Survival period after tube feeding in bedridden older patients.

Science.gov (United States)

Kosaka, Yoichi; Nakagawa-Satoh, Takuma; Ohrui, Takashi; Fujii, Masahiko; Arai, Hiroyuki; Sasaki, Hidetada

2012-04-01

We prospectively studied survival periods after tube feeding. Participants were 163 bedridden older patients suffering from dysphagia. A wide range of survival periods after tube feeding were observed within half a year without tube feeding after being bedridden. After this initial period, survival periods after tube feeding were limited to approximately half a year. Survival periods after tube feeding were positively proportional to the length of time patients were free from pneumonia after tube feeding. After tube feeding, patients died from pneumonia within half a year, and the frequency of pneumonia was 3.1 ± 2.7 times (mean ± SD) before death. Survival periods after tube feeding for less than 1 year were primarily determined by being bedridden for more than half a year without tube feeding and once pneumonia occurred; patients who were tube fed did not survive for more than half a year. © 2012 Japan Geriatrics Society.

Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube

Directory of Open Access Journals (Sweden)

Narjis AL Saif

2015-01-01

Full Text Available Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

Development, prevention, and treatment of feeding tube dependency.

Science.gov (United States)

Krom, Hilde; de Winter, J Peter; Kindermann, Angelika

2017-06-01

Enteral nutrition is effective in ensuring nutritional requirements and growth. However, when tube feeding lasts for a longer period, it can lead to tube dependency in the absence of medical reasons for continuation of tube feeding. Tube-dependent children are unable or refuse to start oral activities and they lack oral skills. Tube dependency has health-, psychosocial-, and economy-related consequences. Therefore, the transition to oral feeding is of great importance. However, this transition can be very difficult and needs a multidisciplinary approach. Most studies for treatment of tube dependency are based on behavioral interventions, such as family therapy, individual behavior therapy, neuro-linguistic programming, and parental anxiety reduction. Furthermore, oral motor therapy and nutritional adjustments can be helpful in tube weaning. The use of medication has been described in the literature. Although mostly chosen as the last resort, hunger-inducing methods, such as the Graz-model and the Dutch clinical hunger provocation program, are also successful in weaning children off tube feeding. The transition from tube to oral feeding is important in tube-dependent children but can be difficult. We present an overview for the prevention and treatment of tube dependency. What is known: • Longer periods of tube feeding can lead to tube dependency. • Tube weaning can be very difficult. What is new: • Weaning as soon as possible and therefore referral to a multidisciplinary team are recommended. • An overview of treatment options for tube dependency is presented in this article.

Otological Findings Ten Years after Myringotomy with Tympanostomy Tube Insertion

Directory of Open Access Journals (Sweden)

Ali Goljanian Tabrizi

2011-01-01

Full Text Available Introduction: To study the long-term complications of tympanostomy tube insertion in young children 10 years after surgery.   Materials and Methods: In September 2011, the medical records of all patients who had undergone myringotomy with tympanostomy tube insertion between February 2000 and March 2001 at the two general hospitals of Isfahan University of Medical Sciences were studied. Of the 98 patients who fulfilled the inclusion criteria, 82 patients agreed to participate and were enrolled in the study. The complications of the operation were evaluated in these patients.   Results: Of the 164 ears that were operated on, myringosclerosis was found in 17.1%, atrophy of the tympanic membrane in 1.2%, permanent perforation of the tympanic membrane in 0.6% and tympanic membrane atelectasis in 0.6%. None of the patients developed cholesteatoma as a complication of tympanostomy tube insertion.   Conclusion:  Considering the low risk of serious complications after 10 years, tympanostomy tube insertion is a safe and effective treatment option in the treatment of otitis media with effusion.

Guide tube insert assembly for use in a nuclear reactor

International Nuclear Information System (INIS)

Hopkins, R.J.; Land, J.T.

1992-01-01

This patent describes an internals assembly for a nuclear reactor of the type including an upper support plate and an upper core plate, each having apertures for conducting control rod assemblies into an out of fuel assemblies with the apertures of the upper support plate being aligned with the apertures of the upper core plate, a guide tube insert assembly comprising: an elongated tubular body extending between at least one of the aligned apertures formed in the upper support plate and the upper core plate; guide plates within the elongated tubular body, each of the guide plates having a planar surface extending substantially perpendicular to an axial direction of the tubular body; at least one interconnecting means for interconnecting the guide plates into a guide tube insert assembly such that the guide plates are simultaneously mountable within and removable from the elongated body, and the periphery of each of the guide plates is spaced apart from the inner walls of the elongated tubular body at every point when the insert assembly is mounted within the tubular body, and a stabilizing means for securing the lowermost guide plate of the guide tube insert assembly within the elongated tubular body to prevent rotational and lateral movement between the guide tube insert assembly and the tubular body

[Effects of slow twisting needle insertion and tubing needle insertion at Neiguan (PC 6) on cardiovascular function: a comparative study].

