhage was not controlled with standard nasal packing. The bleeding points were found in the following different sites: superior wall of inferior nasal meatus (56.5%, 52/92), olfactory cleft of nasal septum (27.2%, 25/92), posterosuperior wall of middle nasal meatus (8.7%, 8/92) and uncertain (7.6%, 7/92). The results showed that the bleeding points had correlation with age. Epistaxis was well controlled by electrocoagulation in 83 cases, gelfoam packing in 8 cases, and transcatheter maxillary artery embolization in 1 case. There were no complications during a followed-up for 1 - 3 months after management. Among the 92 cases, the numbers of treatment needed to stop bleeding were 82 cases (89.1%) after 1 time of treatment, 9 cases (9.8%) after 2 times and in one case (1.1%) after 4 times. Endoscopy combined with displacement of the middle and inferior turbinate gives good visualization and direct management of the deeply-sited bleeding points, which were difficult in localization. The combined method provides an effective and safe way to control intractable epistaxis.

Air Force Systems Engineering Assessment Model (AF SEAM) Management Guide, Version 2

Science.gov (United States)

2010-09-21

gleaned from experienced professionals who assisted with the model’s development. Examples of the references used include the following: • ISO /IEC...Defense Acquisition Guidebook, Chapter 4 • AFI 63-1201, Life Cycle Systems Engineering • IEEE/EIA 12207 , Software Life Cycle Processes • Air...Selection criteria Reference Material: IEEE/EIA 12207 , MIL-HDBK-514 Other Considerations: Modeling, simulation and analysis techniques can be

Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy

International Nuclear Information System (INIS)

Cihoric, Nikola; Crowe, Susanne; Eychmüller, Steffen; Aebersold, Daniel M; Ghadjar, Pirus

2012-01-01

This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37–93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5–45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 (n = 39), 1 (n = 12), 2 (n = 6), 3 (n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients

Contingency power for small turboshaft engines using water injection into turbine cooling air

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Biesiadny, Thomas J.; Berger, Brett; Klann, Gary A.; Clark, David A.

1987-01-01

Because of one engine inoperative requirements, together with hot-gas reingestion and hot day, high altitude takeoff situations, power augmentation for multiengine rotorcraft has always been of critical interest. However, power augmentation using overtemperature at the turbine inlet will shorten turbine life unless a method of limiting thermal and mechanical stresses is found. A possible solution involves allowing the turbine inlet temperature to rise to augment power while injecting water into the turbine cooling air to limit hot-section metal temperatures. An experimental water injection device was installed in an engine and successfully tested. Although concern for unprotected subcomponents in the engine hot section prevented demonstration of the technique's maximum potential, it was still possible to demonstrate increases in power while maintaining nearly constant turbine rotor blade temperature.

AUTOMOTIVE DIESEL MAINTENANCE 1. UNIT XXI, I--MAINTAINING THE AIR SYSTEM--CATERPILLAR DIESEL ENGINE, II--UNDERSTANDING REAR END SUSPENSION.

Science.gov (United States)

Minnesota State Dept. of Education, St. Paul. Div. of Vocational and Technical Education.

THIS MODULE OF A 30-MODULE COURSE IS DESIGNED TO DEVELOP AN UNDERSTANDING OF THE OPERATION AND MAINTENANCE OF THE DIESEL ENGINE AIR SYSTEM AND REAR AXLE SUSPENSION USED ON DIESEL POWERED VEHICLES. TOPICS ARE (1) AIR INDUCTION AND EXHAUST SYSTEM, (2) VALVE MECHANISM, (3) TROUBLESHOOTING THE AIR SYSTEM, (4) PURPOSE OF VEHICLE SUSPENSION, (5) TANDEM…

Scoring Systems for Estimating the Risk of Anticoagulant-Associated Bleeding.

Science.gov (United States)

Parks, Anna L; Fang, Margaret C

2017-07-01

Anticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS-BLED, ATRIA, and HEMORR 2 HAGES risk assessment tools, and can be used to help estimate patients' risk for bleeding on anticoagulants. These tools vary by their individual risk components and in how they define and weigh clinical factors. However, it is not yet clear how best to integrate bleeding risk tools into clinical practice. Current bleeding risk scores generally have modest predictive ability and limited ability to predict the most devastating complication of anticoagulation, intracranial hemorrhage. In clinical practice, bleeding risk tools should be paired with a formal determination of thrombosis risk, as their results may be most influential for patients at the lower end of thrombosis risk, as well as for highlighting potentially modifiable risk factors for bleeding. Use of bleeding risk scores may assist clinicians and patients in making informed and individualized anticoagulation decisions. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Universal definition of perioperative bleeding in adult cardiac surgery

NARCIS (Netherlands)

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

2014-01-01

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

Design and instrumentation of an automotive heat pump system using ambient air, engine coolant and exhaust gas as a heat source

International Nuclear Information System (INIS)

Hosoz, M.; Direk, M.; Yigit, K.S.; Canakci, M.; Alptekin, E.; Turkcan, A.

2009-01-01

Because the amount of waste heat used for comfort heating of the passenger compartment in motor vehicles decreases continuously as a result of the increasing engine efficiencies originating from recent developments in internal combustion engine technology, it is estimated that heat requirement of the passenger compartment in vehicles using future generation diesel engines will not be met by the waste heat taken from the engine coolant. The automotive heat pump (AHP) system can heat the passenger compartment individually, or it can support the present heating system of the vehicle. The AHP system can also be employed in electric vehicles, which do not have waste heat, as well as vehicles driven by a fuel cell. The authors of this paper observed that such an AHP system using ambient air as a heat source could not meet the heat requirement of the compartment when ambient temperature was extremely low. The reason is the decrease in the amount of heat taken from the ambient air as a result of low evaporating temperatures. Furthermore, the moisture condensed from air freezed on the evaporator surface, thus blocking the air flow through it. This problem can be solved by using the heat of engine coolant or exhaust gases. In this case, the AHP system can have a higher heating capacity and reuse waste heat. (author)

Abnormal Uterine Bleeding

Science.gov (United States)

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

Optimization of diesel engine performances for a hybrid wind-diesel system with compressed air energy storage

International Nuclear Information System (INIS)

Ibrahim, H.; Younes, R.; Basbous, T.; Ilinca, A.; Dimitrova, M.

2011-01-01

Electricity supply in remote areas around the world is mostly guaranteed by diesel generators. This relatively inefficient and expensive method is responsible for 1.2 million tons of greenhouse gas (GHG) emission in Canada annually. Some low- and high-penetration wind-diesel hybrid systems (WDS) have been experimented in order to reduce the diesel consumption. We explore the re-engineering of current diesel power plants with the introduction of high-penetration wind systems together with compressed air energy storage (CAES). This is a viable alternative to major the overall percentage of renewable energy and reduce the cost of electricity. In this paper, we present the operative principle of this hybrid system, its economic benefits and advantages and we finally propose a numerical model of each of its components. Moreover, we are demonstrating the energy efficiency of the system, particularly in terms of the increase of the engine performance and the reduction of its fuel consumption illustrated and supported by a village in northern Quebec. -- Highlights: → The Wind-Diesel-Compressed Air Storage System (WDCAS) has a very important commercial potential for remote areas. → The WDCAS is conceived like the adaptation of the existing engines at the level of the intake system. → A wind turbine and an air compression and storage system are added on the diesel plant. → This study demonstrates the potential of WDCAS to reduce fuel consumption and increase the efficiency of the diesel engine. → This study demonstrates that we can expect savings which can reach 50%.

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

Science.gov (United States)

Lirio, Richard A

2016-01-01

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

CHANGE ON SPEED AIR CHARACTERISTICS THE POWER INDICATOR INDEXES OF PNEUMATIC ENGINE WITHOUT HEATING THE CHARGE DURING THE ADMITTANCE

Directory of Open Access Journals (Sweden)

A. Voronkov

2014-10-01

Full Text Available The experimental data on change according to speed characteristics of power indicator indexes of the four cylinder pneumatic engine D/S = 76/66 with a slide-valve air distributor at unchangeable temperature of compressed input air is considered.

Scintigraphy in gastrointestinal bleeding in the pediatric population

International Nuclear Information System (INIS)

Hall, T.R.; Miller, J.H.; Sty, J.R.

1986-01-01

Gastrointestinal (GI) tract bleeding in the pediatric population is not uncommon, especially in chronically ill patients. A total of 29 patients with GI tract bleeding were studied scintigraphically using Tc-99m-labeled red blood cells (RBCs) or sulfur colloid (SC). The patients ranged in age from 3 weeks to 20 years, with an equal sex distribution. Of 19 patients studied with Tc-99m-labeled RBCs using an in vitro labeling technique, evidence of GI tract bleeding was documented scintigraphically in 15. Tc-99m-labeled SC scans in the remaining ten patients demonstrated GI tract bleeding in six. The Tc-99m RBC method was slightly more sensitive than the Tc-99m SC method. Advantages of using labeled RBCs include increased sensitivity in detecting upper abdominal bleeding, ability to delay imaging for up to 18-24 hours, and the use of provocative testing

Duodenal diverticular bleeding: an endoscopic challenge

Directory of Open Access Journals (Sweden)

Eduardo Valdivielso-Cortázar

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

Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.

Science.gov (United States)

Pingleton, S K; Hadzima, S K

1983-01-01

The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.

Gastrointestinal bleeding after intracerebral hemorrhage: a retrospective review of 808 cases.

Science.gov (United States)

Yang, Tie-Cheng; Li, Jian-Guo; Shi, Hong-Mei; Yu, Dong-Ming; Shan, Kai; Li, Li-Xia; Dong, Xiao-Yan; Ren, Tian-Hua

2013-10-01

This study examined the incidence and risk factors for gastrointestinal (GI) bleeding after spontaneous intracerebral hemorrhage (ICH). The available medical records of patients with ICH admitted from June 2008 to December 2009 for any episode of GI bleeding, possible precipitating factors and administration of ulcer prophylaxis were reviewed. The prevalence of GI bleeding was 26.7%, including 3 cases of severe GI bleeding (0.35%). Patients with GI bleeding had significantly longer hospital stay and higher in-hospital mortality compared with patients without GI bleeding. Multivariate logistic regression analyses showed that age, Glasgow Coma Scale scores, sepsis and ICH volume were independent predictors of GI bleeding. About 63.4% of patients with ICH received stress ulcer prophylaxis. GI bleeding occurred frequently after ICH, but severe events were rare. Age, Glasgow Coma Scale score, sepsis and ICH volume were independent predictors of GI bleeding occurring after ICH.

Producing air-stable monolayers of phosphorene and their defect engineering.

Science.gov (United States)

Pei, Jiajie; Gai, Xin; Yang, Jiong; Wang, Xibin; Yu, Zongfu; Choi, Duk-Yong; Luther-Davies, Barry; Lu, Yuerui

2016-01-22

It has been a long-standing challenge to produce air-stable few- or monolayer samples of phosphorene because thin phosphorene films degrade rapidly in ambient conditions. Here we demonstrate a new highly controllable method for fabricating high quality, air-stable phosphorene films with a designated number of layers ranging from a few down to monolayer. Our approach involves the use of oxygen plasma dry etching to thin down thick-exfoliated phosphorene flakes, layer by layer with atomic precision. Moreover, in a stabilized phosphorene monolayer, we were able to precisely engineer defects for the first time, which led to efficient emission of photons at new frequencies in the near infrared at room temperature. In addition, we demonstrate the use of an electrostatic gate to tune the photon emission from the defects in a monolayer phosphorene. This could lead to new electronic and optoelectronic devices, such as electrically tunable, broadband near infrared lighting devices operating at room temperature.

Upper gastrointestinal bleeding - state of the art.

Science.gov (United States)

Szura, Mirosław; Pasternak, Artur

2014-01-01

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

Experimental study of gas engine driven air to water heat pump in cooling mode

International Nuclear Information System (INIS)

Elgendy, E.; Schmidt, J.

2010-01-01

Nowadays a sustainable development for more efficient use of energy and protection of the environment is of increasing importance. Gas engine heat pumps represent one of the most practicable solutions which offer high energy efficiency and environmentally friendly for heating and cooling applications. In this paper, the performance characteristics of gas engine driven heat pump used in water cooling were investigated experimentally without engine heat recovery. The effects of several important factors (evaporator water inlet temperature, evaporator water volume flow rate, ambient air temperature, and engine speed) on the performance of gas engine driven heat pump were studied in a wide range of operating conditions. The results showed that primary energy ratio of the system increased by 22.5% as evaporator water inlet temperature increased from 13 o C to 24 o C. On the other hand, varying of engine speed from 1300 rpm to 1750 rpm led to decrease in system primary energy ratio by 13%. Maximum primary energy ratio has been estimated with a value of two over a wide range of operating conditions.

Abnormal uterine bleeding in perimenopause.

Science.gov (United States)

Goldstein, S R; Lumsden, M A

2017-10-01

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

Reliability measures in managing GI bleeding.

Science.gov (United States)

Sonnenberg, Amnon

2012-06-01

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

Pattern recognition in menstrual bleeding diaries by statistical cluster analysis

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Wessel Jens

2009-07-01

Full Text Available Abstract Background The aim of this paper is to empirically identify a treatment-independent statistical method to describe clinically relevant bleeding patterns by using bleeding diaries of clinical studies on various sex hormone containing drugs. Methods We used the four cluster analysis methods single, average and complete linkage as well as the method of Ward for the pattern recognition in menstrual bleeding diaries. The optimal number of clusters was determined using the semi-partial R2, the cubic cluster criterion, the pseudo-F- and the pseudo-t2-statistic. Finally, the interpretability of the results from a gynecological point of view was assessed. Results The method of Ward yielded distinct clusters of the bleeding diaries. The other methods successively chained the observations into one cluster. The optimal number of distinctive bleeding patterns was six. We found two desirable and four undesirable bleeding patterns. Cyclic and non cyclic bleeding patterns were well separated. Conclusion Using this cluster analysis with the method of Ward medications and devices having an impact on bleeding can be easily compared and categorized.

Small Engines as Bottoming Cycle Steam Expanders for Internal Combustion Engines

Directory of Open Access Journals (Sweden)

Rohitha Weerasinghe

2017-01-01

Full Text Available Heat recovery bottoming cycles for internal combustion engines have opened new avenues for research into small steam expanders (Stobart and Weerasinghe, 2006. Dependable data for small steam expanders will allow us to predict their suitability as bottoming cycle engines and the fuel economy achieved by using them as bottoming cycles. Present paper is based on results of experiments carried out on small scale Wankel and two-stroke reciprocating engines as air expanders and as steam expanders. A test facility developed at Sussex used for measurements is comprised of a torque, power and speed measurements, electronic actuation of valves, synchronized data acquisition of pressure, and temperatures of steam and inside of the engines for steam and internal combustion cycles. Results are presented for four engine modes, namely, reciprocating engine in uniflow steam expansion mode and air expansion mode and rotary Wankel engine in steam expansion mode and air expansion mode. The air tests will provide base data for friction and motoring effects whereas steam tests will tell how effective the engines will be in this mode. Results for power, torque, and p-V diagrams are compared to determine the change in performance from air expansion mode to steam expansion mode.

Experimental study on two-stage air supply downdraft gasifier and dual fuel engine system

Energy Technology Data Exchange (ETDEWEB)

Nhuchhen, Daya Ram; Salam, P.A. [Asian Institute of Technology, Energy Field of Study, School of Environment Resource and Development, P. O. Box 4, Klong Luang, Pathumthani (Thailand)

2012-06-15

Biomass is a widely used renewable energy resource with net balanced carbon dioxide absorptions and emissions. An inefficient use of solid biomass in combustion process emits more gaseous pollutants, increasing the pollution level. Biomass gasification is one of the techniques to support efficient use of biomass. Multistage gasification is a method of gasification to improve quality of the producer gas in which two separate reactors are designed for separating gasification reactions. This study presents experimental results of gasification using Eucalyptus wood in a single long cylindrical reactor with two air supply ports, i.e., primary and secondary. The effect of different air supply rates on the heating values of the producer gas was studied. Optimum primary and secondary air supply rate of 100 and 80 l/min at equivalence ratio of 0.38 was observed with producer gas lower heating value of 4.72 MJ Nm{sup -3}. The performance of a diesel engine in the dual fuel mode was also evaluated. The overall gasifier engine system efficiency was 13.86 % at an electrical load of 10.54 kW{sub e} with specific energy consumption of 16.22 MJ kWh{sup -1}. The heat recovery system was designed and tested to recover heat from producer gas in the form of hot water. (orig.)

