Infective Endocarditis Complicated by Septic Pulmonary Emboli in a Case of a Ventricular Septal Defect

Directory of Open Access Journals (Sweden)

Roodpeyma

2015-11-01

Full Text Available Introduction Infective endocarditis (IE causes serious complications in patients. Congenital heart disease (CHD is an important underlying condition in children. Septic pulmonary embolism is an uncommon syndrome, and pulmonary valve IE is rare. The current study presented a case of right-sided IE with pulmonary valve involvement and its complications as pulmonary septic emboli in a child with CHD. Case Presentation A 6-year-old girl with a ventricular septal defect (VSD was presented. Echocardiography revealed large vegetation in the right ventricular outflow tract near the pulmonary valve. The patient showed clinical symptoms of lung involvement, and radiologic investigation was compatible with a diagnosis of septic pulmonary emboli. She had good response to antibacterial therapy and underwent a successful surgical closure of the heart defect. Conclusions Children with CHD are at risk of severe complications with the involvement of other organs. long-term febrile illness should be taken seriously in these children. They need hospitalization and careful evaluation.

Embolis cutis medicamentosa, a rare preventable iatrogenic complication

Directory of Open Access Journals (Sweden)

Manjunath Kavya,

2015-07-01

Full Text Available Embolis cutis medicamentosa is an uncommon iatrogenic complication characterised by variable degree of skin and tissue necrosis, likely to follow intramuscular injection. Intense pain and purplish discoloration of overlying skin, with or without reticulate pattern subsequently followed by tissue necrosis and scarring is highly specific for this syndrome. It has also been reported following intravenous, intra-articular and subcutaneous injections. Herein we are reporting two cases of this rare preventable entity.

Resuscitation by hyperbaric exposure from a venous gas emboli following laparoscopic surgery

DEFF Research Database (Denmark)

Kjeld, Thomas; Hansen, Egon G; Holler, Nana G

2012-01-01

Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac......, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient....... arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently...

Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study.

Science.gov (United States)

Cheung, Ning; Teo, Kelvin; Zhao, Wanting; Wang, Jie Jin; Neelam, Kumari; Tan, Nicholas Y Q; Mitchell, Paul; Cheng, Ching-Yu; Wong, Tien Yin

2017-10-01

To our knowledge, population-based data on retinal emboli are limited in Asia. Besides its associations with traditional cardiovascular risk factors and stroke, associations between retinal emboli and renal disease and function remain unclear. To examine the prevalence of and risk factors for retinal emboli in a large, contemporary, multiethnic Asian population. This population-based cross-sectional study was conducted from 2004 to 2011 and included a total of 10 033 Chinese, Malay, and Indian persons aged 40 to 80 years residing in the general communities of Singapore. Analyses were performed from November 2016 to February 2017. Retinal emboli were ascertained from retinal photographs obtained from both eyes of all participants according to a standardized protocol. Age-standardized prevalence of retinal emboli was calculated using the 2010 Singapore adult population. Risk factors were assessed from comprehensive systemic and ophthalmic examinations, interviews, and laboratory investigations. Retinal emboli. Of the 10 033 participants, 9978 (99.5%) had gradable retinal photographs. Of these, 5057 (50.7%) were female, and 3375 (33.8%) were Indian. We identified 88 individuals (0.9%) with retinal emboli; the overall person-specific, age-standardized prevalence of retinal emboli was 0.75% (95% CI, 0.60-0.95), with the highest prevalence seen in the Indian cohort (0.98%), followed by the Chinese (0.73%) and Malay (0.44%) cohorts (P = .03). In multivariable-adjusted analysis, factors associated with prevalent retinal emboli included older age (per 5-year increase; odds ratio [OR], 1.22; 95% CI, 1.05-1.41), Indian ethnicity (compared with Malay ethnicity; OR, 3.58; 95% CI, 1.95-6.60), hypertension (OR, 1.95; 95% CI, 1.03-3.70), chronic kidney disease (OR, 2.05; 95% CI, 1.15-3.64), creatinine level (per SD increase; OR, 1.13; 95% CI, 1.05-1.21), glomerular filtration rate (per SD increase; OR, 0.67; 95% CI, 0.51-0.86), and history of stroke (OR, 3.45; 95% CI, 1

Blast pulmonaire primaire chez le brûlé. a propos d’un cas et revue de la littérature

Science.gov (United States)

Siah, S.; Emane, A.; Bertin-Maghit, M.

2016-01-01

Summary Le blast est à l’origine de lésions spécifiques pour lesquelles une prise en charge spécialisée est nécessaire. Après une explosion on peut observer des lésions de blast primaire, liées à l’onde de choc, secondaire par polycriblage et tertiaire par projection du patient. Les blasts secondaire et tertiaire sont plus fréquents que le blast primaire et peuvent entraîner un polytraumatisme. Dans 5% des cas, on retrouve des brûlures pouvant faire partie du blast quaternaire, qui regroupe toutes les lésions d’autres mécanismes que ceux précités. La prise en charge des lésions secondaires et tertiaires de blast est comparable à celle des traumatisés graves. Le blast pulmonaire primaire aggrave le pronostic des blessés les plus graves mais impose rarement une prise en charge spécifique. La connaissance des particularités physiopathologiques et lésionnelles permet de mieux traiter les blastés et brûlés graves survivants. Nous rapportons une observation de blast pulmonaire primaire chez un brûlé. PMID:28149247

Photothermal ablation of inflammatory breast cancer tumor emboli using plasmonic gold nanostars

Directory of Open Access Journals (Sweden)

Crawford BM

2017-08-01

these nanoparticles penetrate the tumor embolic core in 3D culture, allowing effective photothermal ablation of the IBC tumor emboli. These results not only provide an avenue for optimizing the diagnostic and therapeutic application of GNS in the treatment of IBC but also support the continuous development of 3D in vitro models for investigating the efficacy of photothermal therapy as well as to further evaluate photothermal therapy in an IBC in vivo model. Keywords: inflammatory breast cancer, photothermal therapy, hyperthermia, plasmonics, gold nanostars, nanoparticles

Osteomyelitis in lower limbs and pulmonary septic emboli - a case report and radiological diagnosis

International Nuclear Information System (INIS)

Doria, Angela Schwarz; Amaro Junior, Edson; Torre, Marcia Barbosa; Bogus, Luis Carlos Nogueira; Andrade, Marcio Ramalho; Barba, Mario Flores; Scatigno Neto, Andre

1996-01-01

The authors describe a case of osteomyelitis in the lower limbs with subsequent septic emboli pulmonary spread, as a complication of the prior clinical presentation. They discuss clinical and pathological aspects, as well as, the possibility of diagnosis utilizing plain radiography, computed tomography and scintigraphy. (author)

Asymptomatic spontaneous cerebral emboli and mood in a cohort of older people: a prospective study.

NARCIS (Netherlands)

Oude Voshaar, R.C.; Purandare, N.; Hardicre, J.; McCollum, C.N.; Burns, A.

2007-01-01

OBJECTIVE: To examine whether asymptomatic spontaneous cerebral emboli (SCE) predicts subsequent depression in older people. METHODS: Prospective cohort study with 2.5 years of follow-up including 96 nondepressed older subjects in primary care. Presence of SCE was measured at baseline by

Pulmonary Septic Emboli due to Azygos Vein Septic Thrombosis

Directory of Open Access Journals (Sweden)

Ginius Pradhan

2013-01-01

Full Text Available The triad of extrapulmonary infection, contiguous septic vein thrombosis, and septic pulmonary embolism is a rare complex but associated with significant morbidity and mortality. Septic azygos vein thrombosis is extremely rare and potentially serious since it may also cause pulmonary emboli and sudden death. We report a case of a 32-year-old woman with history of IV drug abuse who presented with epidural abscess and methicillin-resistant S. aureus (MRSA bacteremia. Later she developed signs of septic pulmonary embolism secondary to septic azygos vein thrombosis. With early diagnosis, appropriate antimicrobial therapy, and control of the infectious source, resolution of the illness can be expected for most patients with avoidance of potential complications.

Staphylococcus aureus septic pulmonary emboli presenting as angioinvasive aspergillosis: case report

Energy Technology Data Exchange (ETDEWEB)

McKerlie, I. [Montreal General Hospital, Dept. of Diagnostic Radiology, Montreal, Quebec (Canada); Bloom, C. [Jewish General Hospital, Dept. of Diagnostic Imaging, Montreal, Quebec (Canada); Kreisman, H. [Jewish General Hospital, Pulmonary Div., Dept. of Medicine, Montreal, Quebec (Canada)

2001-12-01

Septic pulmonary emboli (SPE) have a wide spectrum of radiologic and clinical presentations. The characteristic chest radiographic findings of SPE have been well documented in the literature, but a significant number of patients present with nonspecific or equivocal infiltrates that are not definitive for septic emboli. Studies comparing computed tomographic (CT) scans and chest radiographs of patients with documented SPE suggest that CT provides a more characteristic and recognizable pattern of parenchymal involvement than can be routinely identified on plain radiographs. These findings include multiple peripheral nodules ranging in size from 0.5 cm to 3.5 cm, a feeding vessel sign, cavitation, wedge-shaped peripheral lesions abutting the pleura, air bronchograms within the nodules and extension into the pleural space. Patients with leukemia or lymphoma and prolonged bone marrow suppression are at high risk for developing opportunistic infections of the lung. Angioinvasive aspergillosis (AIA) can occur in any severely immunocompromised or chronically debilitated patient. By far, the most common clinical setting is the patient with prolonged granulocytopenia during treatment for acute leukemia. On CT images, AIA presents as round soft-tissue lung masses surrounded by a 'halo' of ground-glass attenuation. This appearance was once considered pathognomonic of AIA but is now known to be associated with a wide variety of hemorrhagic and vasculitic pulmonary processes. We report a case of SPE presenting radiographically as multiple lung nodules with surrounding halos, thus mimicking the diagnosis of AIA. To the best of our knowledge, these findings have not been reported in the literature. (author)

CT pulmonary angiography: increasingly diagnosing less severe pulmonary emboli.

Directory of Open Access Journals (Sweden)

Andrew J Schissler

Full Text Available It is unknown whether the observed increase in computed tomography pulmonary angiography (CTPA utilization has resulted in increased detection of pulmonary emboli (PEs with a less severe disease spectrum.Trends in utilization, diagnostic yield, and disease severity were evaluated for 4,048 consecutive initial CTPAs performed in adult patients in the emergency department of a large urban academic medical center between 1/1/2004 and 10/31/2009. Transthoracic echocardiography (TTE findings and peak serum troponin levels were evaluated to assess for the presence of PE-associated right ventricular (RV abnormalities (dysfunction or dilatation and myocardial injury, respectively. Statistical analyses were performed using multivariate logistic regression.268 CTPAs (6.6% were positive for acute PE, and 3,780 (93.4% demonstrated either no PE or chronic PE. There was a significant increase in the likelihood of undergoing CTPA per year during the study period (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04-1.07, P<0.01. There was no significant change in the likelihood of having a CTPA diagnostic of an acute PE per year (OR 1.03, 95% CI 0.95-1.11, P = 0.49. The likelihood of diagnosing a less severe PE on CTPA with no associated RV abnormalities or myocardial injury increased per year during the study period (OR 1.39, 95% CI 1.10-1.75, P = 0.01.CTPA utilization has risen with no corresponding change in diagnostic yield, resulting in an increase in PE detection. There is a concurrent rise in the likelihood of diagnosing a less clinically severe spectrum of PEs.

CT Pulmonary Angiography: Increasingly Diagnosing Less Severe Pulmonary Emboli

Science.gov (United States)

Schissler, Andrew J.; Rozenshtein, Anna; Kulon, Michal E.; Pearson, Gregory D. N.; Green, Robert A.; Stetson, Peter D.; Brenner, David J.; D'Souza, Belinda; Tsai, Wei-Yann; Schluger, Neil W.; Einstein, Andrew J.

2013-01-01

Background It is unknown whether the observed increase in computed tomography pulmonary angiography (CTPA) utilization has resulted in increased detection of pulmonary emboli (PEs) with a less severe disease spectrum. Methods Trends in utilization, diagnostic yield, and disease severity were evaluated for 4,048 consecutive initial CTPAs performed in adult patients in the emergency department of a large urban academic medical center between 1/1/2004 and 10/31/2009. Transthoracic echocardiography (TTE) findings and peak serum troponin levels were evaluated to assess for the presence of PE-associated right ventricular (RV) abnormalities (dysfunction or dilatation) and myocardial injury, respectively. Statistical analyses were performed using multivariate logistic regression. Results 268 CTPAs (6.6%) were positive for acute PE, and 3,780 (93.4%) demonstrated either no PE or chronic PE. There was a significant increase in the likelihood of undergoing CTPA per year during the study period (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.04–1.07, P<0.01). There was no significant change in the likelihood of having a CTPA diagnostic of an acute PE per year (OR 1.03, 95% CI 0.95–1.11, P = 0.49). The likelihood of diagnosing a less severe PE on CTPA with no associated RV abnormalities or myocardial injury increased per year during the study period (OR 1.39, 95% CI 1.10–1.75, P = 0.01). Conclusions CTPA utilization has risen with no corresponding change in diagnostic yield, resulting in an increase in PE detection. There is a concurrent rise in the likelihood of diagnosing a less clinically severe spectrum of PEs. PMID:23776522

Pulmonary emboli cardiac arrest with CPR complication: Liver laceration and massive abdominal bleed, a case report

Directory of Open Access Journals (Sweden)

John Lundqvist

2017-01-01

Conclusion: Pulmonary emboli with subsequent right ventricular failure may cause backwards stasis, and parenchymal organ e.g. liver enlargement. The risk for laceration injuries and internal bleed must be acknowledged when applying external forces as in case of cardiac arrest and need for resuscitation. Frequent and vigilant control of positioning of manual as well as mechanical compressions is of importance.

A Systematic Review of the Causes and Management of Ischaemic Stroke Caused by Nontissue Emboli

Directory of Open Access Journals (Sweden)

Ciaran Judge

2017-01-01

Full Text Available Introduction. The inadvertent or purposeful introduction of foreign bodies or substances can lead to cerebral infarction if they embolize to the brain. Individual reports of these events are uncommon but may increase with the increased occurrences of their risk factors, for example, intra-arterial procedures. Method. We searched EMBASE and MEDLINE for articles on embolic stroke of nontissue origin. 1889 articles were identified and screened and 216 articles were ultimately reviewed in full text and included in qualitative analysis. Articles deemed relevant were assessed by a second reviewer to confirm compatibility with the inclusion criteria. References of included articles were reviewed for relevant publications. We categorized the pathology of the emboli into the following groups: air embolism (141 reports, other arterial gas embolisms (49 reports, missiles and foreign bodies (16 reports, and others, including drug embolism, cotton wool, and vascular sclerosant agents. Conclusion. Air and gaseous embolism are becoming more common with increased use of interventional medical procedures and increased popularity of sports such as diving. There is increasing evidence for the use of hyperbaric oxygen for such events. Causes of solid emboli are diverse. More commonly reported causes include bullets, missiles, and substances used in medical procedures.

Cerebral Fat Embolism in a Trauma Patient with Captured Imaging of Echogenic Emboli in the Inferior Vena Cava

Directory of Open Access Journals (Sweden)

Nancy N. Wang

2016-12-01

Full Text Available The authors present a case of fat embolism syndrome after traumatic long-bone fracture in a patient with rapid neurologic deterioration and multiple cerebral embolic events. Diagnostic workup revealed the neuroradiologic findings classically described with cerebral fat emboli. The authors present hallmark ultrasound imaging of echogenic material actively traveling through the inferior vena cava.

Clinical presentation of multiple cerebral emboli and central retinal artery occlusion (CRAO as signs of cardiac myxoma

Directory of Open Access Journals (Sweden)

Alberto Galvez-Ruiz

2018-04-01

Full Text Available Cardiac myxomas are benign tumors of endocardial origin that usually occur in the left atrium. Trans-thoracic echocardiography is the diagnostic method of choice, and early surgical removal is the preferred method of treatment.We present a patient whose history of cerebral emboli and central retinal artery occlusion (CRAO led to a diagnosis of cardiac myxoma.Neuroimaging studies showed multiple infarcts in the region of the left middle and anterior cerebral arteries. Ophthalmic examination showed gross retinal pallor compatible with left central retinal artery occlusion (CRAO.The etiology of stroke was investigated by performing trans-thoracic echocardiography, which showed a mass in the left atrium compatible with cardiac myxoma. Complete removal of the cardiac tumor was performed by open-heart surgery.Fortunately, after a period of rehabilitation, the patient’s hemiparesis almost completely resolved, but the loss of vision OS remained unchanged.Many cases of myxoma are accompanied by constitutional symptoms, such as anemia, fever and weight loss, which allow for a diagnosis to made before serious complications such as embolism occur. Unfortunately, in some patients, such as ours, the absence of signs and symptoms allows the myxoma to pass completely unnoticed until the first embolic event occurs. Keywords: Cardiac myxoma, Central retinal artery occlusion, Cerebral emboli, Amaurosis

Modelling of impaired cerebral blood flow due to gaseous emboli

International Nuclear Information System (INIS)

Hague, J P; Banahan, C; Chung, E M L

2013-01-01

Bubbles introduced to the arterial circulation during invasive medical procedures can have devastating consequences for brain function but their effects are currently difficult to quantify. Here we present a Monte Carlo simulation investigating the impact of gas bubbles on cerebral blood flow. For the first time, this model includes realistic adhesion forces, bubble deformation, fluid dynamical considerations, and bubble dissolution. This allows investigation of the effects of buoyancy, solubility, and blood pressure on embolus clearance. Our results illustrate that blockages depend on several factors, including the number and size distribution of incident emboli, dissolution time and blood pressure. We found it essential to model the deformation of bubbles to avoid overestimation of arterial obstruction. Incorporation of buoyancy effects within our model slightly reduced the overall level of obstruction but did not decrease embolus clearance times. We found that higher blood pressures generate lower levels of obstruction and improve embolus clearance. Finally, we demonstrate the effects of gas solubility and discuss potential clinical applications of the model. (paper)

Coinfection pulmonaire par pneumocystis jirovecii et pseudomonas aeruginosa au cours du SIDA: à propos de deux cas

Science.gov (United States)

Mamoudou, Savadogo; Bellaud, Guillaume; Ana, Canestri; Gilles, Pialoux

2015-01-01

Rapporter deux cas cliniques de coinfections pulmonaires par Pneumocystis jirovecii et par Pseudomonas aeruginosa chez des patients vivant avec le VIH. Les deux patients étaient âgés respectivement de 32 ans et 46 ans. Un patient a été pris en charge à l'hôpital Yalgado Ouédraogo de Ouagadougou au Burkina Faso et l'autre a été pris en charge à l'hôpital Ténon de Paris, en France. Les deux souffraient de pneumopathie confirmée à la radiographie et à la tomodensitométrie. L'un des patients était sévèrement immuno déprimé, contrairement à l'autre. L'examen bactériologique dans les crachats avait permis d'isoler Pseudomonas aeruginosa et Pneumocystis jirovecii chez les deux patients. Sous traitement, l’évolution a été favorable. Les coinfections morbides sont relativement fréquentes chez les patients vivant avec le VIH. Devant une symptomatologie respiratoire du sujet vivant avec le VIH, il faut savoir rechercher en plus du Bacille de Koch, Pneumocystis jirovecii et Pseudomonas aeruginosa par un lavage broncho alvéolaire. PMID:26516396

Haemophilus parainfluenzae Endocarditis Associated With Maxillary Sinusitis and Complicated by Cerebral Emboli in a Young Man

Directory of Open Access Journals (Sweden)

Anthony E. Duzenli MD

2017-04-01

Full Text Available HACEK endocarditis is often difficult to diagnose given the slow-growing characteristics of the organisms involved. Haemophilus parainfluenzae, one of the HACEK organisms, is an uncommon cause of endocarditis. We describe a case of a previously healthy young man with H parainfluenzae endocarditis that was associated with maxillary sinusitis and severe systemic complications, including septic cerebral emboli and mitral valve perforation. Previously reported cases have also described a predilection for younger people, cardiac valve pathology, and a high prevalence of stroke.

Computer-assisted detection of pulmonary embolism: evaluation of pulmonary CT angiograms performed in an on-call setting

International Nuclear Information System (INIS)

Wittenberg, Rianne; Peters, Joost F.; Sonnemans, Jeroen J.; Prokop, Mathias; Schaefer-Prokop, Cornelia M.

2010-01-01

The purpose of the study was to assess the stand-alone performance of computer-assisted detection (CAD) for evaluation of pulmonary CT angiograms (CTPA) performed in an on-call setting. In this institutional review board-approved study, we retrospectively included 292 consecutive CTPA performed during night shifts and weekends over a period of 16 months. Original reports were compared with a dedicated CAD system for pulmonary emboli (PE). A reference standard for the presence of PE was established using independent evaluation by two readers and consultation of a third experienced radiologist in discordant cases. Original reports had described 225 negative studies and 67 positive studies for PE. CAD found PE in seven patients originally reported as negative but identified by independent evaluation: emboli were located in segmental (n = 2) and subsegmental arteries (n = 5). The negative predictive value (NPV) of the CAD algorithm was 92% (44/48). On average there were 4.7 false positives (FP) per examination (median 2, range 0-42). In 72% of studies ≤5 FP were found, 13% of studies had ≥10 FP. CAD identified small emboli originally missed under clinical conditions and found 93% of the isolated subsegmental emboli. On average there were 4.7 FP per examination. (orig.)

Clinical evaluation of a computer-aided diagnosis (CAD) prototype for the detection of pulmonary embolism.

Science.gov (United States)

Buhmann, Sonja; Herzog, Peter; Liang, Jin; Wolf, Mathias; Salganicoff, Marcos; Kirchhoff, Chlodwig; Reiser, Maximilian; Becker, Christoph H

2007-06-01

To evaluate the performance of a prototype computer-aided diagnosis (CAD) tool using artificial intelligence techniques for the detection of pulmonary embolism (PE) and the possible benefit for general radiologists. Forty multidetector row computed tomography datasets (16/64- channel scanner) using 100 kVp, 100 mAs effective/slice, and 1-mm axial reformats in a low-frequency reconstruction kernel were evaluated. A total of 80 mL iodinated contrast material was injected at a flow rate of 5 mL/seconds. Primarily, six general radiologists marked any PE using a commercially available lung evaluation software with simultaneous, automatic processing by CAD in the background. An expert panel consisting of two chest radiologists analyzed all PE marks from the readers and CAD, also searching for additional finding primarily missed by both, forming the ground truth. The ground truth consisted of 212 emboli. Of these, 65 (31%) were centrally and 147 (69%) were peripherally located. The readers detected 157/212 emboli (74%) leading to a sensitivity of 97% (63/65) for central and 70% (103/147) for peripheral emboli with 9 false-positive findings. CAD detected 168/212 emboli (79%), reaching a sensitivity of 74% for central (48/65) and 82%(120/147) for peripheral emboli. A total of 154 CAD candidates were considered as false positives, yielding an average of 3.85 false positives/case. The CAD software showed a sensitivity comparable to that of the general radiologists, but with more false positives. CAD detection of findings incremental to the radiologists suggests benefit when used as a second reader. Future versions of CAD have the potential to further increase clinical benefit by improving sensitivity and reducing false marks.

Effects of DTPA aerosol on lung contamination by lanthanum; Influence du DTPA en aerosol sur les contaminations pulmonaires au lanthane

Energy Technology Data Exchange (ETDEWEB)

Pasquier, C; Voisin, D; Thieblement, P; Perrault, G; Bayard, J [Commissariat a l' Energie Atomique, Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires

1969-07-01

Applying DTPA aerosol for the treatment of lung contamination by lanthanum we were able to determine its effectiveness as a function of time. Provided it was administered early during the two hours after exposure, over 50 per cent could be removed using lower therapeutic doses than those prescribed for other routes of administration. Its association with some enzymes did not enhance the chelator therapeutic effect. We also calculated the constant of passage of lanthanum through the alveolar wall and found a value of 0.016 mn{sup -1}. Finally, as we have discovered a large part cannot be mobilized by DTPA, we shall now study the physico-chemical mechanisms involved in this protection. (authors) [French] L'emploi du DTPA en aerosol dans le traitement des contaminations pulmonaires par le lanthane, nous a permis d'etablir et d'evaluer son efficacite en fonction du temps. A condition d'etre utilise precocement, dans les deux heures qui suivent la contamination, une fraction superieure a 50 pour cent peut etre eliminee et ceci avec des doses therapeutiques inferieures a celles preconisees pour les autres voies d'administration. L'association avec quelques autres enzymes n'a pas permis d'ameliorer l'effet therapeutique de ce chelateur. Nous avons egalement chiffre la constante de passage du lanthane a travers la barriere alveolaire dont la valeur est de l'ordre de 0.016 mn{sup -1} Enfin, la decouverte d'une importante partie non piegeable par le DTPA nous amene maintenant a etudier les mecanismes physico-chimiques de cette protection. (auteurs)

Tricuspid Annular Plane Systolic Excursion (TAPSE in a Patient with Pulmonary Emboli

Directory of Open Access Journals (Sweden)

Nicole Zawada

2018-01-01

Full Text Available History of present illness: A 60-year-old male with a history of pulmonary emboli (PE presented to the emergency department with exertional shortness of breath following a ten-hour flight. The patient admitted to recently stopping his previously prescribed rivaroxaban. His electrocardiogram (ECG showed findings consistent with a S1Q3T3 pattern. Point-of-care ultrasound (POCUS was performed using the curvilinear probe, which revealed a thrombus in the inferior vena cava (IVC. POCUS using the phased array probe demonstrated an abnormal tricuspid annular plane systolic excursion (TAPSE and a significantly dilated right ventricle (RV. Computed tomography angiogram (CTA showed evidence of acute emboli within the right and left distal main pulmonary arteries, left lobar, and left proximal segmental artery. Additionally, a thrombus was visualized in the left distal subhepatic IVC. The patient was admitted to telemetry for anticoagulation and monitoring. Right heart catheterization revealed a significantly elevated pulmonary artery pressure of 95/27. Significant findings: Video 1 and Image 1 show a thrombus in the patient’s IVC. Video 2 and Images 2-3 demonstrate a positive TAPSE of less than 17mm (blue arrow length with a significantly dilated RV, indicating abnormal excursion of the tricuspid annulus and right ventricular dysfunction. Discussion: Pulmonary embolism is the third leading cause of death from cardiovascular disease following myocardial infarction and stroke.1 Approximately half of all PEs are diagnosed in the emergency department2 and early detection and treatment have been shown to improve outcomes and survival.3 Pulmonary emboli can present with a wide range of symptoms including dyspnea, chest pain, shock, or sustained hypotension, and can even be asymptomatic, making it a potentially challenging diagnosis.4 Studies show a high specificity of over 80% but low sensitivity of lower than 60%, for echocardiography in the diagnosis of PE

Rétraction: plagiat aggravé dans l'article Aspergillose broncho-pulmonaire allergique lors d'un asthme réfractaire: à propos d'un cas clinique. Khalid Lahmadi, Hind El Youssi, Jawad Rochdi, BoughrineNawal, Er-Rami Mohammed. The Pan African Medical Journal. 2015;20:350. (doi:10.11604/pamj.2015.20.350.6572)

Science.gov (United States)

2015-01-01

Cet article retracte l'article "Aspergillose broncho-pulmonaire allergique lors d'un asthme réfractaire: à propos d'un cas clinique. Khalid Lahmadi, Hind El Youssi, Jawad Rochdi, BoughrineNawal, Er-Rami Mohammed. The Pan African Medical Journal. 2015;20:350. (doi:10.11604/pamj.2015.20.350.6572)" PMID:26401219

Paradoxical emboli: demonstration using helical computed tomography of the pulmonary artery associated with abdominal computed tomography

International Nuclear Information System (INIS)

Delalu, P.; Ferretti, G.R.; Bricault, I.; Ayanian, D.; Coulomb, M.

2000-01-01

We report the case of a 60-year-old woman with a recent history of a cerebrovascular accident. Because of clinical suspicion of pulmonary embolism and negative Doppler ultrasound findings of the lower limbs, spiral computed tomography of the pulmonary artery was performed and demonstrated pulmonary emboli. We emphasize the role of computed tomography of the abdomen, performed 3 min after the thoracic acquisition, which showed an unsuspected thrombus within the abdominal aorta and the left renal artery with infarction of the left kidney. Paradoxical embolism was highly suspected on computed tomography data and confirmed by echocardiography which demonstrated a patent foramen ovale. (orig.)

Histiocytose langerhansienne pulmonaire révélée par un pneumothorax: à propos d’un cas

Science.gov (United States)

Sajiai, Hafsa; Rachidi, Mariam; Serhane, Hind; Aitbatahar, Salma; Amro, Lamyae

2016-01-01

L’histiocytose langerhansienne est une affection rare d’étiologie inconnue caractérisée par une infiltration d’un ou plusieurs organes, par des cellules de type Langerhans. Elle a une présentation clinique polymorphe. Nous rapportons le cas de Mr R.Y, âgé de 22 ans, tabagique à 8 PA, admis pour pneumothorax total spontané droit. Un drainage thoracique a été réalisé avec bonne évolution. La TDM thoracique de contrôle a objectivé de multiples formations kystiques diffuses prédominant aux lobes supérieurs. Un bilan a été réalisé à la recherche d’une histiocytose systémique mais s’est révélé négatif. L’évolution était marquée par la récidive du pneumothorax, le recours à une pleurodèse et la réalisation d’une biopsie pulmonaire qui a confirmé le diagnostic. Le diagnostic de l’HistiocytoseLangerhansienne doit être évoqué devant un pneumothorax sur poumon kystique. Le diagnostic est aisé devant un tableau clinique et radiologique évocateur. Néanmoins, les possibilités thérapeutiques restent limitées et la récidive du pneumothorax est fréquente. PMID:28154724

Influence of size of emboli on extravascular lung water

International Nuclear Information System (INIS)

Dawson, C.A.; Rickaby, D.A.; Linehan, J.H.

1989-01-01

We examined the influence of the size of emboli on the vascular volume (QL) and extravascular volume (Qev) accessible to 3 HOH during a single pass through an isolated dog lung lobe using the double indicator-dilution method with 125I-human serum albumin as the vascular indicator. As successively more beads of a given diameter (58, 548, or 3,175 microns) were introduced into a lung lobe, a linear relationship between QL and Qev was obtained as they both decreased. The slope of the graph of QL vs. Qev with progressive embolism was directly proportional to the bead diameter. This suggested an approach for estimating the total vascular volume in vessels smaller than the diameter of the beads before embolization, referred to as Qm. If it is assumed that most of the transvascular diffusional exchange of 3 HOH occurs in vessels smaller than the smallest beads (mainly capillaries) and that vessel obstruction does not change the ratio of Qev to the perfused capillary volume, the slope of the plot of QL vs. Qev is an estimate of the fraction, Qm/QL, of the total vascular volume in vessels smaller than the bead diameter. In the dog lung lobes studied, Qm/QL was approximately 0.64 for 58-microns vessels, 0.75 for 548-microns vessels, and 0.82 for 3,175-microns vessels. The results suggest that, with occlusion of vessels greater than or equal to 58 microns, 3 HOH does not diffuse significantly into unperfused regions

Preoperative 3D FSE T1-Weighted MR Plaque Imaging for Severely Stenotic Cervical ICA: Accuracy of Predicting Emboli during Carotid Endarterectomy

Directory of Open Access Journals (Sweden)

Yasushi Ogasawara

2016-10-01

Full Text Available The aim of the present study was to determine whether preoperative three-dimensional (3D fast spin-echo (FSE T1-weighted magnetic resonance (MR plaque imaging for severely stenotic cervical carotid arteries could accurately predict the development of artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA. Seventy-five patients underwent preoperative MR plaque imaging and CEA under transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. On reformatted axial MR image slices showing the maximum plaque occupation rate (POR and maximum plaque intensity for each patient, the contrast ratio (CR was calculated by dividing the internal carotid artery plaque signal intensity by the sternocleidomastoid muscle signal intensity. For all patients, the area under the receiver operating characteristic curve (AUC—used to discriminate between the presence and absence of microembolic signals—was significantly greater for the CR on the axial image with maximum plaque intensity (CRmax intensity (0.941 than for that with the maximum POR (0.885 (p < 0.05. For 32 patients in whom both the maximum POR and the maximum plaque density were identified, the AUCs for the CR were 1.000. Preoperative 3D FSE T1-weighted MR plaque imaging accurately predicts the development of artery-to-artery emboli during exposure of the carotid arteries in CEA.

AngioVac Aspiration for Paradoxical Emboli Protection through a Fenestrated Fontan During Central Venous Thrombus Manipulation

Energy Technology Data Exchange (ETDEWEB)

Al-Hakim, Ramsey, E-mail: ralhakim@mednet.ucla.edu [University of California, Department of Radiology, Division of Interventional Radiology (United States); Patel, Komal, E-mail: kdpatel@mednet.ucla.edu [University of California, Department of Anesthesiology, Division of Cardiothoracic Anesthesiology (United States); Moriarty, John M., E-mail: jmoriarty@mednet.ucla.edu [University of California, Department of Radiology, Division of Interventional Radiology (United States)

2015-06-15

This case reports describes a 39-year-old female with a history of surgically repaired hypoplastic left heart syndrome who presented with a left peripherally inserted central catheter (PICC) with associated large volume subclavian and brachiocephalic vein thrombus. Due to the presence of a right-to-left shunt via a fenestrated Fontan, there was clinical concern for a paradoxical embolism during removal of the PICC. The AngioVac aspiration system was successfully utilized to aspirate thromboemboli from the level of the proximal Glenn shunt during manipulation and removal of the PICC. This is the first reported case to demonstrate the safe and effective use of the AngioVac aspiration system for protection of paradoxical emboli through a cardiac right-to-left shunt during a procedure at high risk for thromboembolism.

Case series

African Journals Online (AJOL)

abp

1 oct. 2013 ... conduit, 23 patients ont eu une atteinte pulmonaire rhumatoïde à type de pneumonie infiltrante diffuse, de nodules rhumatoïdes pulmonaires ou de fibrose pulmonaire, 38 patients avaient un syndrome sec, dont 7 souffraient d'un goujerot sjogren retenu selon les critères de l'American European Consensus ...

Does computer-assisted detection of pulmonary emboli enhance severity assessment and risk stratification in acute pulmonary embolism?

International Nuclear Information System (INIS)

Engelke, C.; Schmidt, S.; Auer, F.; Rummeny, E.J.; Marten, K.

2010-01-01

Aim: To prospectively assess the value of computer-aided detection (CAD) for the computed tomography (CT) severity assessment of acute pulmonary embolism (PE). Materials and methods: CT angiographic scans of 58 PE-positive patients (34-89 years, mean 66 years) were analysed by four observers for PE severity using the Mastora index, and by CAD. Patients were stratified to three PE risk groups and results compared to an independent reference standard. Interobserver agreement was tested by Bland and Altman and extended kappa (Ke) statistics. Mastora index changes after CAD data review were tested by Wilcoxon signed ranks. Results: CAD detected 343 out of 1118 emboli within given arterial segments and a total of 155 out of 218 polysegmental emboli (segmental vessel-based sensitivity = 30.7%, embolus-based sensitivity = 71.2% false-positive rate = 4.1/scan). Interobserver agreement on PE severity [95% limits of agreement (LOA) = -19.7-7.5% and-5.5-3% for reader pairs 1 versus 2 and 3 versus 4, respectively was enhanced by consensus with CAD data (LOA = -6.5-5.4% and-3.7-2% for reader pairs 1 versus 2 and 3 versus 4, respectively). Simultaneously, the percentual scoring errors (PSE) were significantly decreased (PSE = 35.4 ± 31.8% and 5.1 ± 8.9% for readers1/2 and 2/3, respectively, and PSE = 27.6 ± 31% and 3.8 ± 6.2%, respectively, after CAD consensus; p ≤ 0.005). Misclassifications to PE risk groups occurred in 27.6, 24.1, 5.2, and 5.2% of patients for readers 1-4, respectively, (Ke = 0.74) and were corrected by CAD consensus in 56.3, 36, 33.3, and 33.3% of misclassified patients, respectively (Ke = 0.83; p < 0.05). Conclusion: Radiologists may benefit from consensus with CAD data that improve PE severity scores and stratification to PE risk groups.

Popliteal Venous Aneurysm: A Rare Cause of Recurrent Pulmonary Emboli and Limb Swelling

International Nuclear Information System (INIS)

Russell, David A.; Robinson, Graham J.; Johnson, Brian F.

2008-01-01

Popliteal venous aneurysm is a rare cause of recurrent pulmonary embolism, although the true incidence of aneurysm is probably underestimated. One-third of patients suffer further embolic events despite therapeutic anticoagulation. We report the case of a 59-year-old male who presented with recurrent PEs over a period of 12 years despite anticoagulation therapy. A thrombophilia screen and abdominal ultrasound were normal at that time. He reattended with recurrent pulmonary emboli, left calf swelling, and a mass in his left popliteal fossa causing limitation of knee movement. Venous duplex and MRI of his popliteal fossa demonstrated a thrombosed true popliteal venous aneurysm with popliteal and superficial femoral vein occlusion. In view of the mass effect we proceeded to surgical excision of his aneurysm after prophylactic placement of an IVC filter. The patient regained normal knee function with intensive inpatient physiotherapy. He has been recommenced on lifelong anticoagulant. The presentation, investigation, and management of the condition are briefly discussed. We suggest that a bilateral lower limb duplex is performed to exclude venous aneurysm in all patients presenting with pulmonary embolism in which an underlying source cannot otherwise be identified and no thrombophilic tendency is detected.

Osteomyelitis in lower limbs and pulmonary septic emboli - a case report and radiological diagnosis; Osteomielite em membros inferiores e embolia septica pulmonar na infancia - relato de um caso e diagnostico por imagem

Energy Technology Data Exchange (ETDEWEB)

Doria, Angela Schwarz [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Instituto de Crianca. Servico de Diagnostico por Imagem; Amaro Junior, Edson [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Inst. de Radiologia; Torre, Marcia Barbosa; Bogus, Luis Carlos Nogueira; Andrade, Marcio Ramalho; Barba, Mario Flores [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Instituto da Crianca. Servico de Radiologia; Scatigno Neto, Andre [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

1996-11-01

The authors describe a case of osteomyelitis in the lower limbs with subsequent septic emboli pulmonary spread, as a complication of the prior clinical presentation. They discuss clinical and pathological aspects, as well as, the possibility of diagnosis utilizing plain radiography, computed tomography and scintigraphy. (author) 10 refs., 7 figs.

Association of a patent foramen ovale with myocardial infarction and pulmonary emboli in a peripartum woman.

Science.gov (United States)

Ramineni, Rajesh; Daniel, George K

2010-10-01

Peripartum myocardial infarction is uncommon but devastating in young women. Although it is generally associated with arterial dissection, pregnancy-induced hypercoagulable state can also be a major contributor. Association of patent foramen ovale (PFO) adds to this potential risk. A 29-year-old postpartum female presented with worsening chest pressure, shortness of breath and syncope. She was hypotensive and tachycardic. A ventilation perfusion imaging displayed high probability for pulmonary emboli. With elevated cardiac enzymes and echocardiogram showing wall motion abnormalities, patient underwent percutaneous coronary angioplasty for a midvessel thrombus in the left anterior descending artery. Further workup showed a thrombus straddling into the left atrium via a PFO and a deep venous thrombus in the right iliac vein. Hormonal changes in pregnancy are noted to place young women in a hypercoagulable state. Screening for PFO in this group of patients with timely intervention might prevent a major systemic event caused by paradoxical embolus.

Case report

African Journals Online (AJOL)

abp

2 mai 2017 ... rétrécissement très serré à 1cm de la valve pulmonaire avec une bague fibreuse de 4 mm de diamètre où passait tout le flux du cœur droit. Il n'existe ... rapportées sont: la sténose sous aortique, la sténose valvulaire pulmonaire, la tétralogie de Fallot, les anomalies de retour veineux pulmonaire et la ...

Pulmonary decompression sickness at altitude: early symptoms and circulating gas emboli

Science.gov (United States)

Balldin, Ulf I.; Pilmanis, Andrew A.; Webb, James T.

2002-01-01

INTRODUCTION: Pulmonary altitude decompression sickness (DCS) is a rare condition. 'Chokes' which are characterized by the triad of substernal pain, cough, and dyspnea, are considered to be associated with severe accumulation of gas bubbles in the pulmonary capillaries and may rapidly develop into a life-threatening medical emergency. This study was aimed at characterizing early symptomatology and the appearance of venous gas emboli (VGE). METHODS: Symptoms of simulated-altitude DCS and VGE (with echo-imaging ultrasound) were analyzed in 468 subjects who participated in 22 high altitude hypobaric chamber research protocols from 1983 to 2001 at Brooks Air Force Base, TX. RESULTS: Of 2525 subject-exposures to simulated altitude, 1030 (41%) had symptoms of DCS. Only 29 of those included DCS-related pulmonary symptoms. Of these, only 3 subjects had all three pulmonary symptoms of chokes; 9 subjects had two of the pulmonary symptoms; and 17 subjects had only one. Of the 29 subject-exposures with pulmonary symptoms, 27 had VGE and 21 had severe VGE. The mean onset times of VGE and symptoms in the 29 subject-exposures were 42 +/- 30 min and 109 +/- 61 min, respectively. In 15 subjects, the symptoms disappeared during recompression to ground level followed by 2 h of oxygen breathing. In the remaining 14 cases, the symptoms disappeared with immediate hyperbaric oxygen treatment. CONCLUSIONS: Pulmonary altitude DCS or chokes is confirmed to be a rare condition. Our data showed that when diagnosed early, recompression to ground level pressure and/or hyperbaric oxygen treatment was 100% successful in resolving the symptoms.

Tuberculose pulmonaire révélée par un purpura thrombopénique chez l'enfant-à propos d'un cas clinique observé au service de pédiatrie des Cliniques Universitaires de Lubumbashi

Science.gov (United States)

Lubala, Toni Kasole; Mutombo, Augustin Mulangu; Munkana, Arthur Ndundula; Manika, Michel Muteya

2012-01-01

Nous rapportons le cas d'un enfant de 7 ans, de sexe masculin ayant présenté un purpura thrombopénique avec épistaxis, hématémèse, otorragies et pétéchies généralisées. Durant la même hospitalisation, nous avons mis en évidence une tuberculose pulmonaire documentée par la présence de bacilles acido-alcoolo résistants à l'examen des crachats. Nous avons observé une majoration du taux de plaquettes en une semaine de corticothérapie intraveineuse à haute dose, avant l'instauration d'une poly chimiothérapie antituberculeuse. Nous rappelons également la controverse que suscite la prise en charge de cette association rarement rapportée. PMID:23077696

Central nervous system decompression sickness and venous gas emboli in hypobaric conditions.

Science.gov (United States)

Balldin, Ulf I; Pilmanis, Andrew A; Webb, James T

2004-11-01

Altitude decompression sickness (DCS) that involves the central nervous system (CNS) is a rare but potentially serious condition. Identification of early symptoms and signs of this condition might improve treatment. We studied data from 26 protocols carried out in our laboratory over the period 1983-2003; all were designed to provoke DCS in a substantial proportion of subjects. The data set included 2843 cases. We classified subject-exposures that resulted in DCS as: 1) neurological DCS of peripheral and/or central origin (NEURO); 2) a subset of those that involved only the CNS (CNS); and 3) all other cases, i.e., DCS cases that did not have a neurological component (OTHER). For each case, echo imaging data were used to document whether venous gas emboli (VGE) were present, and their level was classified as: 1) any level, i.e., Grade 1 or higher (VGE-1); and 2) high level, Grade 4 (VGE-4). There were 1108 cases of altitude DCS in the database; 218 were classified as NEURO and 49 of those as CNS. VGE-1 were recorded in 83.8% of OTHER compared with 58.7% of NEURO and 55.1% of CNS (both p Hyperbaric oxygen (HBO) was used to treat about half of the CNS cases, while all other cases were treated with 2 h breathing 100% oxygen at ground level. Since only about half of the rare cases of hypobaric CNS DCS cases were accompanied by any level of VGE, echo imaging for bubbles may have limited application for use as a predictor of such cases.

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism.

Science.gov (United States)

Saric, Muhamed; Armour, Alicia C; Arnaout, M Samir; Chaudhry, Farooq A; Grimm, Richard A; Kronzon, Itzhak; Landeck, Bruce F; Maganti, Kameswari; Michelena, Hector I; Tolstrup, Kirsten

2016-01-01

Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Mise au point

African Journals Online (AJOL)

Le diagnostic de mal de Pott sous occipital associé à une localisation tuberculeuse pulmonaire a été retenu. Le traite- ment anti-tuberculeux a ... The follow-up was 6 years. Discussion : The sub occipital pain Pott localisation was rare. ... 6), associée à une opacité fibreuse rétractile du lobe pulmonaire supérieure gauche.

Pneumoblastome de l'adulte: rapport d'un nouveau cas et revue de ...

African Journals Online (AJOL)

Le blastome pulmonaire décrit surtout chez les enfants, est une tumeur rare. Elle représente 0.25 à 0.5% de toutes les tumeurs pulmonaires avec un pronostic très grave. Sur le plan histologique, il s'agit d'une tumeur à double composante: une composante épithéliale et une composante mésenchymateuse. Cliniquement ...

Drip, ship, and grip, then slice and dice: Comprehensive stroke center management of cervical and intracranial emboli.

Directory of Open Access Journals (Sweden)

Jason D Hinman

2013-07-01

Full Text Available BACKGROUND AND PURPOSE: Tandem acute thrombotic emboli in the cervical and intracranial arteries are an unusual case of stroke presenting unique management challenges. In regional systems of acute stroke care anchored by Comprehensive Stroke Centers, combined fibrinolytic, endovascular, and open surgical intervention is a new therapeutic option. SUMMARY OF CASE: A 28 year old male underwent retinal surgery, including post-operative neck compression and the next day presented to a primary stroke center with aphasia and right hemiplegia. Intravenous tissue plasminogen activator therapy was initiated and the patient was transferred to a comprehensive stroke center (CSC for higher level of care (drip and ship. Imaging at the CSC demonstrated tandem thrombi: a near occlusive lesion at the origin of the left cervical internal carotid artery and a total occlusion of the M1 segment of the left middle cerebral artery. Endovascular thrombectomy with the Solitaire stent retriever resulted in intracranial recanalization (grip. Immediately after the endovascular procedure, open carotid thrombectomy was performed to achieve cervical carotid revascularization without systemic heparinization (slice. Both cervical carotid and intracranial thrombi were processed for proteomic analysis via mass spectrometry (dice. CONCLUSION: Combined fibrinolytic, endovascular, and open surgical intervention can yield revascularization and good clinical outcome in cases of tandem lesions.

Detection of pulmonary emboli

International Nuclear Information System (INIS)

Sostman, H.D.; Gottschalk, A.

1988-01-01

The imaging evaluation of patients who may have pulmonary embolism (PE) is discussed. It is generally accomplished in two stages. In the first stage, clinical suspicion of PE leads to performance of an initial screening test. In current practice, this is the ventilation-perfusion (V/Q) scintigram, which is the safest and most sensitive noninvasive test. In the second stage, the results of the V/Q scan are considered in light of the clinical picture-degree of suspicion of PE, presence of alternate explanations for the clinical and scintigraphic findings, probability level and confidence of the scintigraphic diagnosis, and the likely consequences of therapy, misdiagnosis, or performance of a more invasive test. In some instances, this evaluation leads to performance of pulmonary angiography, an invasive test, for proof of the diagnosis. Although there are exceptions and special cases that do not follow this sequence, it is accurate for the majority of patients

Accuracy of spiral CT and 3D reconstruction in the detection of acute pulmonary embolism - development of an animal model using porcine lungs and technical specimens. Development of an animal model using porcine lungs and technical specimens

International Nuclear Information System (INIS)

Ries, B.G.; Kauczor, H.U.; Thelen, M.; Konerding, M.A.

2001-01-01

Purpose: To develop a model for simulation the CT morphologic situation of acute pulmonary embolism, to evaluate the accuracy of spiral CT and 3D reconstruction in the detection of artificial emboli and to investigate the influence of the orientation of emboli depending on z-axis orientation. Materials and Methods: Standardized artificial emboli made of wax and of defined size and shape were positioned into the pulmonary arteries of porcine lungs. Castings of the embolized pulmonary arterial trees were made by injection of a special opaque resin. After performance of spiral CT the data sets of the emboli and the pulmonary arteries were post-processed. The 3D segmentations were compared with the anatomic preparation to evaluate the accuracy of spiral CT/3D reconstruction-technique. Technical specimens simulating CT-morphology of acute embolized vessels underwent spiral CT in six different positions with respect to the z-axis. The CT data were reconstructed using a standardized and a contrastadapted method with interactive correction. The 3D emboli were analysed under qualitative aspects, and measurements of their extent were done. Results: In nearly 91%, there was complete agreement between CT and the corresponding findings at the anatomical preparation. Measurements of the 3D reconstructed technical specimens showed discrepancies of shape and size in dependence of the size of the original preparation, orientation and reconstruction technique. Overestimation up to 4 mm and underestimation to 2,2 mm were observed. Measurements of preparations with heights from 14 to 26 mm showed variances of ±1,5 mm (∝6-11%). Conclusion: The presented models are suitable to simulate CT morphology of acute pulmonary embolism under ex-vivo conditions. Accuracy in the detection of artificial emboli using spiral CT/3D reconstruction is affected by localization, size and orientation of the emboli and the reconstruction technique. (orig.) [de

The use of the cardiopulmonary flow index to detect cardiac defects in man and animal

International Nuclear Information System (INIS)

Cilliers, G.D.

1982-01-01

The efficiency of the cardiopulmonary flow index (CPFI) to detect cardiac defects and to evaluate therapy in man and animal is tested. The CPFI seems to be sensitive enough to evaluate vasodilator and inotropic therapy during cardiac failure with 'gousiekte' sheep. Pulmonary emboli in sheep is induced by injecting coagulated blood into the pulmonary circulation. These pulmonary emboli caused a decrease in the CPFI. CPFI recordings were made on patients, before and after aorta- and mitralvalve replacements. The CPFI is sensitive enough to detect the valve inefficiency and also to detect the improvement in the pump efficiency of the heart after the double valve replacement. The results obtained prove that the CPFI could have a proper place in modern cardiology to evaluate therapy (clinical and surgical) and also to distinguish between cardiac defects and pulmonary emboli

Impact of gas emboli and hyperbaric treatment on respiratory function of loggerhead sea turtles (Caretta caretta).

Science.gov (United States)

Portugues, Cyril; Crespo-Picazo, Jose Luis; García-Párraga, Daniel; Altimiras, Jordi; Lorenzo, Teresa; Borque-Espinosa, Alicia; Fahlman, Andreas

2018-01-01

Fisheries interactions are the most serious threats for sea turtle populations. Despite the existence of some rescue centres providing post-traumatic care and rehabilitation, adequate treatment is hampered by the lack of understanding of the problems incurred while turtles remain entrapped in fishing gears. Recently it was shown that bycaught loggerhead sea turtles ( Caretta caretta ) could experience formation of gas emboli (GE) and develop decompression sickness (DCS) after trawl and gillnet interaction. This condition could be reversed by hyperbaric O 2 treatment (HBOT). The goal of this study was to assess how GE alters respiratory function in bycaught turtles before recompression therapy and measure the improvement after this treatment. Specifically, we assessed the effect of DCS on breath duration, expiratory and inspiratory flow and tidal volume ( V T ), and the effectiveness of HBOT to improve these parameters. HBOT significantly increased respiratory flows by 32-45% while V T increased by 33-35% immediately after HBOT. Repeated lung function testing indicated a temporal increase in both respiratory flow and V T for all bycaught turtles, but the changes were smaller than those seen immediately following HBOT. The current study suggests that respiratory function is significantly compromised in bycaught turtles with GE and that HBOT effectively restores lung function. Lung function testing may provide a novel means to help diagnose the presence of GE, be used to assess treatment efficacy, and contribute to sea turtle conservation efforts.

Mélanome endobronchique

Directory of Open Access Journals (Sweden)

Fatima zohra Mernissi

2010-08-01

Full Text Available Le mélanome malin a un potentiel métastatique important. Les métastases pulmonaires du mélanome sont communes cependant la localisation endobronchique reste rare et pose le problème de son origine primitive ou secondaire. Nous rapportons le cas d’un mélanome pulmonaire qui présente des particularités intéressantes: une lésion cutanée présumée primitive totalement régressive, la présentation radio clinique mimant parfaitement un cancer bronchique primitif, un aspect endoscopique bourgeonnant et grisâtre dont l’étude histologique a permis de poser le diagnostic, une agressivité tumorale avec une extension intracardiaque et bourgeon tumoral intra cavitaire. A travers cette observation, les auteurs étudient les caractéristiques radio-cliniques pouvant distinguer le mélanome pulmonaire primitif du secondaire; la localisation endobronchique avec une revue de la littérature sur les métastases endo bronchiques; le bilan d’extension à entamer en cas de mélanome pulmonaire ainsi que les difficultés thérapeutiques posés par ce type de lésion dont le pronostic reste péjoratif.

Cardiac Arrest Secondary to Bilateral Pulmonary Emboli following Arteriovenous Fistula Thrombectomy: A Case Report with Review of the Literature

Directory of Open Access Journals (Sweden)

Avni Shah

2012-01-01

Full Text Available Number of patients with End Stage Renal Disease (ESRD is growing worldwide. Hemodialysis remains the main modality of renal replacement therapy for ESRD patients. A patent hemodialysis access (arteriovenous fistula or arteriovenous graft plays a key role in successful delivery of hemodialysis. Common vascular access issues encountered by patients and nephrologists are thrombosis and infection. The thrombosed access is declotted by various percutaneous techniques these days by multiple outpatient access centers in a timely fashion. Thrombolysis can give rise to various complications, a few of which can be life threatening. A young hemodialysis patient underwent percutaneous thrombolysis of his clotted arteriovenous fistula. Outpatient access thrombectomy was complicated immediately afterwards with cardiac arrest requiring cardiac resuscitation in the recovery room. The patient was admitted to intensive care unit after life sustaining care. Work up revealed multiple pulmonary emboli to both lung fields on CT scan of the chest. Patient was anticoagulated and discharged from the hospital. Thrombolysis of clotted hemodialysis access is associated commonly with occurrences of pulmonary embolic which are usually asymptomatic. Massive pulmonary embolization due to access thrombolysis is rare. Nephrologists and radiologists should be aware of this dangerous complication particularly in patients with preexisting cardiopulmonary disease.

In vitro evaluation of gaseous microemboli handling of cardiopulmonary bypass circuits with and without integrated arterial line filters.

Science.gov (United States)

Liu, Saifei; Newland, Richard F; Tully, Phillip J; Tuble, Sigrid C; Baker, Robert A

2011-09-01

The delivery of gaseous microemboli (GME) by the cardiopulmonary bypass circuit should be minimized whenever possible. Innovations in components, such as the integration of arterial line filter (ALF) and ALFs with reduced priming volumes, have provided clinicians with circuit design options. However, before adopting these components clinically, their GME handling ability should be assessed. This study aims to compare the GME handling ability of different oxygenator/ALF combinations with our currently utilized combination. Five commercially available oxygenator/ALF combinations were evaluated in vitro: Terumo Capiox SX25RX and Dideco D734 (SX/D734),Terumo Capiox RX25R and AF125 (RX/AF125), Terumo FX25R (FX), Sorin Synthesis with 102 microm reservoir filter (SYN102), and Sorin Synthesis with 40 microm reservoir filter (SYN40). GME handling was studied by introducing air into the venous return at 100 mL/min for 60 seconds under two flow/ pressure combinations: 3.5 L/min, 150 mmHg and 5 L/min, 200 mmHg. Emboli were measured at three positions in the circuit using the Emboli Detection and Classification (EDAC) Quantifier and analyzed with the General Linear Model. All circuits significantly reduced GME. The SX/D734 and SYN40 circuits were most efficient in GME removal whilst the SYN102 handled embolic load (count and volume) least efficiently (p circuits (p circuits (p circuits to handle GME. Venous reservoir design influenced the overall GME handling ability. GME removal was less efficient at higher flow and pressure, and for smaller sized emboli. The clinical significance of reducing GME requires further investigation.

Pollution Atmosphérique et Santé: Corrélation ou Causalité? Le Cas de la Relation entre l'Exposition aux Particules et la Mortalité Cardio-pulmonaire.

Science.gov (United States)

Dab, William; Ségala, Claire; Dor, Frédéric; Festy, Bernard; Lameloise, Philippe; Moullec, Yvon Le; Tertre, Alain Le; Médina, Sylvia; Quénel, Philippe; Wallaert, Benoît; Zmirou, Et Denis

2001-02-01

De nombreuses études épidémiologiques ont observé dans des contextes différents une faible relation à court terme entre les particules et la mortalité cardio-pulmonaire, même quand les normes de qualité de l'air n'étaient pas dépassées. La causalité de cette relation est un enjeu de santé publique en raison de l'importance de la population exposée. Notre objectif est de faire l'inventaire critique des arguments utilisés dans 15 revues de la littérature publiées. Nous expliquons l'importance de distinguer la validité de la causalité et analysons de façon systématique les différents critères de jugement dans le contexte des études écologiques temporelles. Notre conclusion est que la relation observée est valide et que la plupart des critères de causalité sont respectés. Diminuer le niveau d'exposition des populations aux particules est souhaitable. En Europe, en agissant à la source, notamment sur les émissions Diesel, on diminuera aussi d'autres polluants qui peuvent jouer un rôle sanitaire. Aux États-Unis, la situation est plus complexe car les particules sont surtout secondaires. Il est également indispensable de poursuivre les recherches pour mieux connaître les déterminants des expositions globales des individus et mieux comprendre le rôle toxique des différents facteurs physico-chimiques des particules.

Computer-assisted detection of pulmonary embolism: performance evaluation in consensus with experienced and inexperienced chest radiologists

International Nuclear Information System (INIS)

Engelke, Christoph; Marten, Katharina; Schmidt, Stephan; Auer, Florian; Bakai, Annemarie

2008-01-01

The value of a computer-aided detection tool (CAD) as second reader in combination with experienced and inexperienced radiologists for the diagnosis of acute pulmonary embolism (PE) was assessed prospectively. Computed tomographic angiography (CTA) scans (64 x 0.6 mm collimation; 61.4 mm/rot table feed) of 56 patients (31 women, 34-89 years, mean = 66 years) with suspected PE were analysed by two experienced (R1, R2) and two inexperienced (R3, R4) radiologists for the presence and distribution of emboli using a five-point confidence rating, and by CAD. Informed consent was obtained from all patients. Results were compared with an independent reference standard. Inter-observer agreement was calculated by kappa, confidence assessed by ROC analysis. A total of 1,116 emboli [within mediastinal (n = 72), lobar (n 133), segmental (n = 465) and subsegmental arteries (n = 455)] were included. CAD detected 343 emboli (sensitivity = 30.74%, correct-positive rate 6.13/patient; false-positive rate = 4.1/patient). Inter-observer agreement was good (R1, R2: κ = 0.84, 95% CI = 0.81-0.87; R3, R4: κ = 0.79, 95% CI = 0.76-0.81). Extended inter-observer agreement was higher in mediastinal and lobar than in segmental and subsegmental arteries (κ 0.84-0.86 and κ = 0.51-0.58 for mediastinal/lobar and segmental/subsegmental arteries, respectively P 0.05). Particularly inexperienced readers benefit from consensus with CAD data, greatly improving detection of segmental and subsegmental emboli. This system is advocated as a second reader. (orig.)