Science.gov (United States)

Ning, Shaoli; Zhao, Lihua; Xu, Lingjun; Huang, Yu; Pang, Yong; Huang, Dingjian

2016-01-01

To compare the effects between slow twisting needle insertion and tubing needle insertion. With cross-over design, 100 healthy young subjects (half male and half female) aged from 19 to 23 years were randomly divided into two groups by random digital table, 50 cases in each one. At the first stage, subjects in the group A were treated with slow twisting needle insertion while, subjects in,the group B were treated with tubing needle insertion. One week later, the procedure of second stage was performed alternately. The needle was inserted into Neiguan (PC 6) with two methods by one acupuncturist. The needle was retained for 5 min before removal. Five min before needle insertion as well as needle withdrawal and 30 min after needle withdrawal, ZXG-E automatic cardiovascular diagnostic apparatus was used to test cardiovascular function. At the tim of needle withdrawal, slow twisting needle insertion could improve effect work of kinetics (EWK), effective blood volume (BV) and reduce elastic expansion coefficient of blood vessel (FEK) and left ventricular spray blood impedance (VER), which was significantly different from tubing needle insertion (all P 0.05). The slow twisting needle insertion is significantly superior to tubing needle insertion on lowering vascular tension and VER, improving EWK and BV.

Research on temperature control and influence of the vacuum tubes with inserted tubes solar heater

Science.gov (United States)

Xiao, L. X.; He, Y. T.; Hua, J. Q.

2017-11-01

A novel snake-shape vacuum tube with inserted tubes solar collector is designed in this paper, the heat transfer characteristics of the collector are analyzed according to its structural characteristics, and the influence of different working temperature on thermal characteristics of the collector is studied. The solar water heater prototype consisting of 14 vacuum tubes with inserted tubes is prepared, and the hot water storage control subsystem is designed by hysteresis comparison algorithm. The heat characteristic of the prototype was experimentally studied under hot water output temperature of 40-45°C, 50-55°C and 60-65°C. The daily thermal efficiency was 64%, 50% and 46%, respectively. The experimental results are basically consistent with the theoretical analysis.

The impact of HPV status on weight loss and feeding tube use in oropharyngeal carcinoma.

Science.gov (United States)

Vangelov, Belinda; Kotevski, Damian P; Williams, Janet R; Smee, Robert I

2018-04-01

It has been well established that patients with oropharyngeal carcinoma are at high nutritional risk, with significant weight loss and tube feeding common. Human papillomavirus (HPV)-associated disease has led to a change in the "typical" presentation and nutritional profile of this population. The aim of our study was to determine whether the need for a feeding tube, and weight loss during radiotherapy (RT) in patients with oropharyngeal carcinoma differed with HPV status. Patients who received curative RT ± chemotherapy from January 2011 to January 2016 were included (n = 100). We retrospectively evaluated feeding tube use and timing of insertion (prophylactic vs reactive), percentage weight loss during RT and the prevalence of critical weight loss (CWL) ≥5%. HPV-positive patients had significantly higher weight loss during RT compared to the rest of the cohort (8.4% vs 6.1%, 95%CI 0.8-3.9, p = 0.003). CWL was observed in 86% and in a higher proportion with HPV-positive disease (93%, p = 0.011). Conditional probability modelling analysis revealed, with 74% accuracy, concurrent chemoradiotherapy and HPV-positive status were predictors of CWL when comparing HPV-positive patients to HPV-negative (96%, p = 0.001 and 98%, p = 0.012 respectively). More HPV-positive patients required feeding tubes (n = 43, 63%, p = 0.05), most being reactive (n = 27, 63%). All patients with reactive tubes experienced CWL. The high incidence of CWL in patients with HPV-positive oropharyngeal carcinoma is of concern. Tube feeding continues to be a necessary nutritional intervention in this population and predicting who will require a tube is challenging. Larger, prospective cohort studies are required. Copyright © 2018 Elsevier Ltd. All rights reserved.