Rectal bleeding after hypofractionated radiotherapy for prostate cancer: Correlation between clinical and dosimetric parameters and the incidence of grade 2 or worse rectal bleeding

International Nuclear Information System (INIS)

Akimoto, Tetsuo; Muramatsu, Hiroyuki; Takahashi, Mitsuhiro; Saito, Jun-ichi; Kitamoto, Yoshizumi; Harashima, Koichi; Miyazawa, Yasushi; Yamada, Masami; Ito, Kazuto; Kurokawa, Kouhei; Yamanaka, Hidetoshi; Nakano, Takashi; Mitsuhashi, Norio; Niibe, Hideo

2004-01-01

Purpose: To investigate the incidence and severity of rectal bleeding after high-dose hypofractionated radiotherapy (RT) for prostate cancer, and to explore the factors affecting the incidence of Grade 2 or worse rectal bleeding. Methods and materials: The data of 52 patients who had been treated by external beam RT for localized prostate cancer between 1999 and 2002 were analyzed. All the patients had received hypofractionated external beam RT to a total dose of 69 Gy in 3-Gy fractions, three fractions weekly. The clinical and dosimetric factors affecting the incidence of Grade 2 or worse late rectal bleeding were analyzed by univariate and multivariate analyses. The effect of the percentage of the whole rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose (V 30 , V 50 , V 80 , and V 90 , respectively) on the incidence of rectal bleeding was evaluated. Results: Of the 52 patients, 13 (25%) developed Grade 2 or worse rectal bleeding. One patient who needed laser coagulation and blood transfusion for the treatment of rectal bleeding was classified as having Grade 3 rectal bleeding. The median time to the development of Grade 2 or worse rectal bleeding was 11 months. The results of the univariate analysis revealed that the presence of a history of diabetes mellitus (p 30 ≥ 60%, V 50 ≥ 40% (p 80 ≥ 25%, and V 90 ≥ 15% (p < 0.001) were statistically significant risk factors for the occurrence of Grade 2 or worse rectal bleeding. The results of the multivariate analysis revealed that a history of diabetes mellitus was the most statistically significant risk factor for the occurrence of rectal bleeding after hypofractionated RT for prostate cancer (p < 0.05). Conclusion: A history of diabetes mellitus was the most statistically significant risk factor for the occurrence of Grade 2 or worse rectal bleeding after high-dose hypofractionated RT, although dosimetric factors were also closely associated with the risk of rectal bleeding

Outcomes of Propofol Sedation During Emergency Endoscopy Performed for Upper Gastrointestinal Bleeding.

Science.gov (United States)

Park, Chan Hyuk; Han, Dong Soo; Jeong, Jae Yoon; Eun, Chang Soo; Yoo, Kyo-Sang; Jeon, Yong Cheol; Sohn, Joo Hyun

2016-03-01

Although propofol-based sedation can be used during emergency endoscopy for upper gastrointestinal bleeding (UGIB), there is a potential risk of sedation-related adverse events, especially in patients with variceal bleeding. We compared adverse events related to propofol-based sedation during emergency endoscopy between patients with non-variceal and variceal bleeding. Clinical records of patients who underwent emergency endoscopy for UGIB under sedation were reviewed. Adverse events, including shock, hypoxia, and paradoxical reaction, were compared between the non-variceal and variceal bleeding groups. Of 703 endoscopies, 539 and 164 were performed for non-variceal and variceal bleeding, respectively. Shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding (12.2 vs. 3.5%, P bleeding (non-variceal bleeding vs. variceal bleeding: hypoxia, 3.5 vs. 1.8%, P = 0.275; paradoxical reaction interfering with the procedure, 4.1 vs. 5.5%, P = 0.442). Although shock was more common in patients with variceal bleeding compared to those with non-variceal bleeding, most cases could be controlled without procedure interruption. Paradoxical reaction, rather than shock or hypoxia, was the most common cause of procedure interruption in patients with variceal bleeding, but the rate did not differ between patients with non-variceal and variceal bleeding.

Urban air quality improvement by using a CNG lean burn engine for city buses

NARCIS (Netherlands)

Merétei, T.; Ling, J.A.N. van; Havenith, C.

1998-01-01

The use of compressed natural gas (CNG)-fuelled lean-burn city bus engines has a significant potential for air quality improvement in urban areas. Particularly important is the reduction of NO, as well as particulate and non regulated HC-emissions. For this reason, a CNG-fuelled, lean-burn,

Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation.

Science.gov (United States)

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

2016-01-01

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

Spontaneous bleeding from liver after open heart surgery.

Science.gov (United States)

Mir, Najeeb H; Shah, Mian T; Obeid, Mahmoud Ali; Gallo, Ricardo; Aliter, Hashem

2013-01-01

Intra-abdominal hemorrhage after open heart surgery is very uncommon in routine clinical practice. There are case reports of having bleeding from spleen or liver after starting low molecular weight heparin (LMWH) postoperatively. Our patient is a 58-year-old man with mitral valve regurgitation, who underwent mitral valve repair and developed intra-abdominal hemorrhage 8h after open heart surgery. The exploratory laparotomy revealed the source of bleeding from ruptured sub-capsular liver hematoma and oozing from raw areas of the liver surface. Liver packing was done to control the bleeding. The gastrointestinal complications after open heart surgery are rare and spontaneous bleeding from spleen has been reported. This is the first case from our hospital to have intra-abdominal hemorrhage after open heart surgery. Spontaneous bleeding from liver is a possible complication after open heart surgery. We submit the case for the academic interest and to discuss the possible cause of hemorrhage. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Resin bleed improvement on surface mount semiconductor device

Science.gov (United States)

Rajoo, Indra Kumar; Tahir, Suraya Mohd; Aziz, Faieza Abdul; Shamsul Anuar, Mohd

2018-04-01

Resin bleed is a transparent layer of epoxy compound which occurs during molding process but is difficult to be detected after the molding process. Resin bleed on the lead on the unit from the focused package, SOD123, can cause solderability failure at end customer. This failed unit from the customer will be considered as a customer complaint. Generally, the semiconductor company has to perform visual inspection after the plating process to detect resin bleed. Mold chase with excess hole, split cavity & stepped design ejector pin hole have been found to be the major root cause of resin bleed in this company. The modifications of the mold chase, changing of split cavity to solid cavity and re-design of the ejector pin proposed were derived after a detailed study & analysis conducted to arrive at these solutions. The solutions proposed have yield good results during the pilot run with zero (0) occurrence of resin bleed for 3 consecutive months.

The role of endoscopy in pediatric gastrointestinal bleeding

OpenAIRE

Franke, Markus; Gei?, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-J?rgen; Bausch, Dirk; Fischer, Andreas

2016-01-01

Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20?% of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediat...

Engineering an in vitro air-blood barrier by 3D bioprinting

Science.gov (United States)

Horváth, Lenke; Umehara, Yuki; Jud, Corinne; Blank, Fabian; Petri-Fink, Alke; Rothen-Rutishauser, Barbara

2015-01-01

Intensive efforts in recent years to develop and commercialize in vitro alternatives in the field of risk assessment have yielded new promising two- and three dimensional (3D) cell culture models. Nevertheless, a realistic 3D in vitro alveolar model is not available yet. Here we report on the biofabrication of the human air-blood tissue barrier analogue composed of an endothelial cell, basement membrane and epithelial cell layer by using a bioprinting technology. In contrary to the manual method, we demonstrate that this technique enables automatized and reproducible creation of thinner and more homogeneous cell layers, which is required for an optimal air-blood tissue barrier. This bioprinting platform will offer an excellent tool to engineer an advanced 3D lung model for high-throughput screening for safety assessment and drug efficacy testing. PMID:25609567

Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

Science.gov (United States)

Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

2016-08-01

We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Bleeding tendency in dual antiplatelet therapy with aspirin/clopidogrel: rescue of the template bleeding time in a single-center prospective study

Directory of Open Access Journals (Sweden)

Altman Raul

2012-01-01

Full Text Available Abstract Background Patients with heightened platelet reactivity in response to antiplatelet agents are at an increased risk of recurrent ischemic events. However, there is a lack of diagnostic criteria for increased response to combined aspirin/clopidogrel therapy. The challenge is to identify patients at risk of bleeding. This study sought to characterize bleeding tendency in patients treated with aspirin and clopidogrel. Patients/methods In a single-center prospective study, 100 patients under long-term aspirin/clopidogrel treatment, the effect of therapy was assayed by template bleeding time (BT and the inhibition of platelet aggregation (IPA by light transmission aggregometry (LTA. Arachidonic acid (0.625 mmol/L and adenosine diphosphate (ADP; 2, 4, and 8 μmol/L were used as platelet agonists. Results Bleeding episodes (28 nuisance, 2 hematuria [1 severe], 1 severe proctorrhagia, 1 severe epistaxis were significantly more frequent in patients with longer BT. Template BT ≥ 24 min was associated with bleeding episodes (28 of 32. Risk of bleeding increased 17.4% for each 1 min increase in BT. Correlation was found between BT and IPAmax in response to ADP 2 μmol/L but not to ADP 4 or 8 μmol/L. Conclusion In patients treated with dual aspirin/clopidogrel therapy, nuisance and internal bleeding were significantly associated with template BT and with IPAmax in response to ADP 2 μmol/L but not in response to ADP 4 μmol/L or 8 μmol/L.

Rectal bleeding in children: endoscopic evaluation revisited

NARCIS (Netherlands)

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

2007-01-01

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

Recent Update of Embolization of Upper Gastrointestinal Tract Bleeding

Energy Technology Data Exchange (ETDEWEB)

Shin, Ji Hoon [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

2012-02-15

Nonvariceal upper gastrointestinal (UGI) bleeding is a frequent complication with significant morbidity and mortality. Although endoscopic hemostasis remains the initial treatment modality, severe bleeding despite endoscopic management occurs in 5-10% of patients, necessitating surgery or interventional embolotherapy. Endovascular embolotherapy is now considered the first-line therapy for massive UGI bleeding that is refractory to endoscopic management. Interventional radiologists need to be familiar with the choice of embolic materials, technical aspects of embolotherapy, and the factors affecting the favorable or unfavorable outcomes after embolotherapy for UGI bleeding.

Pseudoxanthoma elasticum: A rare cause of gastrointestinal bleed

Directory of Open Access Journals (Sweden)

Ishrat H Dar

2015-01-01

Full Text Available Causes of obscure gastrointestinal (GI bleed are diverse and rare. The most common cause for GI bleeding of small bowel origin is angiodysplasia, followed by tumors of the small intestine, and various other causes, including small bowel ulcers and aortienteric fistulas. Pseudoxanthoma elasticum (PXE is a rare cause of GI bleed. It is an inherited elastic tissue disorder with degeneration of elastic fibers involving mainly skin, eyes and the cardiovascular system. Upper GI hemorrhage occurs in 13% of cases and is often resistant to nonsurgical methods of treatment. Presented herein is a case of GI bleed in a 65-year-old woman who had PXE and hyperplastic polyps in the stomach.

Use of heparin in the investigation of obscure gastrointestinal bleeding

International Nuclear Information System (INIS)

Mernagh, J.R.; O'Donovan, N.; Somers, S.; Gill, G.; Sridhar, S.

2001-01-01

To determine if the administration of heparin improves the predictive value of angiography in the investigation of obscure gastrointestinal (GI) bleeding. 18 patients with a history of chronic GI bleeding were investigated with angiography. For 6 patients, the cause of GI bleeding was established with angiography; the 12 patients who had negative results were given heparin for 24 h and were reassessed with angiography. After heparin administration, the source of GI bleeding was determined with angiography for 6 of the remaining 12 patients. Thus, heparinization increased diagnostic yield from 33% (6 of 18) to 67% (12 of 18). No significant complications, such as uncontrolled GI bleeding, occurred. Heparinization improves the diagnostic yield of angiography when obscure GI bleeding is being investigated. (author)

Small Bowel Bleeding

Science.gov (United States)

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

Cold Start Emissions of Spark-Ignition Engines at Low Ambient Temperatures as an Air Quality Risk

Directory of Open Access Journals (Sweden)

Bielaczyc Piotr

2014-12-01

Full Text Available SI engines are highly susceptible to excess emissions when started at low ambient temperatures. This phenomenon has multiple air quality and climate forcing implications. Direct injection petrol engines feature a markedly different fuelling strategy, and so their emissions behaviour is somewhat different from indirect injection petrol engines. The excess emissions of direct injection engines at low ambient temperatures should also differ. Additionally, the direct injection fuel delivery process leads to the formation of PM, and DISI engines should show greater PM emissions at low ambient temperatures. This study reports on laboratory experiments quantifying excess emissions of gaseous and solid pollutants over a legislative driving cycle following cold start at a low ambient temperature for both engine types. Over the legislative cycle for testing at -7°C (the UDC, emissions of HC, CO, NOx and CO2 were higher when tested at -7°C than at 24°C. Massive increases in emissions of HC and CO were observed, together with more modest increases in NOx and CO2 emissions. Results from the entire driving cycle showed excess emissions in both phases (though they were much larger for the UDC. The DISI vehicle showed lower increases in fuel consumption than the port injected vehicles, but greater increases in emission of HC and CO. DISI particle number emissions increased by around 50%; DISI particle mass by over 600%. The observed emissions deteriorations varied somewhat by engine type and from vehicle to vehicle. Excesses were greatest following start-up, but persisted, even after several hundred seconds’ driving. The temperature of the intake air appeared to have a limited but significant effect on emissions after the engine has been running for some time. All vehicles tested here comfortably met the relevant EU limits, providing further evidence that these limits are no longer challenging and need updating.

Objectives and Design of BLEEDS: A Cohort Study to Identify New Risk Factors and Predictors for Major Bleeding during Treatment with Vitamin K Antagonists.

Science.gov (United States)

van Rein, Nienke; Lijfering, Willem M; Bos, Mettine H A; Herruer, Martien H; Vermaas, Helga W; van der Meer, Felix J M; Reitsma, Pieter H

2016-01-01

Risk scores for patients who are at high risk for major bleeding complications during treatment with vitamin K antagonists (VKAs) do not perform that well. BLEEDS was initiated to search for new biomarkers that predict bleeding in these patients. To describe the outline and objectives of BLEEDS and to examine whether the study population is generalizable to other VKA treated populations. A cohort was created consisting of all patients starting VKA treatment at three Dutch anticoagulation clinics between January-2012 and July-2014. We stored leftover plasma and DNA following analysis of the INR. Of 16,706 eligible patients, 16,570 (99%) were included in BLEEDS and plasma was stored from 13,779 patients (83%). Patients had a mean age of 70 years (SD 14), 8713 were male (53%). The most common VKA indications were atrial fibrillation (10,876 patients, 66%) and venous thrombosis (3920 patients, 24%). 326 Major bleeds occurred during 17,613 years of follow-up (incidence rate 1.85/100 person years, 95%CI 1.66-2.06). The risk for major bleeding was highest in the initial three months of VKA treatment and increased when the international normalized ratio increased. These results and characteristics are in concordance with results from other VKA treated populations. BLEEDS is generalizable to other VKA treated populations and will permit innovative and unbiased research of biomarkers that may predict major bleeding during VKA treatment.

Acquired Inhibitors: A Special Case of Bleeding in Older Adults

Directory of Open Access Journals (Sweden)

Richard G. Stefanacci

2012-01-01

Full Text Available This literature review is intended to familiarize physicians and healthcare providers of older adults with the potential causes of acute bleeding in older adults and to review diagnostic approaches that can produce prompt identification of acute bleeding and facilitate timely treatment. Adverse events from anticoagulant treatment and nonsteroidal anti-inflammatory drug (NSAID and aspirin use and abuse are among the most common causes of bleeding in older adults. Diagnoses infrequently considered—mild congenital hemophilia, acquired hemophilia, von Willebrand disease, and platelet dysfunction—can contribute to acute bleeding in older adults. The approach to management of bleeding varies. Management of acute bleeding in older adults can be challenging because these patients often have chronic comorbidity and have been prescribed long-term concomitant medications that can complicate diagnosis and treatment. Prompt recognition of acquired hemophilia, referral to an expert hematologist, and timely initiation of treatment could improve outcome in older patients who experience bleeding episodes resulting from this condition.

Endometrial biopsy findings in postmenopausal bleeding

International Nuclear Information System (INIS)

Sarfraz, T.; Tariq, H.