Avaliação in vitro de um novo filtro de veia cava In vitro evaluation of a new vena cava filter

Directory of Open Access Journals (Sweden)

Domingo Marcolino Braile

2005-01-01

Full Text Available OBJETIVO: O objetivo do estudo foi avaliar a eficácia de um novo filtro de veia cava, de baixo perfil, na retenção de coágulos em modelo in vitro. MÉTODO: O filtro consiste em dois cones opostos pelo ápice. O cone distal é formado por oito hastes de aço inoxidável, que têm a função de retenção dos êmbolos. O cone proximal é constituído de quatro hastes, cuja função é ancorar e centralizar. Os filtros foram introduzidos e fixados no interior de um tubo de PVC transparente de 25, 30 e 35 mm de diâmetro interno, em posição vertical, e conectados com um sistema pulsátil de fluxo (bomba peristáltica. Foi utilizado, para veículo, um reservatório com solução salina (0,9% com 40% de glicerina, mantido em temperatura ambiente. Confeccionaram-se trombos com sangue bovino em tubos plásticos de 3, 4,5 e 6 mm de diâmetro e, posteriormente, foram segmentados nas medidas de 10, 15, 20 e 30 mm de comprimento, totalizando 12 diferentes tamanhos. Realizaram-se 100 liberações para cada tipo de êmbolo e tamanho das cânulas, totalizando 3.600 eventos. Foram feitos lançamentos seqüenciais com cinco êmbolos, sendo 10 para cada tamanho de êmbolo e cânulas, totalizando 360 eventos. Fez-se avaliação da capacidade de retenção dinâmica utilizando os três diferentes tamanhos de cânulas com 100 eventos cada, totalizando 300 eventos. RESULTADOS: Detectou-se que o diâmetro e comprimento dos êmbolos, assim como diâmetros da cânula, podem comprometer a eficácia do filtro. A média de captura de êmbolos pelos filtros foi de 80,5% nas cânulas de 35 mm, 88,7% para cânulas de 30 mm e 86,6% para cânulas de 25 mm. CONCLUSÃO: Conclui-se que a eficácia desse filtro sofre interferência relacionada ao tamanho dos êmbolos e diâmetro da cânula.OBJECTIVE: The objective of the current study was to evaluate the efficacy of a new low-profile vena cava filter in the retention of emboli in an in vitro model. METHOD: The filter consists

Identification d’une nouvelle molécule d’intérêt chez le cheval atteint d’obstruction récurrente des voies respiratoires: La Pentraxine 3

OpenAIRE

Ramery, Eve

2010-01-01

L’ORVR ou obstruction récurrente des voies respiratoires (ORVR) est la cause la plus fréquente de maladie pulmonaire chronique chez le cheval adulte. La maladie se caractérise par une hyperréactivité bronchique, une production excessive de mucus et une inflammation neutrophilique pulmonaire qui ont pour effet de réduire la compliance dynamique du poumon et d’augmenter la résistance des voies respiratoires au débit aérien. Alors que la maladie est une entité documentée dans la littérature depu...

Novel J stents reduce the risk of embolic stroke in vitro

International Nuclear Information System (INIS)

Bartoli, Carlo R.; Spence, Paul A.; Giridharan, Guruprasad A.

2010-01-01

Two and a half million Americans with atrial fibrillation are at an elevated risk for embolic stroke. Warfarin therapy is standard treatment for high-risk patients, yet 40-65% of elderly patients do not receive anticoagulation therapy due to bleeding complications. To address this clinical need, we are evaluating a minimally invasive stent-based stroke prevention device to divert emboli from entering the arterial supply of the brain. The feasibility of a J-shaped stroke prevention device was tested in a mock circulatory loop. Sixteen sets of 100 simulated emboli (1-5 mm 3 ) were injected into the left atrium with and without J stents protecting the aortic arch vessels. To determine efficacy, emboli were trapped in filters in the aortic arch vessels and distal aorta for manual counting. J stents decreased the number of emboli that entered the brachiocephalic trunk by 93.7% (p<0.0001), left common carotid artery by 79.8% (p<0.0001), and left subclavian artery by 89.7% (p<0.0001). In a mock circulation, J stents positioned in the aortic arch vessels and oriented downstream of aortic flow significantly decreased the number of emboli that entered the aortic arch vessels. These results warrant further investigation to determine the safety and efficacy of this prophylactic intervention to reduce embolic events, and chronic large animal studies are underway. (orig.)

Novel J stents reduce the risk of embolic stroke in vitro

Energy Technology Data Exchange (ETDEWEB)

Bartoli, Carlo R. [University of Louisville, M.D./Ph.D. Program, Louisville, KY (United States); Spence, Paul A. [SCR Inc., Louisville, KY (United States); Giridharan, Guruprasad A. [Cardiovascular Innovation Institute, University of Louisville, Department of Bioengineering, Louisville, KY (United States)

2010-05-15

Two and a half million Americans with atrial fibrillation are at an elevated risk for embolic stroke. Warfarin therapy is standard treatment for high-risk patients, yet 40-65% of elderly patients do not receive anticoagulation therapy due to bleeding complications. To address this clinical need, we are evaluating a minimally invasive stent-based stroke prevention device to divert emboli from entering the arterial supply of the brain. The feasibility of a J-shaped stroke prevention device was tested in a mock circulatory loop. Sixteen sets of 100 simulated emboli (1-5 mm{sup 3}) were injected into the left atrium with and without J stents protecting the aortic arch vessels. To determine efficacy, emboli were trapped in filters in the aortic arch vessels and distal aorta for manual counting. J stents decreased the number of emboli that entered the brachiocephalic trunk by 93.7% (p<0.0001), left common carotid artery by 79.8% (p<0.0001), and left subclavian artery by 89.7% (p<0.0001). In a mock circulation, J stents positioned in the aortic arch vessels and oriented downstream of aortic flow significantly decreased the number of emboli that entered the aortic arch vessels. These results warrant further investigation to determine the safety and efficacy of this prophylactic intervention to reduce embolic events, and chronic large animal studies are underway. (orig.)

Regional lung function evaluation with nitrogen-13

Energy Technology Data Exchange (ETDEWEB)

Ahluwalia, B; Brownell, G L; Hales, C; Kazemi, H

1981-10-01

Regional ventilation and perfusion studies are routinely performed with molecular nitrogen-13 (a short-lived positron emitter), a multicrystal positron camera, and a computer. These studies have the advantage of viewing with equal sensitivity all sections of the lung simultaneously. Nitrogen-13 is less soluble than xenon in blood and therefore allows more accurate ventilation imaging. The short half-life of the radiopharmaceutical allows simultaneous ventilation and perfusion scintigraphy of the lung. Unlike other imaging techniques in which the residual radioactivity persists in the lung for hours, nitrogen-13 is rapidly cleared allowing repetitive imaging. Ventilation and perfusion studies are part of the routine preoperative evaluation for lung cancer resection or for bullectomy in patients with chronic obstructive pulmonary disease and for assessment of pulmonary emboli in the presence of chronic obstructive disease.

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica Particulate emboli capture by an intra-aortic filter device during aortic valve replacement

Directory of Open Access Journals (Sweden)

Osanan Amorim Leite Filho

2008-09-01

-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes. Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed. RESULTS: There were no strokes or gross neurological events. There were no cases of postoperative renal failure. No deaths were reported during hospitalization. Particulate emboli were found in five (38.5% of the filters. On histological analysis of the particulate emboli captured, two (40% contained fibrin, two (40% presented conjunctive tissue, one (20% contained red blood cells and in one it was not possible to determine the nature of the particulates captured. CONCLUSION: The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis.

Ventilatory-perfusory pulmonary scintigraphy as non invasive election procedure in patients with clinical suspicion of pulmonary thrombo emboli

International Nuclear Information System (INIS)

Altamirano L, J.

2004-01-01

30 patients were studied with suspicion of pulmonary thrombo emboli PTE, in a period of 9 months (January-September of 1992), 20 women and 10 men, with an age range of 26 to 88 years, average of 57.59 18.89. With respect to the clinical data, 24 presented breathing inadequacy (80%). 16 tachycardia (54%), 15 with thoracic pain (50%) and 4 with hemoptysis (13%). Of the cabinet studies, 12 presented electrocardiographic changes (IF, QIII, and TIII) (40%), 14 presented abnormalities in arterial gases. In the thorax tele, 8 presented abnormality; as spill, pneumonia, diaphragmatic elevation, etc. (26.6%) and of 14 the result was not reported (46 6%). They were carried out in all the patients, the ventilatory studies and perfusories in that order. A Siemens mark scintillation camera was used, with a collimator of low energy and of high resolution; the information was stored in a floppy disk, and later on they were printed in radiographic plaques of high resolution. The ventilatory study was carried out with 30 mCi of 99m Tc-DTPA, in radio aerosol form, emitted by a micro nebulizer, to which was applied a pressure of oxygen of 10 ml-min; during 10 to 15 minutes. They took projections antero, posterior, oblique antero left and right, oblique posterior left and right, each one with an acquisition of 150000 counts, or during 5 minutes. Later on and remaining the patient in supine position, was carried out the perfusory study, applying 3-4 mCi of 99 Tc-MAA for endo venous via; they took the same projections that the ventilatory study, but with a density of information greater (500 000 counts each one). Both studies are printed in a radiographic plaque of high resolution, with which is interpreted and the study is filed. (Author)

Cerebral gas embolism due to upper gastrointestinal endoscopy.

Science.gov (United States)

ter Laan, Mark; Totte, Erik; van Hulst, Rob A; van der Linde, Klaas; van der Kamp, Wim; Pierie, Jean-Pierre E

2009-07-01

Cerebral gas embolism as a result of upper gastrointestinal endoscopy is a rare complication and bares a high morbidity. A patient is presented who underwent an upper endoscopy for evaluation of a gastric-mediastinal fistula after subtotal oesophagectomy and gastric tube reconstruction because of oesophageal cancer. During the procedure, cerebral gas emboli developed resulting in an acute left-sided hemiparesis. After hyperbaric oxygen therapy, the patient recovered almost completely. The aetiology and treatment is discussed based on the reviewed literature. Once cerebral gas emboli are recognized, patient outcome can be improved by hyperbaric oxygen therapy.

Accuracy of spiral CT and 3D reconstruction in the detection of acute pulmonary embolism - development of an animal model using porcine lungs and technical specimens. Development of an animal model using porcine lungs and technical specimens; Diagnostik der akuten Lungenembolie mittels Spiral-CT und 3D-Rekonstruktion. Entwicklung eines Tiermodells und technischer Probekoerper im Ex-vivo-Experiment

Energy Technology Data Exchange (ETDEWEB)

Ries, B.G. [Klinik und Poliklinik fuer Radiologie, Univ. Mainz (Germany); Klinik fuer Radiologische Diagnostik, RWTH Aachen (Germany); Kauczor, H.U.; Thelen, M. [Klinik und Poliklinik fuer Radiologie, Univ. Mainz (Germany); Konerding, M.A. [Anatomisches Inst., Mainz Univ (Germany)

2001-02-01

Purpose: To develop a model for simulation the CT morphologic situation of acute pulmonary embolism, to evaluate the accuracy of spiral CT and 3D reconstruction in the detection of artificial emboli and to investigate the influence of the orientation of emboli depending on z-axis orientation. Materials and Methods: Standardized artificial emboli made of wax and of defined size and shape were positioned into the pulmonary arteries of porcine lungs. Castings of the embolized pulmonary arterial trees were made by injection of a special opaque resin. After performance of spiral CT the data sets of the emboli and the pulmonary arteries were post-processed. The 3D segmentations were compared with the anatomic preparation to evaluate the accuracy of spiral CT/3D reconstruction-technique. Technical specimens simulating CT-morphology of acute embolized vessels underwent spiral CT in six different positions with respect to the z-axis. The CT data were reconstructed using a standardized and a contrastadapted method with interactive correction. The 3D emboli were analysed under qualitative aspects, and measurements of their extent were done. Results: In nearly 91%, there was complete agreement between CT and the corresponding findings at the anatomical preparation. Measurements of the 3D reconstructed technical specimens showed discrepancies of shape and size in dependence of the size of the original preparation, orientation and reconstruction technique. Overestimation up to 4 mm and underestimation to 2,2 mm were observed. Measurements of preparations with heights from 14 to 26 mm showed variances of {+-}1,5 mm ({proportional_to}6-11%). Conclusion: The presented models are suitable to simulate CT morphology of acute pulmonary embolism under ex-vivo conditions. Accuracy in the detection of artificial emboli using spiral CT/3D reconstruction is affected by localization, size and orientation of the emboli and the reconstruction technique. (orig.) [German] Ziel: Die Entwicklung

Delayed hyperbaric oxygen therapy for air emboli after open heart surgery: case report and review of a success story.

Science.gov (United States)

Niyibizi, Eva; Kembi, Guillaume Elyes; Lae, Claude; Pignel, Rodrigue; Sologashvili, Tornike

2016-12-05

The current case describes a rare diagnosis of iatrogenic air emboli after elective cardiopulmonary bypass that was successfully treated with delayed hyperbaric oxygen therapy, with good clinical evolution in spite of rare complications. A 35 years old male was admitted to the intensive care unit (ICU) for post-operative management after being placed on cardiopulmonary bypass (CPB) for an elective ventricular septal defect closure and aortic valvuloplasty. The patient initially presented with pathologically late awakening and was extubated 17 h after admission. Neurologic clinical status after extubation showed global aphasia, mental slowness and spatio-temporal disorientation. The injected cerebral CT scan was normal; the EEG was inconclusive (it showed metabolic encephalopathy without epileptic activity); and the cerebral MRI done 48 h after surgery showed multiple small subcortical acute ischemic lesions, mainly on the left fronto- parieto- temporo-occipital lobes. He was taken for hyperbaric oxygen therapy (HOT) over 54 h after cardiac surgery. The first session ended abruptly after 20 min when the patient suffered a generalised tonico-clonic seizure, necessitating a moderately rapid decompression, airway management, and antiepileptic treatment. In total, the patient received 7 HOT sessions over 6 days. He demonstrated full neurological recovery at 4 weeks and GOS (Glasgow Outcome Scale) of 5 out of 5 even after a long delay in initial management. Convulsions are a rare complication of HOT either due to reperfusion syndrome or hyperoxic toxicity and can be managed. Prior imaging by MRI or tympanic paracentesis (myringotomy) should not add further delay of treatment. HOT should be initiated upon late awakening and/or neurologic symptoms after CPB heart surgery, after exclusion of formal counter-indications, even if the delay exceeds 48 h.

Clinical features of pulmonary emboli in patients following cytoreductive surgery (peritonectomy) and hyperthermic intraperitoneal chemotherapy (hipec), a single centre experience.

Science.gov (United States)

Vukadinovic, V; Chiou, J D; Morris, D L

2015-05-01

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can be complicated by pulmonary emboli (PE). Patients are at high risk due to surgery, underlying malignancy, immobility and indwelling lines. This paper aims to identify clinically significant signs and symptoms preceding acute PE in post CRS-HIPEC patients, assess the PE investigative approach in this population and the significance of PE on patient management. 25 cases with a positive and 50 controls with a negative CTPA for PE were isolated from the peritonectomy database at St George Hospital Sydney, January 2006 to July 2013. Vital signs, patient symptoms, adjunct investigation findings and patient outcomes were collected and graphed in Microsoft Excel. P values and 95% confidence intervals were calculated using GraphPad Prism version 6. 25 of 562 (4.4%) CRS-HIPEC patients were diagnosed with acute PE. Raised body temperature was the only statistically significant clinical finding that differentiated cases from controls (p value 0.02). Arterial blood gas results did not correlate with PE (p values 0.62; 0.29; 0.55, 0.84). Troponin, ECG and CXR were not routinely conducted. CXR and CTPA findings were similar between cases and controls (Table 4). PE patients required lower supplementary oxygen and escalation of care. Body temperature is the only statistically significant clinical finding observed with PE. We recommend a standardised investigative approach consisting of troponin, ECG and CXR. PE in CRS-HIPEC does not cause significant cardio-respiratory dysfunction, or escalation of care. PE rates are higher than other major surgeries, thus we propose a trial with increased chemical prophylaxis in CRS-HIPEC patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

Particularites radio-cliniques et bacteriologique de la tuberculose ...

African Journals Online (AJOL)

Particularites radio-cliniques et bacteriologique de la tuberculose pulmonaire chez les patients infectees par le vih au centre hospitalier Sylvanus Olympio de Lome. Radio-clinical and bacteriologial peculiarities of the pulmonary tuberculosis in hiv infe.

WEST AFRICAN JOURNAL OF MEDICINE

African Journals Online (AJOL)

user1

Negative Pressure Pulmonary Oedema Following Adenoidectomy Under. General Anaesthesia: A Case Series œdème pulmonaire par pression négative ... progressed to NPPE which was diagnosed on clinical parameters. The children were ...

Images in medicine

African Journals Online (AJOL)

une tuberculose pulmonaire. La patiente était mise antituberculeux avec bonne amélioration clinique et radiologique. Figure 1: Foyer de dilatation des bronches séquellaire droit. Pan African Medical Journal – ISSN: 1937- ...

Paradoxical embolism: computed tomography demonstration

International Nuclear Information System (INIS)

Kaye, J.; Hayward, M.

2001-01-01

Paradoxical emboli are rare and often presumptively diagnosed. A case of paradoxical embolism, in which both the arterial and venous emboli were documented on CT, is described. While paradoxical emboli are not infrequently diagnosed clinically on a presumptive basis, it is rare to document them with imaging such as CT which, in the present case, confirmed the diagnosis. Copyright (2001) Blackwell Science Pty Ltd

Evaluating How Circle of Willis Topology Affects Embolus Distribution in the Brain

Science.gov (United States)

Jani, Neel; Mukherjee, Debanjan; Shadden, Shawn

2016-11-01

Embolic stroke occurs when fragmented cellular or acellular material (emboli) travels to the brain to occlude an artery. Understanding the transport of emboli across unsteady, pulsatile flow in complex arterial geometries is challenging and influenced by a range of factors, including patient anatomy. The work herein develops the modeling and mechanistic understanding of how embolus transport is affected by the arterial connections at the base of the brain known as the Circle of Willis (CoW). A majority of the human population has an incomplete CoW anatomy, with connections either missing or ill-developed. We employ numerical simulations combining image-based modeling, computational fluid dynamics, discrete particle dynamics, and a sampling based analysis to compare collateral flow through the most prevalent CoW topologies, to determine embolus distribution fractions among vessels in the CoW, and to investigate the role of inertial effects in causing differences in flow and embolus distribution. The computational framework developed enables characterization of the complex interplay of anatomy, hemodynamics, and embolus properties in the context of embolic stroke as well as statistical analysis of embolism risks across common CoW variations.

Pan African Medical Journal - Vol 28, No 1 (2017)

African Journals Online (AJOL)

Intérêt de la TEP-TDM dans le cancer broncho-pulmonaire primitif non à petite ..... of Nigerian children: effects of socio-economic, nutritional and housing factors ... among antenatal attendees at health facilities in West Pokot county, Kenya ...

Pan African Medical Journal

African Journals Online (AJOL)

Intérêt de la TEP-TDM dans le cancer broncho-pulmonaire primitif non à petite ..... framework governing herbal medicine use and practice in Kenya: a review ... of Nigerian children: effects of socio-economic, nutritional and housing factors ...

Tuméfaction du muscle pectoral révélant une tuberculose ...

African Journals Online (AJOL)

Abstract. La tuberculose des parties molles représente l'une des formes rares de la tuberculose extra pulmonaire, la localisation musculaire isolée est parailleurs exceptionnelle. ... We here report the original case of a young immunocompetent patient with isolated muscular tuberculosis involving major pectoralis muscle.

Original Paper Efficacité d'un produit répulsif à base de l ...

African Journals Online (AJOL)

L500

d'Anthranilate de Methyl ont été réalisés au champ, en station de recherche et au laboratoire. L'essai réalisé à ..... coagulation associés à une atrophie des fibres musculaires ... et c) une atteinte pulmonaire de type d'une pneumopathie.

Detection of cerebral arterial gas embolism using regional cerebral oxygen saturation, quantitative electroencephalography, and brain oxygen tension in the swine

NARCIS (Netherlands)

Weenink, R. P.; Hollmann, M. W.; Stevens, M. F.; Kager, J.; van Gulik, T. M.; van Hulst, R. A.

2014-01-01

Cerebral air emboli occur as a complication of invasive medical procedures. The sensitivity of cerebral monitoring methods for the detection of air emboli is not known. This study investigates the utility of electroencephalography and non-invasively measured cerebral oxygen saturation in the

Bilateral sudden sensorineural hearing loss as a first symptom of infective endocarditis: two case reports.

Science.gov (United States)

Chroni, M; Prappa, E; Kokkevi, I

2018-04-01

Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature. This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation. These patients were later diagnosed with infective endocarditis, at two and seven months following the sudden sensorineural hearing loss respectively, showing that septic emboli had been the cause of sudden sensorineural hearing loss. Septic emboli should be considered as a possible cause of sudden sensorineural hearing loss in cases of total hearing loss. This form of hearing loss should prompt the otolaryngologist to further investigate for infective endocarditis.

Browse Title Index

African Journals Online (AJOL)

Mariama Bammo, Pauline Dioussé, Mariétou Thiam, Madoky Maguatte Diop, Adama Berthé, Flugence Abdou Faye, Thierno Abdoul Aziz Diallo, Fatou Seck Sarr, Haby Dione, Papa Souleymane Touré, Bernard Marcel Diop, Mamadou Mourtalla Ka. Vol 10 (2011), Les aspergillomes pulmonaires: à propos de 37 cas à ...

Author Details

African Journals Online (AJOL)

Rguibi, Mustapha Idrissi. Vol 13, No 1 (2012) - Articles Intrathoracic extrapulmonary hydatid cysts. Abstract PDF · Vol 14, No 1 (2013) - Articles Forme pseudotumorale de la tuberculose pulmonaire et les difficultés diagnostic: à propos d'un cas. Abstract PDF. ISSN: 1937-8688. AJOL African Journals Online. HOW TO USE ...

Case report

African Journals Online (AJOL)

abp

8 déc. 2017 ... Résumé. L'aspergillome endobronchique et pulmonaire intracavitaire peut mimer à une néoplasie bronchique cliniquement et radiologiquement, ainsi une recherche systématique d'une association est impérative. Une association confirmée change complètement le pronostic ainsi que la conduite.

Research

African Journals Online (AJOL)

raoul

30 mars 2011 ... Introduction: L'incidence du cancer de la Jonction œsogastrique (JOG) ne .... a été de 8.5 %, les causes du décès sont dominées par les complications ... fragiles, dénutris et dont l'état pleuro-pulmonaire n'était pas toujours.

Experience with three percutaneous vena cava filters

International Nuclear Information System (INIS)

McCowan, T.C.; Ferris, E.J.; Harshfield, D.L.; Hassell, D.R.; Baker, M.L.

1987-01-01

Twenty-one Kimray-Greenfield, 33 bird's nest, and 19 Amplatz vena cava filters were placed percutaneously. The Kimray-Greenfield filter was the most difficult to insert. The major problem was the insertion site, which required venipuncture with a 24-F catheter. Minor hemorrhage was frequent, and femoral vein thrombosis occurred in four patients. No migration, caval thrombosis, or pulmonary emboli were seen after Kimray-Greenfield filter placement. The bird's nest filter was relatively easy to insert, although in two cases the filter prongs could not be adequately seated in the wall of the inferior vena cava. Three patients with bird's nest filters had thrombosis below the filter, and three filters migrated to the heart. One migrated filter could not be removed. One patient had multiple small pulmonary emboli at autopsy. No other pulmonary emboli after filter placement were noted. The Amplatz filter was the easiest of the three filters to insert. Only one patient with an Amplatz filter had thrombosis of the vena cava below the filter. No filter migrations were documented, and no recurrent pulmonary emboli were found on clinical or radiologic follow-up. The Amplatz vena cava filter is easier to place than percutaneous Kimray-Greenfield or bird's nest filters, has a low complication rate, and has proven to be clinically effective in preventing pulmonary emboli

Dual-energy CT based vascular iodine analysis improves sensitivity for peripheral pulmonary artery thrombus detection: An experimental study in canines

Energy Technology Data Exchange (ETDEWEB)

Tang, Chun Xiang [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002 (China); Zhang, Long Jiang, E-mail: kevinzhlj@163.com [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002 (China); Han, Zong Hong; Zhou, Chang Sheng [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002 (China); Krazinski, Aleksander W.; Silverman, Justin R. [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Schoepf, U. Joseph [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002 (China); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (United States); Lu, Guang Ming, E-mail: cjr.luguangming@vip.163.com [Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002 (China)

2013-12-01

Purpose: To evaluate the performance of dual-energy CT (DECT) based vascular iodine analysis for the detection of acute peripheral pulmonary thrombus (PE) in a canine model with histopathological findings as the reference standard. Materials and methods: The study protocol was approved by our institutional animal committee. Thrombi (n = 12) or saline (n = 4) were intravenously injected via right femoral vein in sixteen dogs, respectively. CT pulmonary angiography (CTPA) in DECT mode was performed and conventional CTPA images and DECT based vascular iodine studies using Lung Vessels application were reconstructed. Two radiologists visually evaluated the number and location of PEs using conventional CTPA and DECT series on a per-animal and a per-clot basis. Detailed histopathological examination of lung specimens and catheter angiography served as reference standard. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of DECT and CTPA were calculated on a segmental and subsegmental or more distal pulmonary artery basis. Weighted κ values were computed to evaluate inter-modality and inter-reader agreement. Results: Thirteen dogs were enrolled for final image analysis (experimental group = 9, control group = 4). Histopathological results revealed 237 emboli in 45 lung lobes in 9 experimental dogs, 11 emboli in segmental pulmonary arteries, 49 in subsegmental pulmonary arteries, 177 in fifth-order or more distal pulmonary arteries. Overall sensitivity, specificity, accuracy, PPV, and NPV for CTPA plus DECT were 93.1%, 76.9%, 87.8%, 89.4%, and 84.2% for the detection of pulmonary emboli. With CTPA versus DECT, sensitivities, specificities, accuracies, PPVs, and NPVs are all 100% for the detection of pulmonary emboli on a segmental pulmonary artery basis, 88.9%, 100%, 96.0%, 100%, and 94.1% for CTPA and 90.4%, 93.0%, 92.0%, 88.7%, and 94.1% for DECT on a subsegmental pulmonary artery basis; 23.8%, 96.4%, 50.4%, 93

Preoperative Emboli in a Pregnant Woman with Myxoma

Directory of Open Access Journals (Sweden)

Freidoun Sabzi

2016-07-01

Full Text Available The left atrium is the most common location of myxomas, which are benign tumors. Only a few cases of myxomas in pregnancies have been reported. Our thorough medical literature search showed only 17 reported cases in the course of pregnancy. Myxomas during pregnancy and in the preterm period constitute a serious phenomenon that can mimic an early sign of a life-threatening pathology like severe mitral stenosis. We describe a 33-year-old woman, who presented with acute dyspnea to a gynecology center and was referred to our hospital for further evaluation of pulmonary embolism. Transthoracic echocardiography showed a huge left atrial myxoma, and computed tomography scan illustrated paradoxical pulmonary embolism in the left upper lung lobe via a large patent foramen ovale. The tumor required urgent cardiac surgery. In this article, we review causes of dyspnea in pregnancy and the cardiovascular effects of myxomas in pregnancy. We also describe the pathophysiological effects of cardiopulmonary bypass on the mother, fetus, and the feto-placental system during open-heart surgery. We performed a successful surgical resection of a myxoma in a pregnant woman. Given the rarity of such cases, individual multidisciplinary assessment and management strategies are essential.

Case report

African Journals Online (AJOL)

abp

27 oct. 2017 ... We report the case of a menopausal woman with breast tuberculosis in order to raise concern for diagnosis. Key words: Tuberculosis, breast, diagnosis. Introduction. La tuberculose mammaire est une forme rare de la tuberculose extra-pulmonaire même dans les pays endémiques. Elle représente. 0,06 à 0 ...

Traitement De La Peripneumonie Contagieuse Bovine Par L ...

African Journals Online (AJOL)

Traitement De La Peripneumonie Contagieuse Bovine Par L'oxyteTracycline Longe Action Et Transmission Experimentale de la Maladie A Partir de Bovins Traites. ... Tous les 14 animaux ont séroconverti et l'analyse post-mortem a montré la présence des lésions chroniques dont des séquestres pulmonaires chez 4 d'entre ...

Case report

African Journals Online (AJOL)

abp

2 juil. 2015 ... Page number not for citation purposes. 1. Cancer pulmonaire au cours d'une thromboangéite oblitérante de Léo Buerger. Salem Bouomrani1,&, Alaeddine Slama1, Hanène Nouma1, Maher Béji1. 1Service de Médecine Interne, Hôpital Militaire Gabes, 6000 Tunisie. &Corresponding author: Salem ...

Tuberculose oculaire a l'Hopital d'Instruction des Armees de Cotonou

African Journals Online (AJOL)

Tuberculose oculaire a l'Hopital d'Instruction des Armees de Cotonou. C.O.A. Abouki, S Alamou, C.R.A. Assavedo, M Zannou, R Lawani, S Hounnou-Tchabi. Abstract. La tuberculose peut toucher tous les organes, avec une prépondérance de l'atteinte pulmonaire. La localisation oculaire n'est pas exceptionnelle et peut se ...

MAQUETTE ORL Décembre 2004

African Journals Online (AJOL)

gine du patient (milieu rural), sa profession (précisera s'il y a notion de contact avec les chiens) et ses antécédents médicochirurgicaux notamment une chirurgie pour un kyste hépatique ou pulmonaire. L'examen clinique notera la localisation exacte du kyste, sa taille, sa consistance, ses rapports anatomiques et recher-.

Profil épidémiologique et clinique de la tuberculose dans la zone de santé de Lubumbashi (RD Congo)

Science.gov (United States)

Ngama, Christian Kakisingi; Muteya, Michel Manika; Lukusha, Yves Isango Idi; Kapend, Serge Matanda; Tshamba, Henri Mundongo; Makinko, Paul Ilunga; Mulumba, Claude Mwamba; Kalala, Liévin Kapend a

2014-01-01

Introduction L'objectif de notre travail était de déterminer la distribution sociodémographique des patients tuberculeux, les types de tuberculose en fonction de la localisation de la maladie et déterminer l'issue thérapeutique des patients en fonction de différentes localisations. Méthodes C'est une étude descriptive transversale des patients diagnostiqués et traités pour tuberculose du 1er Janvier 2010 au 30 Juin 2011 dans la zone de santé de Lubumbashi. Une de 11 zones de santé du District de Lubumbashi dans la province du Katanga(RD Congo). Ont été inclus tous les patients tuberculeux de nationalité congolaise consultés dans la zone de santé pendant la période d’étude. L’âge, le sexe, la commune de résidence, le tableau clinique à la première consultation et les résultats des examens de laboratoire des crachats par la coloration Ziehl-Neelsen ont été les paramètres d'analyse. Résultats Nous avons enregistré 708 patients tuberculeux soit une prévalence de 0.5%. Le sexe masculin représentait 58.78% contre 41.25% de sexe féminin avec un sexe ratio de 1.42 en faveur du sexe masculin. La moyenne d’âge était de 33±;15 ans. La majorité des patients soit 54.79 appartiennent à la tranche d’âge entre 21 et 40 ans. La tuberculose extra pulmonaire a représenté 51.8% contre 50.2% de tuberculose pulmonaire dont 31.9% à bacilloscopie positive. Le décès a intéressé les patients bacillifères puis qu'il y a 5 fois plus de décès liés à une tuberculose pulmonaire à microscopie positive qu'aux autres formes de tuberculose (OR (IC 95%): 5.27 (2.92-9.59, p = 0.00). La majorité des patients résidaient les communes Lubumbashi (41.7%) et Kampemba (23.2%). Conclusion La tuberculose extrapulmonaire (pleurale) a été plus rencontrée que la tuberculose pulmonaire et c'est cette dernière forme de tuberculose qui a entrainé beaucoup plus de décès. Ce qui nécessite une amélioration du système de santé de prise en charge des

Experimental evaluation of a new retrievable inferior vena cava filter for protection from acute pulmonary embolism in canine

International Nuclear Information System (INIS)

Zhou Chungao; Shi Haibing; Liu Sheng; Wang Chenghu; Liu Hairi; Li Linsun

2007-01-01

Objective: To evaluate the validity, safety and feasibility of a new retrieval inferior vena cava filter for the prevention of pulmonary embolism in an animal model. Methods: The model of deep iliofemoral venous thrombosis was established in 12 experimental dogs. In control group(6 experimental dogs), the deep venous thrombosis was made to fall off directly. In experimental group (6 experimental dogs), the deep venous thrombosis was made to fall off with an implanted filter in inferior vena cava. The filter's thrombus-trapping efficacy was evaluated by angiography of pulmonary artery, measurement of the mean pressure of pulmonary artery and arterial oxygen saturation before and after the deep venous thrombus falling off. Results: All filters implanted in the experimental dogs could successfully capture clot coming from deep venous thrombosis. There was no case of pulmonary embolism in experimental groups. On the other hand, pulmonary embolism occurred following the fall of deep venous thrombus in all dogs of control group. Conclusion: The retrievable inferior vena cava filter can effectively prevent from the pulmonary embolism due to falling off of the emboli from deep venous thrombosis. The process of implantation and retrieval is relatively simple and easy. (authors)

Tuberculose orale secondaire: a propos d'un cas a Lome | Bissa ...

African Journals Online (AJOL)

L'intérêt de cette présentation est d'attirer l'attention sur la tuberculose que l'on peut retrouver de façon exceptionnelle dans certaines localisations, comme la cavité buccale. Mots-clés: tuberculose orale ; nécrose caséeuse ; tuberculose pulmonaire. English Title: Secondary orale tuberculosis: about one case at Lome.

Contribution a l'etude de la flore lichenique dans la zeenaie de ...

African Journals Online (AJOL)

situe dans l'etage bioclimatique subhumide caracterise par un hiver doux et humide et un ete chaud et sec. ... que si le subsfrat est humide OU meme impregnes d'eau). La plupart des lichens foliaces et presque tous ..... soufre S02 superieure a 30 µI m3 d'air [18]. Le lichen pulmonaire est un excellent indicateur d'une forte ...

MAQUETTE ORL Décembre 2004

African Journals Online (AJOL)

Pièce de monnaie. Médiastinite. Pneumo- médiastin. Exclusion remplacement de l'œsophage. 4. 8 épilepsie. Fil d'acier enroulé. Abcés pulmonaire droit. Exclusion remplacement de l'œsophage. 5. 8. Sténose caustique. Tentative de dilatation. Pleurésie bilatérale. Drainage pleural. Exclusion remplacement de l'œsophage.

Case report

African Journals Online (AJOL)

abp

17 nov. 2017 ... Résumé. La microlithiase alvéolaire (MLA) est une affection rare, caractérisée par l'accumulation de concrétions calciques dans la lumière alvéolaire pulmonaire. Nous rapportons un nouveau cas de MLA, suspecté à la radiographie thoracique et confirmé par le scanner thoracique dont l'aspect.

MAQUETTE ORL Décembre 2004

African Journals Online (AJOL)

souvent indolore. Son histoire naturelle se fait vers lʼaug- mentation de volume et la dissémination métastatique ganglionnaire et pulmonaire essentiellement. Le pronostic est principalement lié à la taille de la tumeur. Le diagnos- tic se doit dʼêtre le plus précoce possible puisque le seul traitement efficace étant chirurgical ...

Les femmes prennent part à la lutte contre les maladies des bovins ...

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

6 juin 2016 ... Des chercheurs du Kenya et du Canada sont à mettre au point un nouveau vaccin contre une maladie pulmonaire des bovins et font participer activement des éleveuses de bovins Somalis au processus. Les femmes Somalis jouent un rôle crucial dans l'élevage des bovins, mais ce sont en général les ...

Complications in percutaneous transluminal stenting for carotid artery stenosis

International Nuclear Information System (INIS)

Li Shenmao; Miao Zhongrong; Zhu Fengshui; Ji Xunming; Jiao Liqun; Qi Jianshu; Ling Feng

2007-01-01

Objective: To discuss the complications of endovascular stenting for carotid artery stenosis. Methods: Cerebral vascular angiography and cervical Doppler sonography were performed in 648 patients with carotid artery stenosis. Emboli-protected device was used in 365 patients and none in 283 patients. Results: All 648 patients were technically successful (100%). Symptoms disappeared or improved in 78.7% patients. Slow heart rate during operation existed in 26.4% patients. Embolism caused by dislodgment of emboli occurred in 5 patients, 3 of them recovered after treatment and 2 had unilateral dyskinesias. Intracranial hemorrhage occurred in 3 patients. Stroke or death within 30 days after operation occurred in 6 patients(1.24%). 322 patients (77.8%)were followed up. Restenosis occurred in 17 patients(3.3%). Conclusion: Percutaneous transluminal stenting is a safe option for carotid artery stenosis. Correct evaluation of clinical and angiographic data before operation, together with normative manipulation and nursing during and after operation are the key points to avoid complications. (authors)

Identification of chronic thromboembolic pulmonary hypertension with MR imaging

International Nuclear Information System (INIS)

Gefter, W.B.; Palevsky, H.I.; Dinsmore, B.J.; Reichek, N.; DeRoos, A.; Kressel, H.Y.

1988-01-01

Thromboembolic pulmonary hypertension (TE-PHT) may be treatable by thromboendarterectomy. To evaluate the role of MR imaging in TE-PHT, the authors imaged eight patients with primary pulmonary hypertension or ASDs and seven patients with TE-PHT. Patients underwent conventional spin-echo (SE) imaging; three of seven patients with TE-PHT and eight of eight without emboli underwent cine MR studies. TE-PHT findings included focal areas of vessel wall thickening or plaquelike lesions in the central pulmonary arteries in six of seven. (Thrombus was not distinguished from flow-related signal in the seventh patient). Studies performed on three patients after thromboendarterectomy showed significant resolution of vascular lesions. Patients without emboli showed dilated central vessels without focal wall or lumen abnormality. Cine studies differentiated flow-related signal from thrombus, but wall thickening was better appreciated on SE images. MR imaging appears useful in identifying patients with TE-PHT who may benefit from surgery

Usefulness of lung scanning in the evaluation of patients with pulmonary hypertension

International Nuclear Information System (INIS)

Powe, J.; McCarthy, K.; Palevsky, H.; Fishman, A.P.; Alavi, A.

1986-01-01

The ventilation-perfusion scans of 30 patients with pulmonary arterial hypertension and established final diagnoses were blindly classified as to the probability of showing pulmonary embolism. Eleven of 12 patients with primary pulmonary hypertension had normal or low-probability scans; one had an intermediate-probability scan. All six patients with thromboembolic pulmonary hypertension had high-probability scans. However, three of 12 patients with nonembolic secondary pulmonary hypetension also had high-probability scans. Although a normal or low-probability scan excludes the possibility of emboli as a cause, a high-probability scan may often be associated with nonembolic causes of secondary pulmonary hypertension

Imaging pulmonary fibrosis; Imagerie des fibroses pulmonaires

Energy Technology Data Exchange (ETDEWEB)

Brauner, M.W.; Rety, F.; Naccache, J.M.; Girard, F.; Valeyre, D.F. [Hopital Avicenne, 93 - Bobigny (France). Service de radiologie et de pneumologie

2001-02-01

Localized fibrosis of the lung is usually scar tissue while diffuse pulmonary fibrosis is more often a sign of active disease. Chronic infiltrative lung disease may be classified into four categories: idiopathic pneumonitis, collagen diseases, granulomatosis (sarcoidosis), and caused by known diseases (pneumoconiosis, hypersensitivity pneumonitis, drug-induced lung disease, radiation). (authors)

Prognostic significance of lymphangiogenesis in pharyngolaryngeal carcinoma patients

International Nuclear Information System (INIS)

Garcia-Carracedo, Darío; Rodrigo, Juan Pablo; Astudillo, Aurora; Nieto, Carlos Suarez; Gonzalez, Maria Victoria

2010-01-01

Lymphatic vessel spread is considered a major route for head and neck squamous cell carcinoma metastasis. Formation of new lymphatic vessels could facilitate the process, raising the malignant potential of these tumours. Recent identification of lymphatic markers allows the study of the lymphangiogenesis phenomenon. We searched for molecular events involved in the lymphangiogenic process that could have prognostic value in laryngeal/pharyngeal carcinoma patients. 104 paraffin-embedded pharyngeal/laryngeal tumour samples were studied. Immunohistochemical analysis of podoplanin and double immunofluorescence analysis of Ki-67 and D2-40 were performed. Lymph vessel density (inside the tumour mass, at its periphery or considered as a whole) and the presence of tumour emboli inside lymphatics were recorded. The proliferative state of endothelial lymphatic cells was evaluated. Lymphatic vessels were detected inside the tumour mass (75%) and in the surrounding tissue (80%); some of them in a proliferative state. Tumour emboli were detected in a high proportion of the cases (45%). Lymphatic vessel density was higher in the pharyngeal cases (p = 0.0029), in greater size (p = 0.039), more advanced stage primary tumours (p = 0.006) and in carcinomas of patients with affected nodes (p = 0.019). The presence of tumour emboli and a high global vessel density were indicators of poor prognosis (recorded as death from tumour) in the laryngeal group (p = 0.015 and p = 0.027, respectively), but notably not in the pharyngeal one. Interestingly, high global vessel density showed a negative prognostic value among pathologically staged N0 laryngeal carcinomas (p = 0.03). The lymphangiogenic process correlated with aggressive tumour features (pN category, tumour size, tumour stage), but might play different roles in tumours arising from different anatomic sites. Our results suggest that detection of tumour emboli and assessment of global vessel density using the D2-40 antibody, may be

Frequency of asymptomatic pulmonary emboli (PE) in patients with a proximal profound veinal thrombosis (PVT) of inferior limbs during the FRAXODI study; Frequence de l`embolie pulmonaire (EP) asymptomatique chez les malades ayant une thrombose veineuse profonde proximale (TVP) des members inferieurs au cours de l`etude FRAXODI

Energy Technology Data Exchange (ETDEWEB)

Gauthier, H.; Rosso, J. [CHU Henri Mondor-Creteil (France); Charbonnier, B. [CHU Trousseau-Tours (France); Meignan, M. [CHU Henri Mondor-Creteil (France)

1997-12-31

FRAXODI, an European multi-center program (n=70), allowed to compare the efficiency of Fraxiparin (20 500 UI AXa/mL) once a day with the conventional treatment by Fraxiparin (10 250 UI AXa/mL) twice a day by sub-cutaneous injection in patients with a PVT of inferior limbs without clinical signs of PE. A pulmonary scintigraphy has been performed at registration in 622 patients (delay {<=} 48 h): a sole perfusion with at least 4 incidences of which 2 were posterior oblique incidences or coupled to a ventilation scintigraphy (Xe-133, Kr-81 or aerosols) in 379 patients. Three diagnostic categories were defined: no PE in case of normal examination or under-segmentary perfusion anomalies ({<=} 3); high probability (HP) of PE if at least a defect of normally ventilated segmentary perfusion existed; non-contributing examination in all the other cases. On the ensemble of the group, 367 patients have had at least a defect of segmentary perfusion, 296 patients had two or more. One hundred and forty one patients have had solely defects of sub-segmentary perfusion; 77 patients have had 3 or less then 3. One hundred and fourteen patients have had a normal examination. In the sub-group of ventilation scintigraphy, 235 patients have had at least one defect of segmentary perfusion, 88 patients have had defects of sub-segmentary perfusion and 56 patients have had a normal examination. The diagnosis analysis showed that 42% of patients have had a HP scintigraphy, 30% a non-contributive scintigraphy and the PE could be eliminated in 27% of patients. These results: 1 - demonstrated the extreme frequency of HP aspects of PE in patients afflicted with PVT; 2 - allowed estimating in this patients, as a function of the results of the PIOPED study, the frequency of asymptomatic PE in more then 50%; 3 - allowed recommending in the systematic practice a perfusion scintigraphy in case of PVT without clinical signs of PE providing the over-estimation of secondary PE occurrence during the treatment of a phlebitis was avoided

Percutaneous Mechanical Thrombectomy Treatment of Acute Superior Mesenteric Artery Embolism

Directory of Open Access Journals (Sweden)

Z. Zhang

Full Text Available : Objective/Background: This report presents a superior mesenteric artery (SMA embolism managed by percutaneous mechanical thrombectomy (PMT. Methods: A 61 year old woman diagnosed with SMA embolism was admitted. Emboli were found in the middle and distal segments of the SMA on abdominal computed tomography angiography. Under local anaesthesia, a 6 F Rotarex system was used to remove the emboli via left brachial artery access. Emboli were successfully removed and patency was restored to the SMA and its branches. Results: Post-operatively, the patient's symptoms were significantly relieved. No post-operative complications were observed and no discomfort was documented during follow-up. Conclusion: Endovascular treatment of SMA embolism using PMT is a feasible and alternative option. Keywords: Acute mesenteric ischaemia, Embolism, Endovascular treatment, Percutaneous mechanical thrombectomy, Superior mesenteric artery

Management outcome of pulmonary tuberculosis: A nine year ...

African Journals Online (AJOL)

Keywords: Pulmonary tuberculosis, Outcome, DTS. Résumé Objectif: Cet étude met en relief le résultat de la prise en charge des patients atteints de tuberculose pulmonaire (PTB) au cours d'une période de neuf ans. Essentiellement, la cadence de la guérison, cadence de la défaillance et la cadence de la fatalité ont été ...

Case series

African Journals Online (AJOL)

ebutamanya

2015-01-29

Jan 29, 2015 ... Doppler cardiaque (121 cas sur 380) soit 39,53%. Les CIV étaient au premier plan des cardiopathies congénitales (28,26%), suivies des CIA. (23,19%), des sténoses pulmonaires (19,57%), des Tétralogie de Fallot (9,42%). Dans leur forme isolée, les CIA étaient les plus fréquentes avec. 21,95% des cas, ...

Vascular air embolism after contrast administration on 64 row multiple detector computed tomography: A prospective analysis

Directory of Open Access Journals (Sweden)

Kushaljit S Sodhi

2015-01-01

Full Text Available Background: Vascular air embolism is being progressively reported as a nonfatal event with increase in use of computed tomography (CT as a diagnostic modality. This study was undertaken to study the frequency and site of vascular air embolism in patients undergoing contrast-enhanced CT (CECT and analyze CT parameters that influence its prevalence and final outcome. Materials and Methods: This was a prospective study approved by departmental ethics committee. Presence and location of air emboli in 200 patients who underwent CT scan of chest on a 64 detector scanner was recorded. We analyzed the role of various factors that could influence the prevalence of air embolism after injection of contrast in CECT scans. These factors included the amount of contrast injected, rate of flow of injection of contrast, site of injection of contrast, and size of intravenous access line. Results: Iatrogenic vascular air emboli were seen in 14 patients (7% of total. The locations of air emboli were main pulmonary artery in 12 (6% of total, left brachiocephalic vein in 3 (1.5% of total, right atrial appendage in 4 (2% of total, and superior vena cava (SVC in 1 (0.5% patient. There was no association between volume of contrast, flow rate, site and size of intravenous access, and presence of air emboli. Conclusion: Radiologists as well as referring physicians should be aware of vascular air embolism, which can occur after contrast injection in patients undergoing CT scan. Age, volume of contrast, flow rate of pressure injector, and site and size of venous cannula do not influence the likelihood or incidence of detection of venous air emboli on CT scans.

Case report

African Journals Online (AJOL)

ebutamanya

19 févr. 2016 ... Dans des formes plus graves, les patients peuvent développer des folliculites, impétigo, des lésions vésiculo-bulleuses, ou même un syndrome de. Loëffer avec une infiltration pulmonaire [7]. Le diagnostic repose sur le tableau clinique et l'anamnèse rapportant à un séjour en zone endémique [4] et/ou un ...

Abcès thyroïdien révélant un basedow: à propos d'un cas et revue ...

African Journals Online (AJOL)

Une radiographie thoracique a été demandée montrant un foyer alvéolaire pulmonaire apical droit. L'étude cytobactériologique des crachats ont isolé le bacille de koch. Le bilan biologique thyroïdien était en faveur d'un Basedow. La prise en charge était médicale comprenait une tri-antibiothérapie par voie parentérale, ...

Comparative analysis of radionuclide inhalation and perfusion lung imaging with X ray pulmonary angiography for the diagnosis of pulmonary embolism

International Nuclear Information System (INIS)

Zhang Yanyan; Chen Man; Shao Maogang; Zhang Songlin; Mao Jieming; Guo Jingxuan

1993-01-01

The result of radionuclide lung imaging was compared in 18 patients of pulmonary embolism (PE) and 2 normal persons. The discovered perfusion defects correlated well with the location of angiographic obstruction. The positive angiographic and radionuclide finding was in 141 and 104 emboli arteries respectively. The sensitivity of total emboli pulmonary segments of lung imaging was 73.8%, the specificity was 82.7 and the accuracy was 79%. The techniques correlated quite well (r = 0.83, P<0.001)

Detection and volume estimation of embolic air in the middle cerebral artery using transcranial Doppler sonography.

Science.gov (United States)

Bunegin, L; Wahl, D; Albin, M S

1994-03-01

Cerebral embolism has been implicated in the development of cognitive and neurological deficits following bypass surgery. This study proposes methodology for estimating cerebral air embolus volume using transcranial Doppler sonography. Transcranial Doppler audio signals of air bubbles in the middle cerebral artery obtained from in vivo experiments were subjected to a fast-Fourier transform analysis. Audio segments when no air was present as well as artifact resulting from electrocautery and sensor movement were also subjected to fast-Fourier transform analysis. Spectra were compared, and frequency and power differences were noted and used for development of audio band-pass filters for isolation of frequencies associated with air emboli. In a bench model of the middle cerebral artery circulation, repetitive injections of various air volumes between 0.5 and 500 microL were made. Transcranial Doppler audio output was band-pass filtered, acquired digitally, then subjected to a fast-Fourier transform power spectrum analysis and power spectrum integration. A linear least-squares correlation was performed on the data. Fast-Fourier transform analysis of audio segments indicated that frequencies between 250 and 500 Hz are consistently dominant in the spectrum when air emboli are present. Background frequencies appear to be below 240 Hz, and artifact resulting from sensor movement and electrocautery appears to be below 300 Hz. Data from the middle cerebral artery model filtered through a 307- to 450-Hz band-pass filter yielded a linear relation between emboli volume and the integrated value of the power spectrum near 40 microL. Detection of emboli less than 0.5 microL was inconsistent, and embolus volumes greater than 40 microL were indistinguishable from one another. The preliminary technique described in this study may represent a starting point from which automated detection and volume estimation of cerebral emboli might be approached.

Pulmonary thromboembolism in children

Energy Technology Data Exchange (ETDEWEB)

Babyn, Paul S.; Gahunia, Harpal K. [Hospital for Sick Children, Department of Pediatric Diagnostic Imaging, Toronto, ON (Canada); Massicotte, Patricia [Stollery Children' s Hospital and University of Alberta, Departments of Pediatric Hematology and Cardiology, Edmonton, AB (Canada)

2005-03-01

Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients. (orig.)

Pulmonary thromboembolism in children

International Nuclear Information System (INIS)

Babyn, Paul S.; Gahunia, Harpal K.; Massicotte, Patricia

2005-01-01

Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients. (orig.)

Anatomy-based automatic detection and segmentation of major vessels in thoracic CTA images

International Nuclear Information System (INIS)

Zou Xiaotao; Liang Jianming; Wolf, M.; Salganicoff, M.; Krishnan, A.; Nadich, D.P.

2007-01-01

Existing approaches for automated computerized detection of pulmonary embolism (PE) using computed tomography angiography (CTA) usually focus on segmental and sub-segmental emboli. The goal of our current research is to extend our existing approach to automated detection of central PE. In order to detect central emboli, the major vessels must be first identified and segmented automatically. This submission presents an anatomy-based method for automatic computerized detection and segmentation of aortas and main pulmonary arteries in CTA images. (orig.)

Maladie de Horton révélée par une dyspnée | Mahfoudhi | Pan ...

African Journals Online (AJOL)

Les manifestations pleuro-pulmonaires de la maladie de Horton sont rares et peu connues. Elles peuvent être inaugurales, à l'origine d'un retard à la prise en charge si elles sont méconnues. Il s'agissait d'un patient âgé de 75 ans, admis pour une dyspnée, une toux chronique et une fièvre. Il a reçu une antibiothérapie et a ...

Case report

African Journals Online (AJOL)

abp

15 oct. 2012 ... péritoine, le foie et la rate [7]. Il s'agit d'une localisation péritonéale dans la première observation, d'une ... à des lésions pulmonaires très bacillifères par voie hématogène ou lymphatique [8]. L'agent bactérien est le plus souvent le bacille de Kokh bovin ou humain, exceptionnellement ce sont les.

Air contamination during hemodialysis should be minimized.

Science.gov (United States)

Stegmayr, Bernd

2017-04-01

During preparation of the hemodialysis (HD) extracorporeal circuit (ECC) a priming solution is used to remove air from the tubes and dialyzer. Ultra sound techniques have verified micro embolic signals (MES) in the ECC that may derive from clots or gas embolies. In vitro studies could clarify that embolies of air develop within the ECC and also pass the safety systems such as air traps and enter the venous line that goes into the patient. Clinical studies have confirmed the presence of MES within the ECC that pass into the return-venous-line during conventional HD without inducing an alarm. In addition, studies confirmed that such MES were present within the AV fistula and subclavian vein, but also detected within the carotid artery. Autopsy studies revealed the presence of gas embolies surrounded by clots within the lung but also brain and myocardial tissue. This review will focus on how the MES develop and measures of how the exposure can be limited. © 2016 International Society for Hemodialysis.

Comparison of the effect of dabigatran and dalteparin on thrombus stability in a murine model of venous thromboembolism.

Science.gov (United States)

Shaya, S A; Saldanha, L J; Vaezzadeh, N; Zhou, J; Ni, R; Gross, P L

2016-01-01

ESSENTIALS: Does thrombus stability alter the presentation of venous thromboembolism and do anticoagulants alter this? In a murine model, we imaged a femoral vein thrombus and quantified emboli in the pulmonary arteries. Dabigatran decreases thrombus stability via factor XIII increasing embolization and pulmonary emboli. This cautions against the unapproved use of dabigatran for acute initial treatment of deep vein thrombosis. Venous thromboembolism (VTE) is a collective term for deep vein thrombosis (DVT) and pulmonary embolism (PE). Thrombus instability possibly contributes to progression of DVT to PE, and direct thrombin inhibitors (DTIs) may alter this. To develop a model to assess thrombus stability and its link to PE burden, and identify whether DTIs, in contrast to low-molecular-weight heparin (LMWH), alter this correlation. Twelve minutes after ferric chloride-induced thrombus formation in the femoral vein of female mice, saline, dalteparin (LMWH) or dabigatran (DTI) was administered. Thrombus size and embolic events breaking off from the thrombus were quantified before treatment and at 10-min intervals after treatment for 2 h using intravital videomicroscopy. Lungs were stained for the presence of PE. Thrombus size was similar over time and between treatment groups. Total and large embolic events and pulmonary emboli were highest after treatment with dabigatran. Variations in amounts of pulmonary embolic events were not attributed to variations in thrombus size. Large embolic events correlated with the number of emboli per lung slice independent of treatment. Embolization in factor XIII deficient (FXIII(-/-) ) saline-treated mice was greater than that in wild-type (WT) saline-treated mice, but was similar to WT dabigatran-treated mice. We have developed a mouse model of VTE that can quantify emboli and correlate this with PE burden. Consistent with clinical data, dabigatran, a DTI, acutely decreases thrombus stability and increases PE burden compared with

Lemierre's syndrome

DEFF Research Database (Denmark)

Johannesen, Katrine M; Bodtger, Uffe

2016-01-01

This is a systematic review of cases with Lemierre's syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or ...... LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.......This is a systematic review of cases with Lemierre's syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and....../or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium...

Pulmonary emboli from blood-biomaterial interaction

International Nuclear Information System (INIS)

Coleman, J.E.; Ramberg, K.; McEnroe, C.S.; Connolly, R.J.; Callow, A.D.

1988-01-01

The problem of surface thrombosis and subsequent embolization remains entrenched as a yet incompletely surmounted barrier to the development of truly satisfactory intravascular prosthetic devices. A baboon ex vivo shunt was used to determine the interaction of Indium-111 platelets and potential biomaterials. The uptake of Indium-111 platelets was monitored continuously by gamma camera scanning. Several of the materials tested demonstrated a saw-toothed pattern of platelet activity, with accumulation followed by rapid decline. Neither PTFE nor Dacron exhibited this pattern. Post shunt scans of the animals' chests showed discrete foci of platelet activity in the lungs, corresponding to each embolic event noted on the material's scan. In conclusion, the search for a smooth surface as a blood material interface may produce a material which accumulates and then sloughs significant platelet aggregates. It is crucial that these materials be subjected to vigorous testing to determine their safety prior to initiation of clinical trials

BP network for atorvastatin effect evaluation from ultrasound images features classification

Science.gov (United States)

Fang, Mengjie; Yang, Xin; Liu, Yang; Xu, Hongwei; Liang, Huageng; Wang, Yujie; Ding, Mingyue

2013-10-01

Atherosclerotic lesions at the carotid artery are a major cause of emboli or atheromatous debris, resulting in approximately 88% of ischemic strokes in the USA in 2006. Stroke is becoming the most common cause of death worldwide, although patient management and prevention strategies have reduced stroke rate considerably over the past decades. Many research studies have been carried out on how to quantitatively evaluate local arterial effects for potential carotid disease treatments. As an inexpensive, convenient and fast means of detection, ultrasonic medical testing has been widespread in the world, so it is very practical to use ultrasound technology in the prevention and treatment of carotid atherosclerosis. This paper is dedicated to this field. Currently, many ultrasound image characteristics on carotid plaque have been proposed. After screening a large number of features (including 26 morphological and 85 texture features), we have got six shape characteristics and six texture characteristics in the combination. In order to test the validity and accuracy of these combined features, we have established a Back-Propagation (BP) neural network to classify atherosclerosis plaques between atorvastatin group and placebo group. The leave-one-case-out protocol was utilized on a database of 768 carotid ultrasound images of 12 patients (5 subjects of placebo group and 7 subjects of atorvastatin group) for the evaluation. The classification results showed that the combined features and classification have good recognition ability, with the overall accuracy 83.93%, sensitivity 82.14%, specificity 85.20%, positive predictive value 79.86%, negative predictive value 86.98%, Matthew's correlation coefficient 67.08%, and Youden's index 67.34%. And the receiver operating characteristic (ROC) curve in our test also performed well.

Fundus autofluorescence in retinal artery occlusion: A more precise diagnosis.