A very feasible alternative in patients with feeding difficulties from gastrostomy: Jejunal tube advanced through the gastrostomy

Directory of Open Access Journals (Sweden)

Ramazan Karabulut

2015-01-01

Full Text Available Background: Our aim is to share our experiences regarding patients who cannot be fed effectively through the gastrostomy tube, but were inserted feeding jejunostomy through the gastrostomy orifice using scopic fluoroscopic techniques utilised by the interventional radiology. Patients and Methods: Between January 2010 and May 2013 the patients that were inserted jejunostomy tube through the gastrostomy orifice using fluoroscopic techniques were retrospectively analysed. Data including primary indication for gastrostomy, sex, concomitant disease and the requirement for gastroesophageal reflux disease (GERD were all recorded. Results: There were five patients with these criteria. They all received either medical or surgical GERD therapy; nevertheless enteral feeding failed to reach an effective level, they all had vomiting and did not gain any weight. Following conversion, all the patients gained minimum 2 kg in 2-5 months; all the patients tolerated enteral feeding and were discharged in the early period. There were neither procedure related complications such as perforation, bleeding nor sedation related complications. Procedure took no more than 30 min as a whole. There was no need for surgical intervention. However in one patient re-intervention was required due to accidental removal of the catheter. Conclusions: In case of feeding difficulties following the gastrostomy; instead of an invasive surgical intervention; physicians should consider jejunal feeding that is advanced through the gastrostomy, which does not require any anaesthesia.

Conservative use of chest-tube insertion in children with pleural effusion.

Science.gov (United States)

Epaud, R; Aubertin, G; Larroquet, M; Pointe, H Ducou-le; Helardot, P; Clement, A; Fauroux, B

2006-04-01

The aim of this work was to evaluate the effect of a more conservative use of chest-tube insertion on the short-term and long-term outcome of pleural infection. Sixty-five patients with pleural infection, aged 1 month to 16 years were each treated according to one of the two protocols: classical management with chest-tube insertion (classical group, n = 33), or conservative use of chest-tube insertion (conservative group, n = 32), with drainage indicated only in the case of voluminous pleural effusion defined by a mediastinal shift and respiratory distress and/or an uncontrolled septic situation. The two groups were comparable with regard to age, baseline C-reactive protein (CRP) value and white blood cell counts, pleural thickness, identified bacteria, and antibiotic treatment. Chest-tube insertion was performed in 17 patients (52%) of the classical group compared to eight patients (25%) of the conservative group (P = 0.03). Duration of temperature above 39 degrees C was shorter in the conservative group (10 +/- 1 vs. 14 +/- 1 days, P = 0.01), as was the normalization of CRP (13 +/- 1 vs. 17 +/- 1 days, P = 0.03). Duration of hospitalization and intravenous (IV) antibiotherapy as well as the delay of chest-radiograph normalization was not significantly different between the two groups. A more conservative use of chest-tube insertion did not change short- and long-term outcome of the pleural infection in children. Drainage could be restricted to the most severely affected patients with pleural empyema causing a mediastinal shift and respiratory distress and/or presenting with an uncontrolled septic situation.

Testing Placement of Gastric Feeding Tubes in Infants.

Science.gov (United States)

Metheny, Norma A; Pawluszka, Ann; Lulic, Melanie; Hinyard, Leslie J; Meert, Kathleen L

2017-11-01

Inadvertent positioning of a nasogastric tube in the lung can cause serious complications, so identifying methods to detect improperly inserted tubes is imperative. To compare the sensitivity, specificity, and negative and positive predictive values of 4 pH cut points (< 4.0, < 4.5, < 5.0, and < 5.5) in differentiating gastric and tracheal aspirates under various treatment conditions and to explore the utility of a pepsin assay for distinguishing between gastric and tracheal aspirates. Gastric and tracheal aspirates were collected from critically ill infants undergoing mechanical ventilation who had nasogastric or orogastric feeding tubes. Aspirates were tested with colorimetric pH indicators and a rapid pepsin assay. Information about treatment conditions was obtained from medical records. Two hundred twelve gastric aspirates and 60 tracheal aspirates were collected from 212 patients. Sensitivity was highest and specificity was lowest at the gastric aspirate pH cut point of less than 5.5. Positive predictive values were 100% at all pH cut points less than 5.0. Negative predictive values were higher at the pH cut point of less than 5.0 than at cut points less than 4.5. A higher percentage of pepsin-positive readings was found in gastric aspirates (88.3%) than in tracheal aspirates (5.4%). For a desired positive predictive value of 100%, a pH cut point of less than 5.0 provides the best negative predictive values, regardless of gastric acid inhibitor administration and feeding status. The pepsin assay is promising as an additional marker to distinguish gastric from tracheal aspirates. ©2017 American Association of Critical-Care Nurses.