2007-01-01

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

Radiotherapy Can Cause Haemostasis in Bleeding Skin Malignancies

Directory of Open Access Journals (Sweden)

Helena Sung-In Jang

2012-01-01

Full Text Available Radiotherapy (RT can cause haemostasis in select cases of malignant bleeding. We present two cases where RT was used to prevent fatal exsanguination from bleeding skin malignancies. Treatment was with radical intent in one case and palliative intent in the other. The dose used in both cases was 20 Gray (Gy in 5 fractions. To our knowledge, this is the first report of radiation-induced haemostasis in bleeding skin malignancies.

Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

Science.gov (United States)

Pham, Phuong-Anh; Pham, Phuong-Thu; Pham, Phuong-Chi; Miller, Jeffrey M; Pham, Phuong-Mai; Pham, Son V

2011-01-01

The advent of potent antiplatelet and antithrombotic agents over the past decade has resulted in significant improvement in reducing ischemic events in acute coronary syndrome (ACS). However, the use of antiplatelet and antithrombotic combination therapy, often in the settings of percutaneous coronary intervention (PCI), has led to an increase in the risk of bleeding. In patients with non-ST elevation myocardial infarction treated with antithrombotic agents, bleeding has been reported to occur in 0.4%–10% of patients, whereas in patients undergoing PCI, periprocedural bleeding occurs in 2.2%–14% of cases. Until recently, bleeding was considered an intrinsic risk of antithrombotic therapy, and efforts to reduce bleeding have received little attention. There have been increasing data demonstrating that bleeding is associated with adverse outcomes, including myocardial infarction, stroke, and death. Therefore, it is imperative to optimize patient outcomes by adopting pharmacological and nonpharmacological strategies to minimize bleeding while maximizing treatment efficacy. In this paper, we present a review of the bleeding classifications used in large-scale clinical trials in patients with ACS and those undergoing PCI treated with antiplatelets and antithrombotic agents, adverse outcomes, particularly mortality associated with bleeding complications, and suggested predictive risk factors. Potential mechanisms of the association between bleeding and mortality and strategies to reduce bleeding complications are also discussed. PMID:21915172

Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

Science.gov (United States)

Fujishiro, Mitsuhiro; Iguchi, Mikitaka; Kakushima, Naomi; Kato, Motohiko; Sakata, Yasuhisa; Hoteya, Shu; Kataoka, Mikinori; Shimaoka, Shunji; Yahagi, Naohisa; Fujimoto, Kazuma

2016-05-01

Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research. © 2016 Japan Gastroenterological Endoscopy Society.

Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients

DEFF Research Database (Denmark)

Johansen, Mathias; Wikkelsø, Anne; Lunde, Jens

2015-01-01

BACKGROUND: Treatment with vitamin K antagonists is associated with increased morbidity and mortality. Reversal therapy with prothrombin complex concentrate (PCC) is used increasingly and is recommended in the treatment of patients with bleeding complications undertaking surgical interventions......, as well as patients at high risk of bleeding. Evidence is lacking regarding indication, dosing, efficacy and safety. OBJECTIVES: We assessed the benefits and harms of PCC compared with fresh frozen plasma in the acute medical and surgical setting involving vitamin K antagonist-treated bleeding and non...... finding a beneficial effect of PCC in reducing the volume of fresh frozen plasma (FFP) transfused to reverse the effect of vitamin K antagonist treatment. The number of new occurrences of transfusion of red blood cells (RBCs) did not seem to be associated with the use of PCC (RR 1.08, 95% CI 0.82 to 1...

Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome.

Science.gov (United States)

Guntipalli, Prathima; Chason, Rebecca; Elliott, Alan; Rockey, Don C

2014-12-01

We have recognized a unique clinical syndrome in patients with upper gastrointestinal bleeding who are found to have severe esophagitis. We aimed to more clearly describe the clinical entity of upper gastrointestinal bleeding in patients with severe esophagitis. We conducted a retrospective matched case-control study designed to investigate clinical features in patients with carefully defined upper gastrointestinal bleeding and severe esophagitis. Patient data were captured prospectively via a Gastrointestinal Bleeding Healthcare Registry, which collects data on all patients admitted with gastrointestinal bleeding. Patients with endoscopically documented esophagitis (cases) were matched with randomly selected controls that had upper gastrointestinal bleeding caused by other lesions. Epidemiologic features in patients with esophagitis were similar to those with other causes of upper gastrointestinal bleeding. However, hematemesis was more common in patients with esophagitis 86% (102/119) than in controls 55% (196/357) (p bleeding than those without cirrhosis. We have described a unique clinical syndrome in patients with upper gastrointestinal bleeding who have erosive esophagitis. This syndrome is manifest by typical clinical features and is associated with favorable outcomes.

Long-term bleeding risk prediction in 'real world' patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project.

Science.gov (United States)

Esteve-Pastor, María Asunción; Rivera-Caravaca, José Miguel; Roldan, Vanessa; Vicente, Vicente; Valdés, Mariano; Marín, Francisco; Lip, Gregory Y H

2017-10-05

Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. The aim of this study was to analyze the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent "real-world" anticoagulated AF patients with long-term follow-up. We enrolled 1,120 patients stable on vitamin K antagonist treatment. The HAS-BLED and ABC-Bleeding scores were quantified. Predictive values were compared by c-indexes, IDI, NRI, as well as decision curve analysis (DCA). Median HAS-BLED score was 2 (IQR 2-3) and median ABC-Bleeding was 16.5 (IQR 14.3-18.6). After 6.5 years of follow-up, 207 (2.84 %/year) patients had major bleeding events, of which 65 (0.89 %/year) had intracranial haemorrhage (ICH) and 85 (1.17 %/year) had gastrointestinal bleeding events (GIB). The c-index of HAS-BLED was significantly higher than ABC-Bleeding for major bleeding (0.583 vs 0.518; p=0.025), GIB (0.596 vs 0.519; p=0.017) and for the composite of ICH-GIB (0.593 vs 0.527; p=0.030). NRI showed a significant negative reclassification for major bleeding and for the composite of ICH-GIB with the ABC-Bleeding score compared to HAS-BLED. Using DCAs, the use of HAS-BLED score gave an approximate net benefit of 4 % over the ABC-Bleeding score. In conclusion, in the first "real-world" validation of the ABC-Bleeding score, HAS-BLED performed significantly better than the ABC-Bleeding score in predicting major bleeding, GIB and the composite of GIB and ICH.

RESEARCH Endoscopic injection sclerotherapy for bleeding varices ...

African Journals Online (AJOL)

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

Air flow quality analysis of modenas engine exhaust system

Science.gov (United States)

Shahriman A., B.; Mohamad Syafiq A., K.; Hashim, M. S. M.; Razlan, Zuradzman M.; Khairunizam W. A., N.; Hazry, D.; Afendi, Mohd; Daud, R.; Rahman, M. D. Tasyrif Abdul; Cheng, E. M.; Zaaba, S. K.

2017-09-01

The simulation process being conducted to determine the air flow effect between the original exhaust system and modified exhaust system. The simulations are conducted to investigate the flow distribution of exhaust gases that will affect the performance of the engine. The back flow pressure in the original exhaust system is predicted toward this simulation. The design modification to the exhaust port, exhaust pipe, and exhaust muffler has been done during this simulation to reduce the back flow effect. The new designs are introduced by enlarging the diameter of the exhaust port, enlarge the diameter of the exhaust pipe and created new design for the exhaust muffler. Based on the result obtained, there the pulsating flow form at the original exhaust port that will increase the velocity and resulting the back pressure occur. The result for new design of exhaust port, the velocity is lower at the valve guide in the exhaust port. New design muffler shows that the streamline of the exhaust flow move smoothly compare to the original muffler. It is proved by using the modification exhaust system, the back pressure are reduced and the engine performance can be improve.

Breast cancer recurrence after reoperation for surgical bleeding

DEFF Research Database (Denmark)

Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

2017-01-01

BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from.......i. 0·89 to 1·26). The estimates did not vary by site of breast cancer recurrence. CONCLUSION: In this large cohort study, there was no evidence of an association between reoperation for bleeding and breast cancer recurrence....

Tamoxifen treatment of bleeding irregularities associated with Norplant use.

Science.gov (United States)

Abdel-Aleem, Hany; Shaaban, Omar M; Amin, Ahmed F; Abdel-Aleem, Aly M

2005-12-01

To evaluate the possible role of tamoxifen (selective estrogen receptor modulators, SERM) in treating bleeding irregularities associated with Norplant contraceptive use. Randomized clinical trial including 100 Norplant users complaining of vaginal bleeding irregularities. The trial was conducted in the Family Planning Clinic of Assiut University Hospital. Women were assigned at random to receive tamoxifen tablets (10 mg) twice daily for 10 days or similar placebo. Women were followed-up for 3 months. The end points were percentage of women who stopped bleeding during treatment, bleeding/spotting days during the period of follow-up, effect of treatment on their lifestyle, and side effects and discontinuation of contraception. There was good compliance with treatment. At the end of treatment, a significantly higher percentage of tamoxifen users stopped bleeding in comparison to the control group (88% vs. 68%, respectively; p=.016). Women who used tamoxifen had significantly less bleeding and/or spotting days than women who used placebo, during the first and second months. During the third month, there were no significant differences between the two groups. Women who used tamoxifen reported improvement in performing household activities, religious duties and in sexual life, during the first 2 months. In the third month, there were no differences between the two groups. There were no significant differences between tamoxifen and placebo groups in reporting side effects. In the group who used tamoxifen, two women discontinued Norplant use because of bleeding vs. nine women in the placebo group. Tamoxifen use at a dose of 10 mg twice daily orally, for 10 days, has a beneficial effect on vaginal bleeding associated with Norplant use. In addition, the bleeding pattern was better in women who used tamoxifen for the following 2 months after treatment. However, these results have to be confirmed in a larger trial before advocating this line of treatment.

21 CFR 864.6100 - Bleeding time device.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bleeding time device. 864.6100 Section 864.6100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Manual Hematology Devices § 864.6100 Bleeding time device...

Upper gastrointestinal bleeding: Five-year experience from one centre

Directory of Open Access Journals (Sweden)

Jovanović Ivan

2008-01-01

Full Text Available Introduction Acute upper gastrointestinal bleeding is the commonest emergency managed by gastroenterologists. Objective To assess the frequency of erosive gastropathy and duodenal ulcer as a cause of upper gastrointestinal (GI bleeding as well as its relation to age, gender and known risk factors. METHOD We conducted retrospective observational analysis of emergency endoscopy reports from the records of the Emergency Department of Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, during the period from 2000 to 2005. Data consisted of patients' demographics, endoscopic findings and potential risk factors. Results During the period 2000-2005, three thousand nine hundred and fifty four emergency upper endoscopies were performed for acute bleeding. In one quarter of cases, acute gastric erosions were the actual cause of bleeding. One half of them were associated with excessive consumption of salicylates and NSAIDs. In most of the examined cases, bleeding stopped spontaneously, while 7.6% of the cases required endoscopic intervention. Duodenal ulcer was detected as a source of bleeding in 1320 (33.4% patients and was significantly associated with a male gender (71.8% and salicylate or NSAID abuse (59.1% (χ2-test; p=0.007. Conclusion Erosive gastropathy and duodenal ulcer represent a significant cause of upper gastrointestinal bleeding accounting for up to 60% of all cases that required emergency endoscopy during the 5- year period. Consumption of NSAIDs and salicylates was associated more frequently with bleeding from a duodenal ulcer than with erosive gastropathy leading to a conclusion that we must explore other causes of erosive gastropathy more thoroughly. .

The Development of an Advanced Anti-Icing/Deicing Capability for U.S. Army Helicopters. Volume II. Ice Protection System Application to the UH-1H helicopter

Science.gov (United States)

1975-11-01

Project Lfgineer for this effort was ]Richard I. Adin of tL* eta ~ ’ -’ ’. -. - " - -ý - - , I - OWLAMWRS The 01 Mp io Otis vap am wae to No conmved an...area. One is the ultrasonic type and the second is the infrared occlusion type. Both sensors include aspirators using engine compressor bleed air to...half pound per minute of enginie bleed air to operate the aspirator . The principal benefit of the aspiration is during hover, as there is sufficient

Dosimetric Analysis of Radiation-induced Gastric Bleeding

Energy Technology Data Exchange (ETDEWEB)

Feng, Mary, E-mail: maryfeng@umich.edu [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Normolle, Daniel [Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Pan, Charlie C. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Dawson, Laura A. [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Amarnath, Sudha [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Ensminger, William D. [Department of Internal Medicine, Division of Hematology Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States); Lawrence, Theodore S.; Ten Haken, Randall K. [Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan (United States)

2012-09-01

Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of {>=}grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD{sub 50} (normal) = 56 Gy and TD{sub 50} (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD{sub 50} value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

Dosimetric Analysis of Radiation-induced Gastric Bleeding

International Nuclear Information System (INIS)

Feng, Mary; Normolle, Daniel; Pan, Charlie C.; Dawson, Laura A.; Amarnath, Sudha; Ensminger, William D.; Lawrence, Theodore S.; Ten Haken, Randall K.

2012-01-01

Purpose: Radiation-induced gastric bleeding has been poorly understood. In this study, we described dosimetric predictors for gastric bleeding after fractionated radiation therapy. Methods and Materials: The records of 139 sequential patients treated with 3-dimensional conformal radiation therapy (3D-CRT) for intrahepatic malignancies were reviewed. Median follow-up was 7.4 months. The parameters of a Lyman normal tissue complication probability (NTCP) model for the occurrence of ≥grade 3 gastric bleed, adjusted for cirrhosis, were fitted to the data. The principle of maximum likelihood was used to estimate parameters for NTCP models. Results: Sixteen of 116 evaluable patients (14%) developed gastric bleeds at a median time of 4.0 months (mean, 6.5 months; range, 2.1-28.3 months) following completion of RT. The median and mean maximum doses to the stomach were 61 and 63 Gy (range, 46-86 Gy), respectively, after biocorrection of each part of the 3D dose distributions to equivalent 2-Gy daily fractions. The Lyman NTCP model with parameters adjusted for cirrhosis predicted gastric bleed. Best-fit Lyman NTCP model parameters were n=0.10 and m=0.21 and with TD 50 (normal) = 56 Gy and TD 50 (cirrhosis) = 22 Gy. The low n value is consistent with the importance of maximum dose; a lower TD 50 value for the cirrhosis patients points out their greater sensitivity. Conclusions: This study demonstrates that the Lyman NTCP model has utility for predicting gastric bleeding and that the presence of cirrhosis greatly increases this risk. These findings should facilitate the design of future clinical trials involving high-dose upper abdominal radiation.

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

International Nuclear Information System (INIS)

Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

2012-01-01

Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

Energy Technology Data Exchange (ETDEWEB)

Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

2012-03-15

Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

High Performance Zero-Bleed CLSM/Grout Mixes for High-Level Waste Tank Closures Strategic Research and Development - FY99 Report

International Nuclear Information System (INIS)

Langton, C.A.

2000-01-01

The overall objective of this program, SRD-99-08, was to design and test suitable materials, which can be used to close high-level waste tanks at SRS. Fill materials can be designed to perform several functions including chemical stabilization and/or physical encapsulation of incidental waste so that the potential for transport of contaminants into the environment is reduced. Also they are needed to physically stabilize the void volume in the tanks to prevent/minimize future subsidence and inadvertent intrusion. The intent of this work was to develop a zero-bleed soil CLSM (ZBS-CLSM) and a zero-bleed concrete mix (ZBC) which meet the unique placement and stabilization/encapsulation requirements for high-level waste tank closures. These mixes in addition to the zero-bleed CLSM mixes formulated for closure of Tanks 17-F and 20-F provide design engineers with a suite of options for specifying materials for future tank closures

Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.

Science.gov (United States)

Jacques, Jérémie; Projetti, Fabrice; Legros, Romain; Valgueblasse, Virginie; Sarabi, Matthieu; Carrier, Paul; Fredon, Fabien; Bouvier, Stéphane; Loustaud-Ratti, Véronique; Sautereau, Denis

2013-09-21

We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation.