Science.gov (United States)

Bacquet, J-L; Sarov-Rivière, M; Denier, C; Querques, G; Riou, B; Bonin, L; Barreau, E; Labetoulle, M; Rousseau, A

2017-10-01

Retinal artery occlusion (RAO) is a medical emergency associated with a high risk of cerebral vascular accident and other cardiovascular events. Among patients with non-arteritic RAO, a retinal embolus is observed in approximately 40% of cases. Fundus examination and retinography are not reliable to predict the nature of the emboli. We report three consecutive cases of central and branch RAO that were investigated with fundus autofluorescence, fluorescein angiography and color retinal photographs. All patients underwent complete neurological and cardiovascular workups, with brain imaging, cardiac Doppler ultrasound, carotid Dopplers and Holter ECG's, to determine the underlying mechanism of retinal embolism. In the three cases, aged 77.7±4 years (2 women and 1 man), fundus autofluorescence demonstrated hyperautofluorescent emboli. In two cases, it allowed visualization of emboli that were not detected with fundus examination or retinography. The cardiovascular work-up demonstrated atheromatous carotid or aortic plaques in all patients. In one case, it permitted the diagnosis of RAO. Two of the three cases were considered to be of atherosclerotic origin and one of undefined origin. Fundus autofluorescence may help to detect and characterize retinal emboli. Since lipofuscin, which is present in large quantity in atherosclerotic plaques, is the main fluorophore detected with fundus autofluorescence, this non-invasive and simple examination may give information about the underlying mechanism of retinal embolism, and thus impact the etiologic assessment of RAO. Additional studies are necessary to confirm this potential role of autofluorescence. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Radiological features of Lemierre's syndrome: A case report; Manifestaciones radiologicas del sindrome de Lemierre: a proposito de un caso

Energy Technology Data Exchange (ETDEWEB)

Tapia-Vine, M. M.; Gonzalez-Garcia, B.; Bustos, A.; Cabello, J. [Hospital Clinico San Carlos. Madrid (Spain)

2001-07-01

Lemierre's syndrome is a type of sepsis caused by anaerobes that is secondary to a pharyngotonsillar infection complicated by suppurative thrombophlebitis of ipsilateral jugular vein and septic emboli. Imaging studies are valuable tools for confirming the diagnosis. Chest x-ray reveals poorly defined cavitated, peripheral, nodular lesions. computed tomography (CT) is useful in confirming the pulmonary lesions, which are suggestive of septic emboli. Doppler ultrasound of the neck plays and indispensable role in demonstrating the internal jugular vein thrombosis. We report the case of patient who presented the characteristic clinical and radiological features of Lemierre's syndrome. (Author) 17 refs.

Radiological features of Lemierre's syndrome: A case report

International Nuclear Information System (INIS)

Tapia-Vine, M. M.; Gonzalez-Garcia, B.; Bustos, A.; Cabello, J.

2001-01-01

Lemierre's syndrome is a type of sepsis caused by anaerobes that is secondary to a pharyngotonsillar infection complicated by suppurative thrombophlebitis of ipsilateral jugular vein and septic emboli. Imaging studies are valuable tools for confirming the diagnosis. Chest x-ray reveals poorly defined cavitated, peripheral, nodular lesions. computed tomography (CT) is useful in confirming the pulmonary lesions, which are suggestive of septic emboli. Doppler ultrasound of the neck plays and indispensable role in demonstrating the internal jugular vein thrombosis. We report the case of patient who presented the characteristic clinical and radiological features of Lemierre's syndrome. (Author) 17 refs

GeneXpert MTB/RIF dans le dépistage de la tuberculose pulmonaire à l’Hôpital Provincial Général de Référence de Bukavu, à l’Est de la République Démocratique du Congo: quelles leçons tirées après 10 mois d’utilisation?

Science.gov (United States)

Lupande, David; Kaishusha, David; Mihigo, Carine; Itongwa, Moise; Yenga, Gustave; Katchunga, Philippe

2017-01-01

Introduction En Afrique subsaharienne, les méthodes de diagnostic de la tuberculose sont insuffisantes et reposent essentiellement sur la microscopie. Elles constituent un réel frein pour le contrôle de la tuberculose. La présente étude voudrait évaluer les performances du GeneXpert MTB/RIF vis à vis de la microscopie classique de Ziehl-Neelsen à l’Hôpital Provincial Général de Référence de Bukavu, à l’Est de la République Démocratique du Congo après 10 mois d’utilisation. Méthodes Les résultats de la coloration au Ziehl-Neelsen et de la biologie moléculaire sur GeneXpert MTB/RIF de 452 patients suspects de tuberculose ont été colligés. La validité d’un test par rapport à l’autre dans la détection de la tuberculose a été étudiée. Résultats Dans le groupe entier, la fréquence de la tuberculose pulmonaire était de 16.3%. La positivité était significativement plus élevée pour le GeneXpert MTB/RIF que pour le Ziehl-Neelsen dans le groupe entier (15.9% vs 9.3%, p= 0.03) et chez les séropositifs pour le VIH (52.0% vs 24.0%; p = 0.007). Cependant, la sensibilité de GeneXpert MTB/RIF comparé au Ziehl-Neelsen n’était pas maximale (95.2%). Enfin, GeneXpert MTB/RIF a détecté 20.8% de résistance à la rifampicine. Conclusion La présente étude confirme la supériorité de GeneXpert MTB/RIF sur la coloration de Ziehl-Neelsen dans la détection de la tuberculose et dans la prédiction de la multi résistance. Son utilisation systématique couplée au Ziehl-Neelsen permettrait de mieux contrôler la tuberculose en Afrique subSaharienne. PMID:29187929

Embolic Signals during Routine Transcranial Doppler Ultrasonography in Aneurysmal Subarachnoid Hemorrhage

Science.gov (United States)

Paschoal, Fernando Mendes; de Almeida Lins Ronconi, Karla; de Lima Oliveira, Marcelo; Nogueira, Ricardo de Carvalho; Paschoal, Eric Homero Albuquerque; Teixeira, Manoel Jacobsen; Figueiredo, Eberval Gadelha; Bor-Seng-Shu, Edson

2015-01-01

Introduction. Cerebral emboli may occur in subarachnoid hemorrhage (SAH) and intracranial aneurysm surgery. Although embolic signs (ES) have been reported in SAH, their origin remains unclear. The aim of this study was to report the detection of ES during routine TCD monitoring in patients with aneurysmal SAH. Methods. A total of 105 patients with aneurysmal SAH were submitted to TCD evaluation. Patients were monitored almost daily (5 times per week). In each monitoring session, one experienced operator performed TCD to detect or assess vasospasm and ES in arteries of the Willis polygon. Results. Four patients out of a total of 105 patients with aneurysmal SAH were found to present spontaneous cerebral embolization during routine TCD monitoring. The average age of the 4 patients (mean ± standard deviation) was 59.5 ± 8.34 years (range 49–68 ys); female patients predominated representing 75% (3/4) of subjects. Conclusion. Although detection of ES was relatively rare in this study, rates of emboli occurrence may be higher under systematic monitoring. The detection of ES after SAH surgery reinforces the need to study the role of embolus in this condition and may be an indicator for prophylactic antithrombotic treatment. PMID:25893190

Développement et évaluation de nanoparticules bioadhésives pour l'administration orale de petides

OpenAIRE

Hecq, Julien

2017-01-01

Ces dernières années, le nombre d’agents thérapeutiques issus des biotechnologies n’a cessé d’augmenter. Parmi ceux-ci, plus de 85% sont administrés par voie parentérale, principalement par injection sous-cutanée ou intraveineuse. Cette forme d’administration ne favorisant pas la compliance des patients, de nombreuses recherches ont été effectuées afin de trouver des alternatives à ces voies invasives, telles que la voie intranasale, pulmonaire, transdermique ou orale. Cette dernière a pour a...

The effect of rapid and sustained decompression on barotrauma in juvenile brook lamprey and Pacific lamprey: implications for passage at hydroelectric facilities

Energy Technology Data Exchange (ETDEWEB)

Colotelo, Alison HA; Pflugrath, Brett D.; Brown, Richard S.; Brauner, Colin J.; Mueller, Robert P.; Carlson, Thomas J.; Deng, Zhiqun; Ahmann, Martin L.; Trumbo, Bradly A.

2012-10-01

Fish passing downstream through hydroelectric facilities may pass through hydroturbines where they experience a rapid decrease in barometric pressure as they pass by turbine blades, which can lead to barotraumas including swim bladder rupture, exopthalmia, emboli, and hemorrhaging. In juvenile Chinook salmon, the main mechanism for injury is thought to be expansion of existing gases (particularly those present in the swim bladder) and the rupture of the swim bladder ultimately leading to exopthalmia, emboli and hemorrhaging. In fish that lack a swim bladder, such as lamprey, the rate and severity of barotraumas due to rapid decompression may be reduced however; this has yet to be extensively studied. Another mechanism for barotrauma can be gases coming out of solution and the rate of this occurrence may vary among species. In this study, juvenile brook and Pacific lamprey acclimated to 146.2 kPa (equivalent to a depth of 4.6 m) were subjected to rapid (<1 sec; brook lamprey only) or sustained decompression (17 minutes) to a very low pressure (13.8 kPa) using a protocol previously applied to juvenile Chinook salmon. No mortality or evidence of barotraumas, as indicated by the presence of hemorrhages, emboli or exopthalmia, were observed during rapid or sustained decompression, nor following recovery for up to 120 h following sustained decompression. In contrast, mortality or injury would be expected for 97.5% of juvenile Chinook salmon exposed to a similar rapid decompression to these very low pressures. Additionally, juvenile Chinook salmon experiencing sustained decompression died within 7 minutes, accompanied by emboli in the fins and gills and hemorrhaging in the tissues. Thus, juvenile lamprey may not be susceptible to barotraumas associated with hydroturbine passage to the same degree as juvenile salmonids, and management of these species should be tailored to their specific morphological and physiological characteristics.

Noninvasive diagnosis of suspected severe pulmonary embolism. Trans-esophageal echocardiography vs spiral CT

International Nuclear Information System (INIS)

Pruszczyk, P.; Torbicki, A.; Pacho, R.

1998-01-01

Patients with pulmonary embolism (PE) and echocardiographic signs of right ventricular over-lead have worse prognosis and may be require aggressive therapy. Unequivocal confirmation of PE is required before thrombolysis or embolectomy. This study compares the value of trans-esophageal echocardiography (TEE) and spiral CT (sCT) in direct visualization of pulmonary artery thrombo-emboli in patients with suspected PE and echocardiographic signs of right ventricular over-lead. Because of high prevalence of bilateral central pulmonary thrombo-emboli in patients with hemo-dynamically significant PE, both sCT and TEE allow its definitive confirmation in most cases. Thrombi reported by sCT distally to lobar arteries should be interpreted with caution. (author)

EMBOli OF CEREBRAL TISSUES IN THE LUNGS*

African Journals Online (AJOL)

sustained during motor-car and aircraft accidents and in the 'battered baby syndrome' is of medico-legal impor- tance, being indicative of injury sustained during life. REFERENCES. 1. McMil!an, J. B. (1956): Amer. J. Path., 32, 405. 2. Tacket!. L. R. (1964): Arch. Path., 78, 292. 3. Valdes-Dapena, M. A. and Arey, J. B. (1967): ...

EMBOli OF CEREBRAL TISSUES IN THE LUNGS*

African Journals Online (AJOL)

J. Path., 32, 405. 2. Tacket!. L. R. (1964): Arch. Path., 78, 292. 3. Valdes-Dapena, M. A. and Arey, J. B. (1967): Ibid., 84. 643. 4. Merkel, H. (1926): Drsch. Z. ges. gerichtl. Med., 7, 217. 5. Krakower, C. (1936): Arch. Path., 22, 113. 6. Walcher, K. (1940): Ergebn. allg. Path. path. Anal., 35, 20':1. 7. Oppenheimer, E. H. (1954): Bull.

The natural history of postoperative venous thromboemboli in gynecologic oncology: a prospective study of 382 patients

International Nuclear Information System (INIS)

Clarke-Pearson, D.L.; Synan, I.S.; Colemen, R.E.; Hinshaw, W.; Creasman, W.T.

1984-01-01

Three hundred eighty-two patients who underwent major operations for gynecologic malignancy were studied prospectively to determine the natural history of postoperative venous thromboemboli. Iodine 125-labeled fibrinogen leg counting, to diagnose deep venous thrombosis, was performed daily. Sixty-three patients (17%) developed postoperative venous thromboembolic complications. Deep venous thrombosis initially arose in the calf veins in 52 patients. Twenty-seven percent of these thrombi lysed spontaneously. Four percent of thrombi in the calf veins progressed to deep venous thrombosis in the femoral vein, and 4% resulted in pulmonary emboli. Nine other patients developed proximal deep venous thrombosis without prior thrombosis in the calf veins. One patient with proximal deep venous thrombosis also had a pulmonary embolus. Two patients with no evidence of deep venous thrombosis on prospective 125 I-labeled fibrinogen leg counting developed pulmonary emboli, including one fatal pulmonary embolus that was found at autopsy to have arisen from the internal iliac veins. Fifty percent of all venous thromboemboli were detected within 48 hours of operation, although two patients developed significant deep venous thrombosis and pulmonary emboli after discharge from the hospital. These results add important information to our understanding of this disease process, and raise issues related to appropriate treatment and prophylaxis of venous thromboembolism in patients after gynecologic operations

Radiologic-pathologic correlation of the mammographic findings retrospectively detected in inflammatory breast cancer. Usefulness in clinical practice

International Nuclear Information System (INIS)

Caumo, F.; Manfrin, E.; Bonetti, F.; Pinali, L.; Procacci, C.

2002-01-01

Background. The aim of this study was to describe the clinical, mammographical and pathological characteristics of inflammatory carcinoma. Patients and methods. Clinical, mammographical and histological sections of twenty-two women (age range 28-60 years) were reviewed. The examinations had been performed over a period of four years. Results. The clinical findings were: erythema, edema, thickening of the skin and breast heat in ten patients; palpable mass in nine patients; nipple discharge in one patient; absent in two patients. Pathological findings were: tumor emboli in the dermal lymphatics in eight patients; tumor emboli in the vessels in ten patients; tumor emboli both in the dermal lymphatics and in the vessels in four patients. The radiologic findings were: skin thickening, trabecular thickening and blurring of structure in ten patients (common presentation); mass in nine patients; malignant-type calcifications in two patients (uncommon presentation); absent in one patient. The follow-up examination (eighteen months) detected that only one patient with common presentation of inflammatory carcinoma had no local or systemic recurrence against eight patients with uncommon presentation. Conclusions. The clinical and mammographical aspects, which suggest the presence of an inflammatory carcinoma, occur only in 45.4% of the patients. The radiological aspect seems to correlate with the different prognosis of the tumour, resulting in a better prognosis in those with an uncommon aspect. (author)

Juvenile ischemic stroke secondary to cardiogenic embolism: A rare case report

Directory of Open Access Journals (Sweden)

Hassan Soleimanpour

2014-01-01

Full Text Available Myxomas, the most common primary cardiac tumors, are known as a source of cardiogenic emboli. The possibility of their early detection has made them of great importance for emergency medicines. Detection of the disease is probable at early stages using echocardiography and associate complications such as syncope, cerebral embolic ischemic strokes, and sudden death. We report experience of a rare case of juvenile acute stroke in a patient with cardiac myxoma affecting all cardiac chambers presenting to the emergency department. In young stroke patients with signs and symptoms compatible with cardiovascular involvement, cardiogenic emboli should be taken into consideration; early echocardiographic studies are highly recommended. Prompt myxoma resection is required in both asymptomatic and stroke patients in whom intravenous thrombolysis course has not been implemented due to any limitations.

Pulmonary nodules secondary to total parenteral alimentation

International Nuclear Information System (INIS)

Landry, B.A.; Melhem, R.E.

1989-01-01

A seven-year-old male, who had a retroperitoneal alveolar rhabdomyosarcoma and was on total parenteral alimentation (TPN) developed muliple pulmonary nodules, indistinguishable from metastases. These proved to be multiple lipid emboli on open biopsy. (orig.)

VENOUS AIR-EMBOLISM, PRESERVATION REPERFUSION INJURY, AND THE PRESENCE OF INTRAVASCULAR AIR COLLECTIONS IN HUMAN DONOR LIVERS - A RETROSPECTIVE CLINICAL-STUDY

NARCIS (Netherlands)

WOLF, RFE; SLUITER, WJ; BALLAST, A; VANDAM, RM; SLOOFF, MJH

In human liver transplantation, air embolism is seldom encountered after graft reperfusion. Nevertheless, despite adequate flushing and clamping routines, air emboli have been reported in transesophageal echocardiography (TEE) studies performed during the reperfusion phase, We retrospectively

Indirect MR venography: contrast medium protocols, postprocessing and combination in diagnosing pulmonary emboli with MRI

International Nuclear Information System (INIS)

Kluge, A.; Bachmann, G.; Rominger, M.; Schoenburg, M.

2004-01-01

Purpose: Integration of MR venography in a comprehensive MR imaging protocol in patients with suspected pulmonary embolism (PE) and evaluation of contrast media dosage, timing and postprocessing for diagnostic accuracy. Materials and Methods: Fortyeight consecutive inpatients with suspected PE or deep vein thrombosis were examined by MR venography according to one of the following protocols: protocol I: MR venography only, 0.25 mmol/kg bodyweight (BW) Gadopentate dimeglumine(Gd-DTPA) as single dose, bolus timing; protocol II: MR angiography of pulmonary arteries with a cumulative dosage of 0.25 mmol/kg contrast media, modification of coil setting for MR venography without further contrast media application; protocol III: as protocol II but with 0.125 mmol/kg BW, followed by MR venography. Signal-to-noise ratio, contrast-to-noise ratio, number of definable vascular segments and image quality were evaluated. The results were compared to conventional bilateral venography. Results: All MR venography examinations were of diagnostic quality and the examination time was below 10 min. MR venography could be performed in all 48 patients comparted to 43 of 48 patients for conventional venography. Significantly more superficial and deep veins of the leg could be visualized by MR venography (94% compared to 83% for conventional venography). Sensitivity and specificity were 100% and 92%, respectively. Quality differed significantly between 0.125 mmol/kg (protocol III) and 0.25 mmol/kg Gd-DTPA (protocols I and II) while timing did not influence quality (protocol I vs. II). (orig.) [de

conception d'un systeme solaire à concentration pour la desinfection de la bacterie de legionelle

OpenAIRE

BELABBACI, Chérifa

2014-01-01

La légionellose est une infection pulmonaire aiguë dont le mode de contamination résulte de l’inhalation d’aérosols contenant des légionelles. La bactérie de la légionelle pneumophile responsable de 90% de la maladie de légionellose. Ces bactéries trouvées dans les milieux aquatiques naturels et colonisent les réservoirs et les systèmes de distribution d’eau potable comme les hôpitaux et les réseaux municipaux avec une concentration qui varie entre 2.3.103UFC/ml à 103UFC/l. Cette bactérie se ...

Mathematical modeling of coupled drug and drug-encapsulated nanoparticle transport in patient-specific coronary artery walls

KAUST Repository

Hossain, Shaolie S.; Hossainy, Syed F A; Bazilevs, Yuri; Calo, Victor M.; Hughes, Thomas Jr R

2011-01-01

The majority of heart attacks occur when there is a sudden rupture of atherosclerotic plaque, exposing prothrombotic emboli to coronary blood flow, forming clots that can cause blockages of the arterial lumen. Diseased arteries can be treated

THROMBOLYTIC THERAPY OF RIGHT HEART EMBOLI-IN-TRANSIT

NARCIS (Netherlands)

JESSURUN, GAJ; BRUGEMANN, J; HAMER, JPM; ROMER, JPH; LIE, KI

1995-01-01

Currently, no consensus exists for the appropriate treatment of echocardiographically diagnosed mobile right heart masses giving rise to a high suspicion of migrant thromboembolism in patients with pulmonary embolism, This may lead to unnecessary delay in the implementation of the most appropriate

Thrombolytic therapy of right heart emboli-in-transit.

Science.gov (United States)

Jessurun, G A; Brügemann, J; Hamer, J P; Römer, J P; Lie, K I

1995-11-01

Currently, no consensus exists for the appropriate treatment of echocardiographically diagnosed mobile right heart masses giving rise to a high suspicion of migrant thromboembolism in patients with pulmonary embolism. This may lead to unnecessary delay in the implementation of the most appropriate treatment for these patients. Several earlier studies have supported the beneficial role of thrombolytic therapy. We report on an additional two patients with mobile right heart thromboemboli, refractory to systemic anticoagulation, who recovered quickly after initiation of thrombolytic therapy.

Percutaneous treatment of complications occurring during hemodialysis graft recanalization

Energy Technology Data Exchange (ETDEWEB)

Sofocleous, Constantinos T. E-mail: constant@pol.net; Schur, Israel; Koh, Elsie; Hinrichs, Clay; Cooper, Stanley G.; Welber, Adam; Brountzos, Elias; Kelekis, Dimitris

2003-09-01

Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.

Isolated Deep Infarcts: Which Size Indicates Single Penetrating Artery Disease?

Directory of Open Access Journals (Sweden)

Nilüfer Yeşilot

2007-06-01

Full Text Available OBJECTIVE: The relationship between infarction size determined in the acute stage and the probability of the presence of large artery stenosis or cardiac source of emboli in patients with isolated deep infarcts was evaluated. METHODS: Maximum transverse diameters of the infarcts seen in 59 consecutive patients’ T2 weighted MRI scans were prospectively recorded. Receiver operating characteristic curves were generated to analyze the optimal size that discriminate IDI with and without underlying large artery stenosis or cardiac source of emboli (LAS/CSE. RESULTS: Twenty-six IDI were in the medial cerebral artery (MCA territory, 24 in pons and 9 in thalamus. Optimal infarct diameter for MCA IDIs was 25 mm. One of the 10 cases with small (2-14 mm and half of the 14 cases (50% with large (17-25 mm pontine infarcts had LAS/CSE, but only 2 patients, one in each group had severe (≥70% basilar artery stenosis. None had major CSE. None of the 9 cases with thalamic infarcts (8-20 mm had LAS/CSE. CONCLUSION: : IDIs in different anatomical locations should be assessed separately. Middle cerebral artery territory IDIs with a maximum diameter of less than 25 mm are rarely associated with LAS/CSE and possibly develop due to occlusion of single lenticulostriate artery. Large unilateral pontine infarcts are usually not associated with severe basilar artery stenosis or major CSE and are probably caused by basilar artery atheromatous branch occlusion

A Novel Carotid Device for Embolic Diversion: Lessons Learned from a “First in Man” Trial in Patients with Atrial Fibrillation

International Nuclear Information System (INIS)

Sievert, Horst; Franke, Jennifer; Grad, Ygael; Nishri, Boaz; Assaf, Yaron; Yodfat, Ofer; Römer, Albrecht; Robertson, Greg C.; Stone, Gregg W.

2012-01-01

Purpose: This study was designed to investigate a novel device that was developed to direct emboli away from the internal carotid artery to the external carotid artery to prevent embolic stroke while avoiding the necessity for anticoagulation with warfarin. Methods: A stent-like, self-expandable filter was developed consisting of fine cobalt alloy mesh. After promising preclinical animal testing, the device was implanted into the common carotid artery extending into the external carotid artery in three patients with atrial fibrillation, each of whom were at high-risk for cerebral emboli and were suboptimal candidates for anticoagulation. Follow-up was performed clinically and with carotid duplex ultrasound. Results: The implantation was successful in all three patients. Unrestricted flow through the filter was demonstrated in each patient at 6 months by duplex sonography. However, at 7 months ultrasound demonstrated occlusion of the internal carotid artery filter in one patient, which was subsequently confirmed by angiography. Subtotal filter occlusion occurred in a second patient at 14 months. Neither patient had clinical symptoms. Both internal carotid arteries were successfully recanalized using standard angioplasty techniques without complication. The third patient had completely normal carotid blood flow at 29 months follow-up. Conclusions: Implantation of a novel device intended to divert emboli away from the internal carotid artery was feasible, but resulted in occlusive neointimal proliferation in two of three patients. These results demonstrate a discrepancy from the findings of preclinical animal studies and human investigation.

Traversing boundaries: thrombus in transit with paradoxical embolism

Directory of Open Access Journals (Sweden)

Varun Miriyala

2016-09-01

Full Text Available A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO. Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy, paradoxical embolism (PDE is uncommon, representing <2% of all arterial emboli. We present a case report where a thrombus has been directly observed passing through the PFO during an echocardiogram study; thus, clearly delineating the true cause of multiple thromboemboli and stoke in our patient. Subsequent Transesophageal Echocardiography (TEE also interestingly showed the thrombus in transit in the aorta and pulmonary artery.

A Case of Acinetobacter Septic Pulmonary Embolism in an Infant

Directory of Open Access Journals (Sweden)

Poonam Wade

2016-01-01

Full Text Available Case Characteristics. An 11-month-old girl presented with fever and breathlessness for 5 days. Patient had respiratory distress with bilateral coarse crepitations. Chest radiograph revealed diffuse infiltrations in the right lung with thick walled cavities in mid and lower zone. Computed tomography showed multiple cystic spaces and emboli. Blood culture grew Acinetobacter species. Intervention. Patient was treated with Meropenem and Vancomycin. Outcome. Complete clinical and radiological recovery was seen in child. Message. Blood cultures and CT of the chest are invaluable in the evaluation of a patient with suspected septic pulmonary embolism. With early diagnosis and appropriate antimicrobial therapy, complete recovery can be expected in patients with septic pulmonary embolism.

WEST AFRICAN JOURNAL OF MEDICINE

African Journals Online (AJOL)

user1

volume in one second to that of forced vital capacity (FEV1/FVC) less than 70%. Patients with other lung diseases like bronchiectasis, pulmonary tuberculosis, pulmonary emboli, lung abscess, pneumonia, pneumoconiosis and kyphoscoliosis were excluded by history, physical examination and appropriate investigations.

Maximum permissible concentration of radon {sup 222}Rn in air; La concentration maximale admissible du radon 222 dans l'air

Energy Technology Data Exchange (ETDEWEB)

Hamard, J; Beau, P G; Ergas, A [Commissariat a l' Energie Atomique, Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires, departement de la protection sanitaire, service d' hygiene atomique

1968-09-01

In order to verify the validity of the values proposed for the maximum permissible concentration of {sup 222}Rn in air, one can either approach the problem: - by epidemiological studies tending to determine the relation dose-effect both quantitatively and qualitatively; - or by choosing a lung model and clearance constants allowing a more accurate determination of the delivered dose and the localisation of the more severely irradiated portions of the bronchial tree. The radon MPC have been calculated using the model and the respiration constants set up by the I.C.R.P. Task Group on Lung dynamics. Two cases have been considered, i.e. when the radon daughter products behave as soluble materials and as insoluble ones. The values which have been found have been compared with those given up to now by several national and international bodies. (authors) [French] Deux voies d'approche peuvent etre empruntees pour verifier la validite des valeurs proposees pour la concentration maximale admissible du radon 222 dans l'air: - etudes epidemiologiques tendant a preciser qualitativement et quantitativement la relation dose-effet; - choix d'un modele pulmonaire et de constantes d'epuration permettant une determination plus precise de la dose delivree et la localisation des segments de l'arbre pulmonaire les plus irradies. Les auteurs ont utilise pour le calcul de la CMA du radon le modele et les constantes respiratoires proposees par le Task Group on Lungs dynamics de la C.I.P.R. On a pris en consideration le cas ou les descendants du radon se comportent comme des substances solubles et celui ou ils se comportent comme des substances insolubles. Les valeurs trouvees sont comparees a celles proposees jusqu'alors par divers organismes nationaux et internationaux. (auteurs)

Early prosthetic aortic valve infection identified with the use of positron emission tomography in a patient with lead endocarditis.

Science.gov (United States)

Amraoui, Sana; Tlili, Ghoufrane; Sohal, Manav; Bordenave, Laurence; Bordachar, Pierre

2016-12-01

18-Fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) scanning has recently been proposed as a diagnostic tool for lead endocarditis (LE). FDG PET/CT might be also useful to localize associated septic emboli in patients with LE. We report an interesting case of a LE patient with a prosthetic aortic valve in whom a trans-esophageal echocardiogram did not show associated aortic endocarditis. FDG PET/CT revealed prosthetic aortic valve infection. A second TEE performed 2 weeks after identified aortic vegetation. A longer duration of antimicrobial therapy with serial follow-up echocardiography was initiated. There was also increased uptake in the sigmoid colon, corresponding to focal polyps resected during a colonoscopy. FDG PET/CT scanning seems to be highly sensitive for prosthetic aortic valve endocarditis diagnosis. This promising diagnostic tool may be beneficial in LE patients, by identifying septic emboli and potential sites of pathogen entry.

Unexpected Multiple Organ Infarctions in a Poisoned Patient

Directory of Open Access Journals (Sweden)

Sung-Wook Park

2015-08-01

Full Text Available Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE. However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

Incidence, predictors and outcomes of infective endocarditis in a contemporary adult congenital heart disease population.

Science.gov (United States)

Moore, Benjamin; Cao, Jacob; Kotchetkova, Irina; Celermajer, David S

2017-12-15

The prevalence of congenital heart disease (CHD) in the adult population is steadily increasing. A substrate of prosthetic material and residual lesions, constantly evolving as surgical techniques change over time, predispose these patients to the potentially devastating complication of infective endocarditis (IE). We retrospectively reviewed 2935 patients in our adult CHD database for all cases of endocarditis between 1991 and 2016. Incidence, clinical course and predictors of outcomes were analysed. We document 74 episodes in 62 patients, with an incidence of 0.9 cases/1000 patient years (py). IE was more common in complex CHD (1.4 cases/1000py) and ventricular septal defects (VSDs) (1.9 cases/1000py). Prosthetic material was involved in 47% and left-sided infection predominated (66%). The incidence in bicuspid aortic valves post aortic valve replacement (AVR) was significantly higher than in unoperated valves, being 1.8 and 1.1 cases/1000 patient years respectively. Streptococcus was the most frequently implicated causative organism (37%). Emboli occurred in 34% of cases with a cerebral predilection. 46% of patients required surgery during the admission for IE, most frequently to replace a severely regurgitant bicuspid aortic valve. Early endocarditis-related mortality was 15%, associated with cerebral emboli and acute renal failure. In a contemporary adult CHD cohort, those with complex underlying lesions, VSDs or an AVR were at higher risk for IE. Mortality remains substantial and is more likely in patients with cerebral emboli and/or acute renal failure. Copyright © 2017 Elsevier B.V. All rights reserved.

Atrial fibrillation in the Danish population

DEFF Research Database (Denmark)

Hansen, Morten Lock

2010-01-01

Atrieflimren er den hyppigst forekommende behandlingskrævende arytmi i den danske befolkning. 50.000 – 70.000 vurderes at lide af sygdommen. Tromboemboli, apopleksi og perifere systemiske embolier, er den hyppigste og alvorligste komplikation til atrieflimren. Det skønnes, at atrieflimren er den ...

Paradoxical embolisation and cerebral white matter lesions in dementia.

NARCIS (Netherlands)

Purandare, N.; Oude Voshaar, R.C.; McCollum, C.; Jackson, A.; Burns, A.

2008-01-01

The study aimed to examine the relationship between spontaneous cerebral emboli (SCE), patent foramen ovale (PFO) and white matter hyperintensities (WMH) on cerebral MRI in patients with Alzheimer's disease (AD) and vascular dementia (VaD). SCE were identified by transcranial Doppler of the middle

Lemierre\\'s syndrome - the uncommon cold | Such | SA Journal of ...

African Journals Online (AJOL)

Lemierre's syndrome (postanginal sepsis/necrobacillosis) is a rare clinical entity characterised by the triad of acute oropharyngeal infection, with secondary thrombophlebitis of the internal jugular vein and metastatic septic emboli.A high degree of clinical suspicion is needed to diagnose the syndrome and the radiologist's ...

Intraoperative fat embolism during core decompression and bone grafting for osteonecrosis of the hip: report of 3 cases and literature review.

Science.gov (United States)

Schaffer, Joseph Christopher; Adib, Farshad; Cui, Quanjun

2014-06-01

Osteonecrosis (ON) of the femoral head, without timely intervention, often progresses to debilitating hip arthritis. Core decompression (CD) with bone grafting was used to treat patients with early-stage ON. In 3 cases, intraoperative oxygen saturation, end-tidal carbon dioxide fluctuations, and/or vital sign fluctuations were observed during insertion of the graft, a mixture of bone marrow and demineralized bone matrix. In 1 case, continued postoperative pulmonary symptoms required admission to intensive care. In this article, we describe these cases and provide supporting evidence that they were caused by fat emboli secondary to forceful insertion of bone graft. We review the literature and present complications data. Although no cases of fat emboli were reported as complications of any CD series with or without bone grafting, CD augmented with bone graft may carry risks not seen before in CD alone. Care should be taken to avoid these complications, possibly through technique modification.

Septic-embolic and septic-metabolic brain abscess

International Nuclear Information System (INIS)

Weber, W.; Henkes, H.; Kuehne, D.; Felber, S.; Jaenisch, W.; Woitalla, D.

2000-01-01

The hematogeneous spread of bacteria, fungi and protozoa may also reach the brain vessels, which happens mostly through septic emboli. From such an embolus a metastatic focal encephalitis and later a septic-embolic brain abscess may arise. The most frequently underlying infections that may cause septic emboli are bacterial endocarditis as well as bacterial infections of artificial heart valve prostheses. Congenital heart malformations with a right-to-left shunt also play here a certain role. Basically, however, all septic conditions and bacteriemias may cause septic-embolic brain abscesses. They occur frequently as multiple lesions. MRI is superior to CT in depicting the different stages of evolution from focal encephalitis, through the hardly encapsulated early abscess, to the formation of a membrane and later a dense fibrous capsule. The medical treatment of a brain abscess requires properly performed CT or MRI follow-up examinations in order to realize early enough a possible growing of such a lesion. (orig.) [de

Intravascular pulmonary metastases from sarcoma: appearance on computed tomography in 3 cases

International Nuclear Information System (INIS)

Ting, P.T.; Burrowes, P.W.; Gray, R.R.

2005-01-01

Various common malignant neoplasms (ie, liver, kidney, stomach and breast) have been reported to embolize to the pulmonary arterial system. This uncommon occurrence can also result from metastatic sarcoma. We report 3 cases- 2 chondrosarcomas and 1 osteosarcoma-associated with intravascular motastases to the pulmonary vasculature and discuss the clinical presentation and differentiating radiologic features on computed tomography (CT). Intravascular pulmonary tumour emboli may present with nonspecific respiratory symptoms or remain completely asymptomatic, and therefore, many patients are often misdiagnosed with thromboembolic disease or undiagnosed until autopsy. Chest CTs in all our patients demonstrated a striking pattern of multifocal tubular branching beaded opacities along the pulmonary vasculature in a multilobular distribution. Our observations and a review of the literature indicate that chest CT is the most useful diagnostic tool for detecting intravascular pulmonary tumour emboli. CT can distinguish this entity from mucous plugging by demonstrating the normal adjacent bronchus. The tubular nature of these metastases distinguishes them from the more common parenchymal metastases. (author)

Medical image of the week: Lynch syndrome

Directory of Open Access Journals (Sweden)

Athale A

2016-11-01

Full Text Available No abstract available. Article truncated at 150 words. A 43-year-old woman with a history of anemia, thrombocytopenia, and recent treatment for pyelonephritis was transferred to our hospital for increasing shortness of breath. Four months prior to admission, she developed unprovoked bilateral deep vein thrombosis (DVT and pulmonary emboli (PE and was started on rivaroxaban at that time. At presentation, she was complaining of worsening shortness of breath, heavy menstrual bleeding and pain in her calves. CT angiography of chest showed multiple pulmonary emboli to the lower lobes and left upper lobe (Figure 1 and lower extremity venous Doppler showed extensive, acute deep vein thrombosis involving the femoral, popliteal and calf veins bilaterally. Rivaroxaban was held due to anemia and thrombocytopenia and there was concern for respiratory failure since she developed new DVT and PE. She was transfused with 1 unit of packed red blood cells and started on a heparin drip. She continued to have significant menorrhagia, the ...

Left Atrium Papillary Fibroelastomas: A Cause of Cerebral Emboli

Directory of Open Access Journals (Sweden)

A. G. Ciss

2012-01-01

Full Text Available Papillary fibroelastomas are cardiac benign tumours. Among the benign cardiac tumor, papillary fibroelastomas are reported second after myxomas. Most often diagnosed incidentally, papillary fibroelastomas may embolize to cerebral circulation. Valvular locations are predominant; location in left atrium is rare. In this paper, we present a case of papillary fibroelastoma located in left atrium with symptoms of cerebral embolization. Transoesophageal echocardiography diagnosed a mobile mass. The patient was treated with surgical resection without further embolic complication.

Acute Infantile Hemiplegia Associated with Ipsilateral Retinal ...

African Journals Online (AJOL)

An 18-month-old patient with acute infantile hemiplegia, aphasia and ipsilateral retinal vascular occlusion, is described. The opthalmic findings suggest that the lesion was due to emboli originating from both internal carotid arteries, probably as a result of upper respiratory tract infection and otitis media. This report ...

Large and medium-sized pulmonary artery obstruction does not play a role of primary importance in the etiology of sickle-cell disease-associated pulmonary hypertension

NARCIS (Netherlands)

van Beers, Eduard J.; van Eck-Smit, Berthe L. F.; Mac Gillavry, Melvin R.; van Tuijn, Charlotte F. J.; van Esser, Joost W. J.; Brandjes, Dees P. M.; Kappers-Klunne, Mies C.; Duits, Ashley J.; Biemond, Bart J.; Schnog, John-John B.

2008-01-01

Background: Pulmonary hypertension (PHT) occurs in approximately 30% of adult patients with sickle-cell disease (SCD) and is a risk factor for early death. The potential role of pulmonary artery obstruction, whether due to emboli or in situ thrombosis, in the etiology of SCD-related PHT is unknown.

Anaesthesia for the child with congenital heart disease: pointers and ...

African Journals Online (AJOL)

Increased pulmonary blood flow (PBF) causes a volume or pressure overload to the ... venous drainage (TAPVD), high left atrial pressure (e.g. hypoplastic left heart ... function. Congenital heart disease (CHD) is the commonest birth defect, with a reported .... Is there valve regurgitation? ... tubing to avoid systemic air emboli.

Nonoperative Management and Novel Imaging for Posterior Circumflex Humeral Artery Injury in Volleyball

NARCIS (Netherlands)

van de Pol, Daan; Planken, R. Nils; Terpstra, Aart; Pannekoek-Hekman, Marja; Kuijer, P. Paul F. M.; Maas, Mario

2017-01-01

We report on a 34-yr-old male elite volleyball player with symptomatic emboli in the spiking hand from a partially thrombosed aneurysm of the posterior circumflex humeral artery (PCHA) in his dominant shoulder. At initial diagnosis and follow-up, a combination of time-resolved and high-resolution

Nonthrombotic artificial mass in right ventricle and pulmonary circulation as a sequence of vertebroplasty

International Nuclear Information System (INIS)

Monovska, T.; Kirova, G.; Bojinov, D.; Kichukov, K.

2013-01-01

Full text: Introduction: Percutaneous vertebroplasty for the treatment of the vertebral body fractures is considered to be relatively safe therapeutic procedure. Nevertheless there is a potential risk of spread of emboli from artificial material through external vertebral venous plexus. What you will learn: This is a 60 -year-old patient with primary diagnosis of multiple myeloma and conducted vertebroplasty due to the vertebral bodies fractures. Accompanying symptoms are: coughing up blood and pain in the right the chest with medication for micro thromboembolism form of Pulmonary thromboembolism (PTE). There are echocardiographic data on hospitalization for a formation in the right ventricle. Based on additionally performed CT study, a ‘foreign body’ - artificial material in right ventricle and subsegmentary branches of the pulmonary arteries as a complication of previous vertebroplasty has been recorded. Paravertebral venous vessels in the area of the thoracic section filled with cement have been noticed. Discussion: non-thrombotic embolism of artificial material prior vertebroplasty can be asymptomatic, or condition may be associated with life-threatening symptoms - compression of the spinal cord resulting in paraplegia, emboli in the cerebral vessels, right ventricle, kidney arteries. The frequency of the topical flowing of the used material is relatively high (80-90 %) to the para-vertebral vein (over 24%), with subsequent pulmonary emboli (4.6 to 6.8 %). The path of the embolization material dissemination is in the course of the para-vertebral veins, v. azygos and v. cafa inf., with the end goal pulmonary circulation. Conclusion: Follow-up of patients after the therapeutic vertebroplasty and integrated diagnostic approach with appropriate imaging methods allow timely diagnosis and treatment of this unusual form of non-thrombotic embolism

Vascularization of air sinuses and fat bodies in the head of the Bottlenose dolphin (Tursiops truncatus: morphological implications on physiology

Directory of Open Access Journals (Sweden)

Alex eCostidis

2012-07-01

Full Text Available AbstractCetaceans have long been considered capable of limiting diving-induced nitrogen absorption and subsequent decompression sickness through a series of behavioral, anatomical, and physiological adaptations. Recent studies however suggest that in some situations these adaptive mechanisms might be overcome, resulting in lethal and sublethal injuries. Perhaps most relevant to this discussion is the finding of intravascular gas and fat emboli in mass-stranded beaked whales. Although the source of the gas emboli has as yet to been ascertained, preliminary findings suggest nitrogen is the primary component. Since nitrogen gas embolus formation in divers is linked to nitrogen saturation, it seems premature to dismiss similar pathogenic mechanisms in breath-hold diving cetaceans. Due to the various anatomical adaptations in cetacean lungs, the pulmonary system is thought of as an unlikely site of significant nitrogen absorption. The accessory sinus system on the ventral head of odontocete cetaceans contains a sizeable volume of air that is exposed to the changing hydrostatic pressures during a dive, and is intimately associated with vasculature potentially capable of absorbing nitrogen through its walls. The source of the fat emboli has also remained elusive. Most mammalian fat deposits are considered poorly-vascularized and therefore unlikely sites of intravascular introduction of lipid, although cetacean blubber may not be as poorly vascularized as previously thought. We present new data on the vasculature of air sinuses and acoustic fat bodies in the head of bottlenose dolphins and compare it to published accounts. We show that the mandibular fat bodies and accessory sinus system are associated with extensive venous plexuses and suggest potential physiological and pathological implications.

Intracardiac tumor: A risk factor for stroke in the young –A case report

African Journals Online (AJOL)

Intracardiac mass should be considered a possible risk factor for ischemic stroke in young adult, especially in the absence of other risk factors such as connective tissue disorders, HIV/AIDS, hemoglobinopathy or use of recreational drugs. High index of suspicion is required in order not to overlook such source of emboli.

Vascular and hypoxic tissue lesions in cranial computerized tomography and their differential diagnosis

Energy Technology Data Exchange (ETDEWEB)

Kuckein, D

1982-09-01

CT findings and differential diagnosis in cerebral infarctions caused by vascular stenosis or occlusion, by emboli or arterial thrombosis are discussed; also in cerebral and sinus venous thrombosis. Brain damage due to hypoxia, to a combination of hypoxia and sinus venous thrombosis or to one of hypoxia and hyperpyrexia are presented.

Retrograde catheterisation vs. Doppler echocardiographic evaluation of aortic stenosis--a survey of contemporary UK practice.

Science.gov (United States)

Fazal, Iftikhar A; Alfakih, Khaled; Wilcox, Robert G; Walsh, John T

2009-05-01

Aortic stenosis (AS) is the most common indication for valve surgery. Recent data suggested an increased risk of cerebral emboli when the aortic valve is crossed to obtain 'pull-back' gradient. We conducted a large questionnaire based study to evaluate current practice in the assessment of aortic valve gradient amongst cardiologists and the preferences of cardiac surgeons in the UK. E-mail questionnaires were sent to 645 (72%) UK consultant cardiologists and to 198 (92%) UK consultant cardiac surgeons. 232 cardiologists and 52 cardiac surgeons responded. 53% of cardiologists routinely attempt to cross the valve in moderate AS while only 23% do so in severe AS. 38% of cardiologists in the age group '50+ years' cross the valve in severe AS compared to 13% in the age group '30-40 years'. Common reasons given for crossing a stenosed valve included 'to verify the echocardiographic gradient' (85%) and 'maintaining skill' (24%). 64% of cardiologists have changed their views on the necessity of crossing the valve in the last ten years. Although the majority appreciate the increased risk of crossing the valve only 18% of patients are consented differently if crossing the valve is planned. 26% of cardiac surgeons prefer the valve to be crossed to provide information on 'pull-back' gradient, 32% for LV function assessment and 14% to confirm MV competence. 92% would accept echocardiographic data alone if both the gradient and aortic valve area were available and considered correct. Our survey found that the practice of crossing the aortic valve has changed in the last 10 years and that younger consultant cardiologists are less likely to cross the aortic valve. Increasing confidence in echocardiographic data and potential complications of crossing the valve are implicated. 92% of cardiac surgeons do not require the valve to be crossed if the echo data is considered accurate.

Processes and xylem anatomical properties involved in rehydration dynamics of cut flowers

NARCIS (Netherlands)

Meeteren, van U.; Ieperen, van W.; Nijsse, J.; Scheenen, T.W.J.; As, van H.; Keijzer, C.J.

2001-01-01

In cut flowers, which are harvested in air and transported dry, all cut xylem vessels in the basal part of the stem contain air instead of water. These air-emboli initially block water transport at the start of vase life, but usually (partly) disappear during the first hours of vase life, resulting

Thromboembolic Complications in Thermally Injured Patients,

Science.gov (United States)

1992-12-01

profilaxis con brdld vanec entre 0.4% et 7%. La signification cliniquc de ces heparina, militan en contra de su uso rutinario, excepto en Ev~nements est...centros adopten rutinariamente la profilaxis 8. Purdue, G.F., Hunt, J.L.: Pulmonary emboli in burned patients. J. con heparina de baja dosificaci6n. Se

Septic-embolic and septic-metabolic brain abscess; Septisch-embolischer und septisch-metastatischer Hirnabszess

Energy Technology Data Exchange (ETDEWEB)

Weber, W.; Henkes, H.; Kuehne, D. [Alfried-Krupp-Krankenhaus Essen (Germany). Klinik fuer Radiologie und Neuroradiologie; Felber, S. [Universitaetsklinik Innsbruck (Austria). Klinische Abt. der Radiologie I; Jaenisch, W. [Freie Univ. Berlin (Germany). Inst. fuer Neuropathologie; Woitalla, D. [Bochum Univ. (Germany). St. Josef-Hospital

2000-11-01

The hematogeneous spread of bacteria, fungi and protozoa may also reach the brain vessels, which happens mostly through septic emboli. >From such an embolus a metastatic focal encephalitis and later a septic-embolic brain abscess may arise. The most frequently underlying infections that may cause septic emboli are bacterial endocarditis as well as bacterial infections of artificial heart valve prostheses. Congenital heart malformations with a right-to-left shunt also play here a certain role. Basically, however, all septic conditions and bacteriemias may cause septic-embolic brain abscesses. They occur frequently as multiple lesions. MRI is superior to CT in depicting the different stages of evolution from focal encephalitis, through the hardly encapsulated early abscess, to the formation of a membrane and later a dense fibrous capsule. The medical treatment of a brain abscess requires properly performed CT or MRI follow-up examinations in order to realize early enough a possible growing of such a lesion. (orig.) [German] Die haemoatogene Ausbreitung von Bakterien, Pilzen oder Protozoen bis in die Hirngefaesse erfolgt meist durch eine septische Embolie. Es entstehen eine metastatische Herdenzephalitis und im weiteren Verlauf daraus ein septisch-embolischer Hirnabszess. Die haeufigste Grunderkrankung die zu septischen Embolien fuehrt, ist die bakterielle Endokarditis sowie die bakterielle Infektion von Herzklappenprothesen. Eine besondere Bedeutung kommt hier den angeborenen kardialen Fehlbildungen mit Rechts-Links-Shunt zu. Grundsaetzlich koennen jedoch alle Bakteriaemien zu septisch-embolischen Hirnabszessen fuehren. Septisch-embolische Hirnabszesse treten aufgrund ihres Entstehungsmechanismus haeufig multipel auf. Die CT und besser noch die MRT erlauben die Darstellung aller Entwicklungsstadien von der Herdenzephalitis ueber den kaum abgegrenzten Abszess, die Membranbildung bis zur Entstehung einer dicken, die eitergefuellte Hoehle allseits umgebenden

Nonoperative Management and Novel Imaging for Posterior Circumflex Humeral Artery Injury in Volleyball.

Science.gov (United States)

van de Pol, Daan; Planken, R Nils; Terpstra, Aart; Pannekoek-Hekman, Marja; Kuijer, P Paul F M; Maas, Mario

We report on a 34-yr-old male elite volleyball player with symptomatic emboli in the spiking hand from a partially thrombosed aneurysm of the posterior circumflex humeral artery (PCHA) in his dominant shoulder. At initial diagnosis and follow-up, a combination of time-resolved and high-resolution steady state contrast-enhanced magnetic resonance angiography (CE-MRA) enabled detailed visualization of: (1) emboli that were not detectable by vascular ultrasound; and (2) the PCHA aneurysm, including compression during abduction and external rotation (ABER provocation). At 15-month follow-up, including forced cessation of volleyball activities over the preceding 9 months, the PCHA aneurysm remained unchanged. Central filling defects in the palmar arch and digital arteries resolved over time and affected arterial vessel segments showed postthrombotic changes. Digital blood pressure values improved substantially and almost normalized during follow-up. In conclusion, this case report is the first to show promising results of nonoperative management for a vascular shoulder overuse injury in a professional volleyball player as an alternative to invasive therapeutic options.

Haemostatic activity of ethamsylate and aminocaproic acid adsorbed poly(2-hydroxyethyl methacrylate) particles.

Science.gov (United States)

Horák, D; Svec, F; Adamyan, A; Titova, M; Skuba, N; Voronkova, O; Trostenyuk, N; Vishnevskii, V; Gumargalieva, K

1992-01-01

A haemostatic material suitable for embolization was prepared by the adsorption of haemostatics--ethamsylate and aminocaproic acid in the spherical particles of porous poly(2-hydroxyethyl methacrylate) (p(HEMA)). The degree of purification of ethamsylate-treated particles was tested by an analysis of donor blood in contact with the material. An evaluation of the haemostatic properties of these materials was obtained by the determination of the indicators of blood clotting: activated partial thromboplastin time, thrombin time, and prothrombin time. Ethamsylate or aminocaproic acid-containing p(HEMA) has a distinct haemostatic effect on pathological blood of patients suffering from focal alterations of the liver. These haemostatic emboli materials show promise for the immediate control of various haemorrhages; when introduced into a zone with increased haemorrhage, they may help to correct disturbed haemostasis.

Iodine-123-labeled radiotracers for cardiovascular and testicular imaging studies: labeling of phenyl fatty acids for myocardial studies, fibronectin for thrombus localization, and human chorionic gonadotropin for testicular studies

International Nuclear Information System (INIS)

Kulkarni, P.V.; Lewis, S.E.; McConnell, J.; Buja, L.M.; Wilson, J.E. III; Willerson, J.T.; Parkey, R.W.

1985-01-01

Development and evaluation of iodine-123-labeled compounds for potential applications in certain imaging studies are described. A new method utilizing an organothallium intermediate has been developed to radioiodinate phenyl fatty acids. The method is simple, and consistently high yields (80 to 90%) can be obtained on a routine basis. The biodistribution patterns of the product prepared by this method were found to be very similar to those produced by the direct electrophilic substitution method. Radioiodinated fibronectin (FN) localized in experimental thrombi and pulmonary emboli. In dogs the deep-vein thrombi could be visualized within 3 hr of postinjection of the tracer. Radioiodinated human chorionic gonadotropin (HCG) localized in rat testes which permitted the scintigraphic visualization of scrotal as well as abdominal testes in rats. The localization appears to be receptor mediated

Postoperative hypoxemia due to fat embolism

Directory of Open Access Journals (Sweden)

Tarun Bhalla

2011-01-01

Full Text Available Although the reported incidence of fat embolism syndrome (FES is low (approximately 1%, it is likely that microscopic fat emboli are showered during manipulation of long bone fractures. Even though there continues to be debate regarding the etiology and proposed mechanism responsible for FES, significant systemic manifestations may occur. Treatment is generally symptomatic based on the clinical presentations. We report a 10-year-old girl who developed hypoxemia following treatment of a displaced Salter-Harris type II fracture of the distal tibia. The subsequent evaluation and hospital course pointed to fat embolism as the most likely etiology for the hypoxemia. We discuss the etiology for FES, review the proposed pathophysiological mechanisms responsible for its clinical manifestations, present currently accepted diagnostic criteria, and discuss its treatment.

Diagnostic moléculaire du complexe Mycobacterium tuberculosis résistant à l'isoniazide et à la rifampicine au Burkina Faso

Science.gov (United States)

Désire, Ilboudo; Cyrille, Bisseye; Florencia, Djigma; Souba, Diande; Albert, Yonli; Valerie, Bazie Jean Telesphore; Rebecca, Compaore; Charlemagne, Gnoula; Tamboura, Djibril; Rémy, Moret; Virginio, Pietra; Simplice, Karou Damintoti; Martial, Ouedraogo; Jacques, Simpore

2015-01-01

Introduction Cette étude a eu pour objectifs de diagnostiquer la tuberculose pulmonaire par l'examen microscopique et par la PCR des crachats et de déterminer les bases moléculaires de la résistance à la rifampicine et à l'isoniazide. Méthodes Le diagnostic du Complexe Mycobacterium Tuberculosis (CMTB) a été effectué par microscopie après coloration au Ziehl Nielsen et par PCR en temps réel en utilisant le kit d'identification du complexe MTB (Sacace Biotechnologie, Italie). Les résistances à la Rifampicine et à l'Isoniazide ont été étudiées par la technique de la PCR en utilisant le kit MTB résistance 8 (Sacace, Biotechnologie). Résultats Sur les 59 patients diagnostiqués pour la tuberculose pulmonaire, 59,3% étaient positifs en microscopie optique et 44,1% étaient positifs par PCR en Temps réel. Les résistances à la rifampicine (rpoB) et à l'isoniazide (katG et inhA) ont été observées chez 9 patients. La résistance à la rifampicine était due aux mutations (Asp516Val, Ser531Trp, Leu533Pro) et celle à l'isoniazide par les substitutions Ser315Thr du gène katG et C209T du gène inhA. Les multi résistances à la rifampicine et à l'isoniazide ont été observées dans 55,5% des échantillons et concernaient les associations: ropBAsp513Val + inhAC209T et rpoBLeu533Pro + katGSer315Thr. Conclusion La PCR en temps réel qui permet l'identification des allèles mutants rpoB, katG et inhA de M. tuberculosis est un outil de diagnostic épidémiologique de grande importance car elle permet de déterminer le niveau de résistance à la rifampicine et à l'isoniazide. PMID:26491516

Maladie de Horton révélée par une dyspnée

Science.gov (United States)

Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel

2015-01-01

Les manifestations pleuro-pulmonaires de la maladie de Horton sont rares et peu connues. Elles peuvent être inaugurales, à l'origine d'un retard à la prise en charge si elles sont méconnues. Il s'agissait d'un patient âgé de 75 ans, admis pour une dyspnée, une toux chronique et une fièvre. Il a reçu une antibiothérapie et a bénéficié d'une fibroscopie bronchique avec lavage broncho-alvéolaire à la recherche d'un germe, qui a révélé plutôt, une alvéolite lymphocytaire. L’évolution était marquée par la persistance des signes cliniques et du syndrome inflammatoire biologique. Un angio-scanner thoracique et une échographie cardiaque étaient sans anomalies. Une origine cardiaque, musculaire, hématologique, néoplasique, vasculaire ou métabolique de la dyspnée a été éliminée. Une maladie de Horton a été évoquée. La biopsie de l'artère temporale a confirmé le diagnostic d'une maladie de Horton. L’évolution sous corticothérapie était marquée par la disparition des signes cliniques et biologiques. Les manifestations pleuro-pulmonaires au cours de la maladie de Horton sont rares, et classiquement, rarement révélatrices de la maladie. La dyspnée peut initialement égarer le diagnostic vers d'autres étiologies notamment infectieuses. Le but de ce travail est d'insister sur le fait que la connaissance de ces différentes manifestations respiratoires au cours de la maladie de Horton (toux persistante, dyspnée, épanchement pleural) est utile au clinicien afin de prescrire une corticothérapie, chez un sujet le plus souvent âgé ayant un état fébrile et inflammatoire prolongé, permettant ainsi d’éviter l'apparition de complications. PMID:26161171

Research and Development of Advanced Life Support Equipment.

Science.gov (United States)

1999-02-01

kg.) were catheterized f or measurement of left ventricular pressure (LVP), right ventricular pressure (RVP), mean aortic pressure (MAP), central ...Orientation Laboratory Venous Gas Emboli Variable Profile Breathing Simulator Wingate Anaerobic Test Weapons System Trainer World Wide Web... history screening of the potential subjects was conducted to eliminate those individuals who have known health conditions/ histories which would

Central venous catheter-related bacteremia caused by Kocuria kristinae: case report and review of the literature.

Science.gov (United States)

Dunn, Ryan; Bares, Sara; David, Michael Z

2011-08-24

Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided.

Quantification of Emboli by Visualization of Air Filled Xylem Vessels

NARCIS (Netherlands)

Nijsse, J.; Keijzer, C.J.; Meeteren, van U.

2001-01-01

Between harvest and vase life the cut surface of most cut flowers is exposed to air for a longer or shorter period. It was hypothesized that under normal harvest and transport conditions air only enters the cut open vessels and does not move to non-cut vessels. The vessel length distribution of

Study on the correlation between SCT features and pathology, MVD, expressions of VEGF in renal cell carcinoma

International Nuclear Information System (INIS)

Chen Xuejun; Gao Jianbo; Yang Xuehua; Zhou Zhigang; Guo Hua; Yue Songwei

2005-01-01

Objective: To evaluate the correlation between spiral CT (SCT) features and pathology, MVD, and expressions of VEGF in renal cell carcinoma (RCC). Methods: Thirty-four patients with RCC diagnosed by pathology underwent SCT examinations. MVD and expressions of VEGF were examined immunohistochemically using SABC techniques. Results: (1) The detection and characterization as well as accuracy of staging in 34 RCC on two-phase enhanced SCT scans were 100%, 100%, and 94%, respectively. (2) Tumors with low density ring on SCT scans mostly had pseudocapsules at pathological examination. The nuclear grade was higher in groups of tumor without low density ring, with central necrosis, and the diameter larger than 3.0 cm than in those of tumor with low density ring, without central necrosis, and the diameter less than 3.0 cm (P<0.01, P<0.01, P<0.01, respectively). (3) In 34 cases of RCC, the mean MVD was 89.5 ± 56.0. The positive expression of VEGF was 70.6% (24/34). (4) The MVD and positive expressions of VEGF in groups of tumor without a low density ring, with central necrosis on SCT scans were higher than in those tumor with a low density ring, without central necrosis (P<0.05 respectively in each of the groups). On early enhanced scans, MVD was closely correlated with tumor enhancement (P<0.05). MVD was higher in tumors with intravenous tumor emboli than in tumors without emboli (P<0.01). Conclusion: (1) Two-phase enhanced SCT scan was a reliable technique in the detection, characterization and staging of RCC. (2) Some SCT features were closely correlated with MVD and expressions of VEGF in RCC, which could be a noninvasive method in predicting aggressiveness and metastasis. (authors)

Central venous catheter-related bacteremia caused by Kocuria kristinae: Case report and review of the literature

Directory of Open Access Journals (Sweden)

David Michael Z

2011-08-01

Full Text Available Abstract Kocuria species are unusual human pathogens isolated most commonly from immunocompromised hosts, such as transplant recipients and cancer patients undergoing chemotherapy, or from patients with chronic medical conditions. A case of catheter-related bacteremia with pulmonary septic emboli in a pregnant adult female without chronic medical conditions is described. A review of other reported Kocuria infections is provided.

Comparative analysis of the long-term results of treatment in patients with Stages I-IIa breast cancer in relation to major prognostic factors

Directory of Open Access Journals (Sweden)

Yu. V. Efimkina

2010-01-01

Full Text Available The analysis of the long-term results of treatment in patients with Stages I-IIa breast cancer in relation to major prognostic factors re- vealed poor morphological factors that greatly influenced the lifespan of female patients, such as tumor invasion along the neural fibers, tumor necrosis, cancer emboli in the lymph gaps and vessels, vascular tumor invasion.