Gastrostomy tube feeding of children with cerebral palsy

DEFF Research Database (Denmark)

Dahlseng, Magnus O; Andersen, Guro L; DA Graca Andrada, Maria

2012-01-01

To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries.......To compare the prevalence of gastrostomy tube feeding (GTF) of children with cerebral palsy (CP) in six European countries....

[Long-term follow-up after tympanostomy tube insertion in children with serous otitis media].

Science.gov (United States)

Fekete-Szabó, Gabriella; Kiss, Fekete; Rovó, László

2015-11-15

The authors report about the efficacy of inserted tympanostomy tube in children with serous otitis media. The aim of the authors was to assess the status of eardrum, the function of Eustachian tube and hearing level 10 years after the use of tympanostomy tube. Patients filled out a questionnaire and microscopic examination of tympanic membrane, tympanometry, Eustachian tube function examination, and audiometry tests were performed. In the period of 2003-2004, ventilation tube insertion was performed in 711 patients in the ENT Department of Pediatric Health Center of University of Szeged. In 349 patients adenotomy and tympanostomy tube insertion, in 18 cases tonsillectomy and grommet insertion and in 344 patients only typmanostomy tube insertion were performed. Due to objective difficulties (address change, no phone number) 453 patients were asked for control test and 312 persons accepted the invitation. Normal hearing level was found in 84.6% of patients and normal tympanometry result occurred in 82%. Tympanic ventilation disorder, perforation of tympanic membrane, sensorineural hearing loss and sensorineural hearing loss due to noise exposure were diagnosed. Application of tympanostomy tube is effective in the treatment of serous otitis media resulting from ventilation disorder. The authors draw attention to the importance of tympanometry examination to prevent the adhesive processes and cholesteatoma in chronic ventilation disorder of the middle ear.

A Study on Thermal Performance of a Novel All-Glass Evacuated Tube Solar Collector Manifold Header with an Inserted Tube

Directory of Open Access Journals (Sweden)

Jichun Yang

2015-01-01

Full Text Available A novel all-glass evacuated tube collector manifold header with an inserted tube is proposed in this paper which makes water in all-glass evacuated solar collector tube be forced circulated to improve the performance of solar collector. And a dynamic numerical model was presented for the novel all-glass evacuated tube collector manifold header water heater system. Also, a test rig was built for model validation and comparison with traditional all-glass evacuated tube collector. The experiment results show that the efficiency of solar water heater with a novel collector manifold header is higher than traditional all-glass evacuated tube collector by about 5% and the heat transfer model of water heater system is valid. Based on the model, the relationship between the average temperature of water tank and inserted tube diameter (water mass flow has been studied. The results show that the optimized diameter of inserted tube is 32 mm for the inner glass with the diameter of 47 mm and the water flow mass should be less than 1.6 Kg/s.

Swirl flow analysis in a helical wire inserted tube using CFD code

International Nuclear Information System (INIS)

Park, Yusun; Chang, Soon Heung

2010-01-01

An analysis on the two-phase flow in a helical wire inserted tube using commercial CFD code, CFX11.0, was performed in bubbly flow and annular flow regions. The analysis method was validated with the experimental results of Takeshima. Bubbly and annular flows in a 10 mm inner diameter tube with varying pitch lengths and inserted wire diameters were simulated using the same analysis methods after validation. The geometry range of p/D was 1-4 and e/D was 0.08-0.12. The results show that the inserted wire with a larger diameter increased swirl flow generation. An increasing swirl flow was seen as the pitch length increased. Regarding pressure loss, smaller pitch lengths and inserted wires with larger diameters resulted in larger pressure loss. The average liquid film thickness increased as the pitch length and the diameter of the inserted wire increased in the annular flow region. Both in the bubbly flow and annular flow regions, the effect of pitch length on swirl flow generation and pressure loss was more significant than that of the inserted wire diameters. Pitch length is a more dominant factor than inserted wire diameter for the design of the swirl flow generator in small diameter tubes.