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

Science.gov (United States)

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

2015-02-09

In people with haemophilia or other congenital bleeding disorders undergoing surgical interventions, haemostatic treatment is needed in order to correct the underlying coagulation abnormalities and minimise the bleeding risk. This treatment varies according to the specific haemostatic defect, its severity and the type of surgical procedure. The aim of treatment is to ensure adequate haemostatic coverage for as long as the bleeding risk persists and until wound healing is complete. To assess the effectiveness and safety of different haemostatic regimens (type, dose and duration, modality of administration and target haemostatic levels) administered in people with haemophilia or other congenital bleeding disorders for preventing bleeding complications during and after surgical procedures. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of the last search: 20 November 2014. Randomised and quasi-randomised controlled trials comparing any hemostatic treatment regimen to no treatment or to another active regimen in children and adults with haemophilia or other congenital bleeding disorders undergoing any surgical intervention. Two authors independently assessed trials (eligibility and risks of bias) and extracted data. Meta-analyses were performed on available and relevant data. Of the 16 identified trials, four (112 participants) were eligible for inclusion.Two trials evaluated 59 people with haemophilia A and B undergoing 63 dental extractions. Trials compared the use of a different type (tranexamic acid or epsilon-aminocaproic acid) and regimen of antifibrinolytic agents as haemostatic support to the initial replacement treatment. Neither trial specifically addressed mortality (one of this review's primary outcomes); however, in the frame

CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

International Nuclear Information System (INIS)

Jain, T.P.; Gulati, M.S.; Makharia, G.K.; Bandhu, S.; Garg, P.K.

2007-01-01

Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding

CT enteroclysis in the diagnosis of obscure gastrointestinal bleeding: initial results

Energy Technology Data Exchange (ETDEWEB)

Jain, T.P. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Gulati, M.S. [Department of Imaging, Queen Elizabeth Hospital NHS Trust, London (United Kingdom); Makharia, G.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)]. E-mail: govindmakharia@aiims.ac.in; Bandhu, S. [Department ofRadiodiagnosis, All India Institute of Medical Sciences, New Delhi (India); Garg, P.K. [Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi (India)

2007-07-15

Aim: To evaluate the usefulness of computed tomography (CT) enteroclysis in patients with obscure gastrointestinal (GI) bleeding. Materials and methods: In a prospective study, CT enteroclysis was performed in 21 patients (median age 50 years; range 13-71 years) with obscure GI bleeding in which the source of the bleeding could not be detected despite the patient having undergone both upper GI endoscopic and colonoscopic examinations. The entire abdomen and pelvis was examined in the arterial and venous phases using multisection CT after distending the small intestine with 2 l of 0.5% methylcellulose as a neutral enteral contrast medium and the administration of 150 ml intravenous contrast medium. Results: Adequate distension of the small intestine was achieved in 20 of the 21 (95.2%) patients. Potential causes of GI bleeding were identified in 10 of the 21 (47.6%) patients using CT enteroclysis. The cause of the bleeding could be detected nine of 14 (64.3%) patients with overt, obscure GI bleeding. However, for patients with occult, obscure GI bleeding, the cause of the bleeding was identified in only one of the seven (14.3%) patients. The lesions identified by CT enteroclysis included small bowel tumours (n = 2), small bowel intussusceptions (n = 2), intestinal tuberculosis (n = 2), and vascular lesions (n = 3). All vascular lesions were seen equally well in both the arterial and venous phases. Conclusions: The success rate in detection of the cause of bleeding using CT enteroclysis was 47.6% in patients with obscure GI bleeding. The diagnostic yield was higher in patients with overt, obscure GI bleeding than in those with occult obscure GI bleeding.

First trimester bleeding and maternal cardiovascular morbidity

DEFF Research Database (Denmark)

Lykke, Jacob A; Langhoff-Roos, Jens

2012-01-01

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

Analysis on the heating performance of a gas engine driven air to water heat pump based on a steady-state model

International Nuclear Information System (INIS)

Zhang, R.R.; Lu, X.S.; Li, S.Z.; Lin, W.S.; Gu, A.Z.

2005-01-01

In this study, the heating performance of a gas engine driven air to water heat pump was analyzed using a steady state model. The thermodynamic model of a natural gas engine is identified by the experimental data and the compressor model is created by several empirical equations. The heat exchanger models are developed by the theory of heat balance. The system model is validated by comparing the experimental and simulation data, which shows good agreement. To understand the heating characteristic in detail, the performance of the system is analyzed in a wide range of operating conditions, and especially the effect of engine waste heat on the heating performance is discussed. The results show that engine waste heat can provide about 1/3 of the total heating capacity in this gas engine driven air to water heat pump. The performance of the engine, heat pump and integral system are analyzed under variations of engine speed and ambient temperature. It shows that engine speed has remarkable effects on both the engine and heat pump, but ambient temperature has little influence on the engine's performance. The system and component performances in variable speed operating conditions is also discussed at the end of the paper

Risk of Gastrointestinal Bleeding with Rivaroxaban: A Comparative Study with Warfarin

Directory of Open Access Journals (Sweden)

Muhammed Sherid

2016-01-01

Full Text Available Introduction. The risk of gastrointestinal (GI bleeding with rivaroxaban has not been studied extensively. The aim of our study was to assess this risk in comparison to warfarin. Methods. We examined the medical records for patients who were started on rivaroxaban or warfarin from April 2011 to April 2013. Results. We identified 300 patients (147 on rivaroxaban versus 153 on warfarin. GI bleeding occurred in 4.8% patients with rivaroxaban when compared to 9.8% patients in warfarin group (p=0.094. GI bleeding occurred in 8% with therapeutic doses of rivaroxaban (>10 mg/d compared to 9.8% with warfarin (p=0.65. Multivariate analysis showed that patients who were on rivaroxaban for ≤40 days had a higher incidence of GI bleeding than those who were on it for >40 days (OR = 2.8, p=0.023. Concomitant use of dual antiplatelet agents was associated with increased risk of GI bleeding in the rivaroxaban group (OR = 7.4, p=0.0378. Prior GI bleeding was also a risk factor for GI bleeding in rivaroxaban group (OR = 15.5. Conclusion. The incidence of GI bleeding was similar between rivaroxaban and warfarin. The risk factors for GI bleeding with rivaroxaban were the first 40 days of taking the drug, concomitant dual antiplatelet agents, and prior GI bleeding.

The medical management of abnormal uterine bleeding in reproductive-aged women.

Science.gov (United States)

Bradley, Linda D; Gueye, Ndeye-Aicha

2016-01-01

In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario. Heavy menstrual bleeding can be treated with a levonorgestrel-releasing intrauterine system, combined oral contraceptives, continuous oral progestins, and tranexamic acid with high efficacy. Nonsteroidal antiinflammatory drugs may be utilized with hormonal methods and tranexamic acid to decrease menstrual bleeding. Gonadotropin-releasing hormone agonists are indicated in patients with leiomyoma and abnormal uterine bleeding in preparation for surgical interventions. In women with inherited bleeding disorders all hormonal methods as well as tranexamic acid can be used to treat abnormal uterine bleeding. Women on anticoagulation therapy should consider using progestin-only methods as well as a gonadotropin-releasing hormone agonist to treat their heavy menstrual bleeding. Given these myriad options for medical treatment of abnormal uterine bleeding, many patients may avoid surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

Systematic review: tranexamic acid for upper gastrointestinal bleeding

DEFF Research Database (Denmark)

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

2008-01-01

BACKGROUND: Tranexamic acid may reduce upper gastrointestinal bleeding and stabilize patients before endoscopic treatments. AIM: To review randomized trials on tranexamic acid for upper gastrointestinal bleeding. METHODS: Manual and electronic searches of The Cochrane Library, MEDLINE, EMBASE...... and Science Citation Index were combined. Intention-to-treat random effect meta-analyses were performed and results presented as RRs with 95% confidence intervals. RESULTS: Seven double-blind randomized trials on tranexamic acid vs. placebo were included. Of 1754 patients randomized, 21% were excluded. Only...... one trial included endoscopic treatments or proton pump inhibitors. Five per cent of patients on tranexamic acid and 8% of controls died (RR: 0.61, 95% CI: 0.42-0.89). No significant differences were found on bleeding, bleeding-related mortality, surgery or transfusion requirements. Adverse events...

Anode reactive bleed and injector shift control strategy

Science.gov (United States)

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

2012-01-03

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

Rectal bleeding and its management after irradiation for cervix cancer

International Nuclear Information System (INIS)

Chun, Mi Son; Kang, Seung Hee; Kil, Hoon Jong; Oh, Young Taek; Sohn, Jeong Hye; Ryu, Hee Suk; Lee, Kwang Jae; Jung, Hye Young

2002-01-01

Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. The study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gy x 7, or 5 Gy x 6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12 ∼ 86 months). The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding: an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor (ρ > 0.0432). The total

Medical treatment for heavy menstrual bleeding

Directory of Open Access Journals (Sweden)

Yi-Jen Chen

2015-10-01

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

Demonstration of Air-Power-Assist Engine Technology for Clean Combustion and Direct Energy Recovery in Heavy Duty Application

Energy Technology Data Exchange (ETDEWEB)

Hyungsuk Kang; Chun Tai

2010-05-01

The first phase of the project consists of four months of applied research, starting from September 1, 2005 and was completed by December 31, 2005. During this time, the project team heavily relied on highly detailed numerical modeling techniques to evaluate the feasibility of the APA technology. Specifically, (i) A GT-Power{sup TM}engine simulation model was constructed to predict engine efficiency at various operating conditions. Efficiency was defined based on the second-law thermodynamic availability. (ii) The engine efficiency map generated by the engine simulation was then fed into a simplified vehicle model, which was constructed in the Matlab/Simulink environment, to predict fuel consumption of a refuse truck on a simple collection cycle. (iii) Design and analysis work supporting the concept of retrofitting an existing Sturman Industries Hydraulic Valve Actuation (HVA) system with the modifications that are required to run the HVA system with Air Power Assist functionality. A Matlab/Simulink model was used to calculate the dynamic response of the HVA system. Computer aided design (CAD) was done in Solidworks for mechanical design and hydraulic layout. At the end of Phase I, 11% fuel economy improvement was predicted. During Phase II, the engine simulation group completed the engine mapping work. The air handling group made substantial progress in identifying suppliers and conducting 3D modelling design. Sturman Industries completed design modification of the HVA system, which was reviewed and accepted by Volvo Powertrain. In Phase II, the possibility of 15% fuel economy improvement was shown with new EGR cooler design by reducing EGR cooler outlet temperature with APA engine technology from Air Handling Group. In addition, Vehicle Simulation with APA technology estimated 4 -21% fuel economy improvement over a wide range of driving cycles. During Phase III, the engine experimental setup was initiated at VPTNA, Hagerstown, MD. Air Handling system and HVA

No increased systemic fibrinolysis in women with heavy menstrual bleeding

NARCIS (Netherlands)

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

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

The physics of pulsed streamer discharge in high pressure air and applications to engine techonologies

Science.gov (United States)

Lin, Yung-Hsu

The goal of this dissertation is to study high pressure streamers in air and apply it to diesel engine technologies. Nanosecond scale pulsed high voltage discharges in air/fuel mixtures can generate radicals which in turn have been shown to improve combustion efficiency in gasoline fueled internal combustion engines. We are exploring the possibility to extend such transient plasma generation and expected radical species generation to the range of pressures encountered in compression-ignition (diesel) engines having compression ratios of ˜20:1, thereby improving lean burning efficiency and extending the range of lean combustion. At the beginning of this dissertation, research into streamer discharges is reviewed. Then, we conducted experiments of streamer propagation at high pressures, calculated the streamer velocity based on both optical and electrical measurements, and the similarity law was checked by analyzing the streamer velocity as a function of the reduced electric field, E/P. Our results showed that the similarity law is invalid, and an empirical scaling factor, E/√P, is obtained and verified by dimensional analysis. The equation derived from the dimensional analysis will be beneficial to proper electrode and pulse generator design for transient plasma assisted internal engine experiments. Along with the high pressure study, we applied such technique on diesel engine to improve the fuel efficiency and exhaust treatment. We observed a small effect of transient plasma on peak pressure, which implied that transient plasma has the capability to improve the fuel consumption. In addition, the NO can be reduced effectively by the same technique and the energy cost is 30 eV per NO molecule.

Effects of Scavenging System Configuration on In-Cylinder Air Flow Organization of an Opposed-Piston Two-Stroke Engine

OpenAIRE

Fukang Ma; Changlu Zhao; Fujun Zhang; Zhenfeng Zhao; Shuanlu Zhang

2015-01-01

In-cylinder air flow is very important from the point of view of mixture formation and combustion. In this direction, intake chamber structure and piston crown shape play a very crucial role for in-cylinder air pattern of opposed-piston two-stroke (OP2S) engines. This study is concerned with the three-dimensional (3D) computational fluid dynamics (CFD) analysis of in-cylinder air motion coupled with the comparison of predicted results with the zero-dimensional (0D) parametric model. Three con...

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

Science.gov (United States)

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

2005-12-21

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

Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients.

Science.gov (United States)

Batman, B; van Bladel, E R; van Hamersveld, M; Pasker-de Jong, P C M; Korporaal, S J A; Urbanus, R T; Roest, M; Boven, L A; Fijnheer, R

2017-11-01

Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric evaluation of platelet function might aid the clinician in identifying patients at risk of bleeding. This evaluation can be performed within the hour and is not hampered by low platelet count. Our objective was to assess a possible correlation between bleeding and platelet function in thrombocytopenic haemato-oncological patients. Inclusion was possible for admitted haemato-oncology patients aged 18 years and above. Furthermore, an expected need for platelet transfusions was necessary. Bleeding was graded according to the WHO bleeding scale. Platelet reactivity to stimulation by either adenosine diphosphate (ADP), cross-linked collagen-related peptide (CRP-xL), PAR1- or PAR4-activating peptide (AP) was measured using flow cytometry. A total of 114 evaluations were available from 21 consecutive patients. Platelet reactivity in response to stimulation by all four studied agonists was inversely correlated with significant bleeding. Odds ratios (OR) for bleeding were 0·28 for every unit increase in median fluorescence intensity (MFI) [95% confidence interval (CI) 0·11-0·73] for ADP; 0·59 [0·40-0·87] for CRP-xL; 0·59 [0·37-0·94] for PAR1-AP; and 0·43 [0·23-0·79] for PAR4-AP. The platelet count was not correlated with bleeding (OR 0·99 [0·96-1·02]). Agonist-induced platelet reactivity was significantly correlated to bleeding. Platelet function testing could provide a basis for a personalized transfusion regimen, in which platelet transfusions are limited to those at risk of bleeding. © 2017 International Society of Blood Transfusion.

Helping mothers survive bleeding after birth

DEFF Research Database (Denmark)

Nelissen, Ellen; Ersdal, Hege; Ostergaard, Doris

2014-01-01

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

Breast cancer recurrence after reoperation for surgical bleeding

DEFF Research Database (Denmark)

Pedersen, Rikke Nørgaard; Bhaskaran, K; Heide-Jørgensen, U

2017-01-01

BACKGROUND: Bleeding activates platelets that can bind tumour cells, potentially promoting metastatic growth in patients with cancer. This study investigated whether reoperation for postoperative bleeding is associated with breast cancer recurrence. METHODS: Using the Danish Breast Cancer Group...... database and the Danish National Patient Register (DNPR), a cohort of women with incident stage I-III breast cancer, who underwent breast-conserving surgery or mastectomy during 1996-2008 was identified. Information on reoperation for bleeding within 14 days of the primary surgery was retrieved from...

Importance of histopathological examination of endometrium in Dysfunctional Uterine Bleeding.

Directory of Open Access Journals (Sweden)

Dr. Yaminee Rana

2017-12-01

Full Text Available Introduction: Abnormal uterine bleeding is a common condition affecting women of reproductive age that has significant social and economic impact. Dysfunctional uterine bleeding (DUB is defined as abnormal uterine bleeding in the absence of organic disease. Dysfunctional uterine bleeding is one of the most commonly encountered gynaecological problems. Objectives: This study is done to evaluate the histopathological pattern of the endometrial biopsies of patients with dysfunctional uterine bleeding and its correlation with clinical data. Methods: The present prospective study included evaluation of 208 cases of dysfunctional uterine bleeding in the Department of Pathology, B. J. Medical College, Ahmedabad over a period of 10 months, from January 2017 to October 2017. Women presenting with abnormal uterine bleeding were included in the study. Those women in which bleeding is secondary to systemic causes, organic causes and due to cervical and vaginal causes were excluded. The specimens were processed, embedded and cut into sections of 3-4 microns. The histopathological patterns were studied. Results: Age distribution varied from 18 years to 70 years, majority of the patients were between 21 to 30 years. Among the cases of DUB, proliferative phase accounted for 66.3% and secretory phase accounted for 21.3%. 18 cases (8.6% of atrophic endometrium, four cases (1.9% of irregular shedding and two cases of luteal phase insufficiency were received. Conclusion: Dysfunctional uterine bleeding is a common and debilitating condition in women of reproductive age. Endometrial biopsy could be effectively used as the first diagnostic step in DUB and thus ensures correct management.