Comparative diagnostic value of pulmonary perfusion and ventilation scintigraphy and angiopneumography in pulmonary embolism

International Nuclear Information System (INIS)

Peltier, P.; Cesbron, J.P.; Dupas, B.; Crochet, D.; Delhumeau, J.

1984-01-01

Fourty-six patients suspected clinically of having a pulmonary embolism (PE) were investigated by angiopneumography (AGP) and perfusion (99m-Tc aggregates) and ventilation (99m-Tc colloid) scintigraohy (SPV Tc). Findings were assessed under blind conditions. A positive diagnosis of pulmonary embolism was made in 19 patients. The SPV Tc was considered as positive if perfusional deficiencies were greater than ventilatory defects, and this was evaluated as such in 23 cases (19 true and 4 false positives). False negatives were not observed. The 4 false positive results corresponded to scintigraphic anomalies suggestive of pulmonary emboli subsegmental in size; true positives were either subsegmental (8), segmental (6) or lobar (5). Sensitivity of the SPV Tc was therefore 100 %; its specificity, all results considered was 76 %, but was 100 % if only images of lobar or segmental lesions are considered [fr

Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD

Directory of Open Access Journals (Sweden)

Grosbois JM

2015-09-01

Full Text Available Jean Marie Grosbois,1,2 Alice Gicquello,3 Carole Langlois,4 Olivier Le Rouzic,3 Frédéric Bart,2 Benoit Wallaert,2,3 Cécile Chenivesse5 1FormAction Santé, rue Pietralunga, Pérenchies, 2Service de Pneumologie, CH Béthune, 3Service de Pneumologie et Immunoallergologie, Centre des Compétences des Maladies Pulmonaires Rares, Hôpital Calmette, CHRU Lille, 4Unité de Biostatistiques, CHRU Lille, 5AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Boulevard de l’Hôpital, Paris, France Introduction: Personalized, global pulmonary rehabilitation (PR management of patients with COPD is effective, regardless of the place in which this rehabilitation is provided. The objective of this retrospective observational study was to study the long-term outcome of exercise capacity and quality of life during management of patients with COPD treated by home-based PR.Methods: Home-based PR was administered to 211 patients with COPD (mean age, 62.3±11.1 years; mean forced expiratory volume in 1 second, 41.5%±17.7%. Home-based PR was chosen because of the distance of the patient’s home from the PR center and the patient’s preference. Each patient was individually managed by a team member once a week for 8 weeks with unsupervised continuation of physical exercises on the other days of the week according to an individual action plan. Exercise conditioning, therapeutic patient education, and self-management were included in the PR program. The home assessment comprised evaluation of the patient’s exercise capacity by a 6-minute stepper test, Timed Up and Go test, ten times sit-to-stand test, Hospital Anxiety and Depression score, and quality of life (Visual Simplified Respiratory Questionnaire, VQ11, Maugeri Respiratory Failure 28.Results: No incidents or accidents were observed during the course of home-based PR. The 6-minute stepper test was significantly improved after completion of the

Brain fat embolism

International Nuclear Information System (INIS)

Sugiura, Yoshihiro; Kawamura, Yasutaka; Suzuki, Hisato; Yanagimoto, Masahiro; Goto, Yukio

1994-01-01

Recently CT and MR imaging have demonstrated that cerebral edema is present in cases of fat embolism syndrome. To simulate this we have made a model of brain-fat embolism in rats under MR imaging. In 20 rats, we did intravenous injection of heparinized blood, 1.5 ml·kg -1 taken from femoral bone marrow cavity. Twenty four hours after the injection, we examined the MR images (1.5 tesla, spin-echo method) of brains and histologic findings of brains and lungs were obtained. In 5 of 20 rats, high signal intensity on T2-weighted images and low signal intensity on T1-weighted images were observed in the area of the unilateral cerebral cortex or hippocampus. These findings showed edema of the brains. They disappeared, however, one week later. Histologic examinations showed massive micro-fat emboli in capillaries of the deep cerebral cortex and substantia nigra, but no edematous findings of the brain were revealed in HE staining. In pulmonary arteries, we also found large fat emboli. We conclude that our model is a useful one for the study of brain fat embolism. (author)

A bench top experimental model of bubble transport in multiple arteriole bifurcations

International Nuclear Information System (INIS)

Eshpuniyani, Brijesh; Fowlkes, J. Brian; Bull, Joseph L.

2005-01-01

Motivated by a novel gas embolotherapy technique, a bench top vascular bifurcation model is used to investigate the splitting of long bubbles in a series of liquid-filled bifurcations. The developmental gas embolotherapy technique aims to treat cancer by infarcting tumors with gas emboli that are formed by selective acoustic vaporization of ∼6 μm, intravascular, perfluorcarbon droplets. The resulting gas bubbles are large enough to extend through several vessel bifurcations. The current bench top experiments examine the effects of gravity and flow on bubble transport through multiple bifurcations. The effect of gravity is varied by changing the roll angle of the bifurcating network about its parent tube. Splitting at each bifurcation is nearly even when the roll angle is zero. It is demonstrated that bubbles can either stick at one of the second bifurcations or in the second generation daughter tubes, even though the flow rate in the parent tube is constant. The findings of this work indicate that both gravity and flow are important in determining the bubble transport, and suggest that a treatment strategy that includes multiple doses may be effective in delivering emboli to vessels not occluded by the initial dose

The place of krypton-81m ventilation in the scintigraphic investigation of the lung

International Nuclear Information System (INIS)

Hoefnagel, C.A.; Marcuse, H.R.

1983-01-01

Fairly recently krypton-81m gas became available for diagnostic purposes. Its advantages and ways to use are surveyed especially for the diagnosis of lung emboli and lung diseases. The combination of perfusion and ventilation scintigrams is the best for specifying the diagnosis. Krypton-81m gas improves the specificity and sensitivity of the examination which is non-invasive and carries no burden for the patient. (Auth.)

[Prevention of postoperative thrombo-embolic accidents following thoracic surgery by low-dose calcium heparinate: a comparative study (author's transl)].

Science.gov (United States)

Le Brigand, H; Morille, P; Garnier, B; Bogaty-Yver, J; Samama, M; Spriet, A

A comparative clinical trial was undertaken in 2420 patients undergoing thoracic surgery during a 4-year period (1973-1977); 40% of the patients had bronchial cancer. Random allocation was not considered as being possible by the surgeons and was replaced by allocation according to the time of operation. There were three protocol groups: Protocol A: First morning operations (1007 patients): subcutaneous calcium heparin, 5000 units (Ul) 2 hours and 30 minutes before surgery then every 12 hours for 15 days. Protocol B: Second morning operations (932 patients): same dose and duration of treatment; the first injection took place 24 to 72 hours after the surgical procedure. The doses were increased from the fourth day after surgery in order to obtain a moderately prolonged partial thromboplastin time (difference patient-control: 7 to 14 seconds). Protocol 0: 481 patients received no anticoagulant treatment because of a contraindication or minor surgical procedure. Preliminary results showed and increase of per-operative bleeding (p less than 0.01) in treated patients; this was very well accepted by the surgeons. Among the heparin-treated patients, 11 pulmonary emboli out of 13 were observed in patients with bronchial cancer. Of these 13, 10 were fatal with 9 being verified at autopsy. The pulmonary emboli episodes occurred significantly earlier in protocol B than in protocol A. Fatal pulmonary embolism in patients with bronchial cancer was significantly more frequent in protocol B (7 cases) than in protocol A (1 case); P less than 0.01. These results have shown a low frequency of fatal pulmonary emboli in patients without bronchial cancer receiving twice-daily subcutaneous injections of heparin (2 of 1102 operated subjects). The rate was higher in patients with bronchial cancer and this results supports a recommended thrice-daily dose in such patients. In addition, the pre-operative administration of heparin is useful in preventing early post-operative pulmonary embolism.

Étude du profil cytokinique de patients atteints d’hydatidose : une possible application en matière d’immunosurveillance

Directory of Open Access Journals (Sweden)

Mezioug D.

2009-03-01

Full Text Available L’hydatidose est une zoonose endémique en Algérie et dans les pays du Maghreb. L’objectif de notre travail a porté sur l’exploration des cytokines exprimées dans le parcours des réponses immunitaires au cours de l’infection par Echinococcus granulosus. Cette étude a été réalisée en vue de situer l’implication du rapport Th1/Th2 dans l’évolution de la pathologie en fonction de la localisation anatomique du kyste, le stade et l’évolution clinique. Un dosage de l’interféron-γ (IFN-γ, de l’interleukine-12 (Il-12, de l’interleukine-16 (Il-16, de l’interleukine-18 (Il-18, de l’interleukine-4 (Il-4, de l’interleukine-5 (Il-5, de l’interleukine-10 (Il-10 et de l’interleukine-13 (Il-13 dans les sérums de patients algériens (n = 177 porteurs de kystes hydatiques au niveau hépatique, pulmonaire, hépatique et pulmonaire associés, splénique, rénale, osseux, cardiaque et multiples a été entrepris. L’analyse du profil des cytokines a été également réalisée chez les patients présentant des formes à complication (fissuration du kyste, rupture, calcification du kyste et les patients en phase de récidive et selon le stade clinique (pré- et post-opératoire. L’identification et l’évaluation des activités des cytokines considérées ont été réalisées par un dosage immuno-enzymatique (ELISA sandwich selon les méthodes préconisées par immunotech (France. Des teneurs significatives en IFN-γ, Il-12, Il-16, Il-18, Il-4, Il-5, Il-10 et Il-13 ont été détectées dans les sérums des patients en comparaison aux sujets “contrôles” (p < 0,001, suggérant la coexistence des deux voies Th1 et Th2 dans le mécanisme de défense mis en jeu par l’homme au cours de l’évolution de la parasitose. La comparaison des niveaux de production de ces médiateurs en fonction de la localisation anatomique des kystes montre que les teneurs sériques en IFN-γ, Il-12, Il-16 et Il-18, mesurées chez

Detection of pulmonary fat embolism with dual-energy CT: an experimental study in rabbits

Energy Technology Data Exchange (ETDEWEB)

Tang, Chun Xiang; Zhou, Chang Sheng; Zhao, Yan E.; Han, Zong Hong; Qi, Li; Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Mangold, Stefanie; Ball, B.D. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States)

2017-04-15

To evaluate the use of dual-energy CT imaging of the lung perfused blood volume (PBV) for the detection of pulmonary fat embolism (PFE). Dual-energy CT was performed in 24 rabbits before and 1 hour, 1 day, 4 days and 7 days after artificial induction of PFE via the right ear vein. CT pulmonary angiography (CTPA) and lung PBV images were evaluated by two radiologists, who recorded the presence, number, and location of PFE on a per-lobe basis. Sensitivity, specificity, and accuracy of CTPA and lung PBV for detecting PFE were calculated using histopathological evaluation as the reference standard. A total of 144 lung lobes in 24 rabbits were evaluated and 70 fat emboli were detected on histopathological analysis. The overall sensitivity, specificity and accuracy were 25.4 %, 98.6 %, and 62.5 % for CTPA, and 82.6 %, 76.0 %, and 79.2 % for lung PBV. Higher sensitivity (p < 0.001) and accuracy (p < 0.01), but lower specificity (p < 0.001), were found for lung PBV compared with CTPA. Dual-energy CT can detect PFE earlier than CTPA (all p < 0.01). Dual-energy CT provided higher sensitivity and accuracy in the detection of PFE as well as earlier detection compared with conventional CTPA in this animal model study. (orig.)

Documentation for the USAF School of Aerospace Medicine Altitude Decompression Sickness Research Database

Science.gov (United States)

2010-05-01

identification during some database operations and that "t" and other such identifiers are dropped in the following headings to allow easier reading of the...chamber floor, the subject cranks at 24 rpm with 20-Watt resistance as read on the 50 rpm ergometer scale, switching hands each 2 pedal revolutions...Emboli DCS Decompression Sickness EKG /ECG Electrokardiograph (German), electrocardiograph (English) EVA Extravehicular Activity ICD Informed Consent

Popliteal vascular entrapment syndrome caused by a rare anomalous slip of the lateral head of the gastrocnemius muscle

International Nuclear Information System (INIS)

Liu, Patrick T.; Moyer, Adrian C.; Huettl, Eric A.; Fowl, Richard J.; Stone, William M.

2005-01-01

Popliteal vascular entrapment syndrome can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. We report two cases of rare anomalous slips of the lateral head of the gastrocnemius muscle causing popliteal vascular entrapment syndrome. (orig.)

Neurologic Manifestation as Initial Presentation in a Case of Hereditary Haemorrhagic Telangiectasia

Directory of Open Access Journals (Sweden)

Yeow Kwan Teo

2010-01-01

Full Text Available Hereditary Haemorrhagic Telangiectasia (HHT, or Osler-Weber-Rendu syndrome is an uncommon autosomal dominant multi-organ condition of vascular dysplasias. We describe a 19 year old Indian female who presented with cerebral abscess secondary to paradoxical emboli from pulmonary arteriovenous malformations (PAVMs associated with HHT. Cerebral, pulmonary, hepatic and gastrointestinal involvement can be life-threatening and it is important to have lifelong follow-ups on these patients.

Clinical Space Medicine A Prospective Look at Medical Problems From Hazards of Space Operations

Science.gov (United States)

1967-07-01

phenomenon can even result in petechial hemorrhages from damaged capillaries. Although subcutaneous fat is a source of these emboli, it has been suggested...over the affected sinus (1, 6) (1). Lacrimation can occur . Infection of a sinus may be accompanied by severe throbbing pain, and possibly fever and...so until the continuity of the ciliated epithe- lium is restored. Severe infections are usually accompanied by fever and general malaise. The remote

Pain control for uterine fibroid emboliSation-an initial exPerience

African Journals Online (AJOL)

2011-06-06

Jun 6, 2011 ... procedural pain management, pain control was better than in the centres where he performed the ufe and simultaneously supervised the sedation and pain management for the patients. two ufe workshops, both conducted over a three day period, in december 2009 and april. 2010. a protocol for sedation ...

Multiple embolier efter DC-konvertering hos en patient forbehandlet med dabigatran

DEFF Research Database (Denmark)

Buch, Torben Nicolai; Holm, Jakob; Munck, Lars Kristian

2013-01-01

A 65-year-old man, who had been treated with dabigatran for 66 days prior to electrical cardioversion, developed extensive intestinal, renal and cerebral thromboembolism five days after cardioversion. There is limited information available on the treatment of thromboembolism in patients being tre...

Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

Science.gov (United States)

Rummel, Christian; Basciani, Reto; Nirkko, Arto; Schroth, Gerhard; Stucki, Monika; Reineke, David; Eberle, Balthasar; Kaiser, Heiko A.

2018-01-01

Stroke due to hypoperfusion or emboli is a devastating adverse event of cardiac surgery, but early detection and treatment could protect patients from an unfavorable postoperative course. Hypoperfusion and emboli can be detected with transcranial Doppler of the middle cerebral artery (MCA). The measured blood flow velocity correlates with cerebral oxygenation determined clinically by near-infrared spectroscopy (NIRS) of the frontal cortex. We tested the potential advantage of a spatially extended NIRS in detecting critical events in three cardiac surgery patients with a whole-head fiber holder of the FOIRE-3000 continuous-wave NIRS system. Principle components analysis was performed to differentiate between global and localized hypoperfusion or ischemic territories of the middle and anterior cerebral arteries. In one patient, we detected a critical hypoperfusion of the right MCA, which was not apparent in the frontal channels but was accompanied by intra- and postoperative neurological correlates of ischemia. We conclude that spatially extended NIRS of temporal and parietal vascular territories could improve the detection of critically low cerebral perfusion. Even in severe hemispheric stroke, NIRS of the frontal lobe may remain normal because the anterior cerebral artery can be supplied by the contralateral side directly or via the anterior communicating artery.

Safety of Carotid Artery Stenting in Elderly Patients with Severe Carotid Artery Stenosis

International Nuclear Information System (INIS)

Choi, Seul Kee; Kim, Seul Kee; Jeong, Min Young; Yoon, Woong

2012-01-01

To determine the safety of carotid artery stenting (CAS) using an emboli-protection device in elderly patients with severe carotid artery stenosis. Ninety consecutive patients who were at high risk for carotid endarterectomy underwent protected CAS using an emboli-protection device. Patients were divided into two groups by age: < 70 and ≥ 70. The primary outcome measure was the combined incidence of stroke, myocardial infarction (MI), and death within 30 days of CAS. The secondary outcome measures were technical success and hyperperfusion syndrome. Associations between age and the clinical outcomes were investigated. Overall, 30-day stroke, MI, and death rates were 6.7%. There was no significant difference in the primary outcome between the older age group (n = 56) and younger age group (n = 34) (8.9% and 2.9%, respectively; HR for age ≥ 70, 1.141; 95% CI, 0.875 to 1.488, p = 0.331). A logistic regression showed there was no independent variable associated with primary outcome. Technical success was achieved in all patients and there was no significant difference in the incidence of hyperperfusion syndrome between the two age groups. The results of this study suggest that protected CAS seems to be safe in elderly patients with severe carotid artery stenosis.

Pulmonary Artery Pseudoaneurysm: A Rare Cause of Fatal Massive Hemoptysis

Directory of Open Access Journals (Sweden)

Himaja Koneru

2018-01-01

Full Text Available Pulmonary artery pseudoaneurysm (PAPA, an uncommon complication of pyogenic bacterial and fungal infections and related septic emboli, is associated with high mortality. The pulmonary artery (PA lacks an adventitial wall; therefore, repeated endovascular seeding of the PA with septic emboli creates saccular dilations that are more likely to rupture than systemic arterial aneurysms. The most common clinical presentation of PAPA is massive hemoptysis and resultant worsening hypoxemia. Computed tomography angiography is the preferred diagnostic modality for PAPA; typical imaging patterns include focal outpouchings of contrast adjacent to a branch of the PA following the same contrast density as the PA in all phases of the study. In mycotic PAPAs, multiple synchronous lesions are often seen in segmental and subsegmental PAs due to ongoing embolic phenomena. The recommended approach for a mycotic PAPA is prolonged antimicrobial therapy; for massive hemoptysis, endovascular treatment (e.g., coil embolization, stenting, or embolization of the feeding vessel is preferred. PAPA resection and lobectomy are a last resort, generally reserved for patients with uncontrolled hemoptysis or pleural hemorrhage. We present a case of a 28-year-old woman with necrotizing pneumonia from intravenous drug use who ultimately died from massive hemoptysis and shock after a ruptured PAPA.

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

Directory of Open Access Journals (Sweden)

Trethowan Brian A

2011-11-01

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

Detection of Doppler Microembolic Signals Using High Order Statistics

Directory of Open Access Journals (Sweden)

Maroun Geryes

2016-01-01

Full Text Available Robust detection of the smallest circulating cerebral microemboli is an efficient way of preventing strokes, which is second cause of mortality worldwide. Transcranial Doppler ultrasound is widely considered the most convenient system for the detection of microemboli. The most common standard detection is achieved through the Doppler energy signal and depends on an empirically set constant threshold. On the other hand, in the past few years, higher order statistics have been an extensive field of research as they represent descriptive statistics that can be used to detect signal outliers. In this study, we propose new types of microembolic detectors based on the windowed calculation of the third moment skewness and fourth moment kurtosis of the energy signal. During energy embolus-free periods the distribution of the energy is not altered and the skewness and kurtosis signals do not exhibit any peak values. In the presence of emboli, the energy distribution is distorted and the skewness and kurtosis signals exhibit peaks, corresponding to the latter emboli. Applied on real signals, the detection of microemboli through the skewness and kurtosis signals outperformed the detection through standard methods. The sensitivities and specificities reached 78% and 91% and 80% and 90% for the skewness and kurtosis detectors, respectively.

Pulmonale arteriovenøse malformationer, moderne behandlingsprincipper

DEFF Research Database (Denmark)

Andersen, P E; Kjeldsen, A D

2001-01-01

Pulmonary arteriovenous malformations are congenital vascular malformations in the lungs, which act as shunts so that the blood is not oxygenated or filtered. These patients are typically hypoxaemic with exercise intolerance and are at high risk of paradoxical emboli to the brain. About 25...... technical success and few complications. Embolisation prevents cerebral stroke and abscess and pulmonary haemorrhage and further raises the functional level. Screening for pulmonary arteriovenous malformations in patients at risk is recommended....

Platelet Glycoprotein lb-1X and Malignancy

Science.gov (United States)

2011-09-01

initiate coagulation, resulting in the formation of a fibrin - rich tumor cell- platelet emboli (Figure 1). Many of these coagulation factor-tumor cell...the tumor cell in a fibrin - rich web. (13;23;24) During this process, the platelet integrin receptor, aIIb 3, serves as a receptor linking fibrin ... platelets , and tumor cells into a fibrin rich clot normally associated with a thrombus. (25;25) Indeed, it can be speculated the fibrin - rich clot

Ocular manifestations of injection drug use.

Science.gov (United States)

Kim, Rubin W; Juzych, Mark S; Eliott, Dean

2002-09-01

Injection drug use can result in a variety of severe ocular conditions. Hematogenous dissemination of various fungi and bacteria may produce endophthalmitis with resultant severe visual loss. Retinal arterial occlusive disease may result from talc and other particulate emboli. Most commonly, life-threatening systemic diseases such as endocarditis and HIV infection secondarily affect the eye. Because many of these conditions may result in blindness if untreated, accurate diagnosis and prompt initiation of therapy are essential.

Infective Endocarditis Presenting as Bilateral Orbital Cellulitis: An Unusual Case

OpenAIRE

Asif, Talal; Hasan, Badar; Ukani, Rehman; Pauly, Rebecca R

2017-01-01

Orbital cellulitis is a severe and sight-threatening infection of orbital tissues posterior to the orbital septum. The most common causes of orbital cellulitis are rhinosinusitis, orbital trauma, and surgery. Infective endocarditis (IE) is a systemic infection that begins on cardiac valves and spreads by means of the bloodstream to peripheral organs. Septic emboli can spread to any organ including the eyes and can cause focal or diffuse ophthalmic infection. Ocular complications of IE classic...

Roth spots seen on ophthalmoscopy: diseases with which they may be associated.

Science.gov (United States)

Falcone, P M; Larrison, W I

1995-05-01

Roth spots seen on fundoscopic examination (white-centered hemorrhages) were classically described as septic emboli in patients with subacute bacterial endocarditis (SBE). Many physicians have considered them pathognomonic for this entity. More recent evidence suggests, however, that they are nonspecific and may be found in other disease states. A review of the pathogenesis of these white-centered hemorrhages will be provided, along with some diseases other than SBE in which they may occur.

White-centred retinal haemorrhages (Roth spots).

OpenAIRE

Ling, R.; James, B.

1998-01-01

Roth spots (white-centred retinal haemorrhages) were classically described as septic emboli lodged in the retina of patients with subacute bacterial endocarditis. Indeed many have considered Roth spots pathognomonic for this condition. More recent histological evidence suggests, however, that they are not foci of bacterial abscess. Instead, they are nonspecific and may be found in many other diseases. A review of the histology and the pathogenesis of these white-centred haemorrhages will be p...

Serial follow up V/P scanning in assessment of treatment response in high probability scans for pulmonary embolism

Energy Technology Data Exchange (ETDEWEB)

Moustafa, H; Elhaddad, SH; Wagih, SH; Ziada, G; Samy, A; Saber, R [Department of nuclear medicine and radiology, faculty of medicine, Cairo university, Cairo, (Egypt)

1995-10-01

138 patients proved with V/P scan to have different probabilities of pulmonary emboli event. Serial follow up scanning after 3 days, 2 weeks, 1 month and 3 months was done, with anticoagulant therapy. Out of the remaining 10 patients, 6 patients died with documented P.E. by P.M. study and lost follow up recorded in 4 patients. Complete response with disappearance of all perfusion defects after 2 weeks was detected in 37 patients (49.3%), partial improvement of lesions after 3 months was elicited in 32%. The overall incidence of response was (81.3%) such response was complete in low probability group (100%), (84.2%) in intermediate group and (79.3%) in high probability group with partial response in 45.3%. New lesions were evident in 18.7% of this series. To conclude that serial follow up V/P scan is mandatory for evaluation of response to anticoagulant therapy specially in first 3 months. 2 figs., 3 tabs.

An interesting septic embolism

Directory of Open Access Journals (Sweden)

Funda Uluorman

2014-01-01

Full Text Available Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

Balloon angioplasty of infrapopliteal artery in chronic lower limb ischemia with diabetes

International Nuclear Information System (INIS)

Wang Jianbo; Zhao Jungong; Zhu Yueqi; Li Minghua; Cheng Yingsheng; Cheng Yongde; Wang Jue

2008-01-01

Objective: To evaluate the technique, successful rate and perioperative complications together with the therapy and prevention of using PTA in treating diabetic patients with infrapopliteal arterial diseases. Methods: Angiographic and clinical data of 27 patients with diabetic lower limb ischemia treated by PTA from January 2006 to May 2007 were retrospectively reviewed. Rutherf0rd-Becker categories and ankle- brachial index(ABI)were evaluated before and after the treatment. The effects were compared between different lesion types (stenosis or occlusion)and between different ways of balloon technique. The complications were also analyzed, together with the primary, discussion of the therapy and prevention. Results: 24 patients showed improvement of ischemic symptoms, and 3 cases fell in failure. The intra-procedural main complications included acute thrombosis, vascular wall perforation, distal emboli resulting from plaque falling off and dissection. There were statistically significant differences between the effects of two type lesions and between different balloon methods. Conclusions: 1. The condition of lower limb arteries should be assessed carefully before operation. 2. PTA shows safe and good clinical result and ought to be recommended in treating diabetic patients with peripheral arterial diseases, especially the lower extremity ischemia. (authors)

Simple Radiowave-Based Method For Measuring Peripheral Blood Flow Project

Science.gov (United States)

Oliva-Buisson, Yvette J.

2014-01-01

Project objective is to design small radio frequency based flow probes for the measurement of blood flow velocity in peripheral arteries such as the femoral artery and middle cerebral artery. The result will be the technological capability to measure peripheral blood flow rates and flow changes during various environmental stressors such as microgravity without contact to the individual being monitored. This technology may also lead to an easier method of detecting venous gas emboli during extravehicular activities.

Pathological Fingerprints, Systems Biology and Biomarkers of Blast Brain Injury

Science.gov (United States)

2010-06-01

changes after blast injury. J. Trauma 56, 393–403. Murthy, J.M., Chopra, J.S., and Gulati, D.R. (1979). Subdural hematoma in an adult following a blast...neuronal damage), diffuse brain injury, and subdural hemorrhage. It is still controversial whether primary blast forces directly damage the brain, and if...emboli, leading to infarction (Guy et al., 2000a; Guy et al., 2000b). The most common types of TBI are diffuse axonal injury, contusion, and subdural

LEFT ATRIUM THROMBOSIS IN PATIENTS WITH RHEUMATIC MITRAL VALVULAR DISEASE

Directory of Open Access Journals (Sweden)

N. D. Kaverin

2012-01-01

Full Text Available Systemic thromboembolism — fairly common complication of mitral valvular disease, often leading to disability or fatal consequences for the patient. The source of emboli in most cases, are blood clots localized in the left atrium. The survey reflected basic views on the pathogenesis, diagnosis, treatment and prevention of intraatrial thrombosis according to new scientific advances. Articles (reviews, meta-analyzes and original researchs from Pub Med database, as well as domestic literature were used.

Gravity separation of pericardial fat in cardiotomy suction blood: an in vitro model.

Science.gov (United States)

Kinard, M Rhett; Shackelford, Anthony G; Sistino, Joseph J

2009-06-01

Fat emboli generated during cardiac surgery have been shown to cause neurologic complications in patients postoperatively. Cardiotomy suction has been known to be a large generator of emboli. This study will examine the efficacy of a separation technique in which the cardiotomy suction blood is stored in a cardiotomy reservoir for various time intervals to allow spontaneous separation of fat from blood by density. Soybean oil was added to heparinized porcine blood to simulate the blood of a patient with hypertriglyceridemia (> 150 mg/dL). Roller pump suction was used to transfer the room temperature blood into the cardiotomy reservoir. Blood was removed from the reservoir in 200-mL aliquots at 0, 15, 30 45, and 60 minutes. Samples were taken at each interval and centrifuged to facilitate further separation of liquid fat. Fat content in each sample was determined by a point-of-care triglyceride analyzer. Three trials were conducted for a total of 30 samples. The 0-minute group was considered a baseline and was compared to the other four times. Fat concentration was reduced significantly in the 45- and 60-minute groups compared to the 0-, 15-, and 30-minute groups (p Gravity separation of cardiotomy suction blood is effective; however, it may require retention of blood for more time than is clinically acceptable during a routing coronary artery bypass graft surgery.

Can perfusion SPECT aid CTPA interpretation?

International Nuclear Information System (INIS)

Gradinscak, D. J.; Roach, P.; Bailey, E.; Kueh, S.

2009-01-01

Full text:Objective: To determine whether fusion of perfusion SPECT and CTPA improves the diagnostic accuracy of CTPA. Methods: 35 patients with suspected PE who underwent both CTPA and SPECT V/Q within 48 hours were included. Of these, the majority (n=30) had PE as determined by the V/Q SPECT scan and the others (n=5) were negative for PE. The clinical reports of CTPA were reviewed and pulmonary emboli tabulated based on anatomical location. A second radiologist, blinded to the results of the clinical read and the V/Q SPECT scan, reviewed the CTPA with and without perfusion SPECT fusion for assistance. Results: A total 57 PE were reported on the clinical reports and 60 PE identified on the blinded read. Fused CTPA/perfursion SPECT images identified a further 5 PE not identified on the clinical read (8% increase) and 2 PE not identified on the blinded read (3% increase). The additional emboli detected resulted in a change in final diagnosis from PE negative to PE positive in 2 patients (6%) compared with the clinical read and 1 patient (3%) compared with the blinded read without SPECT fusion. Conclusion: Fused CTPA-SPECT perfusion improves the sensitivity of CTPA for the detection of PE in a small number of patients. Fused data may help guide the radiologist to identify sites of PE on CTPA.

Cardiorespiratory effects of venous lipid micro embolization in an experimental model of mediastinal shed blood reinfusion

Directory of Open Access Journals (Sweden)

Dencker Magnus

2009-09-01

Full Text Available Abstract Background Retransfusion of the patient's own blood during surgery is used to reduce the need for allogenic blood transfusion. It has however been found that this blood contains lipid particles, which form emboli in different organs if the blood is retransfused on the arterial side. In this study, we tested whether retransfusion of blood containing lipid micro-particles on the venous side in a porcine model will give hemodynamic effects. Methods Seven adult pigs were used. A shed blood surrogate containing 400 ml diluted blood and 5 ml radioactive triolein was produced to generate a lipid embolic load. The shed blood surrogate was rapidly ( Results A more than 30-fold increase in pulmonary vascular resistance was observed, with subsequent increase in pulmonary artery pressure, and decrease in cardiac output and arterial pressure. This response was transient, but was followed by a smaller, persistent increase in pulmonary vascular resistance. Only a small portion of the infused triolein passed the lungs, and only a small fraction could be recirculated by increasing cardiac output and pulmonary pressure. Conclusion Infusion of blood containing lipid micro-emboli on the venous side leads to acute, severe hemodynamic responses that can be life threatening. Lipid particles will be trapped in the lungs, leading to persistent effects on the pulmonary vascular resistance.

Volume and composition of emboli in neuroprotected stenting of the carotid artery.

Science.gov (United States)

Piñero, P; González, A; Martínez, E; Mayol, A; Rafel, E; González-Marcos, J R; Moniche, F; Cayuela, A; Gil-Peralta, A

2009-03-01

Periprocedural microembolization is a major and permanent risk for patients treated by angioplasty and stent placement of high-grade carotid stenoses. Little is known however about the characteristics and significance of these embolized particles. Our aim was to assess the volume and composition of debris captured by filters during carotid angioplasty and stent placement (CAS) of severe internal carotid artery (ICA) stenoses. Institutional review board approval and informed consent from all subjects were obtained. Two hundred one patients (mean age, 66.2 years; range, 35-82 years) with > or = 70% stenosis of the ICA underwent filter-protected CAS. Ultrastructural and semiquantitative analysis of the volume of filters was obtained. Multifactorial statistical analysis was performed to determine factors related to debris volume and composition. Transient ischemic attack occurred in 6 patients (3%), and a major stroke, in 1 (0.5%). Debris was found in 117 filters (58.2%), with volume <1 lambda (0.001 mL) in 71%. The number of balloon dilations, age older than 65 years, and calcified plaques in pre-CAS angiography were significantly associated with the presence of particulates inside the filters (P < .03, P < .004, and P < .05, respectively). Vessel wall and atheromatous plaques are the main source of microemboli during CAS. Embolization is mainly related to the number of balloon dilations during CAS. Planning a proper and individualized strategy for the procedure in each patient is essential to minimize the potential effects of manipulation during CAS.

Medical image of the week: septic pulmonary emboli misdiagnosed as metastatic disease

Directory of Open Access Journals (Sweden)

Dandachi D

2014-07-01

Full Text Available No abstract available. Article truncated at 150 words. A 54-year-old previously healthy man presented with acute onset of left-sided, sharp pleuritic chest pain and dry cough. He denied having fever, hemoptysis, shortness of breath, or unintentional weight loss. Review of system was positive for bright blood per rectum for the last year. He had a root canal procedure done 3 weeks prior to presentation. His is a 30 pack-year smoker, drinks alcohol occasionally, but denied any IV drug use. On admission, he was afebrile and hemodynamically stable. Clinical examination was positive for fecal occult blood test. CBC revealed WBC of 12,800/mm3 and his hemoglobin was11.9 g/dL. Thoracic CT scan with contrast was negative for pulmonary embolism, but showed multiple bilateral pulmonary nodules suspicious for malignancy (Figure 1. The left upper lobe showed a subpleural 2.4 x 1.5 cm rounded opacity and emphysematous changes. CT of the abdomen and pelvis showed folds in the stomach but was otherwise unremarkable...

Quantitative Studies of Microembolization in Man during Surgical Trauma.

Science.gov (United States)

1979-03-01

diphosphoglyceric acid in the red blood cells, and the level of lactate in the blood r1vl constant. There was close correlation be- tween increases In PaCO...he noted that the high SF’ measured in stored blood used during heart-lung bypass was falling to normal levels after passage of the blood through the...blood but not in arterial blood of ether anesthetized rats. The increased micro- emboli ini venous blood returned to control levels within three

Intestinal necrosis in young patient due to arterial tumour embolism

DEFF Research Database (Denmark)

Dahle, Einar; Gögenur, Ismail; Nørgaard, Peter

2012-01-01

A patient in the thirties, currently undergoing chemotherapy for metastatic osteosarcoma diagnosed 3 years earlier, was admitted with in the emergency department with abdominal pain. Laparoscopic surgery revealed severe inflammation and an abscess. 18 cm of small intestine was removed because...... of intestinal necrosis. Histological examination showed several arterial tumour emboli, morphologically similar to the primary sarcoma. The patient died 1 year after successful surgery. Because of the improved survival of patients with osteosarcoma, acute mesenteric ischaemia should be considered in acute...

White-centred retinal haemorrhages (Roth spots).

Science.gov (United States)

Ling, R; James, B

1998-10-01

Roth spots (white-centred retinal haemorrhages) were classically described as septic emboli lodged in the retina of patients with subacute bacterial endocarditis. Indeed many have considered Roth spots pathognomonic for this condition. More recent histological evidence suggests, however, that they are not foci of bacterial abscess. Instead, they are nonspecific and may be found in many other diseases. A review of the histology and the pathogenesis of these white-centred haemorrhages will be provided, along with the work-up of the differential diagnosis.

A rare combination of cardiopulmonary anomalies demonstrated on ventilation-perfusion scan

International Nuclear Information System (INIS)

Khan, S.; Dunn, J.; Al-Nahhas, A.; Ariff, B.; Juli, C.; Karunanithy, N.; Strickland, N.

2008-01-01

In this case report we describe an unusual appearance seen on a ventilation-perfusion (V/Q) scan in a woman with pulmonary hypertension. Although the pulmonary hypertension was not caused by pulmonary emboli, the V/Q scan suggested several cardiac anomalies which may lead to pulmonary hypertension. Most of the cardiac anomalies, including right-sided aortic arch and right-to-left shunt, can be deduced from careful examination of the V/Q scan. A subsequent cardiac MRI scan confirmed the anomalies. (authors)

Transcranial Doppler monitoring during stenting of the carotid bifurcation: evaluation of two different distal protection devices in preventing embolization.

Science.gov (United States)

Rubartelli, Paolo; Brusa, Giulia; Arrigo, Alessandro; Abbadessa, Francesco; Giachero, Corinna; Vischi, Massimo; Ricca, Maria Maddalena; Ottonello, Gian Andrea

2006-08-01

To compare the efficacy of 2 emboli protection devices in preventing embolization during carotid artery stenting (CAS). The GuardWire distal occlusion system (n=19) and the distal FilterWire EX (n=12) were compared in 31 consecutive patients (24 men; mean age 71+/-10 years) monitored with transcranial Doppler for microembolic signals before, during, and after CAS. The choice of the protection device was based on availability and on the patency of the contralateral carotid artery. The baseline characteristics were similar in the patients treated under protection from either device. Placement and retrieval of the protection device, stenting, and postdilation were technically successful in all patients. Two patients suffered a transient ischemic attack shortly after the procedure; no other adverse cardiovascular events occurred at 30 days. Compared to the GuardWire, the use of the FilterWire was associated with more microembolic signals during stent deployment (77.4+/-33.5 versus 1.07+/-1.94, pprotection device (21.4+/-15.4 versus 10.9+/-8.3, p=0.051). Consequently, the total amount of microembolic signals during the procedure was higher when the filter device was employed (183.0+/-42.1 versus 31.7+/-12.0, p<0.0001). The distal occlusion device appears to be more effective than the filter in reducing distal embolization detected by transcranial Doppler monitoring.

Duplex ultrasound evidence of fat embolism syndrome

Directory of Open Access Journals (Sweden)

Abdallah Naddaf, MD

2016-12-01

Full Text Available Fat embolism syndrome is a potentially fatal disease process most commonly associated with long-bone and pelvic fractures. Reports describing ultrasound evidence of fat emboli are restricted to echocardiography. We propose a new objective finding on venous duplex ultrasound imaging of the lower extremities as a useful diagnostic criterion by presenting the case reports of two patients with acute long-bone fractures, possibly leading to earlier orthopedic fixation and allocation of resources to those patients at higher risk of fat embolism syndrome.

Acute pulmonary embolism in helical computed tomography

International Nuclear Information System (INIS)

Paslawski, M.

2005-01-01

Pulmonary embolism is a common condition in which diagnostic and therapeutic delays contribute to substantial morbidity and mortality. Clinical diagnosis is difficult because the signs and symptoms re unspecific, and a differential diagnosis is extensive, including pneumonia or bronchitis, asthma, myocardial infraction, pulmonary edema, anxiety, dissection of the aorta, pericardial tamponade, lung cancer, primary pulmonary hypertension, rib fracture, and pneumothorax. The purpose of the study was to present the use of CT in diagnosing acute pulmonary embolism. A group of 23 patients with clinically suspected pulmonary embolism underwent CT examination with a helical CT scanner (Somatom Emotion, Siemens) before and after administration of 150 ml of Ultravist. Pulmonary embolism was found in the CT examinations of 13 patients. In two of these it was a central filling defect. Amputation of the artery was found in one. Parietal filling defect in three patients formed an acute angle with the vessel walls. Saddle emboli appearing as filling defects in the contrast column that hung over vessel bifurcations was found in two patients. In five patients,emboli were found in small segmental arteries. CT provides information not only on the pulmonary arteries, but also on the lung parenchyma, hila, mediastinum, and the heart. Alternative findings may be identified by CT chest examination, stablishing alternative diagnoses, including pulmonary disorders (such as pneumonia or fibrosis), pleural abnormalities, and cardiovascular disease (such as aortic dissection or pericardial tamponade). Another advantage of the CT is its widespread availability.(author)

[Hypercoagulable workup in ophthalmology. When and what].

Science.gov (United States)

Muñoz-Negrete, F J; Casas-Lleras, P; Pérez-López, M; Rebolleda, G

2009-07-01

Most ophthalmologic disorders secondary to hypercoagulabe state are due to the confluence of congenital and adquired factors. A systematic workup is mandatory. Most of congenital coagulation disorders cause venous trombosis and are inherited autosomal dominantly. In order of frequency these are factor V Leiden mutation (activated protein C resistance), G20210A mutation of the prothrombin gen and protein C, protein S, and antithrombin III deficiencies. Sickle cell anemia can determine arerial and venous thrombosis. In relation with arterial occlusion, the markers most frequently involved are homcysteine fasting levels and the markers of antiphospholipid antibody syndrome. Both of them can also determine venous thrombosis. Several acquired factors can lead to hypoercoagulable state, especially hyperhomocysteinemia, antiphospholipid antibody syndrome, hepatic disease, alcohol and tobacco intake, oral contraceptives, immobilization, surgeries and malignancies. In central venous occlusion is only necessary to rule out hyperhomocysteinemia and antiphospholipid antibody syndrome in young patients without known risk factors. In central artery occlusion, hypercoagulable workup is only recommended for patients less than 50 years-old with unknown emboli source. In this cases protein C, protein S, and antithrombin III deficiencies, homocystein, sickle cell disease and antiphospholipid antibody syndrome will ruled out. In non arteritic ischemic optic neuropathy hypercoagulable work up is not necessary. In amaurosis fugax without known emboli source, it is recommended to rule out etiologies of arterial occlusion, especially antithrombin III deficiencies, homocystein, sickle cell disease and antiphospholipid antibody syndrome.

Medical image of the week: PE with infarct and pulmonary cavitation

Directory of Open Access Journals (Sweden)

Knox KS

2014-12-01

Full Text Available No abstract available. Article truncated at 150 words. A 49 year old man with a history of COPD presented to the ER with the sudden onset of chest pain at 3:30 AM waking him from sleep. His pain was left sided, felt like broken ribs, and was worse with deep inspiration. He acknowledged some shortness of breath which was worse over baseline for the past couple days without cough or hemoptysis. The patient was tachycardic but comfortable with SpO2 saturation 98% on 2 liters. He had trace edema and pleurisy. Laboratory evaluation was unremarkable except for a WBC count 13,000 X 106 cells/L. Chest x-ray was unremarkable but thoracic CT scan showed pulmonary emboli (PE involving left upper and lower lobar arteries (Figure 1A and 1B, arrows. Anticoagulation was started and the patient experienced increasing shortness of breath, worsening oxygenation and fever to 102ºF. On Day 2, frontal chest radiograph showed extensive left lung opacification most dense in ...

Approach To Unstable Plaque In Carotid Disease

Directory of Open Access Journals (Sweden)

Mojdeh Ghabaee

2017-02-01

Full Text Available Risk of cerebral infarction due to thrombo emboli originating  from carotid artery disease estimated to be near 15%, and this risk  is closely associated with the severity of luminal stenosis. But at the same time characteristics  of the plaque should be taken into account for therapeutic planning when the patient is asymptomatic and the diameter of the stenosis does not reach the threshold of 70%. Search for markers of plaque vulnerability, instability, or thromboembolic potential as complementary to the degree of the luminal stenosis in stroke risk prediction should be considered .These morphologic features of carotid plaques are increasingly believed to be one of those markers that could carry further prognostic information, and early recognition of these plaques features may identify a high-risk subgroup of patients who might particularly benefit from aggressive interventions with aggressive medical treatment. Color and duplex Doppler sonography  evaluates both  morphologic and hemodynamic   abnormalitie of carotid. Echogensity, degree of stenosis and plaque surface features are essential parameters of morphological abnormality.

Trikuspidalklapendocarditis med pneumokokker

DEFF Research Database (Denmark)

Rasmussen, S; Talleruphuus, U; Wandall, Johan

1995-01-01

Endocarditis caused by pneumococci is a rare disease and cases that only affect the tricuspid valve represent less than 1% of all cases of endocarditis. A case presenting with a primary pneumonia and septicaemia is described. Due to persistent fever and the occurrence of a cardiac murmur...... echocardiography was done and demonstrated vegetations on the tricuspid valve. The course was complicated with septic pulmonary emboli before the patient recovered. Endocarditis with pneumococci may occur as a complication to a primary pneumonia and underestimation of the frequency with which it occurs...

Does ′heparin-induced thrombocytopenia′ hit our minds?

Directory of Open Access Journals (Sweden)

Arun R Thangavel

2016-01-01

Full Text Available Unfractionated heparin is a widely used drug to prevent deep vein thrombosis and pulmonary emboli in patients at risk. With the advent of newer anticoagulants having lesser side effects, its use has diminished but not out of service. Here, we report a case of deep venous thrombosis, in a patient on prophylactic dose of heparin, which was later found to be a manifestation of heparin-induced thrombocytopenia (HIT. Thrombosis in the presence of heparin prophylaxis should be considered as HIT rather than a failure of anticoagulation.

A temible complication of ischemic stroke: pulmonary embolism

Directory of Open Access Journals (Sweden)

Linda Iurato

2015-12-01

Pulmonary embolism is a major contributor to in-hospital death after stroke. Although the rate of clinically overt pulmonary embolism after stroke has been estimated to be less than 1%, pulmonary emboli account for up to 50% of early deaths after stroke. In daily practice, the clinical burden of pulmonary embolism in patient with stroke is, however, underestimated since the clinical symptoms of stroke may obscure the recognition of this complication. The aim of this article is to describe the clinical and therapeutic aspects of pulmonary embolism as complication after stroke.

Pulmonary embolic disease: roles of angiography and lung scanning in diagnosis

Energy Technology Data Exchange (ETDEWEB)

Jackson, D C; Tyson, J W; Johnsrude, I S; Wilkinson, Jr, R H

1975-06-01

The definitive diagnosis of pulmonary embolism remains difficult despite recent advances in nuclear medicine and angiography. In 10% of a selected series of 145 patients a negative chest x-ray and a positive lung scan was associated with no arteriographic evidence of pulmonary emboli. A normal perfusion lung scan excludes significant pulmonary embolism. When pulmonary arteriography is necessary, a biplane selective pulmonary angiogram should be performed and subselective injections may be required. Pulmonary arteriography is less of a threat to a patient suspected of having pulmonary embolic disease than inappropriate treatment.

McConnell Sign in a Patient with Massive Acute Pulmonary Embolism

Directory of Open Access Journals (Sweden)

Qaiser Shafiq

2011-01-01

Full Text Available A 48-year-old female was admitted after experiencing a brief syncopal episode. Three weeks ago the patient sustained a right arm humerus bone fracture in a motor vehicle accident. Since the accident, her mobility has been limited. CT angiogram of the chest revealed massive bilateral pulmonary emboli. A 2D echocardiogram was performed, which demonstrated McConnell sign and severe right ventricle dysfunction. Considering potential of hemodynamic instability, the patient received fibrinolytic therapy with Alteplase. A subsequent 2D echocardiogram showed complete resolution of McConnell sign and right ventricle dysfunction.

Some problems of treating acute arterial obstruction using hyperbaric oxygenation ultraviolet irradiation of blood and hemosorption

International Nuclear Information System (INIS)

Karyakin, A.M.

1988-01-01

Up-to-date state of the problem of acute arterial obstruction (AAO) is considered and clinical observations of patients with acute emboli and thrombosis of abdominal aorta and main arteries of lower extremitics are analyzed. Complex of detoxication therapy and measures on controlling AAO in patients during postoperation period is presented. Complex application of hemosorption, ultraviolet irradiation of autoblood and hyperbaric oxygenation enabled to achieve correction of some indices. Reliable evidences of high therapeutic efficiency of combined application of mentioned methods to patients with reconstructed blood flow are presented. 38 refs.; 3 tabs

Primary gastric cancer presenting with a metastatic embolus in the common carotid artery: a case report

Directory of Open Access Journals (Sweden)

Zhang Ying

2012-10-01

Full Text Available Abstract Although about 30% of gastric cancers have distant metastasis at the time of initial diagnosis, metastatic tumor embolus in the main blood vessels is not common, especially in the main artery. The report presents, for the first time, an extremely rare clinical case of a metastatic embolus in the common carotid artery (CCA from primary gastric cancer. Metastatic embolus from the primary tumor should be considered when patients present with gastric cancer accompanied by intravascular emboli. The patient should be actively examined further so as to allow early detection and treatment.

Leiomyosarcoma of the Uterus with Intravascular Tumor Extension and Pulmonary Tumor Embolism

International Nuclear Information System (INIS)

McDonald, Douglas K.; Kalva, Sanjeeva P.; Fan, C.-M.; Vasilyev, Aleksandr

2007-01-01

We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism

Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

DEFF Research Database (Denmark)

Lindholt, Jes Sanddal; Sandermann, Jes; Bruun-Petersen, J

1998-01-01

The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits....

Use of intraventricular ribbon gauze to reduce particulate emboli during aortic valve replacement

Directory of Open Access Journals (Sweden)

Loubani Mahmoud

2006-11-01

Full Text Available Abstract Background The incidence of cerebrovascular accidents following aortic valve surgery remains a devastating complication. The aim of this study was to determine the number of potential embolic material arising during aortic valve replacement and to examine the efficacy of using ribbon gauze in the left ventricle during removal of the native valve and decalcification of the aortic annulus. Methods Ribbon gauze was inserted into the left ventricular cavity prior to aortic valve excision in an unselected, prospectively studied series of 30 patients undergoing aortic valve replacement. A further 30 lengths of ribbon gauze were soaked in the pericardiotomy blood of the same patients and all were subjected to histological analysis. Results The median number of tissue fragments from the aortic valve replacement group was significantly higher than in the control group 5 (0–18 versus 0 (0–1 (p = 3.6 × 10-5. The size of tissue fragments varied between 0.1 and 9.0 mm with a mean of 0.61 ± 1.12 mm and a median of 0.2 mm. There was a significantly higher number of tissue fragments associated with patients having surgery for aortic stenosis when compared with patients who had aortic regurgitation with median of 5 (0–18 versus 0 (0–3 (p = 0.8 × 10-3. Conclusion Significant capture of particulate debris by the intraventricular ribbon gauze suggests that the technique of left ventricular ribbon gauze insertion during aortic valve excision has merit.

How man-made interference might cause gas bubble emboli in deep diving whales

Directory of Open Access Journals (Sweden)

Andreas eFahlman

2014-01-01

Full Text Available Recent cetacean mass strandings in close temporal and spatial association with sonar activity has raised the concern that anthropogenic sound may harm breath-hold diving marine mammals. Necropsy results of the stranded whales have shown evidence of bubbles in the tissues, similar to those in human divers suffering from decompression sickness (DCS. It has been proposed that changes in behavior or physiological responses during diving could increase tissue and blood N2 levels, thereby increasing DCS risk. Dive data recorded from sperm, killer, long-finned pilot, Blainville’s beaked and Cuvier’s beaked whales before and during exposure to low- (1-2 kHz and mid- (2-7 kHz frequency active sonar were used to estimate the changes in blood and tissue N2 tension (PN2. Our objectives were to determine if differences in 1 dive behavior or 2 physiological responses to sonar are plausible risk factors for bubble formation. The theoretical estimates indicate that all species may experience high N2 levels. However, unexpectedly, deep diving generally result in higher end-dive PN2 as compared with shallow diving. In this focused review we focus on three possible explanations: 1 We revisit an old hypothesis that CO2, because of its much higher diffusivity, form bubble precursors that continue to grow in N2 supersaturated tissues. Such a mechanism would be less dependent on the alveolar collapse depth but affected by elevated levels of CO2 following a burst of activity during sonar exposure. 2 During deep dives, a greater duration of time might be spent at depths where gas exchange continues as compared with shallow dives. The resulting elevated levels of N2 in deep diving whales might also make them more susceptible to anthropogenic disturbances. 3 Extended duration of dives even at depths beyond where the alveoli collapse could result in slow continuous accumulation of N2 in the adipose tissues that eventually becomes a liability.

111In platelet imaging of left ventricular thrombi. Predictive value for systemic emboli

International Nuclear Information System (INIS)

Stratton, J.R.; Ritchie, J.L.

1990-01-01

To determine whether a positive indium 111 platelet image for a left ventricular thrombus, which indicates ongoing thrombogenic activity, predicts an increased risk of systemic embolization, we compared the embolic rate in 34 patients with positive 111 In platelet images with that in 69 patients with negative images during a mean follow-up of 38 +/- 31 (+/- SD) months after platelet imaging. The positive and negative image groups were similar with respect to age (59 +/- 11 vs. 62 +/- 10 years), prevalence of previous infarction (94% vs. 78%, p less than 0.05), time from last infarction (28 +/- 51 vs. 33 +/- 47 months), ejection fraction (29 +/- 14 vs. 33 +/- 14), long-term or paroxysmal atrial fibrillation (15% vs. 26%), warfarin therapy during follow-up (26% vs. 20%), platelet-inhibitory therapy during follow-up (50% vs. 33%), injected 111 In dose (330 +/- 92 vs. 344 +/- 118 microCi), and latest imaging time (greater than or equal to 48 hours in all patients). During follow-up, embolic events occurred in 21% (seven of 34) of patients with positive platelet images for left ventricular thrombi as compared with 3% (two of 69) of patients with negative images (p = 0.002). By actuarial methods, at 42 months after platelet imaging, only 86% of patients with positive images were embolus free as compared with 98% of patients with negative images (p less than 0.01)

Final Results of the Protected Superficial Femoral Artery Trial Using the FilterWire EZ System

International Nuclear Information System (INIS)

Mueller-Huelsbeck, Stefan; Huemme, Tim H.; Philipp Schaefer, J.; Charalambous, Nikolas; Paulsen, Friedrich; Heller, Martin; Jahnke, Thomas

2010-01-01

The purpose of this study was to evaluate the safety and efficacy of debris-capture for distal protection using the FilterWire EZ Embolic Protection System (Boston Scientific, Mountain View, CA) with the additional aim to further define the incidence of distal embolization during superficial femoral artery (SFA) interventions. A prospective, single-centre registry was designed to evaluate the performance of the FilterWire EZ in capturing debris during standard SFA percutaneous intervention. The PRO-RATA study included 30 patients suitable for PTA (Fontaine IIb to III or Rutherford I to II classification). The primary end points were occurrence of distal embolization or decreased runoff, improvement in ankle-brachial index ankle-brachial index (ABI) after the procedure, and number of filters containing emboli. Secondary end points included major adverse events (i.e., procedure- or device-related death and/or clinical target lesion revascularisation), device delivery, deployment success, and incidence of embolic recovery (patients with device success exhibiting embolic protection in the filter). Procedural success was determined as ≤30% residual stenosis with no worsening of distal runoff as determined on angiography. A total of 29 patients (age 66.2 ± 12 years; total no. of limbs = 30; total no. of lesions = 30) suitable for PTA were enrolled in the study between February 2007 and March 2008. There were 26 patients with claudication (Fontaine IIB) and 3 patients with stage IV peripheral vascular disease. In one patient, lesions in both legs were treated. No procedural or device-related complications occured. The average degree of stenosis was 86 ± 7%. Stenosis length ranged from 8 to 88 mm. The average degree of residual stenosis was 10 ± 10%. ABI improved from 0.56 ± 0.16 to 0.92 ± 0.19 (P < 0.05). No restenosis or dissection was seen at 1-month ultrasound follow-up. Macroscopic debris was found in 27 of 30 filters of all distal protection devices used in

Asymptomatic and symptomatic embolic events in infective endocarditis: associated factors and clinical impact.

Science.gov (United States)

Monteiro, Thaíssa S; Correia, Marcelo G; Golebiovski, Wilma F; Barbosa, Giovanna Ianini F; Weksler, Clara; Lamas, Cristiane C

Embolic complications of infective endocarditis are common. The impact of asymptomatic embolism is uncertain. To determine the frequency of emboli due to IE and to identify events associated with embolism. Retrospective analysis of an endocarditis database, prospectively implemented, with a post hoc study driven by analysis of data on embolic events. Data was obtained from the International Collaboration Endocarditis case report forms and additional information on embolic events and imaging reports were obtained from the medical records. Variables associated with embolism were analyzed by the statistical software R version 3.1.0. In the study period, 2006-2011, 136 episodes of definite infective endocarditis were included. The most common complication was heart failure (55.1%), followed by embolism (50%). Among the 100 medical records analyzed for emboli in left-sided infective endocarditis, 36 (36%) were found to have had asymptomatic events, 11 (11%) to the central nervous system and 28 (28%) to the spleen. Cardiac surgery was performed in 98/136 (72%). In the multivariate analysis, splenomegaly was the only associated factor for embolism to any site (pinfective endocarditis of the mitral valve (p<0.05, OR 3.5, 95% CI 1.23-10) and male gender (p<0.05, OR 3.2, 95% CI 1.04-10). Splenectomy and cardiac surgery did not impact on in-hospital mortality. Asymptomatic embolism to the central nervous system and to the spleen were frequent. Splenomegaly was consistently associated with embolic events. Copyright © 2017 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

Multiple systemic embolism in infective endocarditis underlying in Barlow's disease.

Science.gov (United States)

Yu, Ziqing; Fan, Bing; Wu, Hongyi; Wang, Xiangfei; Li, Chenguang; Xu, Rende; Su, Yangang; Ge, Junbo

2016-08-11

Systemic embolism, especially septic embolism, is a severe complication of infective endocarditis (IE). However, concurrent embolism to the brain, coronary arteries, and spleen is very rare. Because of the risk of hemorrhage or visceral rupture, anticoagulants are recommended only if an indication is present, e.g. prosthetic valve. Antiplatelet therapy in IE is controversial, but theoretically, this therapy has the potential to prevent and treat thrombosis and embolism in IE. Unfortunately, clinical trial results have been inconclusive. We describe a previously healthy 50-year-old man who presented with dysarthria secondary to bacterial endocarditis with multiple cerebral, coronary, splenic, and peripheral emboli; antibiotic therapy contributed to the multiple emboli. Emergency splenectomy was performed, with subsequent mitral valve repair. Pathological examination confirmed mucoid degeneration and mitral valve prolapse (Barlow's disease) as the underlying etiology of the endocardial lesion. Continuous antibiotics were prescribed, postoperatively. Transthoracic echocardiography at 1.5, 3, and 6 months after the onset of his illness showed no severe regurgitation, and there was no respiratory distress, fever, or lethargy during follow-up. Although antibiotic use in IE carries a risk of septic embolism, these drugs have bactericidal and antithrombotic benefits. It is important to consider that negative blood culture and symptom resolution do not confirm complete elimination of bacteria. However, vegetation size and Staphylococcus aureus infection accurately predict embolization. It is also important to consider that bacteria can be segregated from the microbicide when embedded in platelets and fibrin. Therefore, antimicrobial therapy with concurrent antiplatelet therapy should be considered carefully.

A Therapeutic Challenge: Management of Atrial Thrombus

Directory of Open Access Journals (Sweden)

Serkan Burc Deser

2016-09-01

Full Text Available Introduction: Primary cause of atrial thrombi include atrial fibrillation, foreign bodies inside the atrium such as catheters and pacemaker leads, emboli of deep venous thrombus and primary or metastatic tumors of the heart. We review the clinical features, epidemiology, diagnosis and treatment of nine intriguing cases with atrial thrombus. Methods: This is a retrospective study of nine patients (seven female (78%, two male (33% who were diagnosed with atrial thrombi (average age of 50 ± 12 years and were treated at the Ondokuz Mayis University, Department of Cardiovascular Surgery from February 2014 to January 2015. Among them, six patients had atrial fibrillation (one male, five female, seven patients were suffering from dispne and orthopnoea, five patients were suffering from leg swelling, seven patients had a history of hypertension and three patients had a history of mitral valve replacement surgery. Results: All patients underwent surgery except one. Four patients recovered uneventfully and discharged with oral anticoagulation (warfarin therapy (adjusted to maintain an international normalized ratio of INR between two and three times. Five of nine patients (55% died after surgery. Conclusion: The response to the thrombolytic therapy is poor, mostly ineffective and unsafe so it is often recommended as a bridge to surgery. In patients diagnosed with mechanical mitral valve thrombosis, medical therapy has the possibility of end organ emboli and also fail to resolve the organised thrombus on the stuck valve. On the other hand surgery does not always give satisfactory results. J Clin Exp Invest 2016; 7(4: 278-282

Elimination of Gaseous Microemboli from Cardiopulmonary Bypass using Hypobaric Oxygenation

Science.gov (United States)

Gipson, Keith E.; Rosinski, David J.; Schonberger, Robert B.; Kubera, Cathryn; Mathew, Eapen S.; Nichols, Frank; Dyckman, William; Courtin, Francois; Sherburne, Bradford; Bordey, Angelique F; Gross, Jeffrey B.