Thermohydraulic performance comparision of compound inserts for a turbulent flow through a circular tube

Directory of Open Access Journals (Sweden)

Kapse Arvind A.

2017-01-01

Full Text Available Heat transfer and pressure drop characteristics of three different passive inserts are experimentally investigated for individual and compound insertion. Insert cross-section is altered along the length of test section for compound insertion. Test runs were conducted in a concentric circular tube in tube heat exchanger in the Reynolds number range of 8000 to 32000 with water as a working fluid. Enhancements in Nusselt number and friction factors are reported to be in the range of 38-234% and 55-524%, respectively, over plain tube. The average performance ratios based on equal pumping power are also reported and found in the range of 0.63-1.53. Based on experimental results, optimum combination for compound insertion is proposed.

A novel method for improving chest tube insertion skills among medical interns

Science.gov (United States)

Tatli, Ozgur; Turkmen, Suha; Imamoglu, Melih; Karaca, Yunus; Cicek, Mustafa; Yadigaroglu, Metin; Bayrak, Selen T.; Asik, Olgun; Topbas, Murat; Turedi, Suleyman

2017-01-01

Objectives: To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42). Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand. PMID:28917064

Esophagojejunostomy Feeding Tube Placement in 5 Dogs with Pancreatitis and Anorexia

Directory of Open Access Journals (Sweden)

Forrest Cummings

2014-01-01

Full Text Available Enteral feeding tube placement has been described in veterinary medicine for several years. Indications include oral, esophageal, gastrointestinal, pancreatic, hepatic, and neurologic diseases. In this paper, endoscopically assisted placement of an esophagojejunostomy (EJ feeding tube in dogs with pancreatitis and prolonged anorexia is described. To the author’s knowledge there are no published reports of this procedure. Esophagojejunostomy feeding tubes provide an alternative to other forms of postgastric feeding tube placement (e.g., nasojejunal, gastrojejunostomy, and jejunostomy tubes without the associated complications of patient discomfort, sneezing, epistaxis, and peritonitis. Tube occlusion, transient vomiting and loose stool were the most commonly reported complications.

Development of a nasogastric tube insertion simulator: a collaborative interdisciplinary effort.

Science.gov (United States)

Summer, Lindsay; Gonzalez, Laura; Jimeno, Miguel; Christensen, Ken

2009-01-01

The nursing faculty shortage has created the need for more innovative and effective ways to better stimulate nursing students. Simulation technology is one way to increase the effectiveness of teaching faculty. In this article, a collaborative project between the College of Nursing and College of Engineering at the University of South Florida to develop and evaluate a PC-based software simulator based on videogame technologies for nursing skill acquisition is discussed. A software simulator for teaching and assessing mastery of the procedure for nasogastric tube insertion is described. The purpose of the simulator is to complement the standard training of nasogastric tube insertion that uses static mannequins and instruction/assessment by nursing instructors. The simulator was used in a fundamentals of nursing class at the University of South Florida, with 75 students enrolled. Evaluation showed that the simulator significantly increased the confidence of the students in their ability to perform nasogastric tube insertion.

Transition from tube feeding to oral feeding: experience in a tertiary care paediatric cardiology unit.

Science.gov (United States)

Shine, Anne Marie; Finn, Daragh Gerard; Allen, Noeleen; McMahon, Colin J

2018-05-02

Home enteral tube feeding (HETF) is imperative for many infants and children with congenital heart disease (CHD). Tube weaning (TW) facilitates the progression from tube feeding to oral diet. There is limited literature on TW practices, protocols and success for children with CHD that have been tube fed. The objective of this study is to assess the process of weaning HETF in a tertiary referral centre for paediatric CHD. Specifically, we aimed to assess the duration of HETF, duration of TW and the interventions involved. We retrospectively reviewed the medical and dietetic records of all infants and children that were successfully weaned off HETF over a 12-month period from January 2015 to December 2015. There were 30 children included in the study, 9 boys and 21 girls. The diagnoses included 15 septal defects, 8 univentricular diagnosis and other diagnoses in 7 children. The median age at initiation of enteral tube feeding was 45 days (range 2-169). The median duration to wean from enteral tube feeding was 52 days (range 2-359). Number of dietetic consults required for successful TW varied among patients, median 5 (range 2-23). The number of days required for successful TW was associated with age and duration on HETF. Dietetic interventions included discontinuation of nutrient dense feeds, altering feed schedule and reduction of feed volume. Weaning HETF is possible in the outpatient setting. Early and frequent dietetic intervention is recommended to ensure prompt discontinuation of HETF when appropriate.