Diagnosis and management of upper gastrointestinal bleeding in children.

Science.gov (United States)

Owensby, Susan; Taylor, Kellee; Wilkins, Thad

2015-01-01

Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. © Copyright 2015 by the American Board of Family Medicine.

Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

Science.gov (United States)

Kim, Young-Il

2015-01-01

Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated. PMID:25844339

Bleeding Peptic Ulcer - Tertiary Center Experience: Epidemiology, Treatment and Prognosis.

Science.gov (United States)

Budimir, Ivan; Stojsavljević, Sanja; Hrabar, Davor; Kralj, Dominik; Bišćanin, Alen; Kirigin, Lora Stanka; Zovak, Mario; Babić, Žarko; Bohnec, Sven; Budimir, Ivan

2017-12-01

The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute upper gastrointestinal bleeding (UGIB) with special reference to peptic ulcer bleeding (PUB). The study included 2198 consecutive patients referred to our emergency department due to acute UGIB from January 2008 to December 2012. All patients underwent urgent upper GI endoscopy within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed-up. The cumulative incidence of UGIB was 126/100,000 in the 5-year period. Two out of five patients had a bleeding peptic ulcer; in total, 440 (52.3%) had bleeding gastric ulcer, 356 (42.3%) had bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers, and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomoses. PUB was more common in men. The mean patient age was 65.9 years. The majority of patients (57%) with PUB were taking agents that attenuate the cytoprotective function of gastric and duodenal mucosa. Rebleeding occurred in 77 (9.7%) patients and 47 (5.9%) patients required surgical intervention. The 30-day morality was 5.2% and 10% of patients died from uncontrolled bleeding and concomitant diseases. In conclusion, PUB is the main cause of UGIB, characterized by a significant rebleeding rate and mortality.

Intracranial hemorrhage after blunt head trauma in children with bleeding disorders.

Science.gov (United States)

Lee, Lois K; Dayan, Peter S; Gerardi, Michael J; Borgialli, Dominic A; Badawy, Mohamed K; Callahan, James M; Lillis, Kathleen A; Stanley, Rachel M; Gorelick, Marc H; Dong, Li; Zuspan, Sally Jo; Holmes, James F; Kuppermann, Nathan

2011-06-01

To determine computerized tomography (CT) use and prevalence of traumatic intracranial hemorrhage (ICH) in children with and without congenital and acquired bleeding disorders. We compared CT use and ICH prevalence in children with and without bleeding disorders in a multicenter cohort study of 43 904 children bleeding disorders; all had Glasgow Coma Scale (GCS) scores of 14 to 15. These children had higher CT rates than children without bleeding disorders and GCS scores of 14 to 15 (risk ratio, 2.29; 95% CI, 2.15 to 2.44). Of the children who underwent imaging with CT, 2 of 186 children with bleeding disorders had ICH (1.1%; 95% CI, 0.1 to 3.8) , compared with 655 of 14 969 children without bleeding disorders (4.4%; 95% CI, 4.1-4.7; rate ratio, 0.25; 95% CI, 0.06 to 0.98). Both children with bleeding disorders and ICHs had symptoms; none of the children required neurosurgery. In children with head trauma, CTs are obtained twice as often in children with bleeding disorders, although ICHs occurred in only 1.1%, and these patients had symptoms. Routine CT imaging after head trauma may not be required in children without symptoms who have congenital and acquired bleeding disorders. Copyright © 2011 Mosby, Inc. All rights reserved.

INVESTIGATION OF COMBUSTION, PERFORMANCE AND EMISSION CHARACTERISTICS OF SPARK IGNITION ENGINE FUELLED WITH BUTHANOL – GASOLINE MIXTURE AND A HYDROGEN ENRICHED AIR

OpenAIRE

Alfredas Rimkus; Mindaugas Melaika; Jonas Matijošius; Šarūnas Mikaliūnas; Saugirdas Pukalskas

2016-01-01

In this study, spark ignition engine fuelled with buthanol-gasoline mixture and a hydrogen-enriched air was investigated. Engine performance, emissions and combustion characteristics were investigated with different buthanol (10% and 20% by volume) gasoline mixtures and additionally supplied oxygen and hydrogen (HHO) gas mixture (3.6 l/min) in the sucked air. Hydrogen, which is in the HHO gas, improves gasoline and gasoline-buthanol mixture combustion, increases indicated pressure during comb...

Visual study of capabilities of managing IC engine filling degree vs engine ecological indicators

Science.gov (United States)

Kołodziej, Szymon; Ligus, Grzegorz

2017-10-01

The operation of an internal combustion engine in a transient state is related to constant changes in cylinder filling degree. Managing a steady course of engine torque demands constant corrections in the volume of air delivered to the engine. In this work, different engine throttle management strategies were analyzed. The effect of throttle velocity on emissions was depicted. The research has shown that the greatest value of work density is reached by the IC engine for relatively low values of throttle angle. For shown values, disturbances in air flow in engine intake which may adversely affect emissions due to uneven cylinder filling were researched with the use of Digital Particle Image Velocimetry. The conducted research has shown significant unevennes in air supply to individual cylinders in the engine. This effect may cause discrepancies in air excess ratio for each cylinder, and result in heightened harmful substance emission.

DSA diagnosis and interventional management of postoperative bleeding

International Nuclear Information System (INIS)

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

2009-01-01

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

Experimental investigation of in-cylinder air flow to optimize number of helical guide vanes to enhance DI diesel engine performance using mamey sapote biodiesel

Science.gov (United States)

Kumar, A. Raj; Janardhana Raju, G.; Hemachandra Reddy, K.

2018-03-01

The current research work investigates the influence of helical guide vanes in to the intake runner of a D.I diesel engine operating by the high viscous Mamey Sapote biodiesel to enhance in-cylinder suction air flow features. Helical guide vanes of different number of vanes are produced from 3D printing and placed in the intake manifold to examine the air flow characteristics. Four different helical guide vane devices namely 3, 4, 5 and 6 vanes of the same dimensions are tested in a D.I diesel engine operating with Mamey Sapote biodiesel blend. As per the experimental results of engine performance and emission characteristics, it is found that 5 vanes helical guide vane swirl device exhibited in addition number of increased improvements such as the brake power and bake thermal efficiency by 2.4% and 8.63% respectively and the HC, NOx, Carbon monoxide and, Smoke densities are reduced by 15.62%, 4.23%, 14.27% and 9.6% at peak load operating conditions as collate with normal engine at the same load. Hence this investigation concluded that Helical Guide Vane Devices successfully enhanced the in-cylinder air flow to improve better addition of Mamey Sapote biodiesel with air leading in better performance of the engine than without vanes.

Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

International Nuclear Information System (INIS)

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

2006-01-01

The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosions and the varicose veins in oesophagus and stomach. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach, the habitual is to diagnose this entity of accidental form in the course of endoscopic procedures, radiological or surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

Gastrointestinal bleeding secondary to ulcer in duodenal diverticulosis

International Nuclear Information System (INIS)

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

2006-01-01

The reasons more frequent of high gastrointestinal bleeding are the peptic gastric and duodenal, followed by acute erosion and the varicose veins in oesophagus and stomachs. The diverticulosis of the small bowel is a very rare reason of gastrointestinal bleeding, must considerate in patients with bleeding without evident reason in oesophagus and stomach the habitual is to diagnose this entity of occidental form in the course of endoscopic procedures, radiological of surgical. The complications associated with the diverticulosis duodenal are rare; it justifies supporting a not surgical attitude at first

Bleeding stomal varices in portal hypertension

Directory of Open Access Journals (Sweden)

Karen Tran-Harding, MD

2018-04-01

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

Thermodynamic Cycle and CFD Analyses for Hydrogen Fueled Air-breathing Pulse Detonation Engines

Science.gov (United States)

Povinelli, Louis A.; Yungster, Shaye

2002-01-01

This paper presents the results of a thermodynamic cycle analysis of a pulse detonation engine (PDE) using a hydrogen-air mixture at static conditions. The cycle performance results, namely the specific thrust, fuel consumption and impulse are compared to a single cycle CFD analysis for a detonation tube which considers finite rate chemistry. The differences in the impulse values were indicative of the additional performance potential attainable in a PDE.

Appendiceal hemorrhage – An uncommon cause of lower gastrointestinal bleeding

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Ching-Chung Chiang

2011-06-01

Full Text Available Lower gastrointestinal bleeding is a common disease among elderly patients. The common sources of lower gastrointestinal bleeding include vascular disease, Crohn’s disease, neoplasms, inflammatory bowel disease, hemorrhoids, and ischemic colitis. Lower gastrointestinal bleeding arising from the appendix is an extremely rare condition. We report a case of appendiceal hemorrhage in a young male. Diagnosis was made by multidetector computerized tomography during survey for hematochezia. The patient recovered well after appendectomy. The histological finding revealed focal erosion of appendix mucosa with bleeding.

Therapeutic options to manage bleeding in a dentist’s office

Science.gov (United States)

Rostetter, Claudio; Finkenstädt, Tim; Rücker, Martin; Lübbers, Heinz-Theo

2018-06-18

This manuscript provides an overview of therapeutic options for the problem of bleeding in a dentist’s office. Bleeding after tooth extraction is a very common finding in dental medicine and persistent blood in the mouth is obviously uncomfortable and sometimes terrifying for the patient. Most bleedings can be stopped simply with compression, in some cases a homeostatic therapy is necessary. For local compression, a swab with tranexamic acid is useful. If local compression is not sufficient, sutures are often an option. A very effective therapy would also be Tabotamp®, a local hemostypticum which is placed onto the bleeding and should increase the thrombocytic aggregation. In the worst case Floseal®, a human Thrombin, can be placed locally. It stops the bleeding very fast and sufficiently.

Non-Local Sparse Image Inpainting for Document Bleed-Through Removal

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Muhammad Hanif

2018-05-01

Full Text Available Bleed-through is a frequent, pervasive degradation in ancient manuscripts, which is caused by ink seeped from the opposite side of the sheet. Bleed-through, appearing as an extra interfering text, hinders document readability and makes it difficult to decipher the information contents. Digital image restoration techniques have been successfully employed to remove or significantly reduce this distortion. This paper proposes a two-step restoration method for documents affected by bleed-through, exploiting information from the recto and verso images. First, the bleed-through pixels are identified, based on a non-stationary, linear model of the two texts overlapped in the recto-verso pair. In the second step, a dictionary learning-based sparse image inpainting technique, with non-local patch grouping, is used to reconstruct the bleed-through-contaminated image information. An overcomplete sparse dictionary is learned from the bleed-through-free image patches, which is then used to estimate a befitting fill-in for the identified bleed-through pixels. The non-local patch similarity is employed in the sparse reconstruction of each patch, to enforce the local similarity. Thanks to the intrinsic image sparsity and non-local patch similarity, the natural texture of the background is well reproduced in the bleed-through areas, and even a possible overestimation of the bleed through pixels is effectively corrected, so that the original appearance of the document is preserved. We evaluate the performance of the proposed method on the images of a popular database of ancient documents, and the results validate the performance of the proposed method compared to the state of the art.

Double blind, placebo-controlled trial of Tranexamic acid on recent internal hemorrhoid bleeding

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Abdul A. Rani

2002-12-01

Full Text Available Double blind randomized placebo controlled trial was conducted to evaluate the efficacy of Tranexamic acid in 54 patients with recent hemorrhoid bleeding. Age, gender, body weight, height, grade of hemorrhoid, time of onset of recent bleeding were comparable between two groups. Analysis of haemostatic effect or stop bleeding as an immediate outcome of this study revealed that in the grade 2 patients, 23/23 (100% of tranexamic group and 18/23(78.26% of placebo group the bleeding stop. After 3 days of observation, there was statistically significant different for the rate of stop bleeding as well as at the end of observation. Bleeding stop earlier in the Tranexamic group with median 4 days (3-5 days, compare to placebo, median 11(9.55-12.45. Analysis of recurrent bleeding as an outcome of this study revealed that in the placebo group 9/18(50% of grade 2 patients and all grade 3 (100%patients suffered from recurrent bleeding. Since the days 4, both group have significant different time for recurrent bleeding and at the end of observation, cumulative probability of free of bleeding between two groups significantly different. Median still stop bleeding in the placebo group was 36 days, and the tranexamic group never reaches the median until the end of observation. Conclusion: tranexamic acid was an effective drug to stop recent hemorrhoid bleeding and prevent further recurrent bleeding, significantly better than placebo. (Med J Indones 2002;11: 215-21Keywords: Tranexamic acid, hemorrhoid bleeding, haemostatic effect, recurrent bleeding.

Detection and localization of lower gastrointestinal bleeding site with scintigraphic techniques

International Nuclear Information System (INIS)

Alavi, A.

1988-01-01

Successful management of acute gastrointestinal (GI) bleeding frequently depends on accurate localization of the bleeding site. History and clinical findings are often misleading in localizing the site of hemorrhage. The widespread application of flexible endoscopy and selective arteriography now provides accurate diagnoses for the majority of patients with upper GI tract hemorrhage, but lower GI bleeding still is a serious diagnostic problem. Endoscopy and barium studies are of limited value in examining the small bowel and colon in the face of active hemorrhage. Arteriography, although successful in many cases, has limitations. The angiographic demonstration of bleeding is possible only when the injection of contrast material coincides with active bleeding. Since lower GI bleeding is commonly intermittent rather than continuous, a high rate of negative angiographic examinations has been reported. Repeated angiography to pursue recurrent episodes of bleeding is impractical. Because of these shortcomings, in the past decade several noninvasive scintigraphic techniques have been developed to detect and localize sites of GI bleeding. In this chapter the authors discuss details related to the technetium 99m sulfur colloid (Tc-SC) and technetium 99m-labeled red blood cell (Tc-RBC) techniques

Prediction of Outcome in Acute Lower Gastrointestinal Bleeding Using Gradient Boosting.

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Lakshmana Ayaru

Full Text Available There are no widely used models in clinical care to predict outcome in acute lower gastro-intestinal bleeding (ALGIB. If available these could help triage patients at presentation to appropriate levels of care/intervention and improve medical resource utilisation. We aimed to apply a state-of-the-art machine learning classifier, gradient boosting (GB, to predict outcome in ALGIB using non-endoscopic measurements as predictors.Non-endoscopic variables from patients with ALGIB attending the emergency departments of two teaching hospitals were analysed retrospectively for training/internal validation (n=170 and external validation (n=130 of the GB model. The performance of the GB algorithm in predicting recurrent bleeding, clinical intervention and severe bleeding was compared to a multiple logic regression (MLR model and two published MLR-based prediction algorithms (BLEED and Strate prediction rule.The GB algorithm had the best negative predictive values for the chosen outcomes (>88%. On internal validation the accuracy of the GB algorithm for predicting recurrent bleeding, therapeutic intervention and severe bleeding were (88%, 88% and 78% respectively and superior to the BLEED classification (64%, 68% and 63%, Strate prediction rule (78%, 78%, 67% and conventional MLR (74%, 74% 62%. On external validation the accuracy was similar to conventional MLR for recurrent bleeding (88% vs. 83% and therapeutic intervention (91% vs. 87% but superior for severe bleeding (83% vs. 71%.The gradient boosting algorithm accurately predicts outcome in patients with acute lower gastrointestinal bleeding and outperforms multiple logistic regression based models. These may be useful for risk stratification of patients on presentation to the emergency department.

Gastrointestinal bleeding in patients with hereditary hemorrhagic telangiectasia

DEFF Research Database (Denmark)

Kjeldsen, A D; Kjeldsen, J

2000-01-01

Gastrointestinal bleeding occurs in a number of patients with hereditary hemorrhagic telangiectasia (HHT) and may lead to a high transfusion need. The aim of this study was to estimate the occurrence and severity of gastrointestinal bleeding in a geographically well defined HHT population....

Transcatheter embolization for treatment of acute lower gastrointestinal bleeding

International Nuclear Information System (INIS)

Uflacker, R.

1987-01-01

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

Fuel-air mixing and distribution in a direct-injection stratified-charge rotary engine

Science.gov (United States)

Abraham, J.; Bracco, F. V.