2014-01-01

Background Numerous gaseous microemboli (GME) are delivered into the arterial circulation during cardiopulmonary bypass (CPB). These emboli damage end organs through multiple mechanisms that are thought to contribute to neurocognitive deficits following cardiac surgery. Here, we use hypobaric oxygenation to reduce dissolved gases in blood and greatly reduce GME delivery during CPB. Methods Variable subatmospheric pressures were applied to 100% oxygen sweep gas in standard hollow fiber microporous membrane oxygenators to oxygenate and denitrogenate blood. GME were quantified using ultrasound while air embolism from the surgical field was simulated experimentally. We assessed end organ tissues in swine postoperatively using light microscopy. Results Variable sweep gas pressures allowed reliable oxygenation independent of CO2 removal while denitrogenating arterial blood. Hypobaric oxygenation produced dose-dependent reductions of Doppler signals produced by bolus and continuous GME loads in vitro. Swine were maintained using hypobaric oxygenation for four hours on CPB with no apparent adverse events. Compared with current practice standards of O2/air sweep gas, hypobaric oxygenation reduced GME volumes exiting the oxygenator (by 80%), exiting the arterial filter (95%), and arriving at the aortic cannula (∼100%), indicating progressive reabsorption of emboli throughout the CPB circuit in vivo. Analysis of brain tissue suggested decreased microvascular injury under hypobaric conditions. Conclusions Hypobaric oxygenation is an effective, low-cost, common sense approach that capitalizes on the simple physical makeup of GME to achieve their near-total elimination during CPB. This technique holds great potential for limiting end-organ damage and improving outcomes in a variety of patients undergoing extracorporeal circulation. PMID:24206970

Association between right-to-left shunts and brain lesions in sport divers.

Science.gov (United States)

Gerriets, Tibo; Tetzlaff, Kay; Hutzelmann, Alfred; Liceni, Thomas; Kopiske, Gerrit; Struck, Niklas; Reuter, Michael; Kaps, Manfred

2003-10-01

Recent studies suggest that healthy sport divers may develop clinically silent brain damage, based on the association between a finding of multiple brain lesions on MRI and the presence of right-to-left shunt, a pathway for venous gas bubbles to enter the arterial system. We performed echocontrast transcranial Doppler sonography in 42 sport divers to determine the presence of a right-to-left shunt. Cranial MRI was carried out using a 1.5 T magnet. A lesion was counted if it was hyperintense on both T2-weighted and T2-weighted fluid attenuated inversion recovery sequences. To test the hypothesis that the occurrence of postdive arterial gas emboli is related to brain lesions on MRI, we measured postdive intravascular bubbles in a subset of 15 divers 30 min after open water scuba dives. Echocontrast transcranial Doppler sonography revealed a right-to-left shunt in 16 of the divers (38%). Only one hyperintensive lesion of the central white matter was found and that was in a diver with no evidence of a right-to-left shunt. Postdive arterial gas emboli were detected in 3 out of 15 divers; they had a right-to-left shunt, but no pathologic findings on cranial magnetic resonance imaging. Our data support the theory that right-to-left shunts can serve as a pathway for venous gas bubbles into the arterial circulation. However, we could not confirm an association between brain lesions and the presence of a right-to-left shunt in sport divers.

Massive tumor pulmonary embolism following transcatheter arterial chemoembolization of hepatocellular carcinoma

International Nuclear Information System (INIS)

Kim, Jeong Ho; Ko, Gi Young; Yoon, Hyun Ki; Sung, Kyu Bo

2002-01-01

Pulmonary embolism complicated by transcatheter arterial chemoembolization (TACE) in known to be due to the use of large amount of lipiodol as an embolic agent. To our knowledge, massive tumoral pulmonary embolism following TACE and confirmed by surgery has not been described in the literature. In this report, we detail the cas of a 49-year-old man in whom cyanosis and hypotension developed abruptly on the day of TACE.. Chest CT revealed diffuse low-attenuated lesions in both pulmonary arteries. Histopathological specimens after emergent pulmonary arterial embolectomy confirmed the presence of massive tumor emboli of hepatocellular carcinoma

Massive tumor pulmonary embolism following transcatheter arterial chemoembolization of hepatocellular carcinoma

International Nuclear Information System (INIS)

Kim, Jeong Ho; Ko, Gi Young; Yoon, Hyun Ki; Sung, Kyu Bo

2002-01-01

Pulmonary embolism complicated by transcatheter arterial chemoembolization (TACE) is known to be due to the use of large amount of lipiodol as an embolic agent. To our knowledge, massive tumoral pulmonary embolism following TACE and confirmed by surgery has not been described in the literature. In this report, we detail the case of a 49-year-old man in whom cyanosis and hypotension developed abruptly on the day of TACE. Chest CT revealed diffuse low-attenuated lesions in both pulmonary arteries. Histopathological specimens after emergent pulmonary arterial embolectomy confirmed the presence of massive tumor emboli of hepatocellular carcinoma

Pulmonary arterial hypertension secondary to chronic thromboemboli

International Nuclear Information System (INIS)

Crysikopoulos, H.; Forrest, J.V.; Olson, L.K.; Roberts, A.C.

1989-01-01

The authors report their experience in 150 patients with pulmonary arterial hypertension secondary to chronic pulmonary embolism (CPE). Plain film findings are variable, commonly nonspecific. Occasionally nonuniformity of pulmonary perfusion or truncation of central pulmonary arteries suggest CPE. Multiple, large, unmatched perfusion defects are the most common scintigraphic observations. CT can exclude conditions mimicking CPE, particularly fibrosing mediastinitis. Pulmonary arteriography depicts the location and distribution of emboli. CPE is becoming an increasingly important entity to recognize because of available surgical treatment. Thromboendarterectomy may improve functional status and survival. The diagnosis should be considered in any patient with pulmonary arterial hypertension

Thoracic outlet syndrome: Case report

International Nuclear Information System (INIS)

Marquez, Juan Camilo; Acosta, Mauricio Fernando; Uribe Jorge Ricardo

2009-01-01

We report a case of vascular thoracic outlet syndrome in a young man, diagnosed with upper limb arteriography, leading to repeated arterio-arterial emboli originating from a post-stenotic subclavian artery aneurysm. It is of our interest due to its low incidence and the small number of cases reported that have been diagnosed by arteriography. The thoracic outlet is the path through which vascular and neural structures goes from the neck to the axilla, and it has three anatomical strictures, that when pronounced, can compress the brachial plexus or subclavian vessels, leading to different symptoms and signs.

Alveolar hemorrhage in a case of fat embolism syndrome: A case report with short systemic review

Directory of Open Access Journals (Sweden)

Sananta Kumar Dash

2013-01-01

Full Text Available Fat embolism and fat embolism syndrome (FES are well-known complications of long bone fracture and surgery involving manipulation of skeletal elements. Many non-traumatic causes of FES have been suggested but they constitute only a small portion. FES presents with classical symptoms of petechiae, hypoxemia, central nervous system symptoms along with other features such as tachycardia and pyrexia. Diagnosis of FES relies on clinical judgment rather than objective findings such as emboli present in the retinal vessels on fundoscopy, fat globules present in urine and sputum, a sudden inexplicable drop in hematocrit or platelet values, increasing erythrocyte sedimentation rate.

Epidemiological study of venous thromboembolism in a big Danish cohort

DEFF Research Database (Denmark)

Severinsen, Marianne Tang; Kristensen, Søren Risom; Overvad, Kim

Introduction: Epidemiological data on venous thromboembolism (VT), i.e. pulmonary emboli (PE) and deep venous thrombosis (DVT) are sparse. We have examined VT-diagnoses registered in a big Danish Cohort study.  Methods: All first-time VT diagnoses in The Danish National Patient Register were...... were probable cases (1.7%) whereas for 449 (41.6%) the diagnosis could be excluded. The incidence rate was 1 per 1000 personyears. Out of the 632 cases 60% were DVT and 40% PE. 315 VT were considered idiopathic (49.8%), 311 were secondary (49.2%) and 15 were unclassifiable. 122 patients had cancer, 87...

Septic Cerebral Embolisation in Fulminant Mitral Valve Infective Endocarditis

Directory of Open Access Journals (Sweden)

Gemina Doolub

2015-05-01

Full Text Available A 37-year-old male with known intravenous drug use was admitted with an acute onset of worsening confusion and speech impairment. His vitals and biochemical profile demonstrated severe sepsis, with a brain CT showing several lesions suspicious for cerebral emboli. He then went on to have a bedside transthoracic echocardiogram that was positive for vegetation on the mitral valve, with associated severe mitral regurgitation. Unfortunately, before he was stable enough to be transferred for valve surgery, he suffered an episode of acute pulmonary oedema requiring intubation and ventilation on intensive care unit.

Innovations in the management of hip fractures.

Science.gov (United States)

Teasdall, Robert D; Webb, Lawrence X

2003-08-01

Hip fractures include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region that is exposed to large compressive stresses. Implants used to address these fractures must accommodate significant loads while the fractures consolidate. Complications secondary to hip fractures produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

Patient with congenital heart malformation and infective endocarditis

Directory of Open Access Journals (Sweden)

Ramírez Ortiz, Zoraida

2014-10-01

Full Text Available We present the case of a 17 year-old-man, with no remarkable past medical history, who had a one month history of worsening functional class, fatigability and dyspnea, in addition to fever and systemic inflammatory response syndrome (SIRS; a de-novo congenital heart malformation, situs inversus type, with levocardia and a ventricular septal defect (VSD associated with transposition of great vessels were documented. During hospitalization he received several antibiotic treatments without microbiological isolation or identification of the cause of hemodynamic decompensation. An Aspergillus endocarditis with emboli to different organs was identified in the post-mortem examination.

Percutaneous transvenous retrieval of CVP catheter emboli in S. V. C.-A case report-

International Nuclear Information System (INIS)

Zeon, Seok Kil; Lee, Deock Hee; Kim, Hong; Kim, Ok Bae

1987-01-01

The increasing use of the indwelling venous catheters and cardiovascular catheters has led to many iatrogenic complications. One of the most serious complications is catheter embolization, caused by inadvertent fracture of a fragment of catheter remaining within cardiovascular systems. In the catheter embolization, there are serious consequence such as thromboembolism, sepsis, cardiac arrhythmia and others. Fisher and Ferreyro (1978) reported a 71% incidence of serious morbidity or death following to intravascular foreign bodies in patients without removal. The authors experienced a case of retained central venous pressure monitoring catheter (CVP catheter) fragment extending from superior vena cava to hepatic segment of inferior vena cava. CVP catheter wa introduced into right subclavian venous route for hyperalimentation, because of poor general condition for operation of afferent loop syndrome following to resection of the gastric carcinoma with Billoth II operation (5 years age). On attempting removal of CVP catheter on recovery from afferent loop syndrome, a large portion of the CVP catheter was cut off in S.V.C. Percutaneous puncture of right femoral vein with Seldinger technique was done and 9F introducer sheath was indwelled. The helical basket of Dotter intravascular retriever set was advance through the sheath up to retained CVP catheter, and it was grasped. The retrieved CVP catheter fragment showed several tiny blood clots on surface. The patient was uneventfully recovered and was discharged asymptomatic on second day of the procedure.

Characterization of the vascular bed of head-and neck advanced tumors by radioactive emboli

International Nuclear Information System (INIS)

Serson, D.

1982-01-01

A radioisotopic method, using labeled particles for the determination of regions irrigated by an artery is established. Patients with advanced head and neck cancer were studied, whose treatment was carried out with antiblastics by intra-arterial via. To check the vascular territory early reached by intra-arterial chemotherapy we used albumin macro-particles labeled with iodine 131. The method resulted harmless and of great importance for localization of the tumor bed. It was also observed that the method may be used for localization of the chemotherapic infusion in other sectors of the body or for the anatomic determination of the arterial vascularization. (Author) [pt

Pulmonary vascular imaging

International Nuclear Information System (INIS)

Fedullo, P.F.; Shure, D.

1987-01-01

A wide range of pulmonary vascular imaging techniques are available for the diagnostic evaluation of patients with suspected pulmonary vascular disease. The characteristics of any ideal technique would include high sensitivity and specificity, safety, simplicity, and sequential applicability. To date, no single technique meets these ideal characteristics. Conventional pulmonary angiography remains the gold standard for the diagnosis of acute thromboembolic disease despite the introduction of newer techniques such as digital subtraction angiography and magnetic resonance imaging. Improved noninvasive lower extremity venous testing methods, particularly impedance plethysmography, and ventilation-perfusion scanning can play significant roles in the noninvasive diagnosis of acute pulmonary emboli when properly applied. Ventilation-perfusion scanning may also be useful as a screening test to differentiate possible primary pulmonary hypertension from chronic thromboembolic pulmonary hypertension. And, finally, angioscopy may be a useful adjunctive technique to detect chronic thromboembolic disease and determine operability. Optimal clinical decision-making, however, will continue to require the proper interpretation of adjunctive information obtained from the less-invasive techniques, applied with an understanding of the natural history of the various forms of pulmonary vascular disease and with a knowledge of the capabilities and shortcomings of the individual techniques

A favorable impact of preoperative FPLC chemotherapy on patients with gastric cardia cancer.

Science.gov (United States)

Wang, X L; Wu, G X; Zhang, M D; Guo, M; Zhang, H; Sun, X F

2000-01-01

The aim of this study is to evaluate the effects of preoperative chemotherapy with fluorouracili polyphase liposome composita pro orale (FPLC) on the tumour cells and the survival rate of the patients with gastric cardia cancer. Sixty patients with gastric cardia cancer were randomly divided into two groups. Thirty patients were treated with FPLC prior to surgical resection, the other 30, as controls, did not receive the preoperative chemotherapy. Pathological responses of the tumours to the FPLC chemotherapy were determined by gross and microscopic assessments of tumour size, tumour emboli, cell degeneration and necrosis. Expressions of nm23 and CD44 were detected by flow cytometry. All patients were followed up to 5 years. In the FPLC-treated patients, the tumour size (pexpression (pexpression of nm23 (p<0.001) were increased, when compared with those observations seen in the controls. The postoperative 5-year survival rate was 40% in the FPLC-treated group and 23% in the controls (p=0.17). Preoperative FPLC chemotherapy might improve the survival rate of patients with gastric cardia cancer by inhibiting tumour proliferative, invasive and metastatic activities, and stimulating the patient's immune system.

Polymer coating embolism from intravascular medical devices - a clinical literature review.

Science.gov (United States)

Chopra, Amitabh M; Mehta, Monik; Bismuth, Jean; Shapiro, Maksim; Fishbein, Michael C; Bridges, Alina G; Vinters, Harry V

Over the past three decades, lubricious (hydrophobic and/or hydrophilic) polymer-coated devices have been increasingly adopted by interventional physicians and vascular surgeons to access and treat a wider range of clinical presentations. Recent clinical literature highlights the presence of polymer coating emboli within the anatomy - a result of coating separation from an intravascular device - and associates it with a range of adverse clinical sequelae. The 2015 U.S. Food and Drug Administration safety communication titled "Lubricious Coating Separation from Intravascular Medical Devices" acknowledges these concerns and concludes that it will work with stakeholders to develop nonclinical test methodologies, establish performance criteria, and identify gaps in current national and international device standards for coating integrity performance. Despite this communication and multiple case reports from interventional physicians, pathologists, dermatologists and other involved physician specialties, polymer coating embolism remains clinically underrecognized. This article consolidates the available literature on polymer coating embolism (1986-2016) and highlights the following relevant information for the physician: (a) the history and elusive nature of polymer coating embolism; (b) potential incidence rates of this phenomenon; (c) reported histologic findings and clinical effects of polymer emboli in the anatomy; (d) the importance of the collaborative clinician-pathologist partnership to report polymer embolism findings; and (e) the importance to study particulate release from intravascular devices so as to further understand and potentially evolve coated interventional technologies. Preliminary research on coatings highlights the potential of using iterations of coatings on medical devices that attain the desired therapeutic result and mitigate or eliminate particulates altogether. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Multislice CT imaging of pulmonary embolism

International Nuclear Information System (INIS)

Schoepf, J.U.; Kessler, M.A.; Rieger, C.T.; Herzog, P.; Wiesgigl, S.; Becker, C.R.; Exarhos, D.N.; Reiser, M.F.

2001-01-01

In recent years CT has been established as the method of choice for the diagnosis of central pulmonary embolism (PE) to the level of the segmental arteries. The key advantage of CT over competing modalities is the reliable detection of relevant alternative or additional disease causing the patient's symptoms. Although the clinical relevance of isolated peripheral emboli remains unclear, the alleged poor sensitivity of CT for the detection of such small clots has to date prevented the acceptance of CT as the gold standard for diagnosing PE. With the advent of multislice CT we can now cover the entire chest of a patient with 1-mm slices within one breath-hold. In comparison with thicker sections, the detection rate of subsegmental emboli can be significantly increased with 1-mm slices. In addition, the interobserver correlation which can be achieved with 1-mm sections by far exceeds the reproducibility of competing modalities. Meanwhile use of multislice CT for a combined diagnosis of PE and deep venous thrombosis with the same modality appears to be clinically accepted. In the vast majority of patients who receive a combined thoracic and venous multislice CT examination the scan either confirms the suspected diagnosis or reveals relevant alternative or additional disease. The therapeutic regimen is usually chosen based on the functional effect of embolic vascular occlusion. With the advent of fast CT scanning techniques, also functional parameters of lung perfusion can be non-invasively assessed by CT imaging. These advantages let multislice CT appear as an attractive modality for a non-invasive, fast, accurate, and comprehensive diagnosis of PE, its causes, effects, and differential diagnoses. (orig.)

Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion

International Nuclear Information System (INIS)

Acosta, S.; Sonesson, B.; Resch, T.

2009-01-01

The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.

Effect of red blood cells on platelet activation and thrombus formation in tortuous arterioles

Directory of Open Access Journals (Sweden)

Jennifer K. W. Chesnutt

2013-12-01

Full Text Available Thrombosis is a major contributor to cardiovascular disease, which can lead to myocardial infarction and stroke. Thrombosis may form in tortuous microvessels, which are often seen throughout the human body, but the microscale mechanisms and processes are not well understood. In straight vessels, the presence of red blood cells (RBCs is known to push platelets toward walls, which may affect platelet aggregation and thrombus formation. However in tortuous vessels, the effects of RBC interactions with platelets in thrombosis are largely unknown. Accordingly, the objective of this work was to determine the physical effects of RBCs, platelet size, and vessel tortuosity on platelet activation and thrombus formation in tortuous arterioles. A discrete element computational model was used to simulate the transport, collision, adhesion, aggregation, and shear-induced platelet activation of hundreds of individual platelets and RBCs in thrombus formation in tortuous arterioles. Results showed that high shear stress near the inner sides of curved arteriole walls activated platelets to initiate thrombosis. RBCs initially promoted platelet activation, but then collisions of RBCs with mural thrombi reduced the amount of mural thrombus and the size of emboli. In the absence of RBCs, mural thrombus mass was smaller in a highly tortuous arteriole compared to a less tortuous arteriole. In the presence of RBCs however, mural thrombus mass was larger in the highly tortuous arteriole compared to the less tortuous arteriole. As well, smaller platelet size yielded less mural thrombus mass and smaller emboli, either with or without RBCs. This study shed light on microscopic interactions of RBCs and platelets in tortuous microvessels, which have implications in various pathologies associated with thrombosis and bleeding.

The serpentine mitral valve and cerebral embolism

Directory of Open Access Journals (Sweden)

Ker James

2011-02-01

Full Text Available Abstract Valvular strands, well-delineated filiform masses, attached to cardiac valve edges are associated with cerebral embolism and stroke. Strokes, caused by emboli from valvular strands, tend to occur among younger persons. In this case report a valvular strand, giving a peculiar serpentine appearance to the mitral valve is described. This mitral valvular strand was the only explanation for an episode of cerebral embolism, presenting with a transient right sided hemiparesis. It is proposed that a randomized study involving combined treatment with aspirin and clopidogrel is warranted in young patients with valvular strands, presenting with a first episode of cerebral embolism.

Isolated mitral valve replacement with the Kay-Shiley disc. valve. Acturial analysis of the long term results.

Science.gov (United States)

Wellons, H A; Strauch, R S; Nolan, S P; Muller, W H

1975-11-01

During a five-year period the Kay-Shiley (K and T series) prosthesis was used for 83 isolated mitral valve replacements. There were 14 early deaths, for a 17.28 per cent mortality rate. Survival determined by the actuarial method revealed a 6 year cumulative survival rate of 39.8 per cent. Thromboembolism was a significant problem in this series, with 33 patients experiencing a total of 55 embolic events. This represented a rate of 24.7 emboli per 1,000 patient months at risk. From our experience, it is concluded that the Kay-Shiley prosthesis is associated with a high incidence of thromboembolism and late death.

The clinical use of platelet scintigraphy with 111-In-oxine

International Nuclear Information System (INIS)

Kessler, C.; Reuther, R.; Berentelg, J.; Kimmig, B.

1983-01-01

Platelet scintigraphy was performed on 62 patients with cerebral ischaemia. Pathological scintigraphic images were obtained in 29 of the 62 patients. In 79.3% of these 29 patients the scan was abnormal in the vessel clinically affected. Platelet scintigraphy was abnormal in 21 of 34 patients with normal angiogram or only slight atherosclerosis. In patients undergoing antiplatelet therapy, platelet scintigraphy was less often positive than in untreated patients. It is suggested that platelet scintigraphy could be an appropriate technique for detecting small mural thrombi of the carotid artery, which are the source of arterio-arterial emboli, and for controlling the efficiency of antiplatelet therapy. (orig.) [de

Embolus radiolabelling in a new canine model

International Nuclear Information System (INIS)

Kaufman, H.H.; Huchton, J.D.; Woo, J.; Cannon, D.C.; Anderson, J.H.

1980-01-01

Embolus radiolabelling with 131 I fibrinogen was studied in a canine model of internal carotid artery embolization. The dog was chosen as the experimental animal because of its maxillocarotid artery which permits collateral flow round the occlusion and helps to prevent strokes. Clot was prepared by incubating blood at room temperature to inactivate plasminogen activators and then refrigerating it to promote clot retraction. Emboli persisting 48 hours were seen in 80% of animals. Major strokes were not seen when 0.25 to 0.30 cm 3 were used. Autoradiography and well counting revealed uptake of isotope. The test, when refined, should provide a tool for the investigation of thromboemboli. (author)

Proximal femoral fractures.

Science.gov (United States)

Webb, Lawrence X

2002-01-01

Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

Widespread hematogenous metastases and Trousseau's syndrome in gastric adenocarcinoma

Directory of Open Access Journals (Sweden)

Santos Vitorino Modesto dos

2001-01-01

Full Text Available A case of widespread hematogenous metastases and Trousseau's syndrome is reported in a 40 year-old white housewife with gastric cancer, presenting subdural hematoma, ecchymoses, epistaxis, stomach and uterine bleeding. After undergoing hematoma drainage, she was unsuccessfully treated with platelets, red blood cells, plasma cryoprecipitate transfusions, and antibiotics. Necropsy disclosed gastric ring-signet adenocarcinoma invading the serous layer, with massive disseminated intravascular coagulation and systemic neoplastic embolism. Multiple old and recent hyaline (rich in fibrin and platelets microthrombi, and tumor emboli were observed in the bone marrow, meninges, liver, lungs, kidneys, lymph nodes, adrenals, thyroid, heart, pancreas, and ovaries (Krukenberg tumor.

Central nervous system systemic lupus erythematosus in children

International Nuclear Information System (INIS)

Osborn, A.G.; Boyer, R.S.

1989-01-01

Ischemic neurologic events and neuropsychiatric disorders occur in approximately 70% of patients with systematic lupus erythematosus (SLE). The CT and MR findings in adults with central nervous system (CNS) SLE have been described, but to the authors' knowledge no pediatric series has been reported. The MR and CT findings in four children with CNS SLE are compared with those reported in adults. Large infarcts are less frequent in children than in adults with CNS SLE, while multiple small infarctions and white matter lesions are more common. These findings in children who have no obvious source of emboli, intracardiac shunt, or history of trauma should raise the suspicion of SLE

New optional IVC filter for percutaneous retrieval - in vitro evaluation of embolus capturing efficiency

International Nuclear Information System (INIS)

Guenther, R.W.; Mossdorf, A.; Pfeffer, J.; Buecker, A.; Neuerburg, J.; Hoej, A.R.; Moelgaard-Nielsen, A.; Schmitz-Rode, T.

2005-01-01

Purpose: In-vitro evaluation of a new caval filter (Cook Celect Filter) developed for delayed percutaneous retrieval in comparison to the Guenther Tulip filter. Materials and Methods: The new Celect filter is constructed on the basis of the Tulip filter and consists of 4 primary anchoring legs and additional 8 thinner secondary wires to stabilize the filter and to guarantee adequate filtering efficiency. The filtering wires are of the same amount and equal distribution as the filtering wires of the Tulip filter. The secondary wires are arranged in such a way that percutaneous filter retrieval should be possible even if the wires are incorporated into the caval wall. In a flow model (tube size diameter 15-, diameter 22- and diameter 30 mm), the filter was exposed to single and multiple emboli (blood clots) of different sizes (3 x 5, 3 x 10, 5 x 10, 3 x 20, 5 x 20, 7 x 10, 7 x 20 to 10 x 24 mm) to analyse the embolus capturing efficiency under different conditions including eccentric and concentric, horizontal and vertical positions in comparison to the Tulip filter. All testing was carried out in SPSS analytic software; statistical significance was assumed for p-values <0.05. Results: The in-vitro embolus capturing efficiency of the Celect filter proved to be equivalent to the Tulip filter. In the single-embolus test, 91.6% of the clots were captured by the Celect filter and 87.2% by the Tulip filter (p=0.042). Large clots ranging from 7 x 10 to 10 x 24 mm were captured in all cases, whereas the capture rates for the 3 x 5-mm and 3 x 10-mm clots were lower. The filters captured significantly more clots in the concentric than in the eccentric location. There was no significant difference between the overall capture rates of the two filters in the multi-clot test (72.2% vs. 75.1%), which showed deterioration of filter function during multiple clot exposure. With the 15-mm tube, the Celect filter had a significantly higher capture rate than the Tulip filter, whereas it

Submillisievert standard-pitch CT pulmonary angiography with ultra-low dose contrast media administration: A comparison to standard CT imaging.

Science.gov (United States)

Suntharalingam, Saravanabavaan; Mikat, Christian; Stenzel, Elena; Erfanian, Youssef; Wetter, Axel; Schlosser, Thomas; Forsting, Michael; Nassenstein, Kai

2017-01-01

To evaluate the image quality and radiation dose of submillisievert standard-pitch CT pulmonary angiography (CTPA) with ultra-low dose contrast media administration in comparison to standard CTPA. Hundred patients (56 females, 44 males, mean age 69.6±15.4 years; median BMI: 26.6, IQR: 5.9) with suspected pulmonary embolism were examined with two different protocols (n = 50 each, group A: 80 kVp, ref. mAs 115, 25 ml of contrast medium; group B: 100 kVp, ref. mAs 150, 60 ml of contrast medium) using a dual-source CT equipped with automated exposure control. Objective and subjective image qualities, radiation exposure as well as the frequency of pulmonary embolism were evaluated. There was no significant difference in subjective image quality scores between two groups regarding pulmonary arteries (p = 0.776), whereby the interobserver agreement was excellent (group A: k = 0.9; group B k = 1.0). Objective image analysis revealed that signal intensities (SI), signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the pulmonary arteries were equal or significantly higher in group B. There was no significant difference in the frequency of pulmonary embolism (p = 0.65). Using the low dose and low contrast media protocol resulted in a radiation dose reduction by 71.8% (2.4 vs. 0.7 mSv; pcontrast agent volume can obtain sufficient image quality to exclude or diagnose pulmonary emboli while reducing radiation dose by approximately 71%.

Comprehensive automatic assessment of retinal vascular abnormalities for computer-assisted retinopathy grading.

Science.gov (United States)

Joshi, Vinayak; Agurto, Carla; VanNess, Richard; Nemeth, Sheila; Soliz, Peter; Barriga, Simon

2014-01-01

One of the most important signs of systemic disease that presents on the retina is vascular abnormalities such as in hypertensive retinopathy. Manual analysis of fundus images by human readers is qualitative and lacks in accuracy, consistency and repeatability. Present semi-automatic methods for vascular evaluation are reported to increase accuracy and reduce reader variability, but require extensive reader interaction; thus limiting the software-aided efficiency. Automation thus holds a twofold promise. First, decrease variability while increasing accuracy, and second, increasing the efficiency. In this paper we propose fully automated software as a second reader system for comprehensive assessment of retinal vasculature; which aids the readers in the quantitative characterization of vessel abnormalities in fundus images. This system provides the reader with objective measures of vascular morphology such as tortuosity, branching angles, as well as highlights of areas with abnormalities such as artery-venous nicking, copper and silver wiring, and retinal emboli; in order for the reader to make a final screening decision. To test the efficacy of our system, we evaluated the change in performance of a newly certified retinal reader when grading a set of 40 color fundus images with and without the assistance of the software. The results demonstrated an improvement in reader's performance with the software assistance, in terms of accuracy of detection of vessel abnormalities, determination of retinopathy, and reading time. This system enables the reader in making computer-assisted vasculature assessment with high accuracy and consistency, at a reduced reading time.

Phase II and Biomarker Study of the Dual MET/VEGFR2 Inhibitor Foretinib in Patients With Papillary Renal Cell Carcinoma

Science.gov (United States)

Choueiri, Toni K.; Vaishampayan, Ulka; Rosenberg, Jonathan E.; Logan, Theodore F.; Harzstark, Andrea L.; Bukowski, Ronald M.; Rini, Brian I.; Srinivas, Sandy; Stein, Mark N.; Adams, Laurel M.; Ottesen, Lone H.; Laubscher, Kevin H.; Sherman, Laurie; McDermott, David F.; Haas, Naomi B.; Flaherty, Keith T.; Ross, Robert; Eisenberg, Peter; Meltzer, Paul S.; Merino, Maria J.; Bottaro, Donald P.; Linehan, W. Marston; Srinivasan, Ramaprasad

2013-01-01

Purpose Foretinib is an oral multikinase inhibitor targeting MET, VEGF, RON, AXL, and TIE-2 receptors. Activating mutations or amplifications in MET have been described in patients with papillary renal cell carcinoma (PRCC). We aimed to evaluate the efficacy and safety of foretinib in patients with PRCC. Patients and Methods Patients were enrolled onto the study in two cohorts with different dosing schedules of foretinib: cohort A, 240 mg once per day on days 1 through 5 every 14 days (intermittent arm); cohort B, 80 mg daily (daily dosing arm). Patients were stratified on the basis of MET pathway activation (germline or somatic MET mutation, MET [7q31] amplification, or gain of chromosome 7). The primary end point was overall response rate (ORR). Results Overall, 74 patients were enrolled, with 37 in each dosing cohort. ORR by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0 was 13.5%, median progression-free survival was 9.3 months, and median overall survival was not reached. The presence of a germline MET mutation was highly predictive of a response (five of 10 v five of 57 patients with and without germline MET mutations, respectively). The most frequent adverse events of any grade associated with foretinib were fatigue, hypertension, gastrointestinal toxicities, and nonfatal pulmonary emboli. Conclusion Foretinib demonstrated activity in patients with advanced PRCC with a manageable toxicity profile and a high response rate in patients with germline MET mutations. PMID:23213094

Pneumothorax Secondary to Septic Pulmonary Emboli in a Long-term Hemodialysis Patient with Psoas Abscess.

Science.gov (United States)

Okabe, Masahiro; Kasai, Kenji; Yokoo, Takashi

2017-12-01

Pneumothorax secondary to septic pulmonary embolism (SPE) is rare but life-threatening. We herein report a long-term hemodialysis patient with psoas abscess caused by methicillin-resistant Staphylococcus aureus, associated with other muscle and splenic abscesses and SPE. Intravenous vancomycin treatment and percutaneous drainage of the psoas abscess rapidly improved her condition. However, the SPE lesions continued to increase, and right-sided pneumothorax occurred 10 days after treatment. The pneumothorax resolved after two months and SPE and all abscesses after four months of treatment. Since late-onset pneumothorax caused by SPE can occur despite successful treatment of the primary infection, care should be taken with such patients.

Technetium-99m-labeled recombinant tissue plasminogen activator for the imaging of emboli in vivo

Energy Technology Data Exchange (ETDEWEB)

Takahashi, Akihiro; Itoh, Kazuo; Tsukamoto, Eriko; Furudate, Masayori; Kamiyama, Hiroyasu; Abe, Hiroshi [Hokkaido Univ., Sapporo (Japan). School of Medicine

1993-07-01

Tissue-type plasminogen activator (t-PA) effectively lyses activate thrombus by direct action. Recombinant t-PA (rt-PA) was labeled with technetium-99m ([sup 99m]Tc) to investigate the in vivo binding to fibrin clots in a feline cerebral embolism model created by insertion of an artificial fibrin clot within the carotid artery. [sup 99m]Tc-rt-PA administered intravenously provided clearer imaging of clots after priming with cold rt-PA, with uptake peaking 5-10 minutes after the injection. [sup 99m]Tc-labeled human serum albumin was not retained at clot sites. Systemically administered [sup 99m]Tc-rt-PA binds to fibrin clots within carotid arteries in our feline model. Our results suggest that the interaction of intrinsic plasminogen activator inhibitors with extrinsically administered rt-PA may regulate the demonstration of a clot, although the precise mechanism is unclear. (author).

Evaluation models and evaluation use

Science.gov (United States)

Contandriopoulos, Damien; Brousselle, Astrid

2012-01-01

The use of evaluation results is at the core of evaluation theory and practice. Major debates in the field have emphasized the importance of both the evaluator’s role and the evaluation process itself in fostering evaluation use. A recent systematic review of interventions aimed at influencing policy-making or organizational behavior through knowledge exchange offers a new perspective on evaluation use. We propose here a framework for better understanding the embedded relations between evaluation context, choice of an evaluation model and use of results. The article argues that the evaluation context presents conditions that affect both the appropriateness of the evaluation model implemented and the use of results. PMID:23526460

Gain in cellular organization of inflammatory breast cancer: A 3D in vitro model that mimics the in vivo metastasis

International Nuclear Information System (INIS)

Morales, Jorge; Alpaugh, Mary L

2009-01-01

The initial step of metastasis in carcinomas, often referred to as the epithelial-mesenchymal transition (EMT), occurs via the loss of adherens junctions (e.g. cadherins) by the tumor embolus. This leads to a subsequent loss of cell polarity and cellular differentiation and organization, enabling cells of the embolus to become motile and invasive. However highly malignant inflammatory breast cancer (IBC) over-expresses E-cadherin. The human xenograft model of IBC (MARY-X), like IBC, displays the signature phenotype of an exaggerated degree of lymphovascular invasion (LVI) in situ by tumor emboli. An intact E-cadherin/α, β-catenin axis mediates the tight, compact clump of cells found both in vitro and in vivo as spheroids and tumor emboli, respectively. Using electron microscopy and focused ion beam milling to acquire in situ sections, we performed ultrastructural analysis of both an IBC and non-IBC, E-cadherin positive cell line to determine if retention of this adhesion molecule contributed to cellular organization. Here we report through ultrastructural analysis that IBC exhibits a high degree of cellular organization with polar elements such as apical/lateral positioning of E-cadherin, apical surface microvilli, and tortuous lumen-like (canalis) structures. In contrast, agarose-induced spheroids of MCF-7, a weakly invasive E-cadherin positive breast carcinoma cell line, do not exhibit ultrastructural polar features. This study has determined that the highly metastatic IBC with an exaggerated malignant phenotype challenges conventional wisdom in that instead of displaying a loss of cellular organization, IBC acquires a highly structured architecture. These findings suggest that the metastatic efficiency might be linked to the formation and maintenance of these architectural features. The comparative architectural features of both the spheroid and embolus of MARY-X provide an in vitro model with tractable in vivo applications

Dynamics of motion of a clot through an arterial bifurcation: a finite element analysis

Energy Technology Data Exchange (ETDEWEB)

Abolfazli, Ehsan; Fatouraee, Nasser [Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran (Iran, Islamic Republic of); Vahidi, Bahman, E-mail: e.abolfazli@aut.ac.ir, E-mail: nasser@aut.ac.ir, E-mail: bahman_vahidi@ut.ac.ir [Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran (Iran, Islamic Republic of)

2014-10-01

Although arterial embolism is important as a major cause of brain infarction, little information is available about the hemodynamic factors which govern the path emboli tend to follow. A method which predicts the trajectory of emboli in carotid arteries would be of a great value in understanding ischemic attack mechanisms and eventually devising hemodynamically optimal techniques for prevention of strokes. In this paper, computational models are presented to investigate the motion of a blood clot in a human carotid artery bifurcation. The governing equations for blood flow are the Navier–Stokes formulations. To achieve large structural movements, the arbitrary Lagrangian–Eulerian formulation (ALE) with an adaptive mesh method was employed for the fluid domain. The problem was solved by simultaneous solution of the fluid and the structure equations. In this paper, the phenomenon was simulated under laminar and Newtonian flow conditions. The measured stress–strain curve obtained from ultrasound elasticity imaging of the thrombus was set to a Sussman–Bathe material model representing embolus material properties. Shear stress magnitudes in the inner wall of the internal carotid artery (ICA) were measured. High magnitudes of wall shear stress (WSS) occurred in the areas in which the embolus and arterial are in contact with each other. Stress distribution in the embolus was also calculated and areas prone to rapture were identified. Effects of embolus size and embolus density on its motion velocity were investigated and it was observed that an increase in either embolus size or density led to a reduction in movement velocity of the embolus. Embolus trajectory and shear stress from a simulation of embolus movement in a three-dimensional model with patient-specific carotid artery bifurcation geometry are also presented.

Stable xenon CT CBF measurements in prevalent cerebrovascular disorders (stroke)

International Nuclear Information System (INIS)

Meyer, J.S.; Okayasu, H.; Tachibana, H.; Okabe, T.

1984-01-01

Local cerebral blood flow (LCBF) and local tissue: blood partition coefficient (L lambda) values were measured for small volumes of gray or white matter by CT CBF. Single compartment analysis was used but fitted to infinity in normal volunteers aged between 20 to 100 years (N . 20). Hemispheric LCBF and L lambda values were compared to those of 61 age matched patients with transient ischemic attacks (TIAs, N . 10), reversible ischemic neurologic deficits (RINDS, N . 10), acute and chronic cerebral infarctions associated with emboli from atherosclerotic plaques or complete occlusion of internal carotid or middle cerebral arteries (n . 9) or of cardiac origin (N . 3), cerebral hemorrhage (N . 1), multi-infarct dementia (MID) (N . 11) and arteriovenous malformations (AVM) (N . 17). In normal aging, L lambda s were normal, but LCBF showed diffuse age-related declines. Symptomatic cerebrovascular disease was characterized by accentuation of age-related LCBF declines. TIAs with unilateral ICA occlusion showed bilateral reductions of LCBF more evident in ischemic hemispheres. TIAs due to fibrino-platelet emboli from ulcerated, non-occlusive ICA plaques were characterized by transient unilateral, localized LCBF reductions. All TIAs showed normal L lambda values. RINDS showed both LCBF and L lambda reductions. Larger embolic infarctions of ICA origin, whether acute or chronic, showed zones of zero flow with surrounding reductions of LCBF and L lambda values. Recent cerebral embolism of cardiac origin likewise exhibited zones of zero flow surrounded by reduced LCBF and L lambda values; but in chronic stages LCBF and L lambda values adjacent to zero flow zones were normal. MID was characterized by patchy reductions of LCBF and L lambda values throughout both hemispheres. Brain tissues surrounding AVM showed normal L lambda values but LCBF values were reduced due to steal

Evaluation Use in Evaluation Systems

DEFF Research Database (Denmark)

Højlund, Steven

2014-01-01

This article investigates the European Union’s evaluation system and its conduciveness to evaluation use. Taking the European Commission’s LIFE programme as its case, the article makes an empirical contribution to an emerging focus in the literature on the importance of organization...... and institutions when analyzing evaluation use. By focusing on the European Union’s evaluation system the article finds that evaluation use mainly takes place in the European Commission and less so in the European Parliament and the European Council. The main explanatory factors enabling evaluation use relate...... to the system’s formalization of evaluation implementation and use; these factors ensure evaluation quality, timeliness and capacity in the Commission. At the same time, however, the system’s formalization also impedes evaluation use, reducing the direct influence of evaluations on policy-making and effectively...

Lemierre's Syndrome - A rare cause of disseminated sepsis requiring multi-organ support.

Science.gov (United States)

Rae, John; Misselbrook, Katie

2017-11-01

Lemierre's syndrome is a rare complication of acute pharyngitis characterised by septicaemia with infective thrombophlebitis of the internal jugular vein, most commonly due to Fusobacterium necrophorum . It characteristically affects healthy young adults causing persistent pyrexia and systemic sepsis presenting several days after an initial pharyngitis. Septic emboli seed via the bloodstream to distant sites including the lung, joints, skin, liver, spleen and brain. Prolonged antimicrobial therapy is required and admission to intensive care common. This once rare condition is increasing in incidence but awareness amongst clinicians is low. We present a classic case in a young man who developed multi-organ failure requiring intensive care support and describe the epidemiology, pathophysiology, microbiology, clinical features and management of the disease.

An Unusual Case of Metastatic Malignant Melanoma Presenting as Pseudomesothelioma with Intense Diffuse Pleural FDG Uptake Demonstrated on FDG PET/CT

Directory of Open Access Journals (Sweden)

Rosamma Bency

2015-06-01

Full Text Available A 75-year-old male, non-smoker with history of asbestos exposure, and excision of 2 mm Clark IV cutaneous malignant melanoma 15 months earlier, presented with rapidly progressive dyspnea, left pleuritic chest pain, and weight loss. CT Pulmonary Angiography (CTPA demonstrated bilateral pulmonary emboli and findings suspicious of mesothelioma. There was no evidence of infection or malignancy in the hemorrhagic pleural fluid aspirate. FDG PET-CT revealed extensive intense FDG uptake throughout the pleura of left hemi-thorax, bilateral hilar and mediastinal lymph nodes, bilateral adrenals and left gluteal musculature. Subsequent pleural biopsy was consistent with metastatic melanoma. The patient was referred for palliative therapy but died 10 days later

[Embolic stroke immediately after initial administration of intravitreal aflibercept].

Science.gov (United States)

Mizutani, Hironori; Inatomi, Yuichiro; Singu, Takaomi; Nakajima, Makoto; Yonehara, Toshiro; Ando, Yukio

2018-04-28

A 72-year-old man was admitted to our hospital because of right upper limb monoplegia 8 hours after the initial intravitreal injection of aflibercept, which is an inhibitor of vascular endothelial growth factor. Magnetic resonance diffusion-weighted images showed recent ischemic lesions in the left corona radiata and the right superior frontal gyrus. Laboratory findings showed mild hyperfibrinolysis. A patent foramen ovale was diagnosed on transesophageal echocardiography; however, lower-extremity ultrasonography did not detect deep vein thrombosis. The source of embolism remained unknown. A possible mechanism of cerebral emboli in the present case was a rapidly induced hypercoagulative state due to transfer of aflibercept from the vitreous body to the systemic circulation.

Interventional treatment of pulmonary arteriovenous malformations

DEFF Research Database (Denmark)

Andersen, Poul Erik; Kjeldsen, Anette Drøhse

2010-01-01

Pulmonary arteriovenous malformations (PAVM) are congenital vascular communications in the lungs. They act as right to left shunts so that the blood running through these malformations is not oxygenated or filtered. These patients are typically hypoxaemic with exercise intolerance and are at high...... risk of paradoxical emboli to the brain and other organs. These malformations are most commonly seen in hereditary haemorrhagic telangiectasia (HHT) (Mb. Osler-Weber-Rendu syndrome). Nowadays, the generally accepted treatment strategy of first choice is embolization of the afferent arteries...... the functional level. Embolization is a well-established method of treating PAVM, with a significant effect on oxygenation of the blood. Screening for PAVM in patients at risk is recommended, especially in patients with HHT....

Lung contusion and cavitation with exudative plural effusion following extracorporeal shock wave lithotripsy in an adult: a case report

Directory of Open Access Journals (Sweden)

Nouri-Majalan Nader

2010-08-01

Full Text Available Abstract Introduction Among the complications of extracorporeal shock wave lithotripsy are perinephric bleeding and hypertension. Case presentation We describe the case of a 31-year-old Asian man with an unusual case of hemoptysis and lung contusion and cavitation with exudative plural effusion due to pulmonary trauma following false positioning of extracorporeal shock wave lithotripsy. Differential diagnoses included pneumonia and pulmonary emboli, but these diagnoses were ruled out by the uniformly negative results of a lung perfusion scan, Doppler ultrasound, and culture of bronchoalveolar lavage and plural effusion, and because our patient showed spontaneous improvement. Conclusions False positioning of extracorporeal shock wave lithotripsy can cause lung trauma presenting as pulmonary contusion and cavitation with plural effusion.

Primary Ewing's Sarcoma/Primitive Neuroectodermal Tumor of Kidney with Caval Involvement in a Pregnant Woman.

Science.gov (United States)

Ding, Yinghui; Huang, Zhenlin; Ding, Yafei; Jia, Zhankui; Gu, Chaohui; Xue, Rui; Yang, Jinjian

2016-01-01

In this article, we report the case of a woman in whom was found an abdominal mass during pregnancy and who underwent nephrectomy and extraction of the emboli after delivery. The kidney had a volume of 15 × 10 × 8 cm and pathological diagnosis was primary Ewing's sarcoma. The patient was treated with conventional chemotherapy for 1 year after surgery, at which time multiple metastases were found. From this case, we surmise that hormonal changes that occur during pregnancy may accelerate the growth of Ewing's sarcoma of the kidney, suggesting that renal tumors in pregnant women demand serious attention and that anti-cancer treatment should begin as soon as possible. © 2016 S. Karger AG, Basel.

Severe pulmonary hypertension associated with the acute motor sensory axonal neuropathy subtype of Guillain-Barré syndrome.

Science.gov (United States)

Rooney, Kris A; Thomas, Neal J

2010-01-01

To evaluate pulmonary hypertension associated with acute motor sensory axonal neuropathy subtype of Guillain-Barré syndrome. Guillain-Barré syndrome consists of a group of autoimmune disorders that generally manifest as symmetric, progressive, ascending paralysis. There are five subtypes of Guillain-Barré syndrome, and autonomic involvement has been described in all subtypes, including cardiovascular, vasomotor, or pseudomotor dysfunction of both the sympathetic and parasympathetic systems. Case report. Tertiary care pediatric intensive care unit. Three-yr-old female patient. None. Serial measurements of pulmonary artery pressure. We report the case of a young girl with acute motor sensory axonal neuropathy who presented with severe cardiovascular collapse secondary to severe pulmonary hypertension. In this patient, multiple factors may have played a role in the development of pulmonary hypertension including autonomic dysfunction, hypoventilation, and immobility as a risk for thrombosis and pulmonary emboli. It is possible that many other individuals suffering from severe forms of Guillain-Barré syndrome, especially those with significant autonomic dysfunction, may actually have undiagnosed and therefore untreated pulmonary hypertension. Therefore, it is recommended that clinicians caring for critically ill children with Guillain-Barré syndrome have a high index of suspicion for pulmonary hypertension and consider echocardiography if there are clinical signs of this potentially fatal process.

Assessment of atrial electromechanical interval and P wave dispersion in patients with polycystic ovary syndrome.

Science.gov (United States)

Bayır, Pınar Türker; Güray, Ümit; Duyuler, Serkan; Demirkan, Burcu; Kayaalp, Oya; Kanat, Selçuk; Güray, Yeşim

2016-02-01

Polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk, including ischemic stroke. Prolonged atrial electromechanical interval (EMI) is related to increased atrial fibrillation (AF) risk. The aim of the study is to evaluate atrial EMI and electrocardiographic P-wave indices related to increased AF risk in patients with PCOS. Forty PCOS patients diagnosed on the basis of the Rotterdam criteria and 20 age-matched controls were prospectively included. patients with atrioventricular or intraventricular conduction abnormalities, dysrhythmia or taking antiarrhythmic drugs, atherosclerotic heart disease, cardiomyopathies, valvular lesions, pericardial disease, a history of pulmonary emboli or pulmonary hypertension, and abnormal thyroid function were excluded. Intra and interatrial EMI were measured by tissue Doppler imaging and P-wave dispersion (Pd) was calculated on 12-lead electrocardiography (ECG). The Isovolumetric relaxation time was the interval between the aortic valve closure artifact at the end of the LV outflow envelope and the mitral valve opening artifact at the beginning of the mitral E wave. Patients with PCOS had significantly higher interatrial [38 (24-65) ms vs. 16 (9-19) ms pPCOS group compared with control group [45 (27-60) ms vs. 30 (26-38) ms, pPCOS. PCOS is associated with prolonged inter- and intra-atrial conduction times, which are related to increased AF risk.

Computer-assisted diagnostic procedure for multislice computed tomography for assessment of the pulmonary arterial circulation. Clinical relevance

International Nuclear Information System (INIS)

Malich, A.; Hentrich, D.; Hansch, A.; Teichgraeber, U.; Boettcher, J.

2012-01-01

A recently developed CAD software which highlights intravascular thrombotic structures from multislice computed tomography (MSCT) data was tested regarding feasibility, interobserver reliability and effect on radiology reports. The CAD system ImageChecker registered CT-Lung was tested in a randomized double-blinded study on 160 MSCT datasets (standardized technical conditions) performed for suspected pulmonary embolism (PE). The CAD data and images were analyzed by three radiologists in an independent and blinded fashion. The data from all 160 cases could be analyzed and 604 CAD prompts were set. Using the CAD analysis significantly more PEs were found in the peripheral pulmonary arterial circulation than described in the initial report. In 38 cases the 3 radiologists in consensus scored the images with the CAD adjunct as PE positive in peripheral vessels, which were initially reported as negative. Despite differences in the evaluation between two radiologists the amended assessment of the imaging data using the CAD softwear was reliable. There was a significant correlation between D-dimer values and the number of embolic structures detected by the CAD analysis. The recently developed CAD system is a useful adjunct as second reader to detect subtle emboli in peripheral vessels of MSCT datasets. (orig.) [de

Vascular changes in sporadic ergotism. Epidemiology, pathogenesis, clinical practice, and diagnosis with special regard to angiographic documentation

Energy Technology Data Exchange (ETDEWEB)

Hagen, B.

1986-08-01

Whereas the epidemic form of ergotism has been rare in the 20th century, the sporadic form has a wide distribution as a consequence of therapy with ergot-derivative drugs. Favourable prognosis of the condition, with complete recovery from the ischemic peripheral circulatory disorders can be obtained by early diagnosis. Precise evaluation of the history, with recognition of treatment of migraine headache or postpartum hemorraghe with ergot alkaloids, can be determinative in diagnosis. The specific pattern of the angiographic findings, as we saw it in 6 cases within the last 4 years, decisively confirms the diagnosis. We could demonstrate thread-, thorn- and hour glass-like narrowing of the vessels, due to spasm. Total occlusion with the development of collaterals may occur, but we saw no thrombus formation. The stenotic arterial segments had smooth margins. The distribution of the involved arteries was more focal than generalized and more peripheral than central. In two cases spasm could be abolished immediately by a pharmaceutical (i.a. injection of tolazoline) or by anesthetic procedures (halothane). The phenomenologic data, together with the complete reversal of the circulatory ischemic disorders after therapy (particularly the absolute ban of ergots), is so specific that other diseases of ischemic nature (emboli, arteriosclerosis, Buerger's disease, fibromuscular hyperplasia) can be excluded.

Use of isovolemic hemodilution in the management of arterial ischemia in patients with polycythemia.

Science.gov (United States)

Shah, D M; Buchbinder, D; Balko, A; Karmody, A M; Leather, R P

1981-08-01

The management of patients with both polycythemia and limb-threatening ischemia presents many difficulties because in this population, vascular surgical procedures carry a particularly high incidence of hemorrhagic and thromboembolic complications. We evaluated the use of acute isovolemic hemodilution in 12 polycythemic patients who required urgent surgery due to severe ischemia and threatened limb loss. Within 48 hours, blood was withdrawn in units of 500 ml and simultaneously replaced with 1,500 ml of lactated Ringer's solution until a hematocrit of 35 to 40 percent was achieved. After hemodilution, two patients had such a marked improvement that no further therapeutic measures were required immediately. Four patients showed definite improvement in pulmonary vascular resistance tracings and segmental Doppler pressures, but ischemia was not fully ameliorated. These patients together with the remaining six patients underwent vascular surgery within 1 to 14 days after hemodilution. A hematocrit of 32 to 40 percent was maintained during the perioperative period. All arterial reconstructions were successfully completed and there were no perioperative failures. No pulmonary emboli, myocardial infarctions, or deaths occurred in this period. These results indicate that in polycythemic patients, urgent vascular surgery can be performed more safely with the concomitant use of acute isovolemic hemodilution.

Adjustment of a direct method for the determination of man body burden in Pu-239 on by X-ray detection of U-235; Mise au point d'une methode directe de determination de la charge corporelle en plutonium 239 chez l'homme par detection X de l'uranium 235

Energy Technology Data Exchange (ETDEWEB)

Boulay, P [Commissariat a l' Energie Atomique, Bruyeres-le-Chatel (France). Centre d' Etudes

1968-04-01

The use of Pu-239 on a larger scale sets a problem about the contamination measurement by aerosol at lung level. A method of direct measurement of Pu-239 lung burden is possible, thanks to the use of a large area window proportional counter. A counter of such pattern, has been especially carried out for this purpose. The adjustment of the apparatus allows an adequate sensibility to detect a contamination at the maximum permissible body burden level. Besides, a method for individual 'internal calibration', with a plutonium mock: the protactinium-233, is reported. (author) [French] L'utilisation a une echelle de plus en plus large du plutonium-239 pose un probleme de la mesure de la contamination par aerosol au niveau du poumon. Une methode de mesure directe de la charge pulmonaire en plutonium-239 est possible grace a l'utilisation d'un compteur proportionnel a fenetre de grande surface. Un compteur de ce type a specialement ete realise dans ce but. La mise au point de l'appareillage permet une sensibilite suffisante pour deceler une contamination au niveau de la Q.M.A (quantite maximale admissible). D'autre part, une methode 'd'etalonnage interne' de l'individu a l'aide d'un simulateur de plutonium, le protactinium-233, est decrite. (auteur)

Pneumonie organisée révélatrice d'une polymyosite

Science.gov (United States)

Ben Saad, Ahmed; Joobeur, Samah; Rouetbi, Naceur; Mhamed, Saousen Cheikh; Skhiri, Néji; Mribah, Hathami; El Kamel, Ali

2014-01-01

Les polymyosites (PM) sont des connectivites très rares, d’étiologie inconnue, dotées d'un grand polymorphisme clinique et évolutif. Elles peuvent être associées à d'autres manifestations viscérales notamment pulmonaires telles que la pneumopathie interstitielle. Ces complications respiratoires sont souvent associées à un taux de mortalité élevé. Les cas de pneumonie organisée révélatrice de polymyosite sont rarement rapportés dans la littérature et de description récente. Nous rapportons l'observation d'une patiente âgée de 53 ans qui a présenté, 14 mois après avoir porter le diagnostic d'une pneumonie organisée, des myalgies diffuses, un ‘dème des membres inférieurs et une élévation des enzymes musculaires. La biopsie musculaire a confirmé le diagnostic de la myosite. L’évolution était favorable sous corticothérapie. Le traitement de la PO associée au PM n'est pas clairement établi. La corticothérapie constitue le traitement de première intention. PMID:25722789

EVALUATION OF COURSE EVALUATIONS

DEFF Research Database (Denmark)

Friis-Hansen, Peter; Houbak, Niels; Klit, Peder

2005-01-01

and we have seen excellent lectures obtaining poor evaluations due to circumstances out of their control. On the other hand, with the analysis at hand, it is much easier to focus on specific needs for improvements. The effect of ‘chasing the bad performance’ over the past few years will be shown....... have for more than 10 years been evaluating the courses they attend. During the last 5 years, this evaluation has been electronic as an integral part of our CampusNet computing and course admini¬stra¬tion system. At the MEK department we have a committee in charge of our educational activities. One...... obligation is – two times a year – to go through in detail the evaluations for each of our 100+ courses and for each of the 50+ teachers. A rather tedious job, where the outcome seldom justifies the resources spent. The electronic version has opened up for further analysis of the evaluation data...

Deep venous thrombosis after office vasectomy: a case report

Directory of Open Access Journals (Sweden)

Zazove Philip

2010-08-01

Full Text Available Abstract Introduction Postoperative pulmonary embolism is considered a complication of major surgery. However, thromboembolism can also occur following minor procedures. We report a case of a major embolic event following a straightforward office vasectomy. Case presentation A healthy 35-year-old Asian man underwent an uncomplicated office vasectomy. Soon after, he noticed vague chest pain and dyspnea. Lower extremity Doppler ultrasound revealed acute venous thrombosis. A computer-assisted tomography angiogram revealed extensive bilateral pulmonary emboli. Extensive laboratory work-up failed to identify thrombophilia. He has not had any recurrences in the eight years since the initial presentation. Conclusion This case highlights that major embolic events can follow minor office procedures. Patients with suggestive findings should be investigated aggressively.

Bacterial Endocarditis and Cerebrovascular Disease.

Science.gov (United States)

Silver, Brian; Behrouz, Réza; Silliman, Scott

2016-12-01

Cerebrovascular complications of endocarditis occur in 25-70% of patients with infective endocarditis. The cornerstone of treatment is early initiation of antibiotic treatment, which significantly reduces the risk of embolization after 1 week of treatment. In general, thrombolysis and anticoagulation of these patients should be avoided, while antiplatelet therapy may be considered in those with other indications. Endovascular treatment of acute septic emboli is uncertain, but a few case reports have demonstrated benefit. Other complications of infective endocarditis include intracerebral hemorrhage, which may be predicted by the presence of two or more cerebral microbleeds on gradient echo sequences. Intracranial mycotic aneurysms can often be managed with serial imaging and coiled if there is evidence of failure to reduce in size, or enlargement.

Higher levels of serum fibrin-monomer reflect hypercoagulable state and thrombus formation in the left atrial appendage in patients with acute ischemic stroke.

Science.gov (United States)

Okuyama, Hidenobu; Hirono, Osamu; Liu, Ling; Takeishi, Yasuchika; Kayama, Takamasa; Kubota, Isao

2006-08-01

It is sometimes difficult to make a diagnosis of cardioembolic stroke in the stroke care unit, because of the splashing and vanishing of the intracardiac source of the emboli on transesophageal echocardiography. Serum fibrin-monomer (FM) is a new marker for coagulation activity that is useful for identifying older individuals at increased risk of ischemic stroke. Two hundred and four patients with acute ischemic stroke were examined for serum coagulation and fibrinolytic activity on admission, and underwent transesophageal echocardiography within 7 days of onset. Serum levels of FM was significantly higher in patients with left atrial appendage (LAA) thrombus formation (n=24) than in those with no thrombus (88+/-52 vs 14+/-9 microg/ml, pvs 8+/-5 microg/ml, pstroke.

Air and blood fluid dynamics: at the interface between engineering and medicine

International Nuclear Information System (INIS)

Pollard, A; Secretain, F; Milne, B

2014-01-01

The flows in the human upper airway and human heart during open heart surgery are considered. Beginning with idealized models of the human upper airway, current methods to extract realistic airway geometries using a novel implementation of optical coherent tomography modality are introduced. Complementary direct numerical simulations are considered that will assist in pre-surgery planning for obstructive sleep apnea. Cardiac air bubbles often arise during open heart surgery. These bubbles are potential emboli that can cause neurological impairment and even death. An experimental programme is outlined that uses acoustic sound to instil bubble surface oscillations that result in bubble breakup. A novel algorithm is introduced that enables a surgical team to obtain real-time in-vivo bubble data to aid cardiac de-airation procedures.

Yersinia pseudotuberculosis septicemia in a beaver from Washington State.

Science.gov (United States)

Gaydos, Joseph K; Zabek, Erin; Raverty, Stephen

2009-10-01

An emaciated, free-ranging, sub-adult, male beaver (Castor canadensis) was found dead and was necropsied. Microscopically, the beaver had acute necrotizing hepatitis and splenitis with florid lobulated colonies of extracellular coccobacilli. Intravascular septic emboli were identified in lung, small intestine, and kidney, and discrete ulcers with scattered superficial extracellular accumulation of coccobacilli were noted on tail margins and plantar surfaces of the hind feet. Yersinia pseudotuberculosis was cultured on Columbia blood and MacConkey agar and identified by API 20E. Based on the pathology and acute mortality described in this case, as well as historical reports of Y. pseudotuberculosis related mortality in other beavers, this species could serve as a public health sentinel for localized occurrences of this bacterium.

Deep Vein Thrombosis of the Left Leg: A Case of May-Thurner Syndrome

Directory of Open Access Journals (Sweden)

Jiten Desai

2018-02-01

Full Text Available A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization. CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May–Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization.

Lemierre syndrome: a case report

International Nuclear Information System (INIS)

Bae, Young A; Lee, In Jae; Kim, Hyun Beom; Hong, Myung Sun; Lee, Kwan Seop; Lee, Yul; Bae, Sang Hoon

2006-01-01

Lemierre syndrome is a rare disease characterized by internal jugular vein thrombosis and septic emboli, and it primarily occurs in healthy young individuals; this disease usually follows an acute oropharyngeal infection. To the best of our knowledge, only a few reports about this disease have appeared in the radiologic literature. We report here the radiologic findings of a case of Lemierre syndrome in a young healthy female adolescent who had a history of acute pharyngotonsilitis. Chest radiographs showed lung nodules that displayed cavitary changes with rapid progression on the serial studies. High-resolution CT scan showed multi-focal patchy consolidations that connect with vessels, and this was suggestive of septic pulmonary embolism. Ultrasonography and CT scan of the neck revealed right internal jugular vein thrombosis

Interactions of heart disease and lung disease on radionuclide tests of lung anatomy and function

International Nuclear Information System (INIS)

Pierson, R.N. Jr.; Barrett, C.R. Jr.; Yamashina, A.; Friedman, M.I.

1984-01-01

This paper considers the effects of heat diseases on lung anatomy, lung function, and pulmonary nuclear test procedures, and also the effects of lung diseases on cardiac function, with particular reference to radionuclide tests. Historically, pulmonary nuclear medicine has been focused on discovering and quantifying pulmonary embolism, but the potential of nuclear tracer techniques to carry out high-precision, regional, quantitative measurements of blood flow, air flow, and membrane transport promises a much more powerful and wide-ranging diagnostic application than the search for pulmonary emboli. The authors therefore define normal anatomy and function in a framework suitable to develop the relationships between cardiac and pulmonary function, with particular attention to regional differences in lung function, since regional measurements provide a special province for radionuclide lung studies

Deep venous thrombophlebitis following aortoiliac reconstructive surgery

International Nuclear Information System (INIS)

Reilly, M.K.; McCabe, C.J.; Abbott, W.M.; Brewster, D.C.; Moncure, A.C.; Reidy, N.C.; Darling, R.C.

1982-01-01

One hundred patients undergoing elective aortic surgery were scanned prospectively for development of deep venous thrombosis (DVT). The incidence of DVT in this population was 13%. Eleven patients showed only calf vein thrombosis on venography, whereas two had occlusive iliofemoral thrombus. The correlation between venous Doppler ultrasound and venography was 80%. More importantly, Doppler examination correctly identified both patients with occlusive thrombus. Fibrinogen scanning was associated with a false-positive rate of 31%. Only one patient suffered a nonfatal pulmonary embolus. Fibrinogen scanning has an unacceptably high false-positive rate; however, Doppler ultrasound will identify significant occlusive thrombus without a high false-positive rate. The low incidence of pulmonary emboli does not warrant such definitive measures as prophylactic vena caval interruption

Management of thromboembolism-in-transit with pulmonary embolism

Directory of Open Access Journals (Sweden)

V S Ellensen

2017-10-01

Full Text Available We present a rare complication of deep venous thrombosis with pulmonary embolism that threatened the patient with systemic embolization. A 36-year-old female was referred to the hospital after five days of progressive shortness of breath and chest pain. Preceding onset of symptoms, she had undergone surgery leading to reduced physical activity and had just returned from vacation by a long flight. Investigations with transthoracic and transesophageal echocardiography revealed a thromboembolism-in-transit across a patent foramen ovale. Thoracic CT showed submassive bilateral pulmonary embolism. Hemodynamic parameters were stable. The patient was treated surgically with extraction of the thrombus, closure of the foramen ovale and removal of the bilateral pulmonary emboli. She was discharged after an uneventful hospital stay.

Streptococcus agalactiae endocarditis presenting as acalculous cholecystitis in a previously well woman.

LENUS (Irish Health Repository)

Brewer, Linda

2013-01-01

This case report describes the unusual presentation of a previously very well woman with Streptococcus agalactiae endocarditis in the emergency department. History, examination and preliminary laboratory and radiological investigations supported a diagnosis of acalculous cholecystitis, for which she was given intravenous broad spectrum antimicrobial therapy. One day following admission, the patient deteriorated and became unresponsive. Subsequent MRI of the brain revealed multiple bihemispheric cerebral emboli and a large, mobile mitral valve thrombus was visualised on her transoesophageal echocardiogram. S agalactiae was cultured from venous blood samples and her antimicrobial cover was adjusted accordingly. Despite her presumed guarded prognosis, this patient made a remarkable recovery. To our knowledge, the association of S agalactiae endocarditis with acalculous cholecystitis has not been previously described.

Chemical method of labelling proteins with the radionuclides of technetium at physiological condition

International Nuclear Information System (INIS)

Wong, D.W.

1983-01-01

A novel rapid chemical method of labeling plasma proteins, other compounds and/or substances containing protein with radionuclides of technetium such as sup(95m)Tc, sup(99m)Tc or sup(99)Tc at physiologic pH 7.4 condition, producing a sterile non-pyrogenic radioactive tracer material suitable for biological and medical uses. These radiolabeled protein substances are not denatured by the labeling process but retain their natural physiological and immunological properties. This novel labeling technique provides a simple and rapid means of labeling plasma proteins such as human serum albumin, fibrinogen, antibodies, hormones and enzymes with sup(95m)Tc or sup(99m)Tc for scintigraphic imaging which may allow visualization of thrombi, emboli, myocardial infarcts, infectious lesions or tumors

Cryptogenic Stroke

Directory of Open Access Journals (Sweden)

Mohammad Saadatnia

2017-02-01

Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

Multimedia system for creation, transmission and consultation of medical examination records

International Nuclear Information System (INIS)

Le Rest, C.; Fortineau, J.; Bernier, M.; Guillo, P.; Cavarec, M.

1997-01-01

Achieving an urgency examination requires a rapid transmission of the results to the examiner. An efficient method of their communication could be achieved by producing a multimedia record consisting of images, comments and voiced utterances. We have retained for illustration the case of pulmonary scintigraphy in the diagnosis of pulmonary emboli. Following the acquisition the images are transferred to a PC (under Interfile format). These are displayed on the screen in association with anatomic schemes. In order to present all the elements important for interpretation, a series of tools was developed. Thus, to single out the anomalies the editor is provided with arrows to which verbal comments can be associated. Subsequently, he enters up its record. The interpreted examination is transferred to the examiner's PC via an ATM network. The consultant may then investigate the multimedia record by displaying images and comments and listening to the comments and conclusion of the isotope investigator. A prototype is already operational and its evaluation phase is to start. This stage refers to the quality of transmitted information. A quest among examiners will then allow to evaluate whether the examination reading out and the comprehension of the isotope investigators' conclusions are easier. The speed of transmission will be compared with the current routine (based on manuscript records) and its practical impact in case of urgency circumstances will be assessed. The technical facilities utilized by us allow an easy generalization of the approach to other image-based medical examinations performed in case of urgency

Multimedia system for creation, transmission and consultation of medical examination records; Systeme multimedia de creation, transmission and compte-rendu d`examens medicaux

Energy Technology Data Exchange (ETDEWEB)

Le Rest, C. [Service de Medecine Nucleaire, CHU 29609 Brest (France); Fortineau, J.; Bernier, M. [SEI IRESTE 44087 Nantes (France); Guillo, P.; Cavarec, M. [Service de Medecine Nucleaire, CHU 29609 Brest (France)

1997-12-31

Achieving an urgency examination requires a rapid transmission of the results to the examiner. An efficient method of their communication could be achieved by producing a multimedia record consisting of images, comments and voiced utterances. We have retained for illustration the case of pulmonary scintigraphy in the diagnosis of pulmonary emboli. Following the acquisition the images are transferred to a PC (under Interfile format). These are displayed on the screen in association with anatomic schemes. In order to present all the elements important for interpretation, a series of tools was developed. Thus, to single out the anomalies the editor is provided with arrows to which verbal comments can be associated. Subsequently, he enters up its record. The interpreted examination is transferred to the examiner`s PC via an ATM network. The consultant may then investigate the multimedia record by displaying images and comments and listening to the comments and conclusion of the isotope investigator. A prototype is already operational and its evaluation phase is to start. This stage refers to the quality of transmitted information. A quest among examiners will then allow to evaluate whether the examination reading out and the comprehension of the isotope investigators` conclusions are easier. The speed of transmission will be compared with the current routine (based on manuscript records) and its practical impact in case of urgency circumstances will be assessed. The technical facilities utilized by us allow an easy generalization of the approach to other image-based medical examinations performed in case of urgency

American Evaluation Association Guiding Principles for Evaluators

Energy Technology Data Exchange (ETDEWEB)

None

2009-01-18

Five principles developed by American Evaluation Associ intended to guide professional practice of evaluators & to inform evaluation clients and the general public about principles they can expect to be upheld by professional evaluators.

Long-term fate of left atrial thrombi and incidence of cerebral embolism under continuous anticoagulation therapy; MR-tomographische Evaluation der Inzidenz zerebraler Embolien bei Patienten mit Vorhofflimmern und linksatrialen Thromben

Energy Technology Data Exchange (ETDEWEB)

Strach, K.; Meyer, C.; Hackenbroch, M.; Schild, H.; Sommer, T. [Radiologische Universitaetsklinik Bonn (Germany); Tiemann, K. [Medizinische Universitaetsklinik und Poliklinik II, Bonn (Germany); Haase, J. [Klinik Rotes Kreuz, Frankfurt/Main (Germany); Pizulli, L. [Petruskrankenhaus, Bonn (Germany); Omran, H. [St. Marien-Hospital, Bonn (Germany)

2005-12-15

Purpose: Patients (pts.) with atrial fibrillation (AF) and atrial thrombi are known to have an increased risk for cerebral embolism. However, little is known about the clinical course of atrial thrombi and the incidence of cerebral embolism in those patients during anticoagulation therapy. The high sensitivity of MR imaging (MRI) including diffusion-weighted imaging (DWI) suggests that this technique could provide an improved estimate of cerebral embolism associated with the presence of left atrial thrombi. The aims of this prospective study were to evaluate (1) the prevalence of clinically silent and apparent cerebral embolism in pts. with newly diagnosed AF and atrial thrombi using MRI/DWI, (2) the long-term fate of atrial thrombi under continued anticoagulation therapy and (3) the incidence of cerebral embolism during a follow-up period of 12 months with continuous anticoagulation therapy. Materials and methods: The study group consisted of 32 pts. with (1) newly diagnosed AF and evidence of left atrial (LA) thrombi detected by TEE and (2) a new start of anticoagulation therapy [International Normalized Ratio (INR) 2.0-3.0]. 19 pts. with (1) newly diagnosed AF and no evidence of atrial thrombi and (2) an equivalent anticoagulation regimen served as the control group. In both groups (a) MRI/DWI studies of the brain (weeks 0, 4, 8, 12, 20, 28, 36, 44, and 52), (b) transesophageal echocardiographic studies (TEE) for assessment of LA-Thrombi (weeks 0 and 52) and (c) clinical neurological assessments (weeks 0, 20 and 52) were performed. Results: In the study group (AF and LA-Thrombi) 11 out of 32 pts. (34%) displayed signs of acute (n=8) or chronic (n=3) cerebral embolism in the initial MRI studies. In 4 out of 32 pts.(13%), MRI/DWI depicted new or additional cerebral emboli (n=12) during the follow-up period despite continuous anticoagulation therapy. 2 (n=2/4; 50%) of these patients had clinically apparent neurological deficits. In the control group 1 out of 19 pts

Evaluating how we evaluate.

Science.gov (United States)

Vale, Ronald D

2012-09-01

Evaluation of scientific work underlies the process of career advancement in academic science, with publications being a fundamental metric. Many aspects of the evaluation process for grants and promotions are deeply ingrained in institutions and funding agencies and have been altered very little in the past several decades, despite substantial changes that have taken place in the scientific work force, the funding landscape, and the way that science is being conducted. This article examines how scientific productivity is being evaluated, what it is rewarding, where it falls short, and why richer information than a standard curriculum vitae/biosketch might provide a more accurate picture of scientific and educational contributions. The article also explores how the evaluation process exerts a profound influence on many aspects of the scientific enterprise, including the training of new scientists, the way in which grant resources are distributed, the manner in which new knowledge is published, and the culture of science itself.

The Effect of an Externally Attached Neutrally Buoyant Transmitter on Mortal Injury during Simulated Hydroturbine Passage

Energy Technology Data Exchange (ETDEWEB)

Brown, Richard S.; Pflugrath, Brett D.; Carlson, Thomas J.; Deng, Zhiqun

2012-02-03

On their seaward migration, juvenile salmonids commonly pass hydroelectric dams. Fish passing through hydroturbines experience a rapid decrease in pressure as they pass by the turbine blade and the severity of this decompression can be highly variable. This rapid decrease in pressure can result in injuries such as swim bladder rupture, exophthalmia, and emboli and hemorrhaging in the fins and tissues. However, recent research indicates that the presence of a telemetry tag (acoustic, radio, inductive) implanted inside the coelom of a juvenile salmon increases the likelihood that the fish will be injured or die during turbine passage. Thus, previous research conducted using telemetry tags implanted into the coelom of fish may have been inaccurate. Thus, a new technique is needed to provide unbiased estimates of survival through turbines. This research provides an evaluation of the effectiveness of a neutrally buoyant externally attached acoustic transmitter. Both nontagged fish and fish tagged with a neutrally buoyant external transmitter were exposed to a range of rapid decompressions simulating turbine passage. Juvenile Chinook salmon tagged with a neutrally buoyant externally attached acoustic transmitter did not receive a higher degree of barotrauma than their nontagged counterparts. We suggest that future research include field-based comparisons of survival and behavior among fish tagged with a neutrally buoyant external transmitter and those internally implanted with transmitters.

3D-CT angiography with ultrafast CT in the diagnosis of pulmonary thromboembolism

International Nuclear Information System (INIS)

Kuribayashi, Sachio; Hamada, Seiki; Takamiya, Makoto; Imakita, Satoshi; Yamada, Naoaki; Takase, Kei; Iino, Misako; Nakanishi, Norifumi

1995-01-01

The usefulness of 3D-CT angiography (3D-CTA) with ultrafast CT (UFCT) in the diagnosis of pulmonary thromboembolism (PTE) was evaluated. UFCT was carried out in 10 patients with PTE (acute: 5 cases, chronic: 5 cases) and one case with pulmonary artery thrombosis secondary to pulmonary hypertension with atrial septal defect. CT scanning was performed with Imatron C-100XL and C-150L. For the imaging, single-slice step volume scan mode was used with scan time of 100 msec and slice thickness of 6 mm. Contiguous axial images were obtained after contrast enhancement with slice interval of 6 mm. 3D-CTA was reconstructed from 2D-CT images with workstation, and was compared with pulmonary angiograms (PAG) or operative findings. The images of 3D-CTA had good quality and they were more useful than 2D-CT images in better understanding of the configuration and the extent of the thrombi. In comparison with PAG, 3D-CTA gave equivalent information in terms of central pulmonary emboli. Moreover, 3D-CTA had advantages over PAG in demonstrating both the blood lumen and the thrombus on the same image with capability of multi-directional displays. 3D-CTA with UFCT is the useful non-invasive imaging modality in the diagnosis of PTE. (author)

Automated embolic signal detection using Deep Convolutional Neural Network.

Science.gov (United States)

Sombune, Praotasna; Phienphanich, Phongphan; Phuechpanpaisal, Sutanya; Muengtaweepongsa, Sombat; Ruamthanthong, Anuchit; Tantibundhit, Charturong

2017-07-01

This work investigated the potential of Deep Neural Network in detection of cerebral embolic signal (ES) from transcranial Doppler ultrasound (TCD). The resulting system is aimed to couple with TCD devices in diagnosing a risk of stroke in real-time with high accuracy. The Adaptive Gain Control (AGC) approach developed in our previous study is employed to capture suspected ESs in real-time. By using spectrograms of the same TCD signal dataset as that of our previous work as inputs and the same experimental setup, Deep Convolutional Neural Network (CNN), which can learn features while training, was investigated for its ability to bypass the traditional handcrafted feature extraction and selection process. Extracted feature vectors from the suspected ESs are later determined whether they are of an ES, artifact (AF) or normal (NR) interval. The effectiveness of the developed system was evaluated over 19 subjects going under procedures generating emboli. The CNN-based system could achieve in average of 83.0% sensitivity, 80.1% specificity, and 81.4% accuracy, with considerably much less time consumption in development. The certainly growing set of training samples and computational resources will contribute to high performance. Besides having potential use in various clinical ES monitoring settings, continuation of this promising study will benefit developments of wearable applications by leveraging learnable features to serve demographic differentials.

Mesothelioma in Two Nondomestic Felids: North American Cougar (Felis concolor and Cheetah (Acinonyx jubatus

Directory of Open Access Journals (Sweden)

Amanda Whiton

2013-01-01

Full Text Available A 15-year-old male North American cougar (Felis concolor presented with a 2-day history of anorexia, restlessness, and dyspnea. White blood cell count ( cells/μL and absolute segmented neutrophil count ( cells/μL were increased, and BUN (143 mg/dL, creatinine (6.3 mg/dL, and phosphorus (8.5 mg/dL concentrations indicated chronic renal disease. Thoracic radiographs showed severe pleural and pericardial effusion. During attempts to remove the fluid, cardiac tamponade developed and the cat died. At necropsy, nodular masses decorated the pericardium at the level of the base of the heart. The final microscopic diagnosis was mesothelioma of the pericardium, tunica adventitia of the main pulmonary artery, left auricle epicardium, and left ventricular epicardium. A 15-year-old female cheetah (Acinonyx jubatus was evaluated for acute respiratory distress. The white blood cell count ( cells/μL and absolute segmented neutrophil count ( cells/μL were increased. Radiographically pleural effusion and a cranial thoracic mass were seen. The cheetah was euthanized, and a gross diagnosis of disseminated pleural mesothelioma with thoracic effusion was made. Histologically, pleural mesothelioma was confirmed with local invasion of the lung and pulmonary arterial emboli and infarction. In both cases, a diagnosis of mesothelioma was made based on cellular morphology, microscopic architecture, and neoplastic cell coexpression of cytokeratin and vimentin.

Nuclear data evaluation method and evaluation system

International Nuclear Information System (INIS)

Liu Tingjin

1995-01-01

The evaluation methods and Nuclear Data Evaluation System have been developed in China. A new version of the system has been established on Micro-VAX2 computer, which is supported by IAEA under the technology assistance program. The flow chart of Chinese Nuclear Data Evaluation System is shown out. For last ten years, the main efforts have been put on the double differential cross section, covariance data and evaluated data library validation. The developed evaluation method and Chinese Nuclear Data Evaluation System have been widely used at CNDC and in Chinese Nuclear Data Network for CENDL. (1 tab., 15 figs.)

High prevalence of self-reported symptoms of digital ischemia in elite male volleyball players in the Netherlands: a cross-sectional national survey.

Science.gov (United States)

van de Pol, Daan; Kuijer, P Paul F M; Langenhorst, Ton; Maas, Mario

2012-10-01

In the past 3 years, 6 volleyball players with ischemic digits and small microemboli in the digital arteries of the dominant hand presented themselves in our hospital. These complaints were caused by an aneurysmatic dilation of the posterior circumflex humeral artery (PCHA) with distal occlusion and digital emboli in the isolateral limb. All were elite male volleyball players active in the national top league. Little is known about the exact symptoms associated with PCHA pathological lesions with digital emboli (PCHAP with DE) and its prevalence in elite volleyball players. If vascular injury can be identified at an early stage, thromboembolic complications and irreversible damage to the digits might be prevented. To assess the prevalence of symptoms that are consistent with digital ischemia and may be caused by PCHAP with DE in elite male volleyball players in the Netherlands. Cross-sectional study; Level of evidence, 3. A questionnaire survey was performed among elite volleyball players in the Dutch national top league and the Dutch beach volleyball team. The questionnaire was constructed using literature-based data on symptoms associated with PCHAP with DE, together with data retrieved from medical files. A total of 99 of the 107 athletes participated, with a response rate of 93%. The most frequently reported symptoms associated with PCHAP with DE were cold, blue, or pale digits in the dominant hand during or immediately after practice or competition. The prevalence of these symptoms ranged from 11% to 27%. The prevalence of cold digits during practice and competition was 27%. The prevalence of cold, blue, and pale digits during or immediately after practice and competition was 12%. An unexpectedly high percentage of elite volleyball players reported symptoms that are associated with PCHAP with DE in the dominant hand. Because these athletes are considered potentially at risk for developing critical digital ischemia, further analysis of the presence of digital

Lemierre’s syndrome: current perspectives on diagnosis and management

Directory of Open Access Journals (Sweden)

Johannesen KM

2016-09-01

Full Text Available Katrine M Johannesen,1 Uffe Bodtger1–3 1Department of Lung Medicine, Naestved Hospital, Naestved, 2Institute for Regional Health Research, University of Southern Denmark, Odense, 3Department of Pulmonology, Zealand University Hospital, Roskilde, Denmark Abstract: This is a systematic review of cases with Lemierre’s syndrome (LS in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician. Keywords: Lemierre’s syndrome

Thrombus imaging with indium-111 and iodine-131-labeled fibrin-specific monoclonal antibody and its F(ab')2 and Fab fragments

International Nuclear Information System (INIS)

Rosebrough, S.F.; Grossman, Z.D.; McAfee, J.G.

1988-01-01

We have previously reported successful imaging of fresh (2-4 hr old) and aged (1-5 days old) canine thrombi with 131 I-labeled intact monoclonal antibody (MAb) specific for fibrin. We now report thrombus imaging with 131 I-labeled F(ab')2 and Fab and 111 In-labeled intact MAb, F(ab')2, and Fab. Indium-111-labeled F(ab')2 proved to be the best imaging agent due to less nonspecific binding in the liver than whole IgG. Image quality was improved by the higher administered dose permissible with 111 In and its better physical characteristics for imaging, compared to 131 I. Immunofluorescence of fresh human histologic sections showed intact MAb and F(ab')2 binding to thrombi, pulmonary emboli, and atherosclerotic plaques, strengthening the feasibility of clinical thrombus imaging

Middle Cerebral Artery, Ophthalmic Artery, and Multibranch Retinal Vessel Occlusion After Cosmetic Autologous Fat Transfer to Forehead.

Science.gov (United States)

Roshandel, Danial; Soheilian, Masoud; Pakravan, Mohammad; Aghayan, Sara; Peyman, Gholam A

2015-05-01

A 65-year-old woman with left hemiparesis and sudden loss of visual acuity in her right eye presented a few hours after cosmetic injection of autologous fat to her forehead. Right eye visual acuity was no light perception. Funduscopy revealed widespread retinal whitening and multibranch retinal vessel occlusion. Fluorescein angiography showed markedly delayed choroidal and retinal filling together with occlusion of multiple branches of retinal arteries and veins. On magnetic resonance imaging of the brain, multiple lesions compatible with recent infarction were detected. The authors diagnosed multibranch retinal artery and vein occlusion in the right ophthalmic and middle cerebral arteries due to fat emboli. This case emphasizes the need to reevaluate the safety of such aesthetic procedures, particularly in the facial zone to prevent devastating complications. Copyright 2015, SLACK Incorporated.

Clinical effectiveness of percutaneous angioplasty for acute and chronic mesenteric ischemia: a six case series.

Science.gov (United States)

Jung, Yu Min; Jo, Yun Ju; Ahn, Sang Bong; Son, Byoung Kwan; Kim, Seong Hwan; Park, Young Sook; Bae, June Ho; Cho, Young Kwon

2011-04-01

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.

Complicações pulmonares de endocardite tricúspide num doente toxicómano

Directory of Open Access Journals (Sweden)

Carlos Lousada

1997-01-01

Full Text Available RESUMO: Os autore apresentam o caso clínico de um doente toxicodependente com embolias pulmonares sépticas, pneumotórax e derrame pleural secundários a endocardite tricúspide e sindrome nefrótico.Discutese o diagnóstico, mecanismos etiopatogénicos, terapêutica médica, indicações cirúrgicas e prognóstico destas situações. SUMMARY: The authors present a case of an intravenous drug addict with septic pulmonary embolism, pneumothorax and pleural effusion secondary to tricuspid infectious endocarditis and nephrotic syndrome.The diagnosis, etiopathogenic mechanisms, treatment implications, the role of surgery and the prognosis are discussed. Palavras-chave: embolia pulmonar séptica, pneumotórax, endocardite tricúspide, Key-Word: septic pulmonary emboli, pneumothorax, tricuspid endocarditis

Perfusion Pressure Cerebral Infarct (PPCI) trial - the importance of mean arterial pressure during cardiopulmonary bypass to prevent cerebral complications after cardiac surgery

DEFF Research Database (Denmark)

Vedel, Anne G.; Holmgaard, Frederik; Rasmussen, Lars Simon

2016-01-01

Background: Debilitating brain injury occurs in 1.6–5 % of patients undergoing cardiac surgery with cardiopulmonary bypass. Diffusion-weighted magnetic resonance imaging studies have reported stroke-like lesions in up to 51 % of patients after cardiac surgery. The majority of the lesions seem...... to be caused by emboli, but inadequate blood flow caused by other mechanisms may increase ischaemia in the penumbra or cause watershed infarcts. During cardiopulmonary bypass, blood pressure can be below the lower limit of cerebral autoregulation. Although much debated, the constant blood flow provided...... by the cardiopulmonary bypass system is still considered by many as appropriate to avoid cerebral ischaemia despite the low blood pressure. Methods/design: The Perfusion Pressure Cerebral Infarct trial is a single-centre superiority trial with a blinded outcome assessment. The trial is randomising 210 patients...

Vegetation attached to the elephant trunk.

Science.gov (United States)

Tanaka, Akiko; Sakamoto, Toshihito; Okada, Kenji; Okita, Yutaka

2013-09-01

The elephant trunk technique is used as a standard method in the approach to staged repair of extensive thoracic aneurysms. Here, we present a rare case of a graft infection, in which vegetation was attached to the distal end of the elephant trunk. A 36-year old male who had undergone total arch replacement with elephant trunk installation for type A aortic dissection was readmitted for high-grade fever. At the time of admission, Osler's nodules were present and brain magnetic resonance imaging showed multiple small emboli and haemorrhages. Transoesophageal echocardiography could not locate any sign of infection within the cardiac chambers, but disclosed vegetation attached to the elephant trunk. He underwent successful emergent graft replacement of the lesion, and no recurrence of the infection has been observed.

L’actinomycose thoracique multiple chez l’immunocompétent

Science.gov (United States)

Msougar, Yassine; Fenane, Hicham; Maidi, Mehdi; Benosman, Abdellatif

2013-01-01

L′actinomycose est une affection bactérienne granulomateuse, suppurative, étendue et chronique provoquée par la bactérie anaérobique gram positif Actinomyces israelii. La localisation thoracique est rare, elle peut simuler une pathologie néoplasique ou une tuberculose. Il s’agit d’un patient de 54ans sans antécédents pathologiques, qui s’est présenté avec deux tuméfactions pariétales basithoarciques droites, l’une antérieure et l’autre postérieure s’accompagnant d’une altération de l’état général. L’examen clinique ainsi que le bilan radiologique ont montré deux masses de la paroi thoracique et une atteinte parenchymateuse basale droite. L’examen anatomopathologique de la biopsie de la masse antérieure a montré des foyers d’actinomycose permettant d’établir le diagnostic d’actinomycose thoraco-pulmonaire. Un bilan immunologique s’est révélé normal. Le patient est alors mis sous traitement antibiotique à base d’amoxicilline protégée avec bonne évolution clinique et radiologique. Le but de cette observation est de rappeler les aspects radio-clinique, histologiques, thérapeutiques et évolutifs ainsi que les difficultés diagnostiques de cette affection. PMID:24672630

Coronary Emboli in a Young Patient with Mechanical Aortic Valve: A Rare Cause of Acute Myocardial Infarction

Directory of Open Access Journals (Sweden)

Arash Gholoobi

2016-03-01

Full Text Available Coronary artery embolism is an uncommon cause of Acute Myocardial Infarction (AMI. Herein, we reported a 24-year-old male who was admitted with acute infero-posterior myocardial infarction and cerebral Transient Ischemic Attack (TIA. He had undergone mechanical Aortic Valve Replacement (AVR surgery 6 years ago. Surprisingly, the patient had decided to stop taking his medication (warfarin 20 days earlier without any medical advice. Coronary angiography revealed a thrombus located at the distal part of the left circumflex artery. Discontinuation of anticoagulant therapy in the presence of mechanical valve prosthesis, clinical evidence of coincidental TIA, and lack of atherosclerotic risk factors were highly suggestive of coronary thromboembolism as the cause of AMI. Overall, this case report emphasized the necessity of continuous education in patients with mechanical heart valves to prevent such undesired events.

Empowerment Evaluation: A Form of Self-Evaluation.

Science.gov (United States)

Fetterman, David M.

Empowerment evaluation is an innovative approach that uses evaluation concepts and techniques to foster improvement and self-determination. Empowerment evaluation employs qualitative and quantitative methodologies. Although it can be applied to individuals and organizations, the usual focus is on programs. The value orientation of empowerment…

American Evaluation Association: Guiding Principles for Evaluators

Science.gov (United States)

American Journal of Evaluation, 2009

2009-01-01

The American Evaluation Association (AEA) strives to promote ethical practice in the evaluation of programs, products, personnel, and policy. This article presents the list of principles which AEA developed to guide evaluators in their professional practice. These principles are: (1) Systematic Inquiry; (2) Competence; (3) Integrity/Honesty; (4)…

Modifying Formative Evaluation Techniques For Distance Education Class Evaluation

Directory of Open Access Journals (Sweden)

Scott L. WALKER

2005-10-01

Full Text Available Modifying Formative Evaluation Techniques For Distance Education Class Evaluation Assistant Professor Scott L. WALKERDepartment of GeographyTexas State UniversitySan Marcos, USA ABSTRACTPost-secondary classes are usually followed by mandatory summative evaluations, yet changes in teaching and course structure cannot be made with summative evaluations. Formative evaluations in online education can result in candid responses from students if a third-party facilitator is involved in the process. This paper presents a method for conducting formative evaluation in an online class by utilizing the assistance of a colleague. Results of one such evaluation are presented, as are its advantages and disadvantages.

Evaluation Strategy

DEFF Research Database (Denmark)

Coto Chotto, Mayela; Wentzer, Helle; Dirckinck-Holmfeld, Lone

2009-01-01

The paper presents an evaluation strategy based on deliberate ideals and principles of dialogue design. The evaluation strategy is based on experiential phenomenology taking the point of departure for design and evaluation processes in the experienced practitioners themselves. The article present...... the evaluation strategy and methodology of a research project Making Online Path to Enter new Markets, MOPEM. It is an EU-research project with partners from different Educational Institutions of Technology and Business in five European Countries.......The paper presents an evaluation strategy based on deliberate ideals and principles of dialogue design. The evaluation strategy is based on experiential phenomenology taking the point of departure for design and evaluation processes in the experienced practitioners themselves. The article presents...

Collaborative Evaluation within a Framework of Stakeholder-Oriented Evaluation Approaches

Science.gov (United States)

O'Sullivan, Rita G.

2012-01-01

Collaborative Evaluation systematically invites and engages stakeholders in program evaluation planning and implementation. Unlike "distanced" evaluation approaches, which reject stakeholder participation as evaluation team members, Collaborative Evaluation assumes that active, on-going engagement between evaluators and program staff,…

Energy-efficient buildings program evaluations. Volume 2: Evaluation summaries

Energy Technology Data Exchange (ETDEWEB)

Lee, A.D.; Mayi, D.; Edgemon, S.D.

1997-04-01

This document presents summaries of code and utility building program evaluations reviewed as the basis for the information presented in Energy-Efficient Buildings Program Evaluations, Volume 1: Findings and Recommendations, DOE/EE/OBT-11569, Vol. 1. The main purpose of this volume is to summarize information from prior evaluations of similar programs that may be useful background for designing and conducting an evaluation of the BSGP. Another purpose is to summarize an extensive set of relevant evaluations and provide a resource for program designers, mangers, and evaluators.

Aging evaluation of active components by using performance evaluation

International Nuclear Information System (INIS)

Jung, S. K.; Jin, T. E.; Kim, J. S.; Jung, I. S.; Kim, T. R.

2003-01-01

Risk analysis and performance evaluation methodology were applied to the aging evaluation of active components in the periodic safety review of Wolsung unit 1. We conclude that evaluation of performance is more effective to discriminate the aging degradation of active component than the evaluation of aging mechanism. It is essential to analyze the common cause failures of low performance components to evaluate the properness of present maintenance system. Past 10 years failure history is used for establishing the performance criteria. Past 2 years failure history is used for the evaluating the recent performance condition. We analyze the failure mode of the components to improve the maintenance system. Performance evaluation methodology is useful for the quantitative evaluation of aging degradation of active components. Analysis on the repeated failures can be useful for the feedback to maintenance plan and interval

Indirect MR venography: contrast medium protocols, postprocessing and combination in diagnosing pulmonary emboli with MRI; Indirekte MR-Phlebografie: Kontrastmittelprotokolle, Nachverarbeitung und Kombination mit Lungenemboliediagnostik in der MRT

Energy Technology Data Exchange (ETDEWEB)

Kluge, A.; Bachmann, G. [Diagnostische Radiologie, Kerckhoff-Klinik, Bad Nauheim (Germany); Rominger, M. [Diagnostische Radiologie, Phillips-Univ. Marburg (Germany); Schoenburg, M. [Herzchirurgie, Kerckhoff-Klinik, Bad Nauheim (Germany)

2004-07-01

Purpose: Integration of MR venography in a comprehensive MR imaging protocol in patients with suspected pulmonary embolism (PE) and evaluation of contrast media dosage, timing and postprocessing for diagnostic accuracy. Materials and Methods: Fortyeight consecutive inpatients with suspected PE or deep vein thrombosis were examined by MR venography according to one of the following protocols: protocol I: MR venography only, 0.25 mmol/kg bodyweight (BW) Gadopentate dimeglumine(Gd-DTPA) as single dose, bolus timing; protocol II: MR angiography of pulmonary arteries with a cumulative dosage of 0.25 mmol/kg contrast media, modification of coil setting for MR venography without further contrast media application; protocol III: as protocol II but with 0.125 mmol/kg BW, followed by MR venography. Signal-to-noise ratio, contrast-to-noise ratio, number of definable vascular segments and image quality were evaluated. The results were compared to conventional bilateral venography. Results: All MR venography examinations were of diagnostic quality and the examination time was below 10 min. MR venography could be performed in all 48 patients comparted to 43 of 48 patients for conventional venography. Significantly more superficial and deep veins of the leg could be visualized by MR venography (94% compared to 83% for conventional venography). Sensitivity and specificity were 100% and 92%, respectively. Quality differed significantly between 0.125 mmol/kg (protocol III) and 0.25 mmol/kg Gd-DTPA (protocols I and II) while timing did not influence quality (protocol I vs. II). (orig.) [German] Ziel: Integration der MR-Phlebografie in ein umfassendes Konzept der MRT-Diagnostik bei Verdacht auf Lungenembolie (LE). Untersuchung des Einflusses von Kontrastmittelmenge, -bolusform und Verzoegerungszeit sowie der Nachverarbeitung auf die diagnostische Qualitaet von MR-Phlebografien. Material und Methode: Bei 48 konsekutiven stationaeren Patienten mit Verdacht auf Beinvenenthrombose (TVT

A Rare Cause of Acute Kidney Injury in a Female Patient with Breast Cancer Presenting as Renal Colic

Directory of Open Access Journals (Sweden)

Roxana Jurubita

2016-01-01

Full Text Available Renal infarction is a rare cause of acute kidney injury which could lead to permanent loss of renal function. A prompt diagnosis is necessary in order to achieve a successful revascularization of the occluded artery. Given the rarity of the disease and the paucity of the reported cases in the previous literature a high index of suspicion must be maintained not only in the classical cardiac sources of systemic emboli (atrial fibrillation, dilated cardiomyopathy, or endocarditis, but also in the situations when a hypercoagulable state is presumed. The unspecific presenting symptoms often mask the true etiology of the patient’s complaints. We present here a rare case of renal infarction that occurred in the setting of a hypercoagulable state, in a female patient with a history of breast cancer and documented hepatic metastases.

Scintigraphy versus radiography in the early diagnosis of experimental bone necrosis with special reference to caisson disease of bone

International Nuclear Information System (INIS)

Gregg, P.J.; Walder, D.N.

1980-01-01

The early diagnosis of caisson disease of bone is hindered by the long delay which must elapse before an abnormality becomes apparent on a radiograph. The possible use of bone scintigraphy for this purpose was investigated. Necrosis of the bone and marrow was produced in rabbits by glass microspheres to simulate persistent gas-bubble emboli and then serial radiographs and scintigrams using sup(99m)Tc-diphosphonate were obtained. Regions of necrosis could be detected as 'hot spots' on the scintigrams as early as three weeks after the causative insult, which was many weeks before any abnormality could be detected on the radiographs. Histological examination of excised femora suggested that the scintigraphic abnormality might depend on the new bone formation established during a reactive or repair process. It is suggested that scintigraphy may have clinical value in caisson disease. (author)

Scintigraphy versus radiography in the early diagnosis of experimental bone necrosis, with special reference to caisson disease of bone.

Science.gov (United States)

Gregg, P J; Walder, D N

1980-05-01

The early diagnosis of caisson disease of bone is hindered by the long delay which must elapse before an abnormality becomes apparent on a radiograph. The possible use of bone scintigraphy for this purpose was investigated. Necrosis of the bone and marrow was produced in rabbits by glass microspheres to simulate persistent gas-bubble emboli and then serial radiographs and scintigrams using 99mTc-diphosphonate were obtained. Regions of necrosis could be detected as "hot-spots" on the scintigrams as early as three weeks after the causative insult, which was many weeks before any abnormality could be detected on the radiographs. Histological examination of excised femora suggested that the scintigraphic abnormality might depend on the new bone formation during a reactive or repair process. It is suggested that scintigraphy may have clinical value in caisson disease.

Primary Pulmonary Synovial Sarcoma: A Case with Unique and Impressive Computed Tomography Findings

Directory of Open Access Journals (Sweden)

Jaspreet S Kambo

2015-01-01

Full Text Available Primary pulmonary synovial sarcoma (PPSS is a rare malignancy. Its etiology, imaging features and optimal treatment are not well understood. Pulmonary pseudoaneurysms and lymphadenopathy are rare complications of synovial sarcomas. A 40-year-old woman with mild hemoptysis and thoracic back pain underwent a computed tomography scan that revealed multiple pulmonary lesions, paraesophageal lymphadenopathy and incidental bilateral pulmonary emboli. A diagnosis of PPSS was made through the identification of an SS18 translocation by fluorescence in situ hybridization. She was started on adriamycin, ifosfamide and mesna chemotherapy. Over the subsequent two months, she developed three pulmonary artery pseudoaneurysms, ultimately requiring endovascular coiling. Seven months after starting treatment, the patient was asymptomatic. The lesions and lymphadenopathy decreased in size. The present case highlights complications of a rare malignancy and demonstrates positive response to ifosfamide-based chemotherapy in the setting of PPSS.

Secondary Evaluations.

Science.gov (United States)

Cook, Thomas D.

Secondary evaluations, in which an investigator takes a body of evaluation data collected by a primary evaluation researcher and examines the data to see if the original conclusions about the program correspond with his own, are discussed. The different kinds of secondary evaluations and the advantages and disadvantages of each are pointed out,…

Indium-111 labelled platelets: experimental and clinical studies

International Nuclear Information System (INIS)

Gjerloeff Schmidt, K.

1985-10-01

The object of the present study became to develop a method of effective and gentle isolation and 111-In labelling of human platelets, as well as to employ these platelets in human clinical studies with the object of elucidating a number of physiological and pathophysiological mechanisms and processes in which platelets take part. 111-In-oxine presents obvious advantages over 51-Cr-sodium chromate; a high labelling efficiency, and more advantageous physical properties (a half life of 68 hours (against the half life of 28 days for 51-Cr) and considerably more effective gamma emission), making external registration by means of a gamma camera possible. Considering the role played by platelets in the development of atherosclerosis and its thromboembolic complications, in the early phases of deep venous thrombosis, and in graft rejection, it is natural that attempts have been made to use 111-In-labelled platelets for scintigraphic and kinetic evaluation of thromboembolic processes. Accumulation of 111-In-labelled platelets at sites of vessel wall injury, on pulmonary emboli (presumably on deep vein thrombi as well), and on catheter material has been demonstrated. Beyond this, the number of publications concerning the use of 111-In-labelled platelets for visualization of atherosclerosis, venous thromboembolism, arterial grafts, intracardiac thrombi, aortic aneurysms, renal allograft rejection, and other situations in which platelet thromboembolism takes place, provides evidence that a tool has finally been found for the study of their nature and response to therapeutic intervention. (eg)

Histopathological and Bacteriological Analysis of Thrombus Material Extracted During Mechanical Thrombectomy in Acute Stroke Patients.

Science.gov (United States)

Hernández-Fernández, Francisco; Rojas-Bartolomé, Laura; García-García, Jorge; Ayo-Martín, Óscar; Molina-Nuevo, Juan David; Barbella-Aponte, Rosa Angélica; Serrano-Heras, Gemma; Juliá-Molla, Enrique; Pedrosa-Jiménez, María José; Segura, Tomás

2017-12-01

Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot. All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin-eosin, Gram and Gomori trichrome staining.Technical complexity in SE with respect to the series was evaluated by analyzing time of the procedures, number of passes and use of intracranial definitive stents. Over a 24-month period, bacteria were detected in the retrieved clot of four out of 65 patients (incidence 6.2%). Two cases were eventually diagnosed with infective endocarditis, while the remaining two were diagnosed with urinary tract infection and respiratory septicemia, respectively. Three of the four patients (75%) required an intracranial definitive stent in order to achieve successful recanalization.These procedures were significantly longer (137.7 vs. 59.8 min, p vs. 2.2, p vs. 1.6%, p = 0.008), with respect to the rest of the series. In our series, systematic histopathological and bacteriological study of the MT samples allowed a higher proportion of SE diagnosis in comparison with previous reports.

Extracorporeal tubing in the roller pump raceway: physical changes and particulate generation.

Science.gov (United States)

Spiwak, Allison J Bednarski; Horbal, Alexander; Leatherbury, Robert; Hansford, Derek J

2008-09-01

Plasticized polyvinyl chloride tubing is used as the blood conduit in the heart lung bypass circuit. The section in the roller pump undergoes rigorous compression. Fatigue leads to material changes in weight and length of the bulk material. Particles are released during normal pump operation. This study evaluates the time course of particle loss. Three segments of 1/2" ID tubing run in the raceway for 30-minute, 1-hour, or 2-hour. The fluid path of each segment includes an oxygenator; a castor oil blend was used for the prime. The 5 mL sample was acquired at 10 minute intervals. Raceway tubing segments were measured for a change in weight and length. The same procedure repeated with 1/4" ID and 3/8" ID tubing. All tubing increased at least 5 mm by the 2-hour trial. There were no remarkable changes in weight. Particles were measured for size and percent volume. Tubing with 1/2" ID performed most consistently for particle release during all trials. Particles were observed as small as 1 nm. Particles as large as 3 micron could be confirmed. For all tubing there was particle release by 30 minutes. Perfusionists must consider tubing inner diameter and wall thickness in choosing the pPVC for the raceway in order to minimize particulate emboli. This research suggests that 3/8" ID tubing produces spalls inconsistently compared to 2" ID tubing. Thinner wall thickness tubing also has the potential to limit spall formation.

Biochemical and pathological studies on the effects of levamisole and chlorambucil on Ehrlich ascites carcinoma-bearing mice

Directory of Open Access Journals (Sweden)

Fakhry S. Salem

2011-01-01

Full Text Available Clinicopathological studies on the effects of combining immunostimulant drugs (levamisole with anti-cancer drugs (chlorambucil revealed the enhancement of the latter against Ehrlich ascites carcinoma-bearing mice and resulted in a reduction in the size of tumour. An evaluation of liver and kidney functions showed a significant increase of alanine transaminase (ALT, aspartate transaminase (AST and creatinine in all groups. Histopathological studies of one group that received an intraperitoneal injection of Ehrlich ascites carcinoma cells (2.5 × 106 showed that hepatic parenchyma revealed degenerative changes. The portal area was oedematous and showed rounded cell aggregations. Cell death within hypertrophied Kupper cells was observed in some hepatic cells. The neoplastic emboli could be seen either inside blood vessels or hepatic sinusoids, while another group which had been treated orally with a combination of Leukeran™ (0.2 mg/kg body weight and levamisole (5 mg/kg body weight revealed that hepatic parenchyma revealed massive necrosis with proliferative bile duct epithelium. No neoplastic cells were observed without the hepatic parenchyma, while the renal cortex presented a large number of lymphocytes and plasma cells forming bands or aggregates, mainly around the blood vessels. It was concluded that the addition of levamisole to chlorambucil improved the anti-cancer effect of chlorambucil against Ehrlich ascites carcinoma. However, it had adverse effects on the liver and kidneys as shown by liver and kidney function tests and confirmed by histopathology.

Emergency Department Crowding and Loss of Medical Licensure: A New Risk of Patient Care in Hallways

Directory of Open Access Journals (Sweden)

Robert W. Derlet

2014-03-01

Full Text Available We report the case of a 32-year-old male recently diagnosed with type 2 diabetes treated at an urban university emergency department (ED crowded to 250% over capacity. His initial symptoms of shortness of breath and feeling ill for several days were evaluated with chest radiograph, electrocardiogram (EKG, and laboratory studies, which suggested mild diabetic ketoacidosis. His medical care in the ED was conducted in a crowded hallway. After correction of his metabolic abnormalities he felt improved and was discharged with arrangements made for outpatient follow-up. Two days later he returned in cardiac arrest, and resuscitation efforts failed. The autopsy was significant for multiple acute and chronic pulmonary emboli but no coronary artery disease. The hospital settled the case for $1 million and allocated major responsibility to the treating emergency physician (EP. As a result the state medical board named the EP in a disciplinary action, claiming negligence because the EKG had not been personally interpreted by that physician. A formal hearing was conducted with the EP’s medical license placed in jeopardy. This case illustrates the risk to EPs who treat patients in crowded hallways, where it is difficult to provide the highest level of care. This case also demonstrates the failure of hospital administration to accept responsibility and provide resources to the ED to ensure patient safety. [West J Emerg Med. 2014;15(2:137–141.

Efficacy and Safety of Uninterrupted Low-Intensity Warfarin for Radiofrequency Catheter Ablation of Atrial Fibrillation in the Elderly.

Science.gov (United States)

Xing, Yangbo; Xu, Buyun; Xu, Chao; Peng, Fang; Yang, Biao; Qiu, Yufang; Sun, Yong; Wang, Shengkai; Guo, Hangyuan

2017-09-01

No previous studies exist investigating the optimal intensity of uninterrupted anticoagulation with warfarin during radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in the elderly. Evaluate the efficacy and safety of continuous low-intensity warfarin therapy throughout the periprocedural period of RFCA for AF in the elderly. This is a prospective randomized study. We enrolled AF patients (age ≥ 70 years) who underwent first-time RFCA for AF. Enrolled patients were randomized to group A and group B. The international normalized ratios before ablation were maintained at 1.5 to 2.0 and 2.0 to 2.5 in group A and B, respectively. Primary end points were periprocedural thromboembolic complications and major bleeding. Secondary end points included periprocedural asymptomatic cerebral emboli (ACE) and minor bleeding. A total of 101 patients were enrolled in our study (group A: 52; group B: 49). Baseline characteristics were well balanced between the 2 groups. Only 1 patient suffered from stroke in group B. No major bleeding events occurred in either group. The incidence of new ACE lesions was comparable between the 2 groups (11.5% vs 8.2%, P = 0.82). Minor bleeding occurred in 1 of 52 (1.9%) patients in group A and in 5 of 49 (10.2%) patients in group B ( P = 0.10). Uninterrupted low-intensity warfarin for RFCA of AF might be as effective as standard-intensity warfarin in preventing periprocedural thromboembolic complications and might be associated with fewer bleeding events in the elderly.

Evaluate to Improve: Useful Approaches to Student Evaluation

Science.gov (United States)

Golding, Clinton; Adam, Lee

2016-01-01

Many teachers in higher education use feedback from students to evaluate their teaching, but only some use these evaluations to improve their teaching. One important factor that makes the difference is the teacher's approach to their evaluations. In this article, we identify some useful approaches for improving teaching. We conducted focus groups…

Evaluating evaluation as a communication process. What role for formative evaluation in ICT-based knowledge acquisition?

Directory of Open Access Journals (Sweden)

USEILLE Philippe

2005-10-01

Full Text Available This article examines how formative evaluation as a communication process contributes to knowledge acquisition in using ICT (Information and Communication Technologies. Previous studies, especially in the field of education and training, have shown that formative evaluation plays a crucial part in the learning process because it contributes to learning to learn. Through formative evaluation, the learner becomes aware of errors and can adjust learning strategies to the situation. In addition, formative evaluation provides the teaching side with significant and useful information. Consequently, ICT researches have developed a wide range of solutions for this specific purpose. It is however difficult to check the efficiency of these tools by considering the effects of ICT in the knowledge acquisition process. I suggest that formative evaluation includes also a communication system that has an effect on the learning process. This study tackles the issue by proposing an alternative approach to formative evaluation that considers it as both a learning and a communication process. The study is based on SADT (Structure Analysis and Design Technique that provides a suitable description for the whole complex communication process. It allows a rigorous understanding and identification of the variables of evaluation as a communication process in order to take care of an ICT frame. Finally, this article outlines a multidisciplinary method to evaluate formative evaluation by focusing on the validity facets of the communication process. Keywords: formative evaluation, communication process, validity criteria, ICT training context.

Evaluating Evaluation Systems: Policy Levers and Strategies for Studying Implementation of Educator Evaluation. Policy Snapshot

Science.gov (United States)

Matlach, Lauren

2015-01-01

Evaluation studies can provide feedback on implementation, support continuous improvement, and increase understanding of evaluation systems' impact on teaching and learning. Despite the importance of educator evaluation studies, states often need support to prioritize and fund them. Successful studies require expertise, time, and a shared…

Uranium resource evaluation project quality assurance evaluation

International Nuclear Information System (INIS)

Grimes, J.G.

1981-01-01

This evaluation was conducted over an eight-month period from February 4 through October 1, 1980. During this time, field sampling was suspended for an indefinite time period while the National Uranium Resource Evaluation (NURE) Program underwent restructuring. In addition, the Uranium Resource Evaluation (URE) Project archives are being restructured. Since it is difficult to evaluate quality assurance needs of a program that is undergoing drastic change and because sections of the evaluation were well along before these changes were announced, this evaluation reflects the situation as it was during February 1980. The following quality assurance related programs are continuing to date: (1) periodic checks of field sampling procedures by the Supervising Field Geologist and the Director of Field Operations; (2) verification of field form information and laboratory analytical data verification for all geochemical surveys; (3) URE Project laboratory quality control program (all elements routinely analyzed); and (4) Ames interlaboratory quality control program (uranium only). UCC-ND was given the responsibility of conducting a Hydrogeochemical and Stream Sediment Reconnaissance (HSSR) survey in the Central United States (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Nebraska, North Dakota, Oklahoma, Texas, South Dakota, and Wisconsin). During 1979 and 1980, 13 detailed surveys were conducted by the URE Project in the Central and Western United States to characterize the hydrogeochemistry, stream sediment geochemistry, and/or radiometric patterns of known or potential uranium occurrences. Beginning in 1980, the HSSR surveys were modified to the Regional Hydrogeochemical and Stream Sediment (RHSS) surveys

Safeguards Evaluation Method for evaluating vulnerability to insider threats

International Nuclear Information System (INIS)

Al-Ayat, R.A.; Judd, B.R.; Renis, T.A.

1986-01-01

As protection of DOE facilities against outsiders increases to acceptable levels, attention is shifting toward achieving comparable protection against insiders. Since threats and protection measures for insiders are substantially different from those for outsiders, new perspectives and approaches are needed. One such approach is the Safeguards Evaluation Method. This method helps in assessing safeguards vulnerabilities to theft or diversion of special nuclear meterial (SNM) by insiders. The Safeguards Evaluation Method-Insider Threat is a simple model that can be used by safeguards and security planners to evaluate safeguards and proposed upgrades at their own facilities. The method is used to evaluate the effectiveness of safeguards in both timely detection (in time to prevent theft) and late detection (after-the-fact). The method considers the various types of potential insider adversaries working alone or in collusion with other insiders. The approach can be used for a wide variety of facilities with various quantities and forms of SNM. An Evaluation Workbook provides documentation of the baseline assessment; this simplifies subsequent on-site appraisals. Quantitative evaluation is facilitated by an accompanying computer program. The method significantly increases an evaluation team's on-site analytical capabilities, thereby producing a more thorough and accurate safeguards evaluation

Les pneumopathies nosocomiales en réanimation de CHU Hassan II de Fès

Science.gov (United States)

Shimi, Abdelkarim; Touzani, Soumaya; Elbakouri, Nabil; Bechri, Brahim; Derkaoui, Ali; Khatouf, Mohammed

2015-01-01

L'objectif principal de notre étude était d'identifier les bactéries incriminées dans la pneumopathie nosocomiale (PN) au service de réanimation A1 du CHU Hassan II de Fès, en vue d'en améliorer la prise en charge et de diminuer la morbi-mortalité associée. Il s'agit d'une étude rétrospective et descriptive, menée du 1er janvier 2012 au 31 décembre 2013. Seules les infections pulmonaires survenant au-delà de 48 heures de l'admission du patient au service de réanimation ont été incluses. L'incidence de la PN était de 11,2%. Les Bacilles à Gram négatif (BGN) étaient retrouvés dans 48,5% des cas, le Staphylocoque Aureus dans 21,21% des cas et le Klebsiella Pneumoniae était dans 10,7% des cas. Le taux de mortalité était de 48,33%. L’âge, la gravité de la pathologie sous jacente et le retard de l'instauration d'une antibiothérapie adaptée étaient considérées comme facteurs de mauvais pronostic. L’étude de la résistance aux antibiotiques, montre une multirésistance surtout pour les BGN, dont il faut tenir compte en mettant en place une stratégie de prévention active. PMID:26966481

Evaluation and Evaluating the Community Initiative "URBAN"

DEFF Research Database (Denmark)

Alves, Sonia

2013-01-01

focus on a more open and democratic process of evaluation. This paper presents and compares different conceptual and methodological frameworks created for the assessment of the European initiative Urban II, including the one that was used by the author in the context of an academic evaluation...... in the city of Porto. The comparative analysis of the results leads us to the recommendation for more democratic processes of evaluation and intervention, in order to improve their quality and accountability and promote the important goal of learning with this type of experimental initiatives....

Evaluation electric bicycles; Evaluation velos electriques

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-10-01

Leovelo service is the first measure in favor of the bicycle to control the air pollution and to conserve energy. It provides in the city of Clermont-Ferrand (France) a service of bicycle hiring. This document evaluates the project after two years of operating. It provides a technical evaluation (maintenance, equipment, financing) and also the socio-economic impacts. (A.L.B.)

Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

International Nuclear Information System (INIS)

Si, T.-G.; Guo, Z.; Hao, X.-S.

2008-01-01

Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

Energy Technology Data Exchange (ETDEWEB)

Si, T.-G. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China); Guo, Z. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)], E-mail: dr.guozhi@yahoo.com.cn; Hao, X.-S. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)

2008-10-15

Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

Acute, massive pulmonary embolism with right heart strain and hypoxia requiring emergent tissue plasminogen activator (TPA infusion

Directory of Open Access Journals (Sweden)

Jonathan Patane

2017-04-01

Full Text Available History of present illness: A 63-year-old male presented to the emergency department with shortness of breath. He had a history of prostate cancer and two previous pulmonary embolisms, but was not currently on blood thinners. He had no associated chest pain at the time of presentation, but endorsed hemoptysis. Vital signs were significant for a heart rate of 88, blood pressure 145/89, oxygen saturation in the mid-70’s on room air which increased to mid-80’s on 15L facemask. His exam was significant for clear lung sounds bilaterally. He immediately underwent chest x-ray which showed no acute abnormalities. A bedside ultrasound was performed which showed evidence of right ventricular and atrial dilation, consistent with right heart strain. Given that the patient’s oxygen saturations improved to 88% on 15L facemask, the patient was felt to be stable enough for CT angiography. Significant findings: CT angiogram showed multiple large acute pulmonary emboli, most significantly in the distal right main pulmonary artery (image 1 and 2. Additional pulmonary emboli were noted in the bilateral lobar, segmental, and subsegmental levels of all lobes. There was a peripheral, wedge-shaped consolidation surrounded by groundglass changes in the posterolateral basal right lower lobe that was consistent with a small lung infarction (image 3. Discussion: The patient underwent in the Emergency Department a tissue plasminogen activator (TPA infusion of alteplase 100 mg over 2 hours for his massive acute pulmonary embolisms. Throughout his TPA infusion his oxygen saturations became improved to mid-90’s and his shortness of breath symptoms began improving. His troponin returned at 0.15 ng/mL, suggesting right heart strain. He was admitted to the ICU for continued monitoring and treatment. An acute, massive pulmonary embolism is described as having more than 50% occlusion of pulmonary blood flow.1 The main causes of hypoxia includes ventilation

E-cadherin and CD10 expression in atypical hyperplastic and malignant endometrial lesions

International Nuclear Information System (INIS)

Ahmed, A.R.H.; Muhammad, E.M.S.