1989-01-01

A three-dimensional model for flows and combustion in reciprocating and rotary engines is applied to a direct-injection stratified-charge rotary engine to identify the main parameters that control its burning rate. It is concluded that the orientation of the six sprays of the main injector with respect to the air stream is important to enhance vaporization and the production of flammable mixture. In particular, no spray should be in the wake of any other spray. It was predicted that if such a condition is respected, the indicated efficiency would increase by some 6 percent at higher loads and 2 percent at lower loads. The computations led to the design of a new injector tip that has since yielded slightly better efficiency gains than predicted.

Gastrointestinal Bleeding Secondary to Calciphylaxis

Science.gov (United States)

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

2015-01-01

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

Prognostic Significance of Bleeding Location and Severity Among Patients With Acute Coronary Syndromes

Science.gov (United States)

Vavalle, John P.; Clare, Robert; Chiswell, Karen; Rao, Sunil V.; Petersen, John L.; Kleiman, Neal S.; Mahaffey, Kenneth W.; Wang, Tracy Y.

2013-01-01

Objectives This study sought to determine if there is an association between bleed location and clinical outcomes in acute coronary syndromes (ACS) patients. Background The prognostic significance of bleeding location among ACS patients undergoing cardiac catheterization is not well known. Methods We analyzed in-hospital bleeding events among 9,978 patients randomized in the SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors) study. Bleeding events were categorized by location as access site, systemic, surgical, or superficial, and severity was graded using the GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definition. We assessed the association of each bleeding location and severity with 6-month risk of death or myocardial infarction using a multicovariate-adjusted Cox proportional hazard model. Results A total of 4,900 bleeding events were identified among 3,694 ACS patients with in-hospital bleeding. Among 4,679 GUSTO mild/moderate bleeding events, only surgical and systemic bleeds were associated with an increased risk of 6-month death or myocardial infarction (adjusted hazard ratio [HR]: 2.52 [95% confidence interval (CI): 2.16 to 2.94, and 1.40 [95% CI: 1.16 to 1.69], respectively). Mild/moderate superficial and access-site bleeds were not associated with downstream risk (adjusted HR: 1.17 [95% CI: 0.97 to 1.40], and 0.96 [95% CI: 0.82 to 1.12], respectively). Among 221 GUSTO severe bleeds, surgical bleeds were associated with the highest risk (HR: 5.27 [95% CI: 3.80 to 7.29]), followed by systemic (HR: 4.48 [95% CI: 2.98 to 6.72]), and finally access-site bleeds (HR: 3.57 [95% CI: 2.35 to 5.40]). Conclusions Among ACS patients who develop in-hospital bleeding, systemic and surgical bleeding are associated with the highest risks of adverse outcomes regardless of bleeding severity. Although the most frequent among bleeds, GUSTO mild/moderate access-site bleeding is not

Aerosols emitted in underground mine air by diesel engine fueled with biodiesel.

Science.gov (United States)

Bugarski, Aleksandar D; Cauda, Emanuele G; Janisko, Samuel J; Hummer, Jon A; Patts, Larry D

2010-02-01

Using biodiesel in place of petroleum diesel is considered by several underground metal and nonmetal mine operators to be a viable strategy for reducing the exposure of miners to diesel particulate matter. This study was conducted in an underground experimental mine to evaluate the effects of soy methyl ester biodiesel on the concentrations and size distributions of diesel aerosols and nitric oxides in mine air. The objective was to compare the effects of neat and blended biodiesel fuels with those of ultralow sulfur petroleum diesel. The evaluation was performed using a mechanically controlled, naturally aspirated diesel engine equipped with a muffler and a diesel oxidation catalyst. The effects of biodiesel fuels on size distributions and number and total aerosol mass concentrations were found to be strongly dependent on engine operating conditions. When fueled with biodiesel fuels, the engine contributed less to elemental carbon concentrations for all engine operating modes and exhaust configurations. The substantial increases in number concentrations and fraction of organic carbon (OC) in total carbon over the baseline were observed when the engine was fueled with biodiesel fuels and operated at light-load operating conditions. Size distributions for all test conditions were found to be single modal and strongly affected by engine operating conditions, fuel type, and exhaust configuration. The peak and total number concentrations as well as median diameter decreased with an increase in the fraction of biodiesel in the fuels, particularly for high-load operating conditions. The effects of the diesel oxidation catalyst, commonly deployed to counteract the potential increase in OC emissions due to use of biodiesel, were found to vary depending upon fuel formulation and engine operating conditions. The catalyst was relatively effective in reducing aerosol number and mass concentrations, particularly at light-load conditions, but also showed the potential for an

Engine restart aid

Science.gov (United States)

Fedewa, Andrew

2018-01-09

A system is disclosed comprising an engine having coolant passages defined therethrough, a first coolant pump, and a first radiator. The system additionally comprises a second coolant pump, a second radiator, and a liquid-to-air heat exchanger configured to condition the temperature of intake air to the engine. The system further includes a coolant valve means. For a first configuration of the coolant valve means the first coolant pump is configured to urge coolant through the coolant passages in the engine and through the first radiator, and the second coolant pump is configured to urge coolant through the liquid-to-air heat exchanger and through the second radiator. For a second configuration of the coolant valve means the second coolant pump is configured to urge coolant through the coolant passages in the engine and through the liquid-to-air heat exchanger. A method for controlling the system is also disclosed.

Treatment and prognosis in peptic ulcer bleeding.

Science.gov (United States)

Laursen, Stig Borbjerg

2014-01-01

Peptic ulcer bleeding is a frequent cause of admission. Despite several advances in treatment the 30-day mortality seems unchanged at a level around 11%. Use of risk scoring systems is shown to be advantageous in the primary assessment of patients presenting with symptoms of peptic ulcer bleeding. Studies performed outside Denmark have demonstrated that use of risk scoring systems facilitates identification of low-risk patients suitable for outpatient management. Nevertheless, these systems have not been implemented for routine use in Denmark. This is mainly explained by concerns about the external validity due to considerable inter-country variation in patients' characteristics. In recent years, transcatheter arterial embolization (TAE) has become increasingly used for achievement of hemostasis in patients with peptic ulcer bleeding not responding to endoscopic therapy. As rebleeding is associated with poor outcome TAE could, in theory, also be beneficial as a supplementary treatment in patients with ulcer bleeding responding to endoscopic therapy. This has not been examined previously. Several studies have concluded that peptic ulcer bleeding is associated with excess long-term mortality. These findings are, however, questioned as the studies were based on life-table analysis, unmatched control groups, or did not perform adequate adjustment for comorbidity. Treatment with blood transfusion is, among patients undergoing cardiac bypass surgery, shown to increase the long-term mortality. Despite frequent use of blood transfusion in treatment of peptic ulcer bleeding a possible adverse effect of on long-term survival has not been examined in these patients. The aims of the present thesis were: 1. To examine which risk scoring system is best at predicting need of hospital-based intervention, rebleeding, and mortality in patients presenting with upper gastrointestinal bleeding (Study I) 2. To evaluate if supplementary transcatheter arterial embolization (STAE) after

Sliding Mode Control of Diesel Engine Air-path System With Dual-loop EGR and VGT Based on the Reduced-order Model

Directory of Open Access Journals (Sweden)

Kim Sooyoung

2016-01-01

Full Text Available This paper presents the design of a model-based controller for the diesel engine air-path system. The controller is implemented based on a reduced order model consisting of only pressure and power dynamics with practical concerns. To deal with the model uncertainties effectively, a sliding mode controller, which is robust to model uncertainties, is proposed for the air-path system. The control performance of the proposed control scheme is verified through simulation with the valid plant model of a 6,000cc heavy duty diesel engine.

Common management issues in pediatric patients with mild bleeding disorders.

Science.gov (United States)

O'Brien, Sarah H

2012-10-01

Type 1 von Willebrand disease and mild platelet function defects are among the most common disorders seen by pediatric hematologists. The management and prevention of bleeding in these patients can be challenging, as there are limited published data to guide clinical practice, and a complete lack of randomized clinical trials. Desmopressin (DDAVP) and antifibrinolytics are the mainstays of treatment in these patients, yet the optimal dosing and timing of these agents to prevent or resolve bleeding, while minimizing adverse side effects, is sometimes unclear. DDAVP-induced hyponatremia is a particularly under-recognized complication in children with bleeding disorders who undergo surgery. Clinicians need to be aware of local measures that are equally important in treating problems such as epistaxis and surgical bleeding. This review will discuss the published literature and provide practical suggestions regarding four common management issues in the care of children and adolescents with mild bleeding disorders: epistaxis, heavy menstrual bleeding, dental extractions, and tonsillectomy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia

DEFF Research Database (Denmark)

Vinholt, Pernille J; Alnor, Anne; Nybo, Mads

2016-01-01

Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer ...... platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine....... or warfarin OR = 2.34, 95% CI 1.23–4.48; urea nitrogen OR = 1.15, 95% CI 1.07–1.25; creatinine OR = 1.01, 95% CI 1.01–1.01; and haemoglobin OR = 0.62, 95% CI 0.41–0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95% CI 1.19–9.34 and haematuria OR = 3.00, 95% CI 1...

Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

Energy Technology Data Exchange (ETDEWEB)

So, Young Ho; Choi, Young Ho [Seoul National University Boramae Medical Center, Seoul (Korea, Republic of); Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung [Seoul National University Hospital, Seoul (Korea, Republic of); Song, Soon Young [Hanyang University Hospital, Seoul (Korea, Republic of)

2012-01-15

The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; {+-} 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

Selective Embolization for Post-Endoscopic Sphincterotomy Bleeding: Technical Aspects and Clinical Efficacy

International Nuclear Information System (INIS)

So, Young Ho; Choi, Young Ho; Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung; Song, Soon Young

2012-01-01

The objective of this study was to evaluate the technical aspects and clinical efficacy of selective embolization for post-endoscopic sphincterotomy bleeding. We reviewed the records of 10 patients (3%; M:F 6:4; mean age, 63.3 years) that underwent selective embolization for post-endoscopic sphincterotomy bleeding among 344 patients who received arteriography for nonvariceal upper gastrointestinal bleeding from 2000 to 2009. We analyzed the endoscopic procedure, onset of bleeding, underlying clinical condition, angiographic findings, interventional procedure, and outcomes in these patients. Among the 12 bleeding branches, primary success of hemostasis was achieved in 10 bleeding branches (83%). Secondary success occurred in two additional bleeding branches (100%) after repeated embolization. In 10 patients, post-endoscopic sphincterotomy bleedings were detected during the endoscopic procedure (n = 2, 20%) or later (n = 8, 80%), and the delay was from one to eight days (mean, 2.9 days; ± 2.3). Coagulopathy was observed in three patients. Eight patients had a single bleeding branch, whereas two patients had two branches. On the selective arteriography, bleeding branches originated from the posterior pancreaticoduodenal artery (n = 8, 67%) and anterior pancreaticoduodenal artery (n = 4, 33%), respectively. Superselection was achieved in four branches and the embolization was performed with n-butyl cyanoacrylate. The eight branches were embolized by combined use of coil, n-butyl cyanoacrylate, or Gelfoam. After the last embolization, there was no rebleeding or complication related to embolization. Selective embolization is technically feasible and an effective procedure for post-endoscopic sphincterotomy bleeding. In addition, the posterior pancreaticoduodenal artery is the main origin of the causative vessels of post-endoscopic sphincterotomy bleeding.

Focal intestinal lymphangiectasia: An unusual cause of acute overt obscure gastrointestinal bleeding

Directory of Open Access Journals (Sweden)

Ashish Kumar Jha

2014-01-01

Full Text Available Detection of bleeding lesion in a patient of acute overt obscure gastrointestinal bleeding is a real challenge. Recently, authors have showed superiority of urgent capsule endoscopy (CE over angiography in patients with acute overt obscure gastrointestinal bleeding. Focal type of intestinal lymphangiectasia is a rare cause of acute gastrointestinal bleeding. Here, we describe a case of focal lymphangiectasia who presented to us with acute overt obscure gastrointestinal bleeding and diagnosed by urgent CE.

Risk Factors for and Management of MPN-Associated Bleeding and Thrombosis.

Science.gov (United States)

Martin, Karlyn

2017-10-01

The Philadelphia chromosome-negative myeloproliferative neoplasms (MPN) are characterized by both thrombotic and bleeding complications. The purpose of this review is to describe the risk factors associated with bleeding and thrombosis in MPN, as well as to review prevention strategies and management of these complications. Well-described risk factors for thrombotic complications include older age and history of prior thrombosis, along with traditional cardiovascular and venous thromboembolic risk factors. More recently, JAK2 V617F mutation has been found to carry an increased risk of thrombotic complications, whereas CALR has a lower risk than JAK2 mutation. Factors associated with an increased risk of bleeding in MPN include a prior history of bleeding, acquired von Willebrand syndrome, and primary myelofibrosis. Recent findings suggest that thrombocytosis carries a higher risk of bleeding than thrombosis in MPN, and aspirin may exacerbate this risk of bleeding, particularly in CALR-mutated ET. Much of the management of MPN focuses on predicting risk of bleeding and thrombosis and initiating prophylaxis to prevent complications in those at high risk of thrombosis. Emerging evidence suggests that sub-populations may have bleeding risk that outweighs thrombotic risk, particularly in setting of antiplatelet therapy. Future work is needed to better characterize this balance. At present, a thorough assessment of the risks of bleeding and thrombosis should be undertaken for each patient, and herein, we review risk factors for and management of these complications.

The bleeding time may be longer in children than in adults.

Science.gov (United States)

Sanders, J M; Holtkamp, C A; Buchanan, G R

1990-01-01

The bleeding time, the most frequently performed test reflecting in vivo platelet function, is the duration of blood flow from a standardized incision on the volar surface of the forearm. Normal values have been determined in adult subjects, but with the exception of neonates, data on the range of bleeding time values in pediatric patients are unavailable. Standard hematology textbooks imply that bleeding time values in children are similar to those of adults. We have reviewed our 9 years of experience with 137 children (mean age 6.5 years) who were referred for diagnostic evaluation of a bleeding disorder but whose history and physical examination were felt by us to be inconsistent with an abnormality of hemostasis. Bleeding time values in these individuals (mean 6.0 min, 95th percentile 9.0 min) were compared with those of 85 normal adult volunteers (mean 4.4 min, 95th percentile 6.5 min). The Simplate-I disposable device and vertical (perpendicular to elbow crease) incision direction were used in both groups. This difference between the pediatric and adult bleeding time values is statistically significant (p less than 0.0001). Neither age nor sex had a significant effect on the pediatric bleeding time measurements. We conclude that the bleeding time, when performed as described, is longer in children than in adults and that pediatric standards for bleeding time should be used in order to avoid a spurious diagnosis of a primary hemostatic disorder in some normal children.

Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy.

Science.gov (United States)

Park, Min Seon; Lee, Beom Jae; Gu, Dae Hoe; Pyo, Jeung-Hui; Kim, Kyeong Jin; Lee, Yun Ho; Joo, Moon Kyung; Park, Jong-Jae; Kim, Jae Seon; Bak, Young-Tae

2013-12-07

Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.

Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

Science.gov (United States)

Yang, Ju-Yeh; Lee, Tsung-Chun; Montez-Rath, Maria E.; Paik, Jane; Chertow, Glenn M.; Desai, Manisha

2012-01-01

Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; Pupper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial. PMID:22266666

EPIDEMIOLOGICAL CORRELATES OF POSTMENOPAUSAL BLEEDING IN A TERTIARY CARE HOSPITAL

Directory of Open Access Journals (Sweden)

Sonia Arora

2012-06-01

Full Text Available Background: A woman is considered menopausal after 12 months of amenorrhea. The most feared symptom during menopause is postmenopausal bleeding which unless proved otherwise indicates genital malignancy. Objectives: To study Socio-demographic factors related to postmenopausal bleeding and to find time lapse between bleeding and reporting of these cases. Material and Methods: This cross sectional was done in the Department of Obstetrics & Gynecology, Pt. J. N. M. Medical College & DR. B. R. Ambedkar Memorial, Hospital, Raipur (C. G. The participants were 146 women who came with the complaint of postmenopausal bleeding. A detailed, preceded, pre-tested, structured, close ended questionnaire was used to collect the data. By interviewing these women, information was collected about different demographic factors like age, socio-economic status, parity etc. The collected data was put in the master chart and analyzed. Results: The proportion of postmenopausal bleeding cases was 3.5% .Maximum cases(50% with postmenopausal bleeding were found in the age group of 45-54yrs . 60 % of patients were from rural areas and 62% were illiterate. 65% of the patients were grand multipara (Parity4. Most of the patients belonged to lower socioeconomic strata. Almost half (48% of patients presented after, more than 6 months since the first episode of bleeding . Conclusions: The proportion of postmenopausal bleeding is high, requiring immediate investigation. Lack of awareness led to very late presentation of most of the patients, so education at community level is required to reduce this time lapse for earlier diagnosis and management

Microcoil Embolization for Acute Lower Gastrointestinal Bleeding

International Nuclear Information System (INIS)

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

2006-01-01

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

Percutaneous transsplenic varices embolization for upper gastrointestinal bleeding

International Nuclear Information System (INIS)

Zhang Qiang; Li Jingyu; Lu Junliang; Xu Liyang; Liu Tao

2010-01-01

Objective: To investigate the value of percutaneous transsplenic varices embolization (PTSVE) for treatment of upper gastrointestinal bleeding. Methods: Twenty cases with liver cirrhosis and portal hypertension suffered upper gastrointestinal bleeding. PTSVE was administered to them with hardener and coils. Among them, 8 cases had massive hepatocellular carcinoma (HCC) in right lobe; 10 cases with hepatocellular carcinoma had portal vein tumor thrombus and occlusion; the other two cases with liver cirrhosis had portal vein thrombosis. All of these cases were not suitable for percutaneous transhepatic varices embolization (PTHVE). PTSVE was performed under the guidance of fluoroscopy. Results: Technical success was achieved in 18 patients. A total of 35 gastric coronary veins were embolized. In all these cases, upper gastrointestinal bleeding stopped after PTSVE. There was no recurrence within 1 month follow-up. No serious complication occurred. Conclusion: PTSVE is a safe and efficient alternative treatment for upper gastrointestinal bleeding, especially for cases with portal vein occlusion or with massive HCC in right lobe of liver. (authors)

Agonist-induced platelet reactivity correlates with bleeding in haemato-oncological patients

NARCIS (Netherlands)

Batman, B.; van Bladel, E. R.; van Hamersveld, M.; Pasker-De Jong, Pieternel C M; Korporaal, S. J.A.; Urbanus, R. T.; Roest, M.; Boven, Leonie A; Fijnheer, R.

2017-01-01

Background and objective: Prophylactic platelet transfusions are administered to prevent bleeding in haemato-oncological patients. However, bleeding still occurs, despite these transfusions. This practice is costly and not without risk. Better predictors of bleeding are needed, and flow cytometric

Gynaecological and obstetric management of women with inherited bleeding disorders.

Science.gov (United States)

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

2006-10-01

The prevalence of bleeding disorders, notably von Willebrand disease (vWD), among adult women with objectively documented menorrhagia is consistently reported to be 10% to 20% and is even higher in adolescents presenting with menorrhagia. This consensus document has been developed by a multidisciplinary committee consisting of an anesthesiologist, 2 hematologists, and an obstetrician/gynaecologist and has been endorsed by their relevant specialty bodies. It has been prepared with the express purpose of providing guidelines for both women with inherited bleeding disorders and for their caregivers regarding the gynaecological and obstetric management of these women, including appropriate anesthesia support where indicated. Diagnostic tools and specific medical and, where appropriate, surgical alternatives to management are reviewed and evidence-based recommendations presented. A MEDLINE search of the English literature between January 1975 and November 2003 was performed using the following key words: menorrhagia, uterine bleeding, pregnancy, von Willebrand, congenital bleeding disorder, desmopressin/DDAVP, tranexamic acid, oral contraceptives, medroxyprogesterone, therapy, hysterectomy, anesthesia, epidural, spinal. Recommendations from other society guidelines were reviewed. 1. Inherited bleeding disorders should be considered in the differential diagnosis of all patients presenting with menorrhagia (II-2B). The graphical scoring system presented is a validated tool which offers a simple yet practical method that can be used by patients to quantify their blood loss (II-2B). 2. Because underlying bleeding disorders are frequent in women with menorrhagia, physicians should consider performing a hemoglobin/hematocrit, platelet count, ferritin, PT (INR) and APTT in women with menorrhagia. In women who have a personal history of other bleeding or a family history of bleeding, further investigation should be considered, including a vWD workup (factor VIII, vWF antigen

Abnormal Uterine Bleeding- evaluation by Endometrial Aspiration.

Science.gov (United States)

Singh, Pratibha

2018-01-01

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

Contingency power for a small turboshaft engine by using water injection into turbine cooling air

Science.gov (United States)

Biesiadny, Thomas J.; Klann, Gary A.

1992-01-01

Because of one-engine-inoperative (OEI) requirements, together with hot-gas reingestion and hot-day, high-altitude take-off situations, power augmentation for multiengine rotorcraft has always been of critical interest. However, power augmentation by using overtemperature at the turbine inlet will shorten turbine life unless a method of limiting thermal and mechanical stress is found. A possible solution involves allowing the turbine inlet temperature to rise to augment power while injecting water into the turbine cooling air to limit hot-section metal temperatures. An experimental water injection device was installed in an engine and successfully tested. Although concern for unprotected subcomponents in the engine hot section prevented demonstration of the technique's maximum potential, it was still possible to demonstrate increases in power while maintaining nearly constant turbine rotor blade temperature.

Recombinant activated factor VII in the treatment of bleeds and for the prevention of surgery-related bleeding in congenital haemophilia with inhibitors.

Science.gov (United States)

Santagostino, Elena; Escobar, Miguel; Ozelo, Margareth; Solimeno, Luigi; Arkhammar, Per; Lee, Hye Youn; Rosu, Gabriela; Giangrande, Paul

2015-06-01

The availability of recombinant activated factor VII (rFVIIa, eptacog alfa activated) has greatly advanced the care of patients with haemophilia A or B who have developed inhibitors against the infused replacement factor. Recombinant FVIIa is licensed for the on-demand treatment of bleeding episodes and the prevention of bleeding in surgery or invasive procedures in patients with congenital haemophilia with inhibitors. This article attempts to review in detail the extensive evidence of rFVIIa in congenital haemophilia patients with inhibitors. Patients with acute bleeding episodes are best treated on demand at home, to achieve the short- and long-term benefits of rapid bleed control. Key prospective studies have shown that rFVIIa achieves consistently high efficacy rates in the management of acute (including joint) bleeds in inhibitor patients in the home treatment setting. Substantial post-approval data from key registries also support the on-demand efficacy profile of rFVIIa established by the prospective clinical trials. The availability of rFVIIa has allowed major surgery to become a reality for inhibitor patients. Studies in key surgery, including orthopaedic procedures, have found that rFVIIa provides consistently high efficacy rates. Importantly, the wealth of data does not raise any unexpected safety concerns surrounding rFVIIa use; this is likely because rFVIIa is a recombinant product with a localised mechanism of action at the site of vascular injury. In summary, rFVIIa is established as an effective and well-tolerated first-line treatment for on-demand bleeding control and bleed prevention during minor and major (including elective orthopaedic) surgery in inhibitor patients. Use of rFVIIa has been a major step towards narrowing the gap in outcomes between inhibitor patients and non-inhibitor patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding.

Science.gov (United States)

Subramaniam, Kavitha; Spilsbury, Katrina; Ayonrinde, Oyekoya T; Latchmiah, Faye; Mukhtar, Syed A; Semmens, James B; Leahy, Michael F; Olynyk, John K

2016-04-01

Blood products are commonly transfused for patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). While concerns exist about further bleeding and mortality in subsets of patients receiving red blood cell (RBC) transfusion, the impact of non-RBC blood products has not previously been systematically investigated. The aim of the study was to investigate the associations between blood products transfusion, further bleeding, and mortality after acute NVUGIB. A retrospective cohort study examined further bleeding and 30-day and 1-year mortality in adult patients who underwent gastroscopy for suspected acute NVUGIB between 2008 and 2010 in three tertiary hospitals in Western Australia. Survival analysis was performed. A total of 2228 adults (63% male) with 2360 hospital admissions for NVUGIB met the inclusion criteria. Median age at presentation was 70 years (range, 19-99 years). Thirty-day mortality was 4.9% and 1-year mortality was 13.9%. Transfusion of 4 or more units of RBCs was associated with greater than 10 times the odds of further bleeding in patients with a hemoglobin level of more than 90 g/L (odds ratio, 11.9; 95% confidence interval [CI], 3.1-45.7; p ≤ 0.001), but was not associated with mortality. Administration of 5 or more units of fresh-frozen plasma (FFP) was associated with increased 30-day (hazard ratio, 2.8; 95% CI, 1.3-5.9; p = 0.008) and 1-year (hazard ratio, 2.6; 95% CI, 1.3-5.0; p = 0.005) mortality after adjusting for coagulopathy, comorbidity, Rockall score, and other covariates. In this large, multicenter study of NVUGIB, RBC transfusion was associated with further bleeding but not mortality, while FFP transfusion was associated with increased mortality in a subset of patients. © 2015 AABB.

Bleeding gastrointestinal stromal tumour of the stomach complicated ...

African Journals Online (AJOL)

Inferior vena cava filter insertion was not possible due to non-availability. Coexistence of DVT needing anticoagulation and bleeding gastric GIST requiring urgent resection presented a management dilemna. Despite the risk, the patient was taken for an emergency tumor resection primarily to stop the bleeding and facilitate ...

Endovascular management of acute bleeding arterioenteric fistulas

DEFF Research Database (Denmark)

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

2008-01-01

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

Fibrinogen concentrate for bleeding - a systematic review

DEFF Research Database (Denmark)

Lunde, J; Stensballe, J; Wikkelsø, A

2014-01-01

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

Secondary drive of an internal combustion engine for an air presser. Nebenantrieb einer Brennkraftmaschine fuer einen Luftpresser

Energy Technology Data Exchange (ETDEWEB)

Kubis, H.

1990-04-19

The invention concerns an air presser propelled by a gearwheel and designed as a piston compressor. The drive gearwheel on the air presser crankshaft meshes with a gearwheel on the camshaft of the internal combustion engine. In the case of these drives, a negative torque of the air presser results when the top dead centre of the air presser piston is reached. This is accompanied by an unpleasant noise. In addition, the driving torque of the camshaft often has negative fractions. If the negative torque of the air presser is superposed by small or negative torques of the camshaft in the re-expansion phase additionally to the air presser wheel there will be a backward acceleration of the camshaft gear which propagates as impact into the rest of the gear drive. The invention prevents the backward acceleration of the camshaft wheel and minimizes stroke momentum and noise in the mesh of the camshaft wheel.

Premenopausal abnormal uterine bleeding and risk of endometrial cancer.

Science.gov (United States)

Pennant, M E; Mehta, R; Moody, P; Hackett, G; Prentice, A; Sharp, S J; Lakshman, R

2017-02-01

Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy. © 2016 The Authors BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal

Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

Energy Technology Data Exchange (ETDEWEB)

Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Wildi, Stefan [University Hospital Zurich, Department of Visceral and Transplant Surgery, Zurich (Switzerland); Bauerfeind, Peter [University Hospital Zurich, Division of Gastroenterology, Zurich (Switzerland)

2007-06-15

This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)

Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT

International Nuclear Information System (INIS)

Scheffel, Hans; Pfammatter, Thomas; Marincek, Borut; Alkadhi, Hatem; Wildi, Stefan; Bauerfeind, Peter

2007-01-01

This study was conducted to determine the ability of multi-detector-row computed tomography (CT) to identify the source and etiology of acute gastrointestinal bleeding. Eighteen patients with acute upper (n = 10) and lower (n = 8) gastrointestinal bleeding underwent 4-detector-row CT (n = 6), 16-detector-row CT (n = 11), and 64-slice CT (n = 1) with an arterial and portal venous phase of contrast enhancement. Unenhanced scans were performed in nine patients. CT scans were reviewed to determine conspicuity of bleeding source, underlying etiology, and for potential causes of false-negative prospective interpretations. Bleeding sources were prospectively identified with CT in 15 (83%) patients, and three (17%) bleeding sources were visualized in retrospect, allowing the characterization of all sources of bleeding with CT. Contrast extravasation was demonstrated with CT in all 11 patients with severe bleeding, but only in 1 of 7 patients with mild bleeding. The etiology could not be identified on unenhanced CT scans in any patient, whereas arterial-phase and portal venous-phase CT depicted etiology in 15 (83%) patients. Underlying etiology was correctly identified in all eight patients with mild GI bleeding. Multi-detector-row CT enables the identification of bleeding source and precise etiology in patients with acute gastrointestinal bleeding. (orig.)

Mortality caused by intracranial bleeding in non-severe hemophilia A patients.

Science.gov (United States)

Loomans, J I; Eckhardt, C L; Reitter-Pfoertner, S E; Holmström, M; van Gorkom, B Laros; Leebeek, F W G; Santoro, C; Haya, S; Meijer, K; Nijziel, M R; van der Bom, J G; Fijnvandraat, K

2017-06-01

Essentials Data on bleeding-related causes of death in non-severe hemophilia A (HA) patients are scarce. Such data may provide new insights into areas of care that can be improved. Non-severe HA patients have an increased risk of dying from intracranial bleeding. This demonstrates the need for specialized care for non-severe HA patients. Background Non-severe hemophilia (factor VIII concentration [FVIII:C] of 2-40 IU dL -1 ) is characterized by a milder bleeding phenotype than severe hemophilia A. However, some patients with non-severe hemophilia A suffer from severe bleeding complications that may result in death. Data on bleeding-related causes of death, such as fatal intracranial bleeding, in non-severe patients are scarce. Such data may provide new insights into areas of care that can be improved. Aims To describe mortality rates, risk factors and comorbidities associated with fatal intracranial bleeding in non-severe hemophilia A patients. Methods We analyzed data from the INSIGHT study, an international cohort study of all non-severe hemophilia A patients treated with FVIII concentrates during the observation period between 1980 and 2010 in 34 participating centers across Europe and Australia. Clinical data and vital status were collected from 2709 patients. We report the standardized mortality rate for patients who suffered from fatal intracranial bleeding, using a general European male population as a control population. Results Twelve per cent of the 148 deceased patients in our cohort of 2709 patients died from intracranial bleeding. The mortality rate between 1996 and 2010 for all ages was 3.5-fold higher than that in the general population (95% confidence interval [CI] 2.0-5.8). Patients who died from intracranial bleeding mostly presented with mild hemophilia without clear comorbidities. Conclusion Non-severe hemophilia A patients have an increased risk of dying from intracranial bleeding in comparison with the general population. This demonstrates the

Defect Engineering toward Atomic Co-Nx -C in Hierarchical Graphene for Rechargeable Flexible Solid Zn-Air Batteries.

Science.gov (United States)

Tang, Cheng; Wang, Bin; Wang, Hao-Fan; Zhang, Qiang

2017-10-01

Rechargeable flexible solid Zn-air battery, with a high theoretical energy density of 1086 Wh kg -1 , is among the most attractive energy technologies for future flexible and wearable electronics; nevertheless, the practical application is greatly hindered by the sluggish oxygen reduction reaction/oxygen evolution reaction (ORR/OER) kinetics on the air electrode. Precious metal-free functionalized carbon materials are widely demonstrated as the most promising candidates, while it still lacks effective synthetic methodology to controllably synthesize carbocatalysts with targeted active sites. This work demonstrates the direct utilization of the intrinsic structural defects in nanocarbon to generate atomically dispersed Co-N x -C active sites via defect engineering. As-fabricated Co/N/O tri-doped graphene catalysts with highly active sites and hierarchical porous scaffolds exhibit superior ORR/OER bifunctional activities and impressive applications in rechargeable Zn-air batteries. Specifically, when integrated into a rechargeable and flexible solid Zn-air battery, a high open-circuit voltage of 1.44 V, a stable discharge voltage of 1.19 V, and a high energy efficiency of 63% at 1.0 mA cm -2 are achieved even under bending. The defect engineering strategy provides a new concept and effective methodology for the full utilization of nanocarbon materials with various structural features and further development of advanced energy materials. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

A rare cause of recurrent gastrointestinal bleeding: mesenteric hemangioma

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Zeytunlu Murat

2009-01-01

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

No impact of fish oil supplements on bleeding risk

DEFF Research Database (Denmark)

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

2017-01-01

Abstract Introduction: Fish oil supplementation may inhibit platelet aggregation and can potentially increase the risk of bleeding. The aim of the present systematic review was to evaluate the effect of fish oil supplements on haemostasis and bleeding risk, and to provide recommendations on whether...... of the included studies were randomised controlled trials or included a control group. Overall, fish oil supplements reduced platelet aggregation in healthy subjects. Fish oil exposure in surgical patients did not increase bleeding or blood transfusions either during or after surgery. Conclusion: Fish oil...... supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior...