2014-01-01

Background: Loss of E-cadherin is a critical step for development and progression of malignant tumors. CD10; a marker of non-neoplastic and neoplastic endometrial stroma, is associated with aggressiveness of many epithelial malignancies. Aims: To evaluate expression and correlation of E-cadherin and CD10 in endometrial lesions and their possible role in differentiating atypical endometrial hyperplasia from endometrial carcinoma. The association of E-cadherin and CD10 expression with clinico-pathological parameters of endometrial carcinoma was also investigated. Materials and methods: Fifty four cases including 28 endometrial carcinomas; 19 endometrial hyperplasia and 7 cases of normal endometrial changes were enrolled for this study. The expression of E-cadherin and CD10 was evaluated by immunohistochemistry using the streptavidin–biotin technique. Results: There was a strong association between malignant change of endometrial glands and membrano- cytoplasmic localization of E-cadherin (p< 0.001). Expression of E-cadherin but not CD10 was significantly higher in endometrial carcinomas compared to atypical endometrial hyperplasia (p < 0.01). Expression of E-cadherin was not associated with CD10 expression in different endometrial lesions. High grade tumors expressed low levels of both E-cadherin (p<0.01) and CD10 (p < 0.05) and serous endometrial carcinoma had low E-cadherin and CD10 expression compared to endometrioid carcinoma (p< 0.01 and <0.05, respectively). Expression of both molecules showed no association with depth of tumor invasion or FIGO stage. Tumors with lower E-cadherin or CD10 expression had higher rates of vascular tumor emboli (p< 0.01 and <0.07, respectively). Conclusions: Although expression of E-cadherin and CD10 in endometrial lesions was not correlated, reduced expression of both molecules could be critical for progression of endometrial carcinoma.

Accuracy and feasibility of dynamic contrast-enhanced 3D MR imaging in the assessment of lung perfusion: comparison with Tc-99 MAA perfusion scintigraphy

International Nuclear Information System (INIS)

Yilmaz, E.; Akkoclu, A.; Degirmenci, B.; Cooper, R.A.; Sengun, B.; Gulcu, A.; Osma, E.; Ucan, E.S.

2005-01-01

AIM: The aim of this study was to correlate findings of perfusion magnetic resonance imaging (MRI) and perfusion scintigraphy in cases where there was a suspicion of abnormal pulmonary vasculature, and to evaluate the usefulness of MRI in the detection of perfusion deficits of the lung. METHODS: In all, 17 patients with suspected abnormality of the pulmonary vasculature underwent dynamic contrast-enhanced MRI. T1-weighted 3D fast-field echo pulse sequences were obtained (TR/TE 3.3/1.58 ms; flip angle 30 deg ; slice thickness 12 to 15 mm). The dynamic study was acquired in the coronal plane following administration of 0.1 mmol/kg gadopentetate dimeglumine. A total of 8 to 10 sections repeated 20 to 25 times at intervals of 1 s were performed. Perfusion lung scintigraphy was carried out a maximum of 48 h before the MR examination in all cases. Two radiologists, who were blinded to the clinical data and results of other imaging methods, reviewed all coronal sections. MR perfusion images were independently assessed in terms of segmental or lobar perfusion defects in the 85 lobes of the 17 individuals, and the findings were compared with the results of scintigraphy. RESULTS: Of the 17 patients, 8 were found to have pulmonary emboli, 2 chronic obstructive pulmonary disease with emphysema, 2 bullous emphysema, 2 Takayasu arteritis and 1 had a hypoplastic pulmonary artery. Pulmonary perfusion was completely normal in 2 cases. In 35 lobes, perfusion defects were detected using both methods, in 4 with MR alone and in 9 only with scintigraphy. There was good agreement between MRI and scintigraphy findings (kappa=0.695). CONCLUSION: Pulmonary perfusion MRI is a new alternative to scintigraphy in the evaluation of pulmonary perfusion for various lung disorders. In addition, this technique allows measurement and quantification of pulmonary perfusion abnormalities

Reframing Evaluation: Defining an Indigenous Evaluation Framework

Science.gov (United States)

LaFrance, Joan; Nichols, Richard

2008-01-01

The American Indian Higher Education Consortium (AIHEC), comprising 34 American Indian tribally controlled colleges and universities, has undertaken a comprehensive effort to develop an "Indigenous Framework for Evaluation" that synthesizes Indigenous ways of knowing and Western evaluation practice. To ground the framework, AIHEC engaged…

Comprehensive Psychiatric Evaluation

Science.gov (United States)

... Facts for Families Guide Facts for Families - Vietnamese Comprehensive Psychiatric Evaluation No. 52; Updated October 2017 Evaluation ... with serious emotional and behavioral problems need a comprehensive psychiatric evaluation. Comprehensive psychiatric evaluations usually require a ...

Evaluation Strategies in Financial Education: Evaluation with Imperfect Instruments

Science.gov (United States)

Robinson, Lauren; Dudensing, Rebekka; Granovsky, Nancy L.

2016-01-01

Program evaluation often suffers due to time constraints, imperfect instruments, incomplete data, and the need to report standardized metrics. This article about the evaluation process for the Wi$eUp financial education program showcases the difficulties inherent in evaluation and suggests best practices for assessing program effectiveness. We…

Neoliberalization by Evaluation: Explaining the Making of Neoliberal Evaluative State

Directory of Open Access Journals (Sweden)

Diego Giannone

2016-09-01

Full Text Available Starting from the late seventies neoliberalism has emerged as the new global hegemonic par-adigm. Several studies demonstrated that different factors facilitated the global spread of neoliberalism, but little attention has been paid to the role played by evaluation both in legitimizing the neoliberalization of the state and in explaining the resilience of neoliberalism. The article argues that evaluation is a strategy of action which is able to emphasize the adaptive capacity of neoliberalism to different socio-political con-texts and the neoliberal purpose to depoliticize public action. The contribution aims to illustrate how eval-uation works on a twofold level. On the one hand, evaluation is a tool of global governance that acts nor-matively to homogenize states’ action consistently with some neoliberal values, such as competitiveness and economic efficiency. On the other hand, to conform to such values, variegated forms of evaluation are implemented by each state in order to introduce market rationality in non-economic domains, such as ed-ucation and health system. Referring to some empirical cases, these two overlapping processes are termed as the "evaluated state" and "evaluative state". As a result, neoliberalization by evaluation is a process in-volving the elevation of market-based principles and techniques of evaluation to the level of state-endorsed norms

EVALUE : a computer program for evaluating investments in forest products industries

Science.gov (United States)

Peter J. Ince; Philip H. Steele

1980-01-01

EVALUE, a FORTRAN program, was developed to provide a framework for cash flow analysis of investment opportunities. EVALUE was designed to assist researchers in evaluating investment feasibility of new technology or new manufacturing processes. This report serves as user documentation for the EVALUE program. EVALUE is briefly described and notes on preparation of a...

Unbundling Evaluation Use.

Science.gov (United States)

Alkin, Marvin; Taut, Sandy

2003-01-01

Provides a conceptual framework for considering the distinction between evaluation use and evaluation influence and the relationship between evaluation use and knowledge use. Clarifies and expands some of the established definitions of concepts related to evaluation use. (SLD)

Bilateral inferior vena cava filter insertion in a patient with duplication of the infrarenal vena cava.

LENUS (Irish Health Repository)

Leong, S

2010-06-19

BACKGROUND: Inferior vena cava (IVC) filter insertion is a commonly performed procedure for indications such as recurrent pulmonary emboli or contraindication to anticoagulation. Symptomatic duplication of the IVC is exceedingly rare with only a handful of cases being described in the literature. AIM: We report an unusual case of a patient with symptomatic duplication of the IVC. RESULT: A 53-year-old woman presented at our hospital for resection of a cerebral metastasis from a non-small cell lung cancer following a recent diagnosis of bilateral lower limb deep venous thrombosis. This required perioperative reversal of anticoagulation and IVC filter insertion. Conventional venography performed during filter insertion documented the existence of a duplicated IVC. CONCLUSION: We present a case of a symptomatic duplication of the IVC requiring filter insertion. We review the developmental anatomy of the IVC along with the diagnostic findings and management strategies available.

Recurrent Hypothenar Hammer Syndrome: A Case Report.

Science.gov (United States)

Adams, Nicholas S; Ford, Ronald D

2016-10-01

Hypothenar hammer syndrome (HHS) is a rare cause of digital ischemia and pain caused from repetitive trauma to the palm. Often related to occupational practices, thrombosis and embolization can occur. Treatment is often surgical and involves excision with or without reconstruction. We describe a 55 year-old, male pipe fitter previously diagnosed and treated for HHS with excision and repair using a reversed interpositional vein graft in the mid-1980's. He continued to work in the profession, which he regularly used his palm as a hammer and returned approximately 30 years later with recurrent symptoms of cold intolerance and pain. Angiography confirmed occlusion of the ulnar artery with emboli present distally. The patient was again treated with excision and reconstruction. HHS is an uncommon cause of digital ischemia. Its recurrence is even more rare. To our knowledge, this is the first described case of diagnosed and treated recurrent HHS.

Magnetic Resonance Angiography in the Pig using Hyperpolarized Water

DEFF Research Database (Denmark)

Lipsø, Hans Kasper Wigh; Bowen, Sean; Laustsen, Christoffer

, the magnetization achievable with hyperpolarized water is superior to other nuclei. Methods A 1 mL sample of 50% water and 50% glycerol with 30 mM TEMPO is polarized in a Spinlab (GE Healthcare) at 5 T, 0.9 K, 139.9 GHz for an hour. The sample is rapidly dissolved in 16 mL deoxygenized dissolution medium (DM......Introduction Magnetic Resonance Angiography (MRA) is an important tool in diagnostics of medical conditions such as emboli, stenosis and aneurysms. Sub-millimetre resolution can be obtained with proton imaging, and further optimization can be obtained with Gd-based blood pool agents1. However......, the acquisition time is several minutes, and conventional MRA methods thus fail to image within a single respiration or heartbeat and therefore suffers from motion artefacts. We demonstrate that hyperpolarized (HP) water can be used as an imaging agent to provide subsecond angiographies in pigs. Previous work...

A Left Atrial Myxoma Case with a History of Stroke on whom a Coronary Bypass Surgery was Performed

Directory of Open Access Journals (Sweden)

Cihangir Kaymaz

2009-12-01

Full Text Available Cardiac myxomas are the most frequently encountered benign cardiac tumors in adult groups. Patients with myxoma may suffer from variety of clinical features. A patient who had suffered from stroke a yearago came to our hospital with a chest pain complaint. In the echocardiography of the patient suffering from acute coronary syndrome, left ventricular disfunction and left atrial mass was determined. In the coronary angiography, LAD and Cx critical stenosis, and an abnormal feeding artery which roots from Cxperformed was observed. LIMA-AD, Ao-RCA bypass and mass exision withleft atriotomy was made. Cardiac tumor embolism which makes up a rare cause of cerebral embolies should be considered especiallyin patients with sinus rhythm. In the coronary angiography the feeding artery of the myxoma was shown. A patient who has underwent coronary bypass operation and left atrial myxoma exision has beenpresented as a case.

[Valvuloplasty with balloon catheter in biologic prosthesis. Reality or illusion].

Science.gov (United States)

Ledesma Velasco, M; Verdín Vázquez, R; Acosta Valdez, J L; Munayer Calderón, J; Salgado Escobar, J L; Arias Monroy, L; Flores Mendoza, J

1989-01-01

We performed catheter balloon valvuloplasty (CBV) on 8 stenotic operatively-excised bioprosthetic valves (2 Hancock and 6 Ionescu Shiley). Pathology of valves before CBV included degenerative changes: commissural fusion by mounds of calcific deposits (2 valves), fibrotic and focally calcified leaflets (7 valves) and stiff and thick valves (1 valve). Inflation of the balloon resulted in commissural splitting (2 valves), leaflet cracks and fractures (3 valves). Removal of the deflated balloon catheter was associated with debris dislodgement (3 valves). In one case the valve was unable to close with potential for acute regurgitation. Thus, CBV of bioprosthetic valves can split fused commissures by similar mechanisms as in native valves. CBV may fracture calcific deposits causing acute emboli. It can also disrupt the leaflets causing acute insufficiency. The findings suggest a limited role of CBV in the treatment of stenotic bioprosthetic valves in mitral and aortic position.

A case of Lemierre's syndrome with septic shock and complicated parapneumonic effusions requiring intrapleural fibrinolysis

Directory of Open Access Journals (Sweden)

Daniel P. Croft

2015-01-01

Full Text Available Lemierre's syndrome is a septic thrombophlebitis of the internal jugular vein, which can lead to severe systemic illness. We report a case of an otherwise healthy 26-year-old man who suffered from pharyngitis followed by septic shock requiring intubation and vasopressor support from Fusobacterium necrophorum bacteremia. The septic emboli to his lungs caused complicated bilateral parapneumonic effusions, which recurred after initial drainage. He required bilateral chest tubes and intrapleural tPA to successfully drain his effusions. His fever curve and overall condition improved with the resolution of his effusions and after a 33-day hospitalization, he recovered without significant disability. The severity of his illness and difficult to manage complicated parapneumonic effusions were the unique facets of this case. Using an evidence-based approach of tPA and DNase for complicated parapneumonic effusions in Lemierre's syndrome can be safe and effective.

Report: dosimetry of diagnostic exams in nuclear medicine

International Nuclear Information System (INIS)

Touzery, C.; Aubert, B.; Caselles, O.; Gardin, I.; Guilhem, M.Th.; Laffont, S.; Lisbona, A.

2002-01-01

A compilation about dosimetry of diagnosis explorations in nuclear medicine is presented in this issue. Dosimetry tables of the different radiopharmaceuticals used in nuclear medicine give indications on absorbed and efficient doses according the patients age from one year to adult age. The doses received by a fetus during a lung scintigraphy realized for the pregnant woman susceptible to suffer of pulmonary emboli is presented. A table of efficient doses for the infants until the age of six months for the principal scintigraphy explorations realized in nuclear medicine are given. A chapter of theoretical headlines is devoted to dosimetry and the calculations methods of absorbed and efficient doses in function of patients age. A short chapter concerns the recommendations to explore nursing mothers by scintigraphy. A last chapter treats the efficient doses received during explorations using ionizing radiations in radiology and their place in annual natural irradiation scale. (N.C.)

Ophthalmic masquerades of the atherosclerotic carotids

Directory of Open Access Journals (Sweden)

Anupriya Arthur

2014-01-01

Full Text Available Patients with carotid atherosclerosis can present with ophthalmic symptoms. These symptoms and signs can be due to retinal emboli, hypoperfusion of the retina and choroid, opening up of collateral channels, or chronic hypoperfusion of the globe (ocular ischemic syndrome. These pathological mechanisms can produce many interesting signs and a careful history can bring out important past symptoms pointing toward the carotid as the source of the patient′s presenting symptom. Such patients are at high risk for an ischemic stroke, especially in the subsequent few days following their first acute symptom. It is important for clinicians to be familiar with these ophthalmic symptoms and signs caused by carotid atherosclerosis for making an early diagnosis and to take appropriate measures to prevent a stroke. This review elaborates the clinical features, importance, and implications of various ophthalmic symptoms and signs resulting from atherosclerotic carotid artery disease.

Radiologic manifestations of extra-cardiac complications of infective endocarditis

Energy Technology Data Exchange (ETDEWEB)

Colen, Teran W.; Gunn, Martin; Cook, Erin; Dubinsky, Theodore [University of Washington Medical Center, Department of Radiology, 1959 NE Pacific Ave, Box 357115, Seattle, WA (United States)

2008-11-15

Infective endocarditis (IE) is a disease with high morbidity and a mortality rate of 9-30%, even with appropriate diagnosis and therapy. Septic emboli, caused by IE, can affect any organ or tissue in the body with an arterial supply and occur in 12-40% of IE cases. The most common extra-cardiac organ system involved in IE is the central nervous system. Other organs frequently involved are the lungs (especially in right-sided IE), spleen, kidneys, liver, and the musculoskeletal system. In addition, the arterial system itself is susceptible to the development of potentially fatal mycotic aneurysms. As extra-cardiac complications often antedate the clinical diagnosis of IE, it is important that the diagnosis is suggested when characteristic findings are encountered during imaging. In addition, imaging is often used to monitor the extent of complications in patients with a known diagnosis of IE. (orig.)

Extracardiac manifestations of infective endocarditis and their historical descriptions.

Science.gov (United States)

Silverman, Mark E; Upshaw, Charles B

2007-12-15

In his landmark "Gulstonian Lectures on Malignant Endocarditis," published in 1885, William Osler commented, "Few diseases present greater difficulties in the way of diagnosis than malignant endocarditis, difficulties which in many cases are practically insurmountable." At that time, the fields of microbiology and blood cultures were in their infancy, and the diagnosis was made premortem in just half the patients with the condition. After Osler's report, extracardiac physical findings became essential clues to earlier diagnosis. Today, infective endocarditis is most commonly suggested from the history and often clinched by an echocardiogram and blood cultures. Although prized physical manifestations are much less frequent now, they still do occur and may be an invaluable clue that leads to earlier, more effective treatment. The investigators review these extracardiac findings along with their historical descriptions: splinter hemorrhages, emboli, Osler's nodes, Janeway and Bowman lesions of the eye, Roth spots, petechiae, and clubbing.

Unusual Infections Complicating the Use of Steroids with Severe Alcoholic Hepatitis: Report of 2 Cases

Directory of Open Access Journals (Sweden)

Vitor Arantes

1995-01-01

Full Text Available Corticosteroid therapy for acute alcoholic hepatitis has been demonstrated to enhance survival in patients who are encephalopathic, and who do not have renal failure or gastrointestinal bleeding. However, the complications of steroid therapy in such patients have been less well documented. The authors report two patients with alcoholic liver disease who developed life-threatening infections after steroid therapy was started. The first patient initially developed diabetes followed by Fournier's gangrene of the perineum, and a lung abscess following septic emboli. The second patient had established alcoholic cirrhosis rather than alcoholic hepatitis. She developed a necrotic ulcer on the arm at the site of an intravenous line, which was infected with a rhizopus species. Despite surgical debridement the lesion progressed and contributed to her death. Treatment of alcoholic hepatitis with steroids is not innocuous, and physicians should be aware of the potential for life-threatening complications.

Radiologic manifestations of extra-cardiac complications of infective endocarditis

International Nuclear Information System (INIS)

Colen, Teran W.; Gunn, Martin; Cook, Erin; Dubinsky, Theodore

2008-01-01

Infective endocarditis (IE) is a disease with high morbidity and a mortality rate of 9-30%, even with appropriate diagnosis and therapy. Septic emboli, caused by IE, can affect any organ or tissue in the body with an arterial supply and occur in 12-40% of IE cases. The most common extra-cardiac organ system involved in IE is the central nervous system. Other organs frequently involved are the lungs (especially in right-sided IE), spleen, kidneys, liver, and the musculoskeletal system. In addition, the arterial system itself is susceptible to the development of potentially fatal mycotic aneurysms. As extra-cardiac complications often antedate the clinical diagnosis of IE, it is important that the diagnosis is suggested when characteristic findings are encountered during imaging. In addition, imaging is often used to monitor the extent of complications in patients with a known diagnosis of IE. (orig.)

Hand and digital ischemia due to arteriosclerosis and thromboembolization in young adults: pathologic features with clinical correlations.

Science.gov (United States)

Guarda, L A; Borrero, J L

1990-11-01

Twenty young adult patients with hand and digital ischemia were found to have obstructive arterial disease. All patients were surgically explored, and the occluded vessels were resected and by-passed. Eighteen patients had obstruction at the level of the distal ulnar artery and palmar arch, and 12 had obstruction of the common digital and digital proper arteries. Occlusive arteriosclerotic lesions were found in all patients; these lesions were characterized by prominent fibromuscular intimal plaques with superimposed thrombosis. Six patients had also thromboembolism to distal digital vessels. Vasculitis, calcifications, cholesterol deposits, and atheromatous emboli were not observed. Five patients had transmural neovascularization of the lesions in a similar manner to that described in coronary artery lesions. Obstructive lesions due to fibromuscular intimal proliferation with associated thrombosis and/or distal thromboembolization affecting arteries of hands and digits appear to be an important lesion that can affect young patients.

Empowerment evaluation: An approach that has literally altered the landscape of evaluation.

Science.gov (United States)

Donaldson, Stewart I

2017-08-01

The quest for credible and actionable evidence to improve decision making, foster improvement, enhance self-determination, and promote social betterment is now a global phenomenon. Evaluation theorists and practitioners alike have responded to and overcome the challenges that limited the effectiveness and usefulness of traditional evaluation approaches primarily focused on seeking rigorous scientific knowledge about social programs and policies. No modern evaluation approach has received a more robust welcome from stakeholders across the globe than empowerment evaluation. Empowerment evaluation has been a leader in the development of stakeholder involvement approaches to evaluation, setting a high bar. In addition, empowerment evaluation's respect for community knowledge and commitment to the people's right to build their own evaluation capacity has influenced the evaluation mainstream, particularly concerning evaluation capacity building. Empowerment evaluation's most significant contributions to the field have been to improving evaluation use and knowledge utilization. Copyright © 2016. Published by Elsevier Ltd.

Affective Evaluations of Exercising: The Role of Automatic-Reflective Evaluation Discrepancy.

Science.gov (United States)

Brand, Ralf; Antoniewicz, Franziska

2016-12-01

Sometimes our automatic evaluations do not correspond well with those we can reflect on and articulate. We present a novel approach to the assessment of automatic and reflective affective evaluations of exercising. Based on the assumptions of the associative-propositional processes in evaluation model, we measured participants' automatic evaluations of exercise and then shared this information with them, asked them to reflect on it and rate eventual discrepancy between their reflective evaluation and the assessment of their automatic evaluation. We found that mismatch between self-reported ideal exercise frequency and actual exercise frequency over the previous 14 weeks could be regressed on the discrepancy between a relatively negative automatic and a more positive reflective evaluation. This study illustrates the potential of a dual-process approach to the measurement of evaluative responses and suggests that mistrusting one's negative spontaneous reaction to exercise and asserting a very positive reflective evaluation instead leads to the adoption of inflated exercise goals.

Report of the evaluation by the Ad Hoc Review Committee on advance science research. Result evaluation, interim evaluation, in-advance evaluation in fiscal year 2003

International Nuclear Information System (INIS)

2003-11-01

The Research Evaluation Committee, which consisted of 13 members from outside of the Japan Atomic Energy Research Institute (JAERI), set up an Ad Hoc Review Committee on Advanced Science Research in accordance with the Fundamental Guideline for the Evaluation of Research and Development (R and D) at JAERI' and its subsidiary regulations in order to evaluate the accomplishments of the research completed in Fiscal Year 2002, the accomplishments of the research started in Fiscal Year 2001, and the adequacy of the programs of the research to be started in Fiscal Year 2004 at Advanced Science Research Center of JAERI. The Ad Hoc Review Committee consisted of nine specialists from outside of JAERI. The Ad Hoc Review Committee conducted its activities from May to July 2003. The evaluation was performed on the basis of the materials submitted in advance and of the oral presentations made at the Ad Hoc Review Committee meeting which was held on June 24, 2003, in line with the items, viewpoints, and criteria for the evaluation specified by the Research Evaluation Committee. The result of the evaluation by the Ad Hoc Review Committee was submitted to the Research Evaluation Committee, and was judged to be appropriate at its meeting held on August 4, 2003. This report describes the result of the evaluation by the Ad Hoc Review Committee on Advanced Science Research. (author)

Report of the evaluation by the Ad Hoc Review Committee on Advance Science Research. Result evaluation, interim evaluation, in-advance evaluation in fiscal year 2002

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-11-01

The Research Evaluation Committee, which consisted of 13 members from outside of the Japan Atomic Energy Research Institute (JAERI), set up an Ad Hoc Review Committee on Advanced Science Research in accordance with the Fundamental Guideline for the Evaluation of Research and Development (R and D) at JAERI' and its subsidiary regulations in order to evaluate the accomplishments of the research completed in Fiscal Year 2001, the accomplishments of the research started in Fiscal Year 2000, and the adequacy of the programs of the research to be started in Fiscal Year 2003 at Advanced Science Research Center of JAERI. The Ad Hoc Review Committee consisted of eight specialists from outside of JAERI. The Ad Hoc Review Committee conducted its activities from May to July 2002. The evaluation was performed on the basis of the materials submitted in advance and of the oral presentations made at the Ad Hoc Review Committee meeting which was held on June 4, 2002, in line with the items, viewpoints, and criteria for the evaluation specified by the Research Evaluation Committee. The result of the evaluation by the Ad Hoc Review Committee was submitted to the Research Evaluation Committee, and was judged to be appropriate at its meeting held on August 5, 2002. This report describes the result of the evaluation by the Ad Hoc Review Committee on Advanced Science Research. (author)

Evaluating psychodiagnostic decisions.

Science.gov (United States)

Witteman, Cilia L M; Harries, Clare; Bekker, Hilary L; Van Aarle, Edward J M

2007-02-01

Several frameworks can be used to evaluate decision making. These may relate to different aspects of the decision-making process, or concern the decision outcome. Evaluations of psychodiagnostic decisions have shown diagnosticians to be poor decision makers. In this essay we argue that this finding results from the evaluation of only one part of the diagnostic process. We put forward that evaluations are typically carried out by comparing clinicians' behaviour to one of several normative models, for example hypothetico-deductive reasoning. These models make strong assumptions about human reasoning capabilities, which make it almost impossible for people to measure up to them. The subsequent two parts of the psychodiagnostic process (causal explanation and treatment decisions), are typically not included in these evaluation studies. Treatment decisions are evaluated in effectiveness studies; that is, they are evaluated in terms of their outcomes, not in terms of the diagnosticians' decision processes. Psychodiagnosticians' causal explanation has hardly ever been the subject of evaluation. We argue that in order to achieve clinical excellence, this part of the psychodiagnostic process should also be well understood. In this essay we first describe evaluation of psychodiagnostic decision making. We then propose a framework to describe causal explanation, that is, a situation assessment in terms of a causal schema or a story or script. We identify and discuss the tools available for evaluating this part of the psychodiagnostic process.

Evaluate Yourself. Evaluation: Research-Based Decision Making Series, Number 9304.

Science.gov (United States)

Fetterman, David M.

This document considers both self-examination and external evaluation of gifted and talented education programs. Principles of the self-examination process are offered, noting similarities to external evaluation models. Principles of self-evaluation efforts include the importance of maintaining a nonjudgmental orientation, soliciting views from…

Combining Internal and External Evaluation: A Case for School-Based Evaluation.

Science.gov (United States)

Nevo, David

1994-01-01

School-based evaluation, the focus of this article, is conceived of as neither a synonym for internal evaluation nor an antonym for external evaluation, but as a combination that is examined through a review of recent research. A school-based evaluation in Israel illustrates combining these approaches in a complementary way. (SLD)

Measure Evaluation Dataverse

Data.gov (United States)

US Agency for International Development — The MEASURE Evaluation Dataverse is a collection of innovative evaluation data sets assembled in order to increase the evidence-base on program impact and evaluate...

Evaluation Program initiative

International Nuclear Information System (INIS)

Rich, B.L.

1987-01-01

The purpose of this paper is to provide the Department of Energy's (DOE) safeguards and security community with some insights on an important management initiative by the Office of Security Evaluations (OSE). The paper will present the ''what, where, who, when, and why'' of a new Evaluation Program. The Evaluation Program will be comprised of a continuing series of regular and special evaluations of DOE safeguards and security programs and policies. The evaluations will be integrative and ''crosscutting,'' i.e. will extend across DOE organizational lines. Evaluations will be offered as positive advisories to DOE managers with safeguards and security responsibilities and will not be rated. They will complement the ongoing OSE Inspection Program of inspections conducted by OSE's Inspection Division. The purpose for the evaluations is to establish an accurate and current assessment of the effectiveness and status of safeguards and security programs and policies and to provide DOE managers with required information on program and policy effectiveness

Critical evaluation of international health programs: Reframing global health and evaluation.

Science.gov (United States)

Chi, Chunhuei; Tuepker, Anaïs; Schoon, Rebecca; Núñez Mondaca, Alicia

2018-01-05

Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research. Copyright © 2018 John Wiley & Sons, Ltd.

Evaluation of the quality of CR mammography images in Chugoku Rosai Hospital. Visual evaluation and digital evaluation

International Nuclear Information System (INIS)

Makihata, Hiroshi; Fukuda, Tomoya; Aomori, Masaji; Hara, Shinji

2005-01-01

New mammography system (50-micrometer system) composed of Fuji computed tomography (FCR) both sides IP, 5000MA and dry imager was introduced in the Department of Physical Checkup of Chugoku Rosai Hospital in 2003. We performed visual evaluation and digital evaluation using 50-micrometer system in accordance with (the quality control guidance of) Non-Profit Organization the Central Committee on Quality Control of Mammographic Screening. In visual evaluation using RMI156 phantom the system cleared the quality control guidance about a fiber, calcification, and masses. On step phantom, it passed about 10 steps, masses, and calcifications. Since a success standard was not announced officially, the performance in digital evaluation cannot be judged and only the result is presented. In digital evaluation, signal-to-noise ratio (SNR) is 14.9, root of mean squares (RMS) is 32.9, SNRC is 16.4, SNRT is 3.65. This system image has high sharpness and is considered from the result in visual evaluation to have the ability of offering images with a high degree of information. (author)

Evaluating the "Evaluative State": Implications for Research in Higher Education.

Science.gov (United States)

Dill, David D.

1998-01-01

Examines the "evaluative state" that is, public management-based evaluation systems--in the context of experiences in the United Kingdom and New Zealand, and suggests that further research is needed to examine problems in the evaluative state itself, in how market competition impacts upon it, and how academic oligarchies influence the…

Descriptive sensory evaluations

DEFF Research Database (Denmark)

Dehlholm, Christian

A recent trend in descriptive sensory evaluation methodology has been the application of rapid evaluation techniques. The ease in use makes the techniques extremely easy to implement by industry and university environments. Thus, one might not consider validity in the choice of method. The overall...... aim of this thesis is to compare and evaluate selected rapid evaluation techniques for sensory profiling. Method variations have been suggested for evaluations in product development and quality control, and method insight is provided. The thesis includes three original studies, designed...... as a consequence of the current practices and needs faced in the industry. Study I compared applicability and validity of rapid methods across several panels of trained assessors. Two rapid approaches were introduced for the evaluation of foods. The first method, ‘Free Multiple Sorting’, allows subjects to perform...

Support for system connectivity –Learning from evaluating an evaluation

DEFF Research Database (Denmark)

Christensen, Jesper Lindgaard

been sparse on investigat-ing effects of these as well as on the broader criteria to evaluate the innovation networks and functioning of the system. This paper discusses what are such criteria for evaluating innovation policies that rely on enhanc-ing system connectivity and repair system failures......Innovation is said to be dependent upon collaboration and networks. The innovation system thinking empha-sizes networks but also their supporting informal institutions, learning processes, and the relations between actors in the system. Despite the importance of networks, evaluation studies have......? By way of illustration, and as a mean to be specific on these criteria, the paper discusses the possible rationale for governments to support business angel networks (BAN) and what criteria to apply when evaluating such networks. It is found that applying traditional evaluation criteria for assessing...

Mini-clinical evaluation exercise til evaluering af kommunikation og samarbejde i ambulatoriet

DEFF Research Database (Denmark)

Eriksen, Jesper Grau; Simonsen, Dorit; Bastholt, Lars

2009-01-01

INTRODUCTION: In the revised Danish medical specialist training increased focus has been placed on competences which are hard to evaluate such as communication skills. Mini-CEX seems promising as an evaluation tool. Our aim was to test: 1) whether mini-CEX was useable in the evaluation of communi......INTRODUCTION: In the revised Danish medical specialist training increased focus has been placed on competences which are hard to evaluate such as communication skills. Mini-CEX seems promising as an evaluation tool. Our aim was to test: 1) whether mini-CEX was useable in the evaluation...

Broadening the Educational Evaluation Lens with Communicative Evaluation

Science.gov (United States)

Brooks-LaRaviere, Margaret; Ryan, Katherine; Miron, Luis; Samuels, Maurice

2009-01-01

Outcomes-based accountability in the form of test scores and performance indicators are a primary lever for improving student achievement in the current educational landscape. The article presents communicative evaluation as a complementary evaluation approach that may be used along with the primary methods of school accountability to provide a…

Evaluation and Policy Learning

DEFF Research Database (Denmark)

Borrás, Susana; Højlund, Steven

2015-01-01

This article examines how evaluation induces policy learning – a question largely neglected by the scholarly literature on evaluation and policy learning. Following a learner's perspective, the article attempts to ascertain who the learners are, and what, and how, learners actually learn from...... evaluations. In so doing, it focuses on what different types of learners actually learn within the context of the evaluation framework (the set of administrative structures defining the evaluation goals and process). Taking the empirical case of three EU programme evaluations, the patterns of policy learning...... emanating from them are examined. The findings are that only two types of actors involved in the evaluation are actually learning (programme units and external evaluators), that learners learn different things (programme overview, small-scale programme adjustments, policy change and evaluation methods...

Development, evaluation, and utility of a peer evaluation form for online teaching.

Science.gov (United States)

Gaskamp, Carol D; Kintner, Eileen

2014-01-01

Formative assessment of teaching by peers is an important component of quality improvement for educators. Teaching portfolios submitted for promotion and tenure are expected to include peer evaluations. Faculty resources designed for peer evaluation of classroom teaching are often inadequate for evaluating online teaching. The authors describe development, evaluation, and utility of a new peer evaluation form for formative assessment of online teaching deemed relevant, sound, feasible, and beneficial.

Evaluating impact of clinical guidelines using a realist evaluation framework.

Science.gov (United States)

Reddy, Sandeep; Wakerman, John; Westhorp, Gill; Herring, Sally

2015-12-01

The Remote Primary Health Care Manuals (RPHCM) project team manages the development and publication of clinical protocols and procedures for primary care clinicians practicing in remote Australia. The Central Australian Rural Practitioners Association Standard Treatment Manual, the flagship manual of the RPHCM suite, has been evaluated for accessibility and acceptability in remote clinics three times in its 20-year history. These evaluations did not consider a theory-based framework or a programme theory, resulting in some limitations with the evaluation findings. With the RPHCM having an aim of enabling evidence-based practice in remote clinics and anecdotally reported to do so, testing this empirically for the full suite is vital for both stakeholders and future editions of the RPHCM. The project team utilized a realist evaluation framework to assess how, why and for what the RPHCM were being used by remote practitioners. A theory regarding the circumstances in which the manuals have and have not enabled evidence-based practice in the remote clinical context was tested. The project assessed this theory for all the manuals in the RPHCM suite, across government and aboriginal community-controlled clinics, in three regions of Australia. Implementing a realist evaluation framework to generate robust findings in this context has required innovation in the evaluation design and adaptation by researchers. This article captures the RPHCM team's experience in designing this evaluation. © 2015 John Wiley & Sons, Ltd.

Evaluation Influence: The Evaluation Event and Capital Flow in International Development.

Science.gov (United States)

Bell, David A

2017-12-01

Assessing program effectiveness in human development is central to informing foreign aid policy-making and organizational learning. Foreign aid effectiveness discussions have increasingly given attention to the devaluing effects of aid flow volatility. This study reveals that the external evaluation event influences actor behavior, serving as a volatility-constraining tool. A case study of a multidonor aid development mechanism served examining the influence of an evaluation event when considering anticipatory effects. The qualitative component used text and focus group data combined with individual interview data (organizations n = 10, including 26 individuals). Quantitative data included financial information on all 75 capital investments. The integrated theory of influence and model of alternative mechanisms used these components to identify the linkage between the evaluation event and capital flow volatility. Aid approved in the year of the midterm evaluation was disbursed by the mechanism with low capital volatility. Anticipating the evaluation event influenced behavior resulting in an empirical record that program outcomes were enhanced and the mechanism was an improved organization. Formative evaluations in a development program can trigger activity as an interim process. That activity provides for a more robust assessment of ultimate consequence of interest. Anticipating an evaluation can stimulate donor reality testing. The findings inform and strengthen future research on the influence of anticipating an evaluation. Closely examining activities before, during, and shortly after the evaluation event can aid development of other systematic methods to improve understanding this phenomenon, as well as improve donor effectiveness strategies.

Prototype of evaluation guidance system in Integrated Nuclear Data Evaluation System

International Nuclear Information System (INIS)

Fukahori, T.; Nakagawa, T.

1992-01-01

Integrated Nuclear Data Evaluation System (INDES) is being developed to keep experiences of nuclear data evaluation for JENDL-3 and to support new evaluations. One of the INDES functions is to set up input data of theoretical calculation codes automatically. In order to use INDES effectively, a prototype of nuclear data evaluation guidance system (E.T.; Evaluation Tutor) was made to help users in selecting a set of suitable theoretical calculation codes by applying knowledge engineering technology. E.T. consists of an inference engine, frames, a rule-base, two example-bases and calculating modules of certainty factors. The inference engine and the calculating modules are written in FORTRAN77. (author)

A subtraction and 3D display program for the assessment of pulmonary embolism in SPECT V/Q scans

International Nuclear Information System (INIS)

Barnden, Leighton; Badger, Daniel P.

2009-01-01

Full text: There is interest in whether SPECT can improve the detection of pulmonary emboli with ventilation/perfusion (V /Q) scanning compared to the conventional multi-view planar imaging approach. We have extended V/Q SPECT processing to include coregistration, normalization and subtraction of the two scans. The unpredictable deposition of technegas activity in bronchi can introduce significant differences between otherwise normal V and Q scans and poses a challenge to both the coregistration and normalization needed before performing subtraction. QONSUB, a graphical-user-interface driven program originally written to assess epilepsy with brain SPECT (Badger and Barnden. Proc ANZSNM, 2008) has been adapted for assessment of V/Q lung SPECT. It includes rigid (+zoom) coregistration of the whole images or automatically determined sub images that contain the entire lungs. Count normalization was performed with either the mean or median counts. Extreme hot spots in ventilation images were observed to adversely affect the co-registration. We show that truncation to an upper threshold before co-registration corrects this. Similarly, normalization using a mean was seriously affected by such ventilation hotspots. This was circumvented by using the median instead. The program offers display of the ventilation, perfusion and difference images in 3 linked panels with mouse-driven roam through their transaxial, sagittal and coronal sections, and mouse-driven scaling. Dragging the cursor horizontally across a sagittal image causes the corresponding coronal sections to change in all 4 panels, and so on. The multi-panel 3D display was well accepted by physicians and the program's clinical usefulness is under evaluation.

Complications in Endovascular Neurosurgery: Critical Analysis and Classification.

Science.gov (United States)

Ravindra, Vijay M; Mazur, Marcus D; Park, Min S; Kilburg, Craig; Moran, Christopher J; Hardman, Rulon L; Couldwell, William T; Taussky, Philipp

2016-11-01

Precisely defining complications, which are used to measure overall quality, is necessary for critical review of delivery of care and quality improvement in endovascular neurosurgery, which lacks common definitions for complications. Furthermore, in endovascular interventions, events that may be labeled complications may not always negatively affect outcome. Our objective is to provide precise definitions for quality evaluation within endovascular neurosurgery. Thus, we propose an endovascular-specific classification system of complications based on our own patient series. This single-center review included all patients who had endovascular interventions from September 2013 to August 2015. Complication types were analyzed, and a descriptive analysis was undertaken to calculate the incidence of complications overall and in each category. Two hundred and seventy-five endovascular interventions were performed in 245 patients (65% female; mean age, 55 years). Forty complications occurred in 39 patients (15%), most commonly during treatment of intracranial aneurysms (24/40). Mechanical complications (eg, device deployment, catheter, or closure device failure) occurred in 8/40, technical complications (eg, failure to deploy flow diverter, unintended embolization, air emboli, retroperitoneal hemorrhage, dissection) in 11/40, judgment errors (eg, patient or equipment selection) in 9/40, and critical events (eg, groin hematoma, hemorrhagic or thromboembolic complications) in 12/40 patients. Only 12/40 complications (30%) resulted in new neurologic deficits, vessel injury requiring surgery, or blood transfusion. We propose an endovascular-specific classification system of complications with 4 categories: mechanical, technical, judgment errors, and critical events. This system provides a framework for future studies and quality control in endovascular neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Mechanical Thrombectomy of Iliac Vein Thrombosis in a Pig Model Using the Rotarex and Aspirex Catheters

Energy Technology Data Exchange (ETDEWEB)

Minko, P., E-mail: peterminko@yahoo.com; Bücker, A. [University Hospital Homburg/Saar, Department of Diagnostic and Interventional Radiology (Germany); Laschke, M.; Menger, M. [University Hospital Homburg/Saar, Institute of Clinical and Experimental Surgery (Germany); Bohle, R. [University Hospital Homburg/Saar, Department of Pathology (Germany); Katoh, M. [University Hospital Homburg/Saar, Department of Diagnostic and Interventional Radiology (Germany)

2013-06-08

PurposeTo investigate the efficacy and safety of mechanical thrombectomy for iliac vein thrombosis using Rotarex and Aspirex catheters in a pig model.Materials and MethodsIliac vein thrombosis was induced in six pigs by means of an occlusion-balloon catheter and thrombin injection. The presence of thrombi was verified by digital subtraction angiography (DSA) and computed tomography (CT). Thrombectomy was performed using 6F and 8F Rotarex and 6F, 8F, and 10F Aspirex catheters (Straub Medical AG, Wangs, Switzerland). After intervention, DSA and CT were repeated to evaluate the efficacy of mechanical thrombectomy and to exclude local complications. In addition, pulmonary CT was performed to rule out pulmonary embolism. Finally, all pigs were killed, and iliac veins were dissected to perform macroscopic and histological examination.ResultsThrombus induction was successfully achieved in all animals as verified by DSA and CT. Subsequent thrombectomy lead to incomplete recanalization of the iliac veins with residual thrombi in all cases. However, the use of the 6F and 8F Rotarex catheters caused vessel perforation and retroperitoneal hemorrhage in all cases. Application of the Aspirex device caused one small transmural perforation in a vessel treated with a 10F Aspirex catheter, and this was only seen microscopically. Pulmonary embolism was detected in one animal treated with the Rotarex catheters, whereas no pulmonary emboli were seen in animals treated with the Aspirex catheters.ConclusionThe Aspirex catheter allowed subtotal and safe recanalization of iliac vein thrombosis. In contrast, the use of the Rotarex catheter caused macroscopically obvious vessel perforations in all cases.

The Auscultation of a Carbon Dioxide Embolization Event during Endoscopic Vein Harvest

Directory of Open Access Journals (Sweden)

Erik Strauss

2016-01-01

Full Text Available Endoscopic vein harvest in preparation for coronary artery bypass surgery has become a preferred method of procuring saphenous vein. Several case reports have documented carbon dioxide (CO2 embolization with this procedure as well as CO2 embolization during other laparoscopic surgeries (Markar et al., 2010. Although uncommon, the potential for CO2 entrainment through an open vein or through absorption by vascular structures exists and should be recognized (Lin et al., 2003. We report a case of CO2 embolization during EVH for a 77-year-old patient who underwent CABG that was identified early by the cardiac surgeon through the indirect auscultation of a mill-wheel murmur after the pericardium was opened. This may be the first reported case of a murmur related to air emboli identified without the use of a precordial Doppler probe or a stethoscope. This diagnosis was further supported by TEE before systemic hypotension or cardiovascular collapse occurred.

Cardiac myxoma: An uncommon cause of recurrent stroke in uncommon age

Directory of Open Access Journals (Sweden)

Harish Kumar

2015-01-01

Full Text Available Atrial fibrillation is the most common cause of cardiogenic emboli in stroke, responsible for over 50% cases of total stroke patients. Myxoma is responsible only in few cases. A stroke caused by left atrial myxoma commonly occur in young females. This patient presented with the repeated attack of stroke in the age of 80 years. However, it is the most common benign cardiac tumor found more frequently. In young adults with stroke or transient ischemic attack than in older patients. Age of the patient and unusual cause of recurrent stroke make this case report interesting. An 80-year-old male with no other conventional vascular risk factors such as hypertension, diabetes, or hyperlipidemia presented with left hemiparesis. Infarction over the right middle cerebral artery was disclosed on a magnetic resonance imaging study. The patient was a known case of right hemiparesis 3 years back, which was improved. The cause of repeated attack of stroke was left atrial myxoma, diagnosed by two-dimensional echocardiography.

An Uncommon Cause of Stroke: Non-bacterial Thrombotic Endocarditis.

Science.gov (United States)

Gundersen, Hilde; Moynihan, Barry

2016-10-01

Our objective is to present the case of an uncommon but probably under-recognized cause of stroke: Non-bacterial thrombotic endocarditis (NBTE). A 59-year-old man presented to our hospital with multiple bihemispheric infarcts despite taking rivaroxaban for pulmonary emboli diagnosed 2 weeks earlier. The patient's symptoms progressed quickly and he died within a week of his initial presentation despite attempts at neuroradiologically guided clot retrieval and early recognition and treatment of disseminated intravascular coagulation. On postmortem examination it was discovered that he had an undiagnosed squamous cell adenocarcinoma of the lung and NBTE. NBTE is difficult to diagnose and difficult to treat. It is associated with a mortality rate and is often not diagnosed until autopsy. However there are case reports in the literature where NBTE has been successfully treated. Early recognition and prompt treatment of the underlying disease process is the essential first step. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

John Paul Jones: An Overlooked Autopsy Finding that May Explain His Terminal Illness.

Science.gov (United States)

Hamrell, Burt B

2016-03-01

A finding in the autopsy of John Paul Jones, the American Revolutionary War naval hero, may explain his terminal illness. During his last 2 years, he had a persistent productive cough and dyspnea. Ten days before death, he developed rapidly progressive dependent edema and ascites. He died in France in 1792. His body, preserved in alcohol in a lead coffin, was, in 1905, removed to the United States. Glomerulonephritis was noted on an autopsy, performed in France, but there was no comment then or since about ventricular wall thickness being the same in both ventricles at 5-6 mm. Hypertrophy and dilatation with biventricular failure followed by tissue shrinkage during 113 years in alcohol could have resulted in these ventricular wall findings. Systemic hypertension and left ventricular failure are consistent with his respiratory symptoms complicated perhaps by pulmonary emboli, right ventricular failure with tricuspid regurgitation, peripheral congestion, and jaundice. © 2015 American Academy of Forensic Sciences.

Osteonecrosis in the knee joint

International Nuclear Information System (INIS)

Poeschl, M.

1981-01-01

The following forms are discussed: spontaneous osteonecrosis (Ahlbaeck's necrosis), which extends subchondrally into one of the femur condyles. It usually occurs in older patients, especially females. Blunt trauma may cause similar lesions. These often occur with cartilage and bone avulsions (flake fractures), which are often diagnosed much later (arthroscopy). Patellar chondropathy is increasing in frequency due to more intensive participation in sports. Pain localized at the apex of the patella (patellar apex syndrome) can develop from chondropathy, tendon lesions or primary juvenile necrosis of the patellar apex. Gas emboli occur near the knee joint during deep sea diving. Similar cartilage infarctions are seen in many hemoglobinopathies. The incidence of this is increasing due to the increased number of people immigrating from regions were these diseases are common. We have also observed vascular juvenile lesions of the epi- and metaphyses in Klippel-Trenaunay-Weber's syndrome. Their radiological appearance is similar to that of necroses. (orig.) [de

Medical image of the week: acute amiodarone pulmonary toxicity

Directory of Open Access Journals (Sweden)

Mazursky K

2015-10-01

Full Text Available No abstract available. Article truncated after 150 words. A 71 year old man with a medical history significant for chronic obstructive pulmonary disease, coronary artery disease with post-operative status coronary artery bypass grafting, heart failure with reduced ejection fraction (25% and atrial fibrillation/flutter underwent an elective ablation of the tachyarrhythmia at another facility and was prescribed amiodarone post procedure. He started complaining of cough and dyspnea one day post procedure and was empirically treated with 2 weeks of broad spectrum antibiotics. He subsequently was transferred to our facility due to worsening symptoms. He also complained of nausea, anorexia with resultant weight loss since starting amiodarone, which was stopped 5 days prior to transfer. Infectious work up was negative. On arrival to our facility, he was diagnosed with small sub-segmental pulmonary emboli, pulmonary edema and possible acute amiodarone toxicity. His was profoundly hypoxic requiring high flow nasal cannula or 100% non-rebreather mask at all times. His symptoms persisted despite ...

Percutaneous Occlusion of the Left Atrial Appendage with the Watchman Device in an Active Duty Sailor with Atrial Fibrillation and Recurrent Thromboembolism Despite Appropriate Use of Oral Anticoagulation.

Science.gov (United States)

Cox, Justin M; Choi, Anthony J; Oakley, Luke S; Francisco, Gregory M; Nayak, Keshav R

2018-05-23

Atrial fibrillation is the most common significant cardiac arrhythmia and is associated with a five-fold increased risk of stroke from thromboembolism. Over 94% of these emboli arise from the left atrial appendage. Systemic embolic phenomena are rare, accounting for less than 1 out of 10 of all embolic events, but have a similar prevention strategy. Anticoagulation significantly reduces the risk of these events, and thus forms the cornerstone of therapy for most patients with atrial fibrillation. Left atrial appendage occlusion with the Watchman device is a recently approved alternative for stroke prevention in selected patients. We present a case of an active duty U.S. Navy sailor at low risk for thromboembolism who nonetheless suffered recurrent thromboembolic events despite appropriate anticoagulation, and thus underwent Watchman implantation. The therapy in this case will ideally provide a lifetime of protection from recurrent systemic embolization while allowing the patient to continue his active duty military career without restriction due to oral anticoagulation.

Diagnosis of deep venous thrombosis by radioisotopic phlebography; Valor da flebografia radioisotopica no diagnostico da trombose venosa profunda

Energy Technology Data Exchange (ETDEWEB)

Araujo, Antonio Luiz de [Universidade do Rio de Janeiro (UNIRIO), RJ (Brazil)

1993-10-01

The author studied 20 patients with deep venous thrombosis of members (one of them attacked on both arms), from various etiologies, by mean radioisotopic phlebography, in the Vascular Diseases, Radiology and Nuclear Medicine Services of Army Central Hospital (Rio de Janeiro, Brazil) from january 1988 to june 1990. The years old was 18 to 72. The cause most frequency of deep venous thrombosis was idiopathic (seven cases 33.3%). The presence of clot by radionuclide marker in all cases, 16 observations (76.2%) in the lower members and five in the upper extremities (23.9%); 17 cases (85%) also were a conventional venography and his images were confirmed. The diagnostic of deep venous thrombosis from {sup 99m} T{sub c}MAA (macro aggregate of albumin tagged with technetium) should always de complemented by pulmonary mapping, tracking possible silent emboli. Permit as well repetitions evolutionary until daily and using in patients with history of allergy to radiologic contrast because has not complication. (author)

Diagnosis of deep venous thrombosis by radioisotopic phlebography

International Nuclear Information System (INIS)

Araujo, Antonio Luiz de

1993-01-01

The author studied 20 patients with deep venous thrombosis of members (one of them attacked on both arms), from various etiologies, by mean radioisotopic phlebography, in the Vascular Diseases, Radiology and Nuclear Medicine Services of Army Central Hospital (Rio de Janeiro, Brazil) from january 1988 to june 1990. The years old was 18 to 72. The cause most frequency of deep venous thrombosis was idiopathic (seven cases 33.3%). The presence of clot by radionuclide marker in all cases, 16 observations (76.2%) in the lower members and five in the upper extremities (23.9%); 17 cases (85%) also were a conventional venography and his images were confirmed. The diagnostic of deep venous thrombosis from 99m T c MAA (macro aggregate of albumin tagged with technetium) should always de complemented by pulmonary mapping, tracking possible silent emboli. Permit as well repetitions evolutionary until daily and using in patients with history of allergy to radiologic contrast because has not complication. (author)

A rare nidus for pulmonary thromboembolism after vertebroplasty.

Science.gov (United States)

Vallabhajosyula, Saraschandra; Sundaragiri, Pranathi Rao; Bansal, Ojas; Townley, Theresa A

2013-10-23

Percutaneous vertebroplasty is used to treat osteoporotic compression fractures and bone loss due to malignancy. The cement used can serve as a potential nidus for pulmonary thromboembolism (PTE). An 87-year-old woman with recent L2 vertebroplasty presented with abdominal pain and shortness of breath. Thoracoabdominal CT scan revealed extensive bilateral pulmonary emboli associated with a 9 cm cement fragment in the inferior vena cava (IVC) extending proximally from the level of the right superior renal vein, likely secondary to cement leak from the vertebral plexus into the IVC. She refused catheter extraction was managed conservatively. There are 51 reported cases of cement pulmonary embolism. IVC foreign bodies serving as a nidus for PTE have been reported with IVC filters with an incidence of 6.2%. This is the second reported case of vertebroplasty cement serving as a nidus for PTE. Treatment depends on time interval between the procedure and the symptom onset.

The Difficult Diagnosis of Ischaemic Papillary Muscle Rupture; Case report from an urban emergency department

Directory of Open Access Journals (Sweden)

Christian T. Braun

2016-05-01

Full Text Available We present a rare case of severe ischaemic papillary muscle rupture in a 67-year-old male patient who was admitted to the Emergency Department of the University Hospital Bern, Switzerland, in November 2013 with acute chest pain. On admission, the patient’s blood pressure was 60/40 mm/Hg, his pulse was 110 beats per minute and his respiratory rate was 20 breaths per minute. An electrocardiogram was normal and focused assessment with sonography in trauma was negative. Transthoracic echocardiography showed possible thickening of the mitral valve leaflet with no indications of severe mitral insufficiency or wall motion abnormalities. Triple-ruleout computed tomography angiography revealed no pulmonary emboli or aortic dissection, although coronary atherosclerosis was present. Finally, severe insufficiency of the mitral valve with rupture of the papillary muscle, likely due to ischaemia, was observed via transoesophageal echocardiography. The patient underwent a successful surgical intervention and was discharged 10 days later in stable condition.

ENDOCARDITIS WITH AN UNCOMMON GERM

Directory of Open Access Journals (Sweden)

M. Gharouni

2006-07-01

Full Text Available Enterococci are normal inhabitants of gastrointestinal tract, being responsible for 5 to 18% of infective endocarditis and the incidence appears to be increasing. Eleven patients with enterococcal endocarditis were studied. In a case series group, 10 men (average 57 years and one woman (37 years were studied. Two patients had rheumatic heart disease, 5 patients arteriosclerotic disease and one patient chronic renal failure on hemodialysis. Ten patients were treated with ampicillin and gentamycin. Valve replacement was performed in 3 patients with aortic valve endocarditis, one on 8th day and two at the end of the treatment. Overall clinical cure was achieved in 9 patients. Two relapses occurred and 2 patients died as a result of refractory congestive heart failure and cerebral emboli. All of the enterococcal endocarditis cases were community acquired. In conclusion, infective endocarditis in patients with preexistent valvular heart disease, community acquisition and non specific symptoms with bacteriuria should be considered as enterococcal endocarditis.

Medical image of the week: bilateral vocal cord paralysis

Directory of Open Access Journals (Sweden)

Van Hook CJ

2017-08-01

Full Text Available A 59-year-old morbidly obese woman with acute hypoxemic respiratory failure secondary to pulmonary emboli required emergency intubation. She was described by the anesthesiologist as having a difficult airway. The patient was liberated from the ventilator after two days. Following extubation she complained of hoarse voice and dyspnea. Physical exam revealed audible stridor. The upper airway was normal by CAT imaging. Flow-volume curve demonstrated marked flattening of both the inspiratory and expiratory limbs, consistent with a fixed extra-thoracic obstruction (Figure 1. Endoscopy revealed the vocal cords to be in the adducted position, with minimal movement throughout the respiratory cycle, consistent with bilateral vocal cord paralysis (Figure 2. Traumatic intubation follows thyroid surgery as the most common cause of bilateral vocal cord paralysis (1. In a minority of patients spontaneous recovery may occur. Surgical treatment options include cordotomy or tracheostomy. Nocturnal BIPAP has been used in patients who decline surgery (2.

Spectral-domain optical coherence tomography of roth spots.

Science.gov (United States)

Giovinazzo, Jerome; Mrejen, Sarah; Freund, K Bailey

2013-01-01

To describe the retinal findings of subacute bacterial endocarditis, their evolution after treatment, and analysis with spectral-domain optical coherence tomography. Retrospective chart review. A 21-year-old man presented with the sudden onset of a central scotoma in his left eye because of a sub-internal limiting membrane hemorrhage overlying the left fovea. When examined 2 weeks later, Roth spots were noted in his right eye. The patient was immediately referred to his internist and diagnosed with subacute bacterial endocarditis with cultures positive for Streptococcus viridans. He subsequently underwent aortic valve replacement surgery after 4 weeks of intravenous antibiotic therapy. When examined 4 weeks after valve replacement surgery, there was regression of the Roth spots. The present case demonstrates the importance of a funduscopic examination in the early diagnosis and management of subacute bacterial endocarditis. The analysis of Roth spots with spectral-domain optical coherence tomography suggested that they were septic emboli.

Positive imaging of venous thrombi and thromboemboli with Ga-67 DFO-DAS-fibrinogen

Energy Technology Data Exchange (ETDEWEB)

Yamamoto, Kazutaka; Senda, Michio; Fujita, Toru; Yonekura, Yoshiharu; Kumada, Kaoru; Yokoyama, Akira; Torizuka, Kanji

1988-05-01

A newly developed thrombus imaging agent, /sup 67/Ga-DFO-DAS-fibrinogen (/sup 67/Ga-fibrinogen), was used for 22 studies in 20 cases of suspected deep venous thrombosis. Increased accumulation of /sup 67/Ga-fibrinogen in venous thrombi was depicted at 48 h after injection in 10 of the 15 cases (10 of 17 studies) who showed abnormal findings in radionuclide venography. A hot spot in the lung emboli was visualized in two cases. Seven of the eight cases having anticoagulant therapy showed increased /sup 67/Ga-fibrinogen uptake, while follow-up /sup 67/Ga-fibrinogen scintigraphy after the administration of heparin and urokinase did not reveal an abnormal hot spot in one case. /sup 67/Ga-fibrinogen can be made available simply by adding /sup 67/Ga solution to a vial containing fibrinogen-DAS-DFO conjugate. In conclusion, /sup 67/Ga-fibrinogen is considered to be a promising agent for detecting active venous thrombi and to assess the effect of anticoagulant therapy.

Identification of Xylem Occlusions Occurring in Cut Clematis (Clematis L., fam. Ranunculaceae Juss. Stems during Their Vase Life

Directory of Open Access Journals (Sweden)

Agata Jedrzejuk

2012-01-01

Full Text Available During the vase life of cut stems obstruction of xylem vessels occurs due to microbial growth, formation of tyloses, deposition of materials in the lumen of xylem vessels and the presence of air emboli in the vascular system. Such obstructions may restrict water uptake and its transport towards upwards thus lowering their ornamental value and longevity of cut flowers. Clematis is a very attractive plant material which may be used as cut flower in floral compositions. Nothing is known about the histochemical or cytological nature of xylem blockages occurring in cut stems of this plant. This study shows that in clematis, tyloses are the main source of occlusions, although bacteria and some amorphic substances may also appear inside the vessels. A preservative composed of 200 mg dm−3 8-HQC (8-hydroxyquinolin citrate and 2% sucrose arrested bacterial development and the growth of tyloses. This information can be helpful in the development of new treatments to improve keeping qualities of cut clematis stems.

Mathematical modeling of coupled drug and drug-encapsulated nanoparticle transport in patient-specific coronary artery walls

KAUST Repository

Hossain, Shaolie S.

2011-08-20

The majority of heart attacks occur when there is a sudden rupture of atherosclerotic plaque, exposing prothrombotic emboli to coronary blood flow, forming clots that can cause blockages of the arterial lumen. Diseased arteries can be treated with drugs delivered locally to vulnerable plaques. The objective of this work was to develop a computational tool-set to support the design and analysis of a catheter-based nanoparticulate drug delivery system to treat vulnerable plaques and diffuse atherosclerosis. A threedimensional mathematical model of coupled mass transport of drug and drug-encapsulated nanoparticles was developed and solved numerically utilizing isogeometric finite element analysis. Simulations were run on a patient-specific multilayered coronary artery wall segment with a vulnerable plaque and the effect of artery and plaque inhomogeneity was analyzed. The method captured trends observed in local drug delivery and demonstrated potential for optimizing drug design parameters, including delivery location, nanoparticle surface properties, and drug release rate. © Springer-Verlag 2011.

Indications for intra-arterial infusion of urokinase in the treatment of acute gut ischaemia in patients with heart disease

Energy Technology Data Exchange (ETDEWEB)

Inoue, Y; Schichijo, Y; Ibukuro, K

1985-12-01

The poor prognosis of acute mesenteric artery occlusion can be improved by reaching a rapid angiographic diagnosis and by instituting treatment at an early stage. In addition to operative embolectomy, success may be expected from the use of urokinase infused superselectively into the superior mesenteric artery. This treatment is only likely to be successful if it is carried out within ten hours of the onset of clinical signs and symptoms. In patients with heart disease, angiography is recommended as soon as there is any suspicion of mesenteric occlusion, in order to confirm the diagnosis, localise the embolus and decide on the form of treatment. Urokinase treatment can be successful for embolic occlusion of the main branches or peripheral branches of the superior mesenteric artery. However, complete occlusion of the main superior mesenteric artery should be treated operatively. A contra-indication to urokinase therapy is occlusion due to infected emboli from an endocarditis.

Cryptogenic embolic stroke in a girl with a trisomy 21 mosaic.

Science.gov (United States)

Stöllberger, Claudia; Weiss, Simone; Zlabinger, Gerhard; Finsterer, Josef

2012-06-01

Stroke in trisomy 21 may be due to cardioembolism, atherosclerosis, vasculitis, moyamoya disease, sinus venous thrombosis, internal carotid hypoplasia or infections like endocarditis with septic emboli, meningitis or brain abscess. In rare cases, however, stroke etiology remains unexplained. We present a 19 year old Caucasian girl with trisomy 21 with a 47XX+21 karyotype who suffered at age 11 years from a transient ischemic attack with left hemiparesis, and at age 17 years from an ischemic stroke in the territory of the right cerebral medial artery. She suffered from arterial hypertension, obesity and hypercholesterolemia. Since blood coagulation studies, immunologic parameters, blood cultures, 24-h Holter monitoring, transthoracic and transesophageal echocardiography, magnetic resonance angiography of the extra- and intracranial vessels, thoracic and abdominal aorta and renal arteries did not provide any explanation for the stroke, implantation of a loop recorder is considered in order to detect episodes of clinically silent atrial fibrillation.

Novel technique for airless connection of artificial heart to vascular conduits.

Science.gov (United States)

Karimov, Jamshid H; Gao, Shengqiang; Dessoffy, Raymond; Sunagawa, Gengo; Sinkewich, Martin; Grady, Patrick; Sale, Shiva; Moazami, Nader; Fukamachi, Kiyotaka

2017-12-01

Successful implantation of a total artificial heart relies on multiple standardized procedures, primarily the resection of the native heart, and exacting preparation of the atrial and vascular conduits for pump implant and activation. Achieving secure pump connections to inflow/outflow conduits is critical to a successful outcome. During the connection process, however, air may be introduced into the circulation, traveling to the brain and multiple organs. Such air emboli block blood flow to these areas and are detrimental to long-term survival. A correctly managed pump-to-conduit connection prevents air from collecting in the pump and conduits. To further optimize pump-connection techniques, we have developed a novel connecting sleeve that enables airless connection of the Cleveland Clinic continuous-flow total artificial heart (CFTAH) to the conduits. In this brief report, we describe the connecting sleeve design and our initial results from two acute in vivo implantations using a scaled-down version of the CFTAH.

Osteonecrosis in the knee joint

Energy Technology Data Exchange (ETDEWEB)

Poeschl, M

1981-12-01

The following forms are discussed: spontaneous osteonecrosis (Ahlbaeck's necrosis), which extends subchondrally into one of the femur condyles. It usually occurs in older patients, especially females. Blunt trauma may cause similar lesions. These often occur with cartilage and bone avulsions (flake fractures), which are often diagnosed much later (arthroscopy). Patellar chondropathy is increasing in frequency due to more intensive participation in sports. Pain localized at the apex of the patella (patellar apex syndrome) can develop from chondropathy, tendon lesions or primary juvenile necrosis of the patellar apex. Gas emboli occur near the knee joint during deep sea diving. Similar cartilage infarctions are seen in many hemoglobinopathies. The incidence of this is increasing due to the increased number of people immigrating from regions where these diseases are common. We have also observed vascular juvenile lesions of the epi- and metaphyses in Klippel-Trenaunay-Weber's syndrome. Their radiological appearance is similar to that of necroses.

Preparation of 99m Tc-Macroaggregated albumin for lung perfusion studies

International Nuclear Information System (INIS)

Alfonso Marin, Yumisley; Zayas Crespo, Francisco I.; Mesa Duennas Niurka; Hernandez Gonzalez, Ignacio; Leon Perez, Mariela; Rivero Santamaria, Alejandro

2009-01-01

The present paper shows the design, optimization, quality control for testing radiochemical purity, biological quality and realtime stability studies of a preparation of macroaggregated albumin from the controlled denaturation of HSA. An experimental design with a 2 3 factorial plan was carried out in order to determine the ideal conditions for the preparation. The results showed that variations of albumin concentrations within the range of 515 mg/mL were irrelevant, however, the final pH of the mixture and the stirring speed were significant variables, as well as their interaction. Formulations with particles of diameter between 11 and 80 μ were obtained with the conditions selected in the experimental design which met the internationally established criteria for radiochemical purity, sterility and apyrogenicity. The biodistribution in experimental animals showed good quality lung images. The produced lots maintained physical, radiochemical, biological and microbiological stability during 90 days of storage at 4 o C. Key words: albumins, blood serum, emboli, labelling, lungs, quality control, radiopharmaceuticals, thrombosis, technetium 99. (author)

Reduced clot debris size using standing waves formed via high intensity focused ultrasound

Science.gov (United States)

Guo, Shifang; Du, Xuan; Wang, Xin; Lu, Shukuan; Shi, Aiwei; Xu, Shanshan; Bouakaz, Ayache; Wan, Mingxi

2017-09-01

The feasibility of utilizing high intensity focused ultrasound (HIFU) to induce thrombolysis has been demonstrated previously. However, clinical concerns still remain related to the clot debris produced via fragmentation of the original clot potentially being too large and hence occluding downstream vessels, causing hazardous emboli. This study investigates the use of standing wave fields formed via HIFU to disintegrate the thrombus while achieving a reduced clot debris size in vitro. The results showed that the average diameter of the clot debris calculated by volume percentage was smaller in the standing wave mode than in the travelling wave mode at identical ultrasound thrombolysis settings. Furthermore, the inertial cavitation dose was shown to be lower in the standing wave mode, while the estimated cavitation bubble size distribution was similar in both modes. These results show that a reduction of the clot debris size with standing waves may be attributed to the particle trapping of the acoustic potential well which contributed to particle fragmentation.

Constructionism, postmodernism and evaluation theory. The strategic function of evaluation

Directory of Open Access Journals (Sweden)

Baltasar Fernández-Ramírez

2009-05-01

Full Text Available "Testing"  and "evaluating" are money-making activities that offer a rewarding professional career; perhaps it is no surprise that the field includes numbers of self-styled "evaluators" who provide services without the required training. Evaluation means the systematic application of given criteria for judging the merit or value of a variety of 'assessables' - capacities, powers and services, including social policy interventions. The conventional perspective is rationalist (in diagnosis, planning, intervention and impact analysis, even though rationalism have lost their pre-eminence in the social sciences, in favour of political, symbolic or chaotic alternatives, as the history of organizational thought reveals. Alternatively, from a constructionist perspective, we see the power of evaluation criteria to reify what they ostensibly assess. Evaluations suggest or impose what is right; criteria of value define, give meaning and prioritize just one way of understanding social relations, program goals or individual and organizational behaviour. The suggestion in this article is to make a positive virtue of this inevitable pragmatic consequence of evaluation: to openly embrace it as an agent of change, emphasizing a strategical function beyond the traditional purposes of enhancement and accountability. 

Simulation of lung motions using an artificial neural network; Utilisation d'un reseau de neurones artificiels pour la simulation des mouvements pulmonaires

Energy Technology Data Exchange (ETDEWEB)

Laurent, R.; Henriet, J.; Sauget, M.; Gschwind, R.; Makovicka, L. [IRMA/ENISYS/FEMTO-ST, UMR 6174 CNRS, pole universitaire des Portes du Jura, BP 71427, 25211 Montbeliard cedex (France); Salomon, M. [AND/LIFC, universite de Franche-Comte, BP 527, rue Engel-Gros, 90016 Belfort cedex (France); Nguyen, F. [Service de radiotherapie, CHU Jean-Minjoz, 3, boulevard Fleming, 25030 Besancon cedex (France)

2011-04-15

Purpose. A way to improve the accuracy of lung radiotherapy for a patient is to get a better understanding of its lung motion. Indeed, thanks to this knowledge it becomes possible to follow the displacements of the clinical target volume (CTV) induced by the lung breathing. This paper presents a feasibility study of an original method to simulate the positions of points in patient's lung at all breathing phases. Patients and methods. This method, based on an artificial neural network, allowed learning the lung motion on real cases and then to simulate it for new patients for which only the beginning and the end breathing data are known. The neural network learning set is made up of more than 600 points. These points, shared out on three patients and gathered on a specific lung area, were plotted by a MD. Results. - The first results are promising: an average accuracy of 1 mm is obtained for a spatial resolution of 1 x 1 x 2.5 mm{sup 3}. Conclusion. We have demonstrated that it is possible to simulate lung motion with accuracy using an artificial neural network. As future work we plan to improve the accuracy of our method with the addition of new patient data and a coverage of the whole lungs. (authors)

Inflammation aiguë pulmonaire en réanimation : développement d'axes diagnostiques, préventifs et de thérapies immunomodulatrices

OpenAIRE

Monsel , Antoine

2016-01-01

Pneumonia and acute respiratory distress syndrome (ARDS) are two facets of severe acute lunginflammation, often met in intensive care unit (ICU). Rapid diagnosis of pneumonia remains essential inorder to optimize their management. We worked on setting up a quick test diagnosis based on theintensity of alveolar neutrophils autofluorescence. The validation of this test in a multicenter cohort isunderway. Preventing microaspiration across the cuff remains a priority to prevent pneumonia inmechan...

Evaluation der ärztlichen Ausbildung [Evaluation of medical education

Directory of Open Access Journals (Sweden)

van den Bussche, Hendrik

2006-05-01

Full Text Available [english] Background: The importance of evaluation is increasing, not only in medical education. Apart from giving feedback to the teachers the results of evaluations can be used for allocation of educational funds. At the medical faculty of the University of Hamburg the evaluation of medical education has been performed since ten years. Results: An analysis of the Hamburg experience in the standardized evaluation of medical education shows a series of problems. 1. The cumulative evaluation of curriculum parts tends to turn out different than the detailed evaluation of its consisting parts. 2. Theoretical courses tend to be assessed worse than clinical courses - irrespective of their real quality. The reason for this "handicap" of theoretical courses is that students tend to rate their benefit for clinical practice lower. 3. There are differences between prompt and delayed assessments of the same courses. 4. Students' assessment also depends on the stage of their training and on the didactic type of the evaluated course. Conclusion: Ranking of courses should be performed with caution. To improve reliability and validity of results the following suggestions are made: 1. Results of cumulative evaluation of curriculum parts should be interpreted with care. 2. Unequal opportunities of theoretical and clinical courses to gain good results should be considered. 3. Repeated assessments and longitudinal comparisons are essential. 4. Comparisons should be made only between similar didactical types of courses. 5. Results should be analysed with respect to their possible causes, preferably by mixed evaluation commissions. 6. It is recommended to evaluate aspects of process quality rather than of result quality. [german] Hintergrund: Die Evaluation von Lehrveranstaltungen und curricularen Abschnitten durch Studierende nimmt nicht nur in der ärztlichen Ausbildung zu. Neben der Rückmeldung an die Dozenten können die Ergebnisse eine wichtige Basis f

Information Retrieval Evaluation

CERN Document Server

Harman, Donna

2011-01-01

Evaluation has always played a major role in information retrieval, with the early pioneers such as Cyril Cleverdon and Gerard Salton laying the foundations for most of the evaluation methodologies in use today. The retrieval community has been extremely fortunate to have such a well-grounded evaluation paradigm during a period when most of the human language technologies were just developing. This lecture has the goal of explaining where these evaluation methodologies came from and how they have continued to adapt to the vastly changed environment in the search engine world today. The lecture

The Practice of Evaluation Research and the Use of Evaluation Results.

Science.gov (United States)

Van den Berg, G.; Hoeben, W. Th. J. G.

1984-01-01

Lack of use of educational evaluation results in the Netherlands was investigated by analyzing 14 curriculum evaluation studies. Results indicated that rational decision making with a technical (empirical) evaluation approach makes utilization of results most likely. Incremental decision making and a conformative approach make utilization least…

Assessment of low-dose radiotherapy (two 2 Gy sessions) for the cure of MALT lymphoma of the lung; evaluation de la radiotherapie faible (deux seances de 2 Gy) a visee curative dans le lymphome du Malt pulmonaire

Energy Technology Data Exchange (ETDEWEB)

Paumier, A.; Ghalibafian, M.; Gilmore, J.; Girinsky, T. [Departement de radiotherapie, institut de cancerologie Gustave-Roussy, Villejuif (France); Hanna, C.; Raphael, J.; Ferme, C.; Ribrag, V. [Departement d' hematologie, institut de cancerologie Gustave-Roussy, Villejuif (France)

2011-10-15

The authors report the assessment of low-dose radiotherapy (two sessions of 2 Gy in two days) for the curative treatment of mucosa-associated lymphoid tissue (MALT) lymphoma of the lung. The treatment of this lymphoma is discussed in terms of surgery, chemotherapy, radiotherapy, or even simple monitoring. The authors analyse the results obtained on nine patients who have been treated this way since 2002, straight away for some of them, after surgery or chemotherapy for others. Survival rate, recurrence, evolutions and responses are discussed. Short communication

Evaluating human resource interventions

Directory of Open Access Journals (Sweden)

Joha Louw-Potgieter

2012-07-01

Research purpose: The purpose of this special edition is to introduce readers to the evaluation of human resource (HR programmes. Motivation for the study: There are few comprehensive evaluations of HR programmes despite many publications on functional efficiency measures of HR (i.e. measures of cost, time, quantity, error and quality. Research design, approach and method: This article provides a value chain for HR activities and introduces the reader to programme theory-driven evaluation. Main findings: In summarising all of the contributions in this edition, one of the main findings was the lack of programme evaluation experience within HR functions and the difficulty this posed for the evaluators. Practical/managerial implications: This introductory article presents answers to two simple questions: What does HR do? and, What is programme evaluation? These answers will enable practitioners to understand what programme evaluators mean when we say that programme evaluation seeks to determine the merit of a programme. Contribution/value-add: The main contribution of this introductory article is to set the scene for the HR evaluations that follow. It alerts the reader to the rich theory contribution in HR literature and how to apply this in a theory-driven evaluation.

Politics in evaluation: Politically responsive evaluation in high stakes environments.

Science.gov (United States)

Azzam, Tarek; Levine, Bret

2015-12-01

The role of politics has often been discussed in evaluation theory and practice. The political influence of the situation can have major effects on the evaluation design, approach and methods. Politics also has the potential to influence the decisions made from the evaluation findings. The current study focuses on the influence of the political context on stakeholder decision making. Utilizing a simulation scenario, this study compares stakeholder decision making in high and low stakes evaluation contexts. Findings suggest that high stakes political environments are more likely than low stakes environments to lead to reduced reliance on technically appropriate measures and increased dependence on measures better reflect the broader political environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Data modeling and evaluation

International Nuclear Information System (INIS)

Bauge, E.; Hilaire, S.

2006-01-01

This lecture is devoted to the nuclear data evaluation process, during which the current knowledge (experimental or theoretical) of nuclear reactions is condensed and synthesised into a computer file (the evaluated data file) that application codes can process and use for simulation calculations. After an overview of the content of evaluated nuclear data files, we describe the different methods used for evaluating nuclear data. We specifically focus on the model based approach which we use to evaluate data in the continuum region. A few examples, coming from the day to day practice of data evaluation will illustrate this lecture. Finally, we will discuss the most likely perspectives for improvement of the evaluation process in the next decade. (author)

Preliminary data from {gamma}-cardiography during the abatement of an asthmatic attack (1961); Premieres donnees de la {gamma}-cardiographie au decours de l'etat de mal asthmatique (1961)

Energy Technology Data Exchange (ETDEWEB)

Georges, R; Vernejoul, P de; Raynaud, C; Blanchon, P; Kellershohn, C; Turiaf, J [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1961-07-01

The authors used gamma cardiology during the abatement of 16 cases of asthma with a view to detecting heart attacks not otherwise visible with routine methods of examination: clinical, radiological and electro-cardio-graphical. In gamma cardiology, a radioactive indicator is used and its path followed in the cavities of the heart. The method makes it possible to study the circulation in the right heart, the pulmonary crossing, and the left heart, as well as evaluation of the heart-flow. As a result of their investigations the authors, after having discussed the significance of the data obtained with the method, suggest that it is possible by the use of gamma cardiography during the abatement of an asthma attack: 1- To confirm attacks of the right heart which have already been detected by ordinary methods. 2- To confirm the presence of modifications in the recorded curves which suggest, in the case of the left heart, possible attack; such on attack is also indicated, in a small number of cases, by electrocardiography curves. Some considerations are put forward by the authors concerning the physiopathology of attacks on the left heart. (authors) [French] Les auteurs ont fait appel a la gammacardiographie au decours de 16 cas d'etat de mal asthmatique, dans le but d'objectiver des atteintes cardiaques incapables d'etre revelees par les moyens d'exploration de routine: cliniques, radiologiques et electrocardiographiques. La gammacardiographie est un procede qui enregistre a l'aide d'un indicateur radioactif, le trajet de celui-ci dans les cavites cardiaques. Elle permet l'etude de la circulation dans le coeur droit, de la traversee pulmonaire, et le coeur gauche, de meme que le calcul du debit cardiaque. Au terme de leurs investigations, les auteurs apres avoir discute la signification des donnees fournies par la methode admettent que la gammacardiographie objective au secours de l'etat de mal asthmatique: 1- La confirmation de l'atteinte du coeur droit deja etablie

Evaluated Nuclear Data

Energy Technology Data Exchange (ETDEWEB)

Oblozinsky, P.; Oblozinsky,P.; Herman,M.; Mughabghab,S.F.

2010-10-01

This chapter describes the current status of evaluated nuclear data for nuclear technology applications. We start with evaluation procedures for neutron-induced reactions focusing on incident energies from the thermal energy up to 20 MeV, though higher energies are also mentioned. This is followed by examining the status of evaluated neutron data for actinides that play dominant role in most of the applications, followed by coolants/moderators, structural materials and fission products. We then discuss neutron covariance data that characterize uncertainties and correlations. We explain how modern nuclear evaluated data libraries are validated against an extensive set of integral benchmark experiments. Afterwards, we briefly examine other data of importance for nuclear technology, including fission yields, thermal neutron scattering and decay data. A description of three major evaluated nuclear data libraries is provided, including the latest version of the US library ENDF/B-VII.0, European JEFF-3.1 and Japanese JENDL-3.3. A brief introduction is made to current web retrieval systems that allow easy access to a vast amount of up-to-date evaluated nuclear data for nuclear technology applications.

Characteristics of breathing apparatus used in health physics; Caracteristiques de l'appareil respiratoire utilisables en radioprotection

Energy Technology Data Exchange (ETDEWEB)

Perissin-Pirasset, F [Commissariat a l' Energie Atomique, Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires

1967-07-01

The present state of knowledge makes it possible to envisage the calculation of doses absorbed by various parts of the respiration apparatus following inhalation of radio-active dusts contained in aerosols. After recalling some anatomical and histological considerations, the author presents various curves showing the deposition of dusts in the three parts of the breathing apparatus: - the rhino-pharynx - the trachea and wind-pipe - the pulmonary parenchyma. The dusts can be classified in three groups of biological solubility according to which the rates of elimination of the particles from the organs are different. A synthesis of these data is given in elimination diagrams. In order to calculate the doses it is necessary furthermore to know certain anatomical and physiological characteristics of a standard man. (author) [French] L'etat actuel des connaissances permet d'envisager le calcul des doses recues par les differentes parties de l'arbre respiratoire, a la suite d'inhalation de poussieres radioactives contenues dans des aerosols. Apres un rappel de notions anatomiques et histologiques, nous presentons differentes courbes de depot des poussieres dans les trois etages respiratoires: - le rhino-pharynx - la trachee et les bronches - le parenchyme pulmonaire. Les poussieres peuvent etre classees en trois groupes de solubilite biologique selon lesquels les vitesses d'elimination des particules a partir des organes sont differentes. Ceci peut etre synthetise dans des schemas d'elimination. Pour permettre le calcul des doses, il faut en outre disposer des caracteristiques d'un homme standard, du point de vue anatomique et physiologique. (auteur)

Characteristics of breathing apparatus used in health physics; Caracteristiques de l'appareil respiratoire utilisables en radioprotection

Energy Technology Data Exchange (ETDEWEB)

Perissin-Pirasset, F. [Commissariat a l' Energie Atomique, Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires

1967-07-01

The present state of knowledge makes it possible to envisage the calculation of doses absorbed by various parts of the respiration apparatus following inhalation of radio-active dusts contained in aerosols. After recalling some anatomical and histological considerations, the author presents various curves showing the deposition of dusts in the three parts of the breathing apparatus: - the rhino-pharynx - the trachea and wind-pipe - the pulmonary parenchyma. The dusts can be classified in three groups of biological solubility according to which the rates of elimination of the particles from the organs are different. A synthesis of these data is given in elimination diagrams. In order to calculate the doses it is necessary furthermore to know certain anatomical and physiological characteristics of a standard man. (author) [French] L'etat actuel des connaissances permet d'envisager le calcul des doses recues par les differentes parties de l'arbre respiratoire, a la suite d'inhalation de poussieres radioactives contenues dans des aerosols. Apres un rappel de notions anatomiques et histologiques, nous presentons differentes courbes de depot des poussieres dans les trois etages respiratoires: - le rhino-pharynx - la trachee et les bronches - le parenchyme pulmonaire. Les poussieres peuvent etre classees en trois groupes de solubilite biologique selon lesquels les vitesses d'elimination des particules a partir des organes sont differentes. Ceci peut etre synthetise dans des schemas d'elimination. Pour permettre le calcul des doses, il faut en outre disposer des caracteristiques d'un homme standard, du point de vue anatomique et physiologique. (auteur)

The City Intelligence Quotient (City IQ Evaluation System: Conception and Evaluation

Directory of Open Access Journals (Sweden)

Zhiqiang Wu

2016-06-01

Full Text Available After a systematic review of 38 current intelligent city evaluation systems (ICESs from around the world, this research analyzes the secondary and tertiary indicators of these 38 ICESs from the perspectives of scale structuring, approaches and indicator selection, and determines their common base. From this base, the fundamentals of the City Intelligence Quotient (City IQ Evaluation System are developed and five dimensions are selected after a clustering analysis. The basic version, City IQ Evaluation System 1.0, involves 275 experts from 14 high-end research institutions, which include the Chinese Academy of Engineering, the National Academy of Science and Engineering (Germany, the Royal Swedish Academy of Engineering Sciences, the Planning Management Center of the Ministry of Housing and Urban-Rural Development of China, and the Development Research Center of the State Council of China. City IQ Evaluation System 2.0 is further developed, with improvements in its universality, openness, and dynamic adjustment capability. After employing deviation evaluation methods in the IQ assessment, City IQ Evaluation System 3.0 was conceived. The research team has conducted a repeated assessment of 41 intelligent cities around the world using City IQ Evaluation System 3.0. The results have proved that the City IQ Evaluation System, developed on the basis of intelligent life, features more rational indicators selected from data sources that can offer better universality, openness, and dynamics, and is more sensitive and precise.

The EMEFS model evaluation

International Nuclear Information System (INIS)

Barchet, W.R.; Dennis, R.L.; Seilkop, S.K.; Banic, C.M.; Davies, D.; Hoff, R.M.; Macdonald, A.M.; Mickle, R.E.; Padro, J.; Puckett, K.; Byun, D.; McHenry, J.N.; Karamchandani, P.; Venkatram, A.; Fung, C.; Misra, P.K.; Hansen, D.A.; Chang, J.S.

1991-12-01

The binational Eulerian Model Evaluation Field Study (EMEFS) consisted of several coordinated data gathering and model evaluation activities. In the EMEFS, data were collected by five air and precipitation monitoring networks between June 1988 and June 1990. Model evaluation is continuing. This interim report summarizes the progress made in the evaluation of the Regional Acid Deposition Model (RADM) and the Acid Deposition and Oxidant Model (ADOM) through the December 1990 completion of a State of Science and Technology report on model evaluation for the National Acid Precipitation Assessment Program (NAPAP). Because various assessment applications of RADM had to be evaluated for NAPAP, the report emphasizes the RADM component of the evaluation. A protocol for the evaluation was developed by the model evaluation team and defined the observed and predicted values to be used and the methods by which the observed and predicted values were to be compared. Scatter plots and time series of predicted and observed values were used to present the comparisons graphically. Difference statistics and correlations were used to quantify model performance. 64 refs., 34 figs., 6 tabs

The EMEFS model evaluation

Energy Technology Data Exchange (ETDEWEB)

Barchet, W.R. (Pacific Northwest Lab., Richland, WA (United States)); Dennis, R.L. (Environmental Protection Agency, Research Triangle Park, NC (United States)); Seilkop, S.K. (Analytical Sciences, Inc., Durham, NC (United States)); Banic, C.M.; Davies, D.; Hoff, R.M.; Macdonald, A.M.; Mickle, R.E.; Padro, J.; Puckett, K. (Atmospheric Environment Service, Downsview, ON (Canada)); Byun, D.; McHenry, J.N.

1991-12-01

The binational Eulerian Model Evaluation Field Study (EMEFS) consisted of several coordinated data gathering and model evaluation activities. In the EMEFS, data were collected by five air and precipitation monitoring networks between June 1988 and June 1990. Model evaluation is continuing. This interim report summarizes the progress made in the evaluation of the Regional Acid Deposition Model (RADM) and the Acid Deposition and Oxidant Model (ADOM) through the December 1990 completion of a State of Science and Technology report on model evaluation for the National Acid Precipitation Assessment Program (NAPAP). Because various assessment applications of RADM had to be evaluated for NAPAP, the report emphasizes the RADM component of the evaluation. A protocol for the evaluation was developed by the model evaluation team and defined the observed and predicted values to be used and the methods by which the observed and predicted values were to be compared. Scatter plots and time series of predicted and observed values were used to present the comparisons graphically. Difference statistics and correlations were used to quantify model performance. 64 refs., 34 figs., 6 tabs.

Program evaluation

Energy Technology Data Exchange (ETDEWEB)

1988-01-01

This book contains the proceedings from the panel on program evaluation. Some of the papers included are the following: Seattle City Light's Industrial Retrofit Demonstration Project Uses Quasi-Experimental Research Design and Metering to Measure Savings, Evaluation for PUCs, and The Takeback Effect Low-income Weatherizations Fact or Fiction

Reading Evaluation

Science.gov (United States)

Fagan, W. T.

1978-01-01

The Canadian Institute for Research in Behavioral and Social Sciences of Calgary was awarded a contract by the Provincial Government of Alberta to assess student skills and knowledge in reading and written composition. Here evaluation is defined and the use of standardized and criterion referenced tests for evaluating reading performance are…

Evaluation, Language, and Untranslatables

DEFF Research Database (Denmark)

Dahler-Larsen, Peter; Dahler-Larsen, Peter

2017-01-01

The issue of translatability is pressing in international evaluation, in global transfer of evaluative instruments, in comparative performance management, and in culturally responsive evaluation. Terms that are never fully understood, digested, or accepted may continue to influence issues, problems......, and social interactions in and around and after evaluations. Their meanings can be imposed or reinvented. Untranslatable terms are not just “lost in translation” but may produce overflows that do not go away. The purpose of this article is to increase attention to the issue of translatability in evaluation...... of relevance that appear to be “foreign”; increase the language skills of evaluators; and make research on frictions in translation an articulate part of the agenda for research on evaluation....

Presidential Address: Empowerment Evaluation.

Science.gov (United States)

Fetterman, David

1994-01-01

Empowerment evaluation is the use of evaluation concepts and techniques to foster self-determination, focusing on helping people help themselves. This collaborative evaluation approach requires both qualitative and quantitative methodologies. It is a multifaceted approach that can be applied to evaluation in any area. (SLD)

Scientific evaluation at the CEA; Evaluation scientifique au CEA

Energy Technology Data Exchange (ETDEWEB)

NONE

1999-11-01

This report presents a statement of the scientific and technical activity of the French atomic energy commission (CEA) for the year 1998. This evaluation is made by external and independent experts and requires some specific dispositions for the nuclear protection and safety institute (IPSN) and for the direction of military applications (DAM). The report is divided into 5 parts dealing successively with: part 1 - the CEA, a public research organization (civil nuclear research, technology research and transfers, defence activities); the scientific and technical evaluation at the CEA (general framework, evaluation of the IPSN and DAM); part 2 - the scientific and technical councils (directions of fuel cycle, of nuclear reactors, and of advanced technologies); part 3 - the scientific councils (directions of matter and of life sciences); the nuclear protection and safety institute; the direction of military applications; part 4 - the corresponding members of the evaluation; part 5 - the list of scientific and technical councils and members. (J.S.)

Peer Evaluation of Teaching or "Fear" Evaluation: In Search of Compatibility

Science.gov (United States)

Salih, Abdel Rahman Abdalla

2013-01-01

Peer evaluation or review of teaching is one of the factors of quality assurance system at the present time. However, peer evaluation is sometimes approached with trepidation and with the feeling that it may not be fair and free of bias. This paper examines teachers' perceptions of peer evaluation as an enhancement for quality teaching. A…

Organizational use of evaluations

DEFF Research Database (Denmark)

Hansson, Finn

2004-01-01

Organizations perform evaluations in order to demonstrate their trustworthiness to theoutside world and to produce knowledge for use by the management of the organization.In the planning and application of specific evaluations in the organization, differentparticipants or stakeholders very often...... as part of the evaluation process and the long-term impact of this new systematicallyorganised set of data on organizational activities are normally not taken seriously intoconsideration when the use of evaluations in organizations are discussed. Saiddifferently, evaluations have become a major factor...... of organizational sociology, that people tend to adapt to external behaviouraldemands especially when related to power relations in the organization.keywords: research evaluation, governance, social control, publication counts....

Plaidoyer pour l'auto-evaluation (Avocating Student Self-Evaluation).

Science.gov (United States)

Holec, Henri

1981-01-01

Advocates student self-evaluation as a practice that can impart new vigor to language courses and benefit both student and teacher as well as their relationship. Cautions, however, that self-evaluation procedures must be learned and that students must acquire a clear perception of the relevant criteria and objectives. (MES)

Adaptation, Evaluation and Inclusion

Science.gov (United States)

Basson, R.

2011-01-01

In this article I reflect on a recent development currently shaping programme evaluation as field, which makes the case for evaluators facilitating evaluation training evaluees to self-evaluate and improve the programmes they teach. Fetterman argues persuasively that the practice was incipient in the field and required formalization and acceptance…

Health services research evaluation principles. Broadening a general framework for evaluating health information technology.

Science.gov (United States)

Sockolow, P S; Crawford, P R; Lehmann, H P

2012-01-01

Our forthcoming national experiment in increased health information technology (HIT) adoption funded by the American Recovery and Reinvestment Act of 2009 will require a comprehensive approach to evaluating HIT. The quality of evaluation studies of HIT to date reveals a need for broader evaluation frameworks that limits the generalizability of findings and the depth of lessons learned. Develop an informatics evaluation framework for health information technology (HIT) integrating components of health services research (HSR) evaluation and informatics evaluation to address identified shortcomings in available HIT evaluation frameworks. A systematic literature review updated and expanded the exhaustive review by Ammenwerth and deKeizer (AdK). From retained studies, criteria were elicited and organized into classes within a framework. The resulting Health Information Technology Research-based Evaluation Framework (HITREF) was used to guide clinician satisfaction survey construction, multi-dimensional analysis of data, and interpretation of findings in an evaluation of a vanguard community health care EHR. The updated review identified 128 electronic health record (EHR) evaluation studies and seven evaluation criteria not in AdK: EHR Selection/Development/Training; Patient Privacy Concerns; Unintended Consequences/ Benefits; Functionality; Patient Satisfaction with EHR; Barriers/Facilitators to Adoption; and Patient Satisfaction with Care. HITREF was used productively and was a complete evaluation framework which included all themes that emerged. We can recommend to future EHR evaluators that they consider adding a complete, research-based HIT evaluation framework, such as HITREF, to their evaluation tools suite to monitor HIT challenges as the federal government strives to increase HIT adoption.

Technical Evaluation Report 30: Vendor-Assisted Evaluation of a Learning Management System

Directory of Open Access Journals (Sweden)

Adrienne De Schutter

2004-04-01

Full Text Available A product evaluation was conducted of Desire2Learn, an online learning management system gaining popularity in educational institutions. Since an online trial version of the software was not available for evaluation, an inspection meeting with the vendor was arranged. This provided the evaluation team with an opportunity to examine the precautions necessary for ensuring the objectivity of a product evaluation based on vendor-supplied information. The report outlines the team’s use of evaluator-driven enquiry and a triangulated approach to information checking. The Desire2Learn product is assessed as a flexible and useful addition to the range of learning management system options.

Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods

Science.gov (United States)

2010-01-01

Background Schools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion. This article presents a research protocol of a program developed to evaluate HP. After reviewing HP evaluation issues, the various possible approaches are analyzed and the importance of a realistic evaluation framework and a mixed methods (MM) design are demonstrated. Methods/Design The design is based on a systemic approach to evaluation, taking into account the mechanisms, context and outcomes, as defined in realistic evaluation, adjusted to our own French context using an MM approach. The characteristics of the design are illustrated through the evaluation of a nationwide HP program in French primary schools designed to enhance children's social, emotional and physical health by improving teachers' HP practices and promoting a healthy school environment. An embedded MM design is used in which a qualitative data set plays a supportive, secondary role in a study based primarily on a different quantitative data set. The way the qualitative and quantitative approaches are combined through the entire evaluation framework is detailed. Discussion This study is a contribution towards the development of suitable approaches for evaluating HP programs in schools. The systemic approach of the evaluation carried out in this research is appropriate since it takes account of the limitations of traditional evaluation approaches and considers suggestions made by the HP research community. PMID:20109202

MINERGY CORPORATION GLASS FURNACE TECHNOLOGY EVALUATION: INNOVATION TECHNOLOGY EVALUATION REPORT

Science.gov (United States)

This report presents performance and economic data for a U.S. Environmental Protection Agency (EPA) Superfund Innovative Technology Evaluation (SITE) Program demonstration of the Minergy Corporation (Minergy) Glass Furnace Technology (GFT). The demonstration evaluated the techno...

Evaluation in Context

DEFF Research Database (Denmark)

Jaap, Kamps; Lalmas, Mounia; Larsen, Birger

All search happens in a particular context - such as the particular collection of a digital library, its associated search tasks, and its associated users. Information retrieval researchers usually agree on the importance of context, but they rarely address the issue. In particular, evaluation in......, e.g. those that suit a particular task scenario, and zoom in on the relative performance for such a group of topics.......All search happens in a particular context - such as the particular collection of a digital library, its associated search tasks, and its associated users. Information retrieval researchers usually agree on the importance of context, but they rarely address the issue. In particular, evaluation....../assessors - by designing targeted questionnaires. The questionnaire data becomes part of the evaluation test-suite as valuable data on the context of the search requests.We have experimented with this questionnaire approach during the evaluation campaign of the INitiative for the Evaluation of XML Retrieval (INEX...

Radiological evaluation of tumor response in oncological studies (tumor response evaluation)

International Nuclear Information System (INIS)

Gebauer, B.; Riess, H.

2011-01-01

Purpose: Radiological-morphological response evaluation plays a major role in oncological therapy and studies for approval. Specific criteria have been developed for some tumor entities and chemotherapeutics. Application, limitations and definitions of the most frequently used criteria for tumor response evaluation will be presented. Materials and Methods: Review based on a selective literature research. Results: In clinical oncological therapy studies, WHO and RECIST are the most frequently used criteria to evaluate morphological therapy response. RECIST criteria have been modified recently, especially with respect to the evaluation of lymph nodes, and were published as RECIST 1.1 in 2009. All criteria were originally developed and defined to review clinical multicenter trials for approval. Using these criteria in a clinical situation, certain limitations have to be considered. To evaluate response, a baseline scan before therapy start is mandatory. Special tumor response criteria have been defined for some certain tumor entities. Oncologists and radiologists should define in advance which criteria are used before starting therapy. Conclusion: The use of defined criteria is very important in oncology response evaluation. In-depth knowledge of the criteria and their limits is required for correct usage. (orig.)

Practice-centred evaluation and the privileging of care in health information technology evaluation.

Science.gov (United States)

Darking, Mary; Anson, Rachel; Bravo, Ferdinand; Davis, Julie; Flowers, Steve; Gillingham, Emma; Goldberg, Lawrence; Helliwell, Paul; Henwood, Flis; Hudson, Claire; Latimer, Simon; Lowes, Paul; Stirling, Ian

2014-06-05

Our contribution, drawn from our experience of the case study provided, is a protocol for practice-centred, participative evaluation of technology in the clinical setting that privileges care. In this context 'practice-centred' evaluation acts as a scalable, coordinating framework for evaluation that recognises health information technology supported care as an achievement that is contingent and ongoing. We argue that if complex programmes of technology-enabled service innovation are understood in terms of their contribution to patient care and supported by participative, capability-building evaluation methodologies, conditions are created for practitioners and patients to realise the potential of technologies and make substantive contributions to the evidence base underpinning health innovation programmes. Electronic Patient Records (EPRs) and telemedicine are positioned by policymakers as health information technologies that are integral to achieving improved clinical outcomes and efficiency savings. However, evaluating the extent to which these aims are met poses distinct evaluation challenges, particularly where clinical and cost outcomes form the sole focus of evaluation design. We propose that a practice-centred approach to evaluation - in which those whose day-to-day care practice is altered (or not) by the introduction of new technologies are placed at the centre of evaluation efforts - can complement and in some instances offer advantages over, outcome-centric evaluation models. We carried out a regional programme of innovation in renal services where a participative approach was taken to the introduction of new technologies, including: a regional EPR system and a system to support video clinics. An 'action learning' approach was taken to procurement, pre-implementation planning, implementation, ongoing development and evaluation. Participants included clinicians, technology specialists, patients and external academic researchers. Whilst undergoing these

Evaluation Use: Results from a Survey of U.S. American Evaluation Association Members

Science.gov (United States)

Fleischer, Dreolin N.; Christie, Christina A.

2009-01-01

This paper presents the results of a cross-sectional survey on evaluation use completed by 1,140 U.S. American Evaluation Association members. This study had three foci: evaluators' current attitudes, perceptions, and experiences related to evaluation use theory and practice, how these data are similar to those reported in a previous study…

Evaluating the future of HCI: challenges for the evaluation of emerging applications

NARCIS (Netherlands)

Poppe, Ronald Walter; Rienks, R.J.

2007-01-01

Current evaluation methods are inappropriate for emerging HCI applications. In this paper, we give three examples of these applications and show that traditional evaluation methods fail. We identify trends in HCI development and discuss the issues that arise with evaluation. We aim at achieving

Evaluating the Future of HCI : Challenges for the Evaluation of Emerging Applications

NARCIS (Netherlands)

Poppe, Ronald Walter; Rienks, R.J.; van Dijk, Elisabeth M.A.G.; Huang, T.S; Nijholt, Antinus; Pantic, Maja; Pentland, A.

2007-01-01

Current evaluation methods are inappropriate for emerging HCI applications. In this paper, we give three examples of these applications and show that traditional evaluation methods fail. We identify trends in HCI development and discuss the issues that arise with evaluation. We aim at achieving

ADMS Evaluation Platform

Energy Technology Data Exchange (ETDEWEB)

2018-01-23

Deploying an ADMS or looking to optimize its value? NREL offers a low-cost, low-risk evaluation platform for assessing ADMS performance. The National Renewable Energy Laboratory (NREL) has developed a vendor-neutral advanced distribution management system (ADMS) evaluation platform and is expanding its capabilities. The platform uses actual grid-scale hardware, large-scale distribution system models, and advanced visualization to simulate realworld conditions for the most accurate ADMS evaluation and experimentation.

Where Local and National Evaluators Meet: Unintended Threats to Ethical Evaluation Practice

Science.gov (United States)

Rodi, Michael S.; Paget, Kathleen D.

2007-01-01

The ethical work of program evaluators is based on a covenant of honesty and transparency among stakeholders. Yet even under the most favorable evaluation conditions, threats to ethical standards exist and muddle that covenant. Unfortunately, ethical issues associated with different evaluation structures and contracting arrangements have received…

Airborne Evaluation Facility

Data.gov (United States)

Federal Laboratory Consortium — AFRL's Airborne Evaluation Facility (AEF) utilizes Air Force Aero Club resources to conduct test and evaluation of a variety of equipment and concepts. Twin engine...

Fission product yield evaluation for the USA evaluated nuclear data files

International Nuclear Information System (INIS)

Rider, B.F.; England, T.R.

1994-01-01

An evaluated set of fission product yields for use in calculation of decay heat curves with improved accuracy has been prepared. These evaluated yields are based on all known experimental data through 1992. Unmeasured fission product yields are calculated from charge distribution, pairing effects, and isomeric state models developed at Los Alamos National Laboratory. The current evaluation has been distributed as the ENDF/B-VI fission product yield data set

Evaluation as institution: a contractarian argument for needs-based economic evaluation.

Science.gov (United States)

Rogowski, Wolf H

2018-06-13

There is a gap between health economic evaluation methods and the value judgments of coverage decision makers, at least in Germany. Measuring preference satisfaction has been claimed to be inappropriate for allocating health care resources, e.g. because it disregards medical need. The existing methods oriented at medical need have been claimed to disregard non-consequentialist fairness concerns. The aim of this article is to propose a new, contractarian argument for justifying needs-based economic evaluation. It is based on consent rather than maximization of some impersonal unit of value to accommodate the fairness concerns. This conceptual paper draws upon contractarian ethics and constitution economics to show how economic evaluation can be viewed as an institution to overcome societal conflicts in the allocation of scarce health care resources. For this, the problem of allocating scarce health care resources in a society is reconstructed as a social dilemma. Both disadvantaged patients and affluent healthy individuals can be argued to share interests in a societal contract to provide technologies which ameliorate medical need, based on progressive funding. The use of needs-based economic evaluation methods for coverage determination can be interpreted as institutions for conflict resolution as far as they use consented criteria to ensure the social contract's sustainability and avoid implicit rationing or unaffordable contribution rates. This justifies the use of needs-based evaluation methods by Pareto-superiority and consent (rather than by some needs-based value function per se). The view of economic evaluation presented here may help account for fairness concerns in the further development of evaluation methods. This is because it directs the attention away from determining some unit of value to be maximized towards determining those persons who are most likely not to consent and meeting their concerns. Following this direction in methods development is

Systematic evaluation program. Status report and initial evaluation

International Nuclear Information System (INIS)

1983-06-01

The MHB Ongoing Systematic Evaluation Program (SEP) Assessment Study was initiated by the Swedish Nuclear Power Inspectorate (SKI) in 1980. This MHB report is a status report and initial evaluation of SEP. The methodology and results of SEP are disscused with particular emphasis on the first two SEP plant reviews - the Palisades and R.E. Ginna nuclear power plants. The comments of cognizant persons in the NRC and the ACRS, as well as private consultants, are included herein. MHBs major findings are as follows: The SEP plant review methodology was acceptable to the NRC Commissioners, the ACRS, and the NRC Staffs consultants who evaluated the first two SEP plant reviews. A concern raised by all who commented on SEP was the absence of Three Mile Island Action Plan Items and Unresolved Safety Issues from current SEP reviews. The SEP reviews of the Palisades and R.E. Ginna plants concluded that the two plant designs were adequate with respect to a majority of safety topics. Several topics remain unresolved in both the Palisades and R.E. Ginna SEP reviews. In the case of the Ginna plant, several related topics have been grouped together in a major structural reevaluation study. In general, due to the number of unresolved and excluded topics, SEP has not at this time produced a plant safety evaluation which can be considered complete and integrated. (author)

Navigating Theory and Practice through Evaluation Fieldwork: Experiences of Novice Evaluation Practitioners

Science.gov (United States)

Chouinard, Jill Anne; Boyce, Ayesha S.; Hicks, Juanita; Jones, Jennie; Long, Justin; Pitts, Robyn; Stockdale, Myrah

2017-01-01

To explore the relationship between theory and practice in evaluation, we focus on the perspectives and experiences of student evaluators, as they move from the classroom to an engagement with the social, political, and cultural dynamics of evaluation in the field. Through reflective journals, postcourse interviews, and facilitated group…

Is evaluating complementary and alternative medicine equivalent to evaluating the absurd?

Science.gov (United States)

Greasley, Pete

2010-06-01

Complementary and alternative therapies such as reflexology and acupuncture have been the subject of numerous evaluations, clinical trials, and systematic reviews, yet the empirical evidence in support of their efficacy remains equivocal. The empirical evaluation of a therapy would normally assume a plausible rationale regarding the mechanism of action. However, examination of the historical background and underlying principles for reflexology, iridology, acupuncture, auricular acupuncture, and some herbal medicines, reveals a rationale founded on the principle of analogical correspondences, which is a common basis for magical thinking and pseudoscientific beliefs such as astrology and chiromancy. Where this is the case, it is suggested that subjecting these therapies to empirical evaluation may be tantamount to evaluating the absurd.

Evaluation matters: lessons learned on the evaluation of surgical teaching.

Science.gov (United States)

Woods, Nicole N

2011-01-01

The traditional system of academic promotion and tenure can make it difficult to reward those who excel at surgical teaching. A successful faculty evaluation process can provide the objective measures of teaching performance needed for performance appraisals and promotion decisions. Over the course of two decades, an extensive faculty evaluation process has been developed in the Department of Surgery at the University of Toronto. This paper presents some of the non-psychometric characteristics of that system. Faculty awareness of the evaluation process, the consistency of its application, trainee anonymity and the materiality of the results are described key factors of a faculty evaluation system that meets the assessment needs of individual teachers and raises the profile of teaching in surgical departments. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Study on team evaluation. Team process model for team evaluation

International Nuclear Information System (INIS)

Sasou Kunihide; Ebisu, Mitsuhiro; Hirose, Ayako

2004-01-01

Several studies have been done to evaluate or improve team performance in nuclear and aviation industries. Crew resource management is the typical example. In addition, team evaluation recently gathers interests in other teams of lawyers, medical staff, accountants, psychiatrics, executive, etc. However, the most evaluation methods focus on the results of team behavior that can be observed through training or actual business situations. What is expected team is not only resolving problems but also training younger members being destined to lead the next generation. Therefore, the authors set the final goal of this study establishing a series of methods to evaluate and improve teams inclusively such as decision making, motivation, staffing, etc. As the first step, this study develops team process model describing viewpoints for the evaluation. The team process is defined as some kinds of power that activate or inactivate competency of individuals that is the components of team's competency. To find the team process, the authors discussed the merits of team behavior with the experienced training instructors and shift supervisors of nuclear/thermal power plants. The discussion finds four team merits and many components to realize those team merits. Classifying those components into eight groups of team processes such as 'Orientation', 'Decision Making', 'Power and Responsibility', 'Workload Management', 'Professional Trust', 'Motivation', 'Training' and 'staffing', the authors propose Team Process Model with two to four sub processes in each team process. In the future, the authors will develop methods to evaluate some of the team processes for nuclear/thermal power plant operation teams. (author)

STRUCTURED CLINICAL EVALUATION

Directory of Open Access Journals (Sweden)

Arabela Maria Barbosa Sampaio

2014-05-01

Full Text Available In a world experiencing profound technological and socio-political changes in areas of knowledge and capacity, healthcare can not remain static. A new kind of professional is required, whose practice is based on ethics, scientific standards, integrity, citizenship, and health promotion, who develops skills beyond healthcare, such as decision making, communication,leadership, management, and continuing education. No single method can assess all of these elements (knowledge, skills, and attitudes, and only a combination of methods is able to produce a valid evaluation. An alternative method exists: structured clinical assessments based on observation of "to do, or how to do" that aim to complete this evaluation by focusing attention on the performance of specific skills. In order to broaden the scope of evaluation methods that have been used in health education, this article, a literature review, intends to offer readers an overview of the diverse types of structured clinical evaluation, emphasizing Objective Structured Clinical Examination, the most widely used in Brazil, with a goal of advancing opportunities for health professionals to make use of this evaluative tool.

Evaluating a federated medical search engine: tailoring the methodology and reporting the evaluation outcomes.

Science.gov (United States)

Saparova, D; Belden, J; Williams, J; Richardson, B; Schuster, K

2014-01-01

Federated medical search engines are health information systems that provide a single access point to different types of information. Their efficiency as clinical decision support tools has been demonstrated through numerous evaluations. Despite their rigor, very few of these studies report holistic evaluations of medical search engines and even fewer base their evaluations on existing evaluation frameworks. To evaluate a federated medical search engine, MedSocket, for its potential net benefits in an established clinical setting. This study applied the Human, Organization, and Technology (HOT-fit) evaluation framework in order to evaluate MedSocket. The hierarchical structure of the HOT-factors allowed for identification of a combination of efficiency metrics. Human fit was evaluated through user satisfaction and patterns of system use; technology fit was evaluated through the measurements of time-on-task and the accuracy of the found answers; and organization fit was evaluated from the perspective of system fit to the existing organizational structure. Evaluations produced mixed results and suggested several opportunities for system improvement. On average, participants were satisfied with MedSocket searches and confident in the accuracy of retrieved answers. However, MedSocket did not meet participants' expectations in terms of download speed, access to information, and relevance of the search results. These mixed results made it necessary to conclude that in the case of MedSocket, technology fit had a significant influence on the human and organization fit. Hence, improving technological capabilities of the system is critical before its net benefits can become noticeable. The HOT-fit evaluation framework was instrumental in tailoring the methodology for conducting a comprehensive evaluation of the search engine. Such multidimensional evaluation of the search engine resulted in recommendations for system improvement.

Smartphone-based evaluations of clinical placements—a useful complement to web-based evaluation tools

Directory of Open Access Journals (Sweden)

Jesper Hessius

2015-11-01

Full Text Available Purpose: Web-based questionnaires are currently the standard method for course evaluations. The high rate of smartphone adoption in Sweden makes possible a range of new uses, including course evaluation. This study examines the potential advantages and disadvantages of using a smartphone app as a complement to web-based course evaluationsystems. Methods: An iPhone app for course evaluations was developed and interfaced to an existing web-based tool. Evaluations submitted using the app were compared with those submitted using the web between August 2012 and June 2013, at the Faculty of Medicine at Uppsala University, Sweden. Results: At the time of the study, 49% of the students were judged to own iPhones. Over the course of the study, 3,340 evaluations were submitted, of which 22.8% were submitted using the app. The median of mean scores in the submitted evaluations was 4.50 for the app (with an interquartile range of 3.70-5.20 and 4.60 (3.70-5.20 for the web (P=0.24. The proportion of evaluations that included a free-text comment was 50.5% for the app and 49.9% for the web (P=0.80. Conclusion: An app introduced as a complement to a web-based course evaluation system met with rapid adoption. We found no difference in the frequency of free-text comments or in the evaluation scores. Apps appear to be promising tools for course evaluations. web-based course evaluation system met with rapid adoption. We found no difference in the frequency of free-text comments or in the evaluation scores. Apps appear to be promising tools for course evaluations.

Smartphone-based evaluations of clinical placements-a useful complement to web-based evaluation tools.

Science.gov (United States)

Hessius, Jesper; Johansson, Jakob

2015-01-01

Web-based questionnaires are currently the standard method for course evaluations. The high rate of smartphone adoption in Sweden makes possible a range of new uses, including course evaluation. This study examines the potential advantages and disadvantages of using a smartphone app as a complement to web-based course evaluationsystems. An iPhone app for course evaluations was developed and interfaced to an existing web-based tool. Evaluations submitted using the app were compared with those submitted using the web between August 2012 and June 2013, at the Faculty of Medicine at Uppsala University, Sweden. At the time of the study, 49% of the students were judged to own iPhones. Over the course of the study, 3,340 evaluations were submitted, of which 22.8% were submitted using the app. The median of mean scores in the submitted evaluations was 4.50 for the app (with an interquartile range of 3.70-5.20) and 4.60 (3.70-5.20) for the web (P=0.24). The proportion of evaluations that included a free-text comment was 50.5% for the app and 49.9% for the web (P=0.80). An app introduced as a complement to a web-based course evaluation system met with rapid adoption. We found no difference in the frequency of free-text comments or in the evaluation scores. Apps appear to be promising tools for course evaluations. web-based course evaluation system met with rapid adoption. We found no difference in the frequency of free-text comments or in the evaluation scores. Apps appear to be promising tools for course evaluations.

Covariance evaluation system

International Nuclear Information System (INIS)

Kawano, Toshihiko; Shibata, Keiichi.

1997-09-01

A covariance evaluation system for the evaluated nuclear data library was established. The parameter estimation method and the least squares method with a spline function are used to generate the covariance data. Uncertainties of nuclear reaction model parameters are estimated from experimental data uncertainties, then the covariance of the evaluated cross sections is calculated by means of error propagation. Computer programs ELIESE-3, EGNASH4, ECIS, and CASTHY are used. Covariances of 238 U reaction cross sections were calculated with this system. (author)

The DLESE Evaluation Toolkit Project

Science.gov (United States)

Buhr, S. M.; Barker, L. J.; Marlino, M.

2002-12-01

The Evaluation Toolkit and Community project is a new Digital Library for Earth System Education (DLESE) collection designed to raise awareness of project evaluation within the geoscience education community, and to enable principal investigators, teachers, and evaluators to implement project evaluation more readily. This new resource is grounded in the needs of geoscience educators, and will provide a virtual home for a geoscience education evaluation community. The goals of the project are to 1) provide a robust collection of evaluation resources useful for Earth systems educators, 2) establish a forum and community for evaluation dialogue within DLESE, and 3) disseminate the resources through the DLESE infrastructure and through professional society workshops and proceedings. Collaboration and expertise in education, geoscience and evaluation are necessary if we are to conduct the best possible geoscience education. The Toolkit allows users to engage in evaluation at whichever level best suits their needs, get more evaluation professional development if desired, and access the expertise of other segments of the community. To date, a test web site has been built and populated, initial community feedback from the DLESE and broader community is being garnered, and we have begun to heighten awareness of geoscience education evaluation within our community. The web site contains features that allow users to access professional development about evaluation, search and find evaluation resources, submit resources, find or offer evaluation services, sign up for upcoming workshops, take the user survey, and submit calendar items. The evaluation resource matrix currently contains resources that have met our initial review. The resources are currently organized by type; they will become searchable on multiple dimensions of project type, audience, objectives and evaluation resource type as efforts to develop a collection-specific search engine mature. The peer review

Which Way Is Better for Teacher Evaluation? The Discourse on Teacher Evaluation in Taiwan

Science.gov (United States)

Wang, Juei-Hsin; Chen, Yen-Ting

2016-01-01

There are no summative evaluations for compulsory and basic education in Taiwan. This research discusses and analyzes present teacher evaluation implementation. The implementation of policy nowadays means "Teacher evaluation for professional development". Teacher evaluation for professional development is a voluntary growing project of…

Evaluation Guide for the Evaluated Spent Nuclear Fuel Assay Database (SFCOMPO)

International Nuclear Information System (INIS)

Ortego, P.; Boulanger, D.; Gauld, I.; Gysemans, M.; Hennebach, M.; Mennerdahl, D.; Neuber, J.C.; Tore, C.; Tittelbach, S.; Van Winckel, S.; Zwicky, H.-U.

2016-01-01

The Expert Group on Assay Data for Spent Nuclear Fuel (EGADSNF) of the Working Party on Nuclear Criticality Safety (WPNCS) under the auspices of the NEA Nuclear Science Committee was set up in 2007 with the objective of compiling and evaluating experimental data on the nuclide compositions of irradiated nuclear fuel. Experimental data refer not only to the measured nuclide inventories and uncertainties as determined mainly by destructive radiochemical assay of spent fuel samples, but also the fuel assembly design data, reactor design information, and operating data necessary to develop benchmark models. These data provide an important basis for validating calculation methods (computer codes and nuclear data) used in fuel burn-up analyses applied to spent fuel criticality safety analyses using burnup credit, thermal analysis, radiation shielding, accident dose consequence analysis, fuel cycle safety, reprocessing, and deep geological repository safety studies. The quality and usefulness of the experimental data for methods validation can be improved by developing complete descriptions of the experiments, providing benchmark specifications, and by performing independent evaluations of the experimental and benchmark data. Evaluations of the experimental data have been identified as an important task to verify the quality of the information in the spent fuel composition (SFCOMPO) database maintained by the Nuclear Energy Agency (NEA) Data Bank. This guide defines the evaluation document format and data review procedures for evaluators tasked with reviewing the experimental data. Guidance is developed to provide recommended procedures and criteria developed by experts in the field on how to perform standardised reviews, how to identify potential problems in the measurement data and gaps in the experimental description, and provide guidance on how to resolve these issues, when possible, using a consistent technical basis. Procedures for deriving benchmark data and models

Age Differences in Voice Evaluation: From Auditory-Perceptual Evaluation to Social Interactions

Science.gov (United States)

Lortie, Catherine L.; Deschamps, Isabelle; Guitton, Matthieu J.; Tremblay, Pascale

2018-01-01

Purpose: The factors that influence the evaluation of voice in adulthood, as well as the consequences of such evaluation on social interactions, are not well understood. Here, we examined the effect of listeners' age and the effect of talker age, sex, and smoking status on the auditory-perceptual evaluation of voice, voice-related psychosocial…

Definitions of Evaluation Use and Misuse, Evaluation Influence, and Factors Affecting Use

Science.gov (United States)

Alkin, Marvin C.; King, Jean A.

2017-01-01

The second article in this series on the history of evaluation use has three sections. The first and longest develops a functional definition of the term "use," noting that a thorough definition of evaluation use includes the initial stimulus (i.e., evaluation findings or process), the user, the way people use the information, the aspect…

Type-Directed Partial Evaluation

DEFF Research Database (Denmark)

Danvy, Olivier

1998-01-01

Type-directed partial evaluation uses a normalization function to achieve partial evaluation. These lecture notes review its background, foundations, practice, and applications. Of specific interest is the modular technique of offline and online type-directed partial evaluation in Standard ML...