Modern issues on the treatment of peptic ulcer bleedings

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Potakhin S.N.

2014-03-01

Full Text Available Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

Post-biliary sphincterotomy bleeding despite covered metallic stent deployment

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Gianfranco Donatelli

2016-05-01

Full Text Available Objectives: Several endoscopic techniques have been proposed for the management of post-sphincterotomy bleeding. Lately, self-expandable metal stents deployment has gained popularity especially as a rescue therapy when other endoscopic techniques fail. Methods-results: We report the case report of a massive post-sphincterotomy bleeding in a patient with a self-expandable metal stent in the biliary tree. Despite the presence of a correctly positioned self-expandable metal stent, a new endoscopic session was required to control the bleeding. Conclusions: Self-expandable metal stent may be useful to manage post-endoscopic sphincterotomy bleeding. However, up to now there is no specifically designed self-expandable metal stent for such complication. Large new designed self-expandable metal stent may be a useful tool for biliary endoscopist.

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

NARCIS (Netherlands)

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

2008-01-01

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

Risk factors for bleeding complications after nephrologist-performed native renal biopsy.

Science.gov (United States)

Lees, Jennifer S; McQuarrie, Emily P; Mordi, Natalie; Geddes, Colin C; Fox, Jonathan G; Mackinnon, Bruce

2017-08-01

Bleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding after biopsy in a single centre over a 15-year period and examine factors associated with major bleeding. We identified consecutive adult patients undergoing ultrasound-guided native renal biopsy in the Glasgow Renal and Transplant Unit from 2000 to 2014. From the electronic patient record, we collected data pertaining to biopsy indication, pre- and post-biopsy laboratory measurements, prescribed medication and diagnosis. Aspirin was routinely continued. We defined major bleeding post-biopsy as the need for blood transfusion, surgical or radiological intervention or death. Binary logistic regression analysis was used to assess factors associated with increased risk of major bleeding. There were 2563 patients who underwent native renal biopsy (1499 elective, 1064 emergency). The average age of patients was 57 (SD 17) years and 57.4% were male. Overall, the rate of major bleeding was 2.2%. In all, 46 patients required transfusion (1.8%), 9 patients underwent embolization (0.4%), no patient required nephrectomy and 1 patient died as a result of a significant late retroperitoneal bleed. Major bleeding was more common in those undergoing emergency compared with elective renal biopsy (3.4 versus 1.1%; P 30). The risk of major bleeding following native renal biopsy in the modern era is low. Complications are more common when biopsy is conducted as an emergency, which has implications for obtaining informed consent. Our data support the strategy of not stopping aspirin before renal biopsy.

Hot air engines: Study of a Stirling engine and of an Ericsson engine; Moteurs thermiques a apport de chaleur externe: etude d'un moteur stirling et d'un moteur ericsson

Energy Technology Data Exchange (ETDEWEB)

Bonnet, S.

2005-11-15

In the current energy context, we attend the development of technologies of production of 'clean' energy. Thus, news prospects like thermodynamic solar energy conversion or waste energy conversion are offered to research on 'renewable energies'. Within this framework, we are interested in hot air engines: Stirling and Ericsson engines. First of all, this thesis concerns the study of a small Stirling engine on which we measured the fluid instantaneous temperature and pressure in various points. The original results obtained are compared to results from two different analyses. We conclude that these models are not suitable to explain the experimental results. Then, we study a micro-cogeneration system based on an Ericsson engine coupled with a system of natural gas combustion. An Ericsson engine is a reciprocating engine working on a JOULE cycle. The objective of this plant is to produce 11 kW of electric output as well as useful heat. In order to design this system, we carried out energetic, exergetic and exergo-economic studies. (author)

Experimental investigation on performance characteristics of a diesel engine using diesel-water emulsion with oxygen enriched air

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P. Baskar

2017-03-01

Full Text Available Diesel engines occupy a crucial position in automobile industry due to their high thermal efficiency and high power to weight ratio. However, they lag behind in controlling air polluting components coming out of the engine exhaust. Therefore, diesel consumption should be analyzed for future energy consumption and this can be primarily controlled by the petroleum fuel substitution techniques for existing diesel engines, which include biodiesel, alcohol-diesel emulsions and diesel water emulsions. Among them the diesel water emulsion is found to be most suitable fuel due to reduction in particulate matter and NOx emission, besides that it also improves the brake thermal efficiency. But the major problem associated with emulsions is the ignition delay, since this is responsible for the power and torque loss. A reduction in NOx emission was observed due to reduction in combustion chamber temperature as the water concentration increases. However the side effect of emulsified diesel is a reduction in power which can be compensated by oxygen enrichment. The present study investigates the effects of oxygen concentration on the performance characteristics of a diesel engine when the intake air is enriched to 27% of oxygen and fueled by 10% of water diesel emulsion. It was found that the brake thermal efficiency was enhanced, combustion characteristics improved and there is also a reduction in HC emissions.

Control of Flow Structure on Non-Slender Delta Wing: Bio-inspired Edge Modifications, Passive Bleeding, and Pulsed Blowing

Science.gov (United States)

Yavuz, Mehmet Metin; Celik, Alper; Cetin, Cenk

2016-11-01

In the present study, different flow control approaches including bio-inspired edge modifications, passive bleeding, and pulsed blowing are introduced and applied for the flow over non-slender delta wing. Experiments are conducted in a low speed wind tunnel for a 45 degree swept delta wing using qualitative and quantitative measurement techniques including laser illuminated smoke visualization, particle image velocimety (PIV), and surface pressure measurements. For the bio-inspired edge modifications, the edges of the wing are modified to dolphin fluke geometry. In addition, the concept of flexion ratio, a ratio depending on the flexible length of animal propulsors such as wings, is introduced. For passive bleeding, directing the free stream air from the pressure side of the planform to the suction side of the wing is applied. For pulsed blowing, periodic air injection through the leading edge of the wing is performed in a square waveform with 25% duty cycle at different excitation frequencies and compared with the steady and no blowing cases. The results indicate that each control approach is quite effective in terms of altering the overall flow structure on the planform. However, the success level, considering the elimination of stall or delaying the vortex breakdown, depends on the parameters in each method.

Endovascular management for significant iatrogenic portal vein bleeding.

Science.gov (United States)

Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

2017-11-01

Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

Energy Technology Data Exchange (ETDEWEB)

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

2015-12-15

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

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

Science.gov (United States)

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

2015-05-28

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

Controlled air incinerator for radioactive waste. Volume II. Engineering design references manual

International Nuclear Information System (INIS)

Koenig, R.A.; Draper, W.E.; Newmyer, J.M.; Warner, C.L.

1982-11-01

This two-volume report is a detailed design and operating documentation of the Los Alamos National Laboratory Controlled Air Incinerator (CAI) and is an aid to technology transfer to other Department of Energy contractor sites and the commercial sector. Volume I describes the CAI process, equipment, and performance, and it recommends modifications based on Los Alamos experience. It provides the necessary information for conceptual design and feasibility studies. Volume II provides descriptive engineering information such as drawings, specifications, calculations, and costs. It aids duplication of the process at other facilities

Estimation of Individual Cylinder Air-Fuel Ratio in Gasoline Engine with Output Delay

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Changhui Wang

2016-01-01

Full Text Available The estimation of the individual cylinder air-fuel ratio (AFR with a single universal exhaust gas oxygen (UEGO sensor installed in the exhaust pipe is an important issue for the cylinder-to-cylinder AFR balancing control, which can provide high-quality torque generation and reduce emissions in multicylinder engine. In this paper, the system dynamic for the gas in exhaust pipe including the gas mixing, gas transport, and sensor dynamics is described as an output delay system, and a new method using the output delay system observer is developed to estimate the individual cylinder AFR. With the AFR at confluence point augmented as a system state, an observer for the augmented discrete system with output delay is designed to estimate the AFR at confluence point. Using the gas mixing model, a method with the designed observer to estimate the individual cylinder AFR is presented. The validity of the proposed method is verified by the simulation results from a spark ignition gasoline engine from engine software enDYNA by Tesis.

The use of selective serotonin receptor inhibitors (SSRIs) is not associated with increased risk of endoscopy-refractory bleeding, rebleeding or mortality in peptic ulcer bleeding.

Science.gov (United States)

Laursen, S B; Leontiadis, G I; Stanley, A J; Hallas, J; Schaffalitzky de Muckadell, O B

2017-08-01

Observational studies have consistently shown an increased risk of upper gastrointestinal bleeding in users of selective serotonin receptor inhibitors (SSRIs), probably explained by their inhibition of platelet aggregation. Therefore, treatment with SSRIs is often temporarily withheld in patients with peptic ulcer bleeding. However, abrupt discontinuation of SSRIs is associated with development of withdrawal symptoms in one-third of patients. Further data are needed to clarify whether treatment with SSRIs is associated with poor outcomes, which would support temporary discontinuation of treatment. To identify if treatment with SSRIs is associated with increased risk of: (1) endoscopy-refractory bleeding, (2) rebleeding or (3) 30-day mortality due to peptic ulcer bleeding. A nationwide cohort study. Analyses were performed on prospectively collected data on consecutive patients admitted to hospital with peptic ulcer bleeding in Denmark in the period 2006-2014. Logistic regression analyses were used to investigate the association between treatment with SSRIs and outcome following adjustment for pre-defined confounders. Sensitivity and subgroup analyses were performed to evaluate the validity of the findings. A total of 14 343 patients were included. Following adjustment, treatment with SSRIs was not associated with increased risk of endoscopy-refractory bleeding (odds ratio [OR] [95% Confidence Interval (CI)]: 1.03 [0.79-1.33]), rebleeding (OR [95% CI]: 0.96 [0.83-1.11]) or 30-day mortality (OR [95% CI]: 1.01 [0.85-1.19]. These findings were supported by sensitivity and subgroup analyses. According to our data, treatment with SSRIs does not influence the risk of endoscopy-refractory bleeding, rebleeding or 30-day mortality in peptic ulcer bleeding. © 2017 John Wiley & Sons Ltd.

Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

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Jan Yi-Yin

2006-01-01

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

Large eddy simulation of air pollution produced by aircraft engine emissions inside the airport

Energy Technology Data Exchange (ETDEWEB)

Synylo, Kateryna [National Aviation University (Ukraine)], email: synylo@nau.edu.ua

2011-07-01

With the increase of air traffic movement, air pollution from airport emissions has become an important concern. In the past, various research has been undertaken on the impact of aircraft engines on the upper troposphere and lower stratosphere, however the impact that emissions have on airports themselves is not taken into account by the most frequently used monitoring software programs. The aim of this paper is to present the use of a CFD simulation to determine the dynamic and fluid mechanics characteristics of aircraft emissions near the ground. The CFD simulation was carried out using Fluent 6.3 software and the effects of counter-rotating vortices and wind conditions on fulfilled gases jet. It was found that numerical simulation is able to resolve difficult equations and provide realistic results. This study demonstrated that the use of CFD computation could be used to improve local air quality modeling and assessment of the impact of aircraft emissions at airports.

Preventive Strategies against Bleeding due to Nonvitamin K Antagonist Oral Anticoagulants

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Lessire Sarah

2014-01-01

Full Text Available Dabigatran etexilate (DE, rivaroxaban, and apixaban are nonvitamin K antagonist oral anticoagulants (NOACs that have been compared in clinical trials with existing anticoagulants (warfarin and enoxaparin in several indications for the prevention and treatment of thrombotic events. All NOACs presented bleeding events despite a careful selection and control of patients. Compared with warfarin, NOACs had a decreased risk of intracranial hemorrhage, and apixaban and DE (110 mg BID had a decreased risk of major bleeding from any site. Rivaroxaban and DE showed an increased risk of major gastrointestinal bleeding compared with warfarin. Developing strategies to minimize the risk of bleeding is essential, as major bleedings are reported in clinical practice and specific antidotes are currently not available. In this paper, the following preventive approaches are reviewed: improvement of appropriate prescription, identification of modifiable bleeding risk factors, tailoring NOAC’s dose, dealing with a missed dose as well as adhesion to switching, bridging and anesthetic procedures.

Bayesian network modelling of upper gastrointestinal bleeding

Science.gov (United States)

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

2013-09-01

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

A novel semi-quantitative method for measuring tissue bleeding.

Science.gov (United States)

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

2014-03-01

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

Complex endoscopic treatment of acute gastrointestinal bleeding of ulcer origin

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V. V. Izbitsky

2013-06-01

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

Ibrutinib-associated bleeding: pathogenesis, management and risk reduction strategies.

Science.gov (United States)

Shatzel, J J; Olson, S R; Tao, D L; McCarty, O J T; Danilov, A V; DeLoughery, T G

2017-05-01

Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase (Btk) that has proven to be an effective therapeutic agent for multiple B-cell-mediated lymphoproliferative disorders. Ibrutinib, however, carries an increased bleeding risk compared with standard chemotherapy. Bleeding events range from minor mucocutaneous bleeding to life-threatening hemorrhage, due in large part to the effects of ibrutinib on several distinct platelet signaling pathways. There is currently a minimal amount of data to guide clinicians regarding the use of ibrutinib in patients at high risk of bleeding or on anticoagulant or antiplatelet therapy. In addition, the potential cardiovascular protective effects of ibrutinib monotherapy in patients at risk of vascular disease are unknown. Patients should be cautioned against using non-steroidal anti-inflammatory drugs, fish oils, vitamin E and aspirin-containing products, and consider replacing ibrutinib with a different agent if dual antiplatelet therapy is indicated. Patients should not take vitamin K antagonists concurrently with ibrutinib; direct oral anticoagulants should be used if extended anticoagulation is strongly indicated. In this review, we describe the pathophysiology of ibrutinib-mediated bleeding and suggest risk reduction strategies for common clinical scenarios associated with ibrutinib. © 2017 International Society on Thrombosis and Haemostasis.

Histopathological pattern of abnormal uterine bleeding in endometrial biopsies.

Science.gov (United States)

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

2013-03-01

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

Evaluation and Management of Adolescents with Abnormal Uterine Bleeding.

Science.gov (United States)

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

2015-09-01

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

Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

Science.gov (United States)

Kim, Seung Young; Hyun, Jong Jin; Suh, Sang Jun; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Park, Jong Jae; Chun, Hoon Jai; Lee, Sang Woo

2016-04-01

To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke. Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups. Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.

Knee arthroplasty and bleeding: when to remove drainages.

Science.gov (United States)

Ares, Oscar; Seijas, Roberto; Hernandez, Alberto; Castellet, Enric; Sallent, Andrea

2013-02-01

The aim of this study is an attempt to clarify the productive time of drainages as we find that the use of drains in knee arthroplasty is controversial, and there is no consensus regarding their length-time maintenance. We analysed the survival curve of bleeding within three surgical techniques for knee arthroplasty and the effect of two variables on survival curve. One hundred and eighty-eight out of 234 knees were included in the study, and patients were divided into three groups according to the surgical technique: conventional total knee arthroplasty (TKA), subvastus TKA and unicompartmental knee arthroplasty. Variables of study were type of surgery, number and placement of drains. Mean of survival curve for postoperative bleeding time was 16 h (95 % CI: 15.4; 16.6). The risk for longer bleeding increased 1.38-fold with each additional drain used (95 % CI 1.1; 1.8). According to the present study, drains can be safely removed at around 17 h postoperative. Bleeding time reduces as less drains are applied. Therapeutic study, Level III.

Transvaginal Ultrasound for the Diagnosis of Abnormal Uterine Bleeding.

Science.gov (United States)

Wheeler, Karen C; Goldstein, Steven R

2017-03-01

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

Clival chordoma manifesting as nasal bleeding. A case report

Energy Technology Data Exchange (ETDEWEB)

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

2005-05-01

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

Clival chordoma manifesting as nasal bleeding. A case report

International Nuclear Information System (INIS)

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

2005-01-01

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

B-2 Systems Engineering Case Study

Science.gov (United States)

2007-01-01

of four small circles on the top view in front of the cockpit and on the bottom view engine bay doors. This air data system has no standard pitot ...Skantze, General, Air Force, Source Selection Advisory Board Chairman Erich Smith, Vought, Test Engineer, Systems Engineer, Chief engineer Henry