[Intraoperative placement of transnasal small intestinal feeding tube during the surgery in 5 cases with high position intestinal obstruction and postoperative feeding].

Science.gov (United States)

Duan, Guang-qi; Zhang, Min; Guan, Xiao-hao; Yin, Zhi-qing

2012-09-01

To explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant. Five newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[ the State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged. All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper

Alternative method for predicting optimal insertion depth of the laryngeal tube in children.

Science.gov (United States)

Kim, J T; Jeon, S Y; Kim, C S; Kim, S D; Kim, H S

2007-11-01

Little information is available about the accuracy of the teeth mark on the laryngeal tube (LT) as a guide to correct placement in children. The aim of this crossover study was to evaluate three methods for optimal insertion depth of the size (#) 2 tube in children weighing 12-25 kg. In 24 children, the LT #2 was consecutively inserted by three different methods: (A) until the thick teeth mark on the tube was aligned with the upper incisors, (B) until resistance was felt, and (C) by inserting to a depth, previously measured, of the curved distance between the cricoid cartilage and the upper incisor. In each case, the depth of insertion, the degree of effective ventilation, the presence of leakage, and the fibreoptic view were assessed. Insertion based on the teeth mark led to a shorter insertion depth and a greater incidence of inadequate ventilation compared with the other two methods. There was no difference in the adequacy of ventilation between methods B and C. The vocal cords were more easily identified with methods B (62.5%) and C (75%) than with method A (12.5%). Insertion of the LT #2 aligned with the teeth mark can result in a shallow insertion depth and inadequate ventilation. The measured distance from the cricoid cartilage to the upper incisor offers alternative guidance for correct LT insertion.

The feeding tube of cyst nematodes: characterisation of protein exclusion.

Directory of Open Access Journals (Sweden)

Sebastian Eves-van den Akker

Full Text Available Plant parasitic nematodes comprise several groups; the most economically damaging of these are the sedentary endoparasites. Sedentary endoparasitic nematodes are obligate biotrophs and modify host root tissue, using a suite of effector proteins, to create a feeding site that is their sole source of nutrition. They feed by withdrawing host cell assimilate from the feeding site though a structure known as the feeding tube. The function, composition and molecular characteristics of feeding tubes are poorly characterised. It is hypothesised that the feeding tube facilitates uptake of host cell assimilate by acting as a molecular sieve. Several studies, using molecular mass as the sole indicator of protein size, have given contradictory results about the exclusion limits of the cyst nematode feeding tube. In this study we propose a method to predict protein size, based on protein database coordinates in silico. We tested the validity of these predictions using travelling wave ion mobility spectrometry--mass spectrometry, where predictions and measured values were within approximately 6%. We used the predictions, coupled with mass spectrometry, analytical ultracentrifugation and protein electrophoresis, to resolve previous conflicts and define the exclusion characteristics of the cyst nematode feeding tube. Heterogeneity was tested in the liquid, solid and gas phase to provide a comprehensive evaluation of three proteins of particular interest to feeding tube size exclusion, GFP, mRFP and Dual PI. The data and procedures described here could be applied to the design of plant expressed defence compounds intended for uptake into cyst nematodes. We also highlight the need to assess protein heterogeneity when creating novel fusion proteins.

The feeding tube of cyst nematodes: characterisation of protein exclusion.

Science.gov (United States)

Eves-van den Akker, Sebastian; Lilley, Catherine J; Ault, James R; Ashcroft, Alison E; Jones, John T; Urwin, Peter E

2014-01-01

Plant parasitic nematodes comprise several groups; the most economically damaging of these are the sedentary endoparasites. Sedentary endoparasitic nematodes are obligate biotrophs and modify host root tissue, using a suite of effector proteins, to create a feeding site that is their sole source of nutrition. They feed by withdrawing host cell assimilate from the feeding site though a structure known as the feeding tube. The function, composition and molecular characteristics of feeding tubes are poorly characterised. It is hypothesised that the feeding tube facilitates uptake of host cell assimilate by acting as a molecular sieve. Several studies, using molecular mass as the sole indicator of protein size, have given contradictory results about the exclusion limits of the cyst nematode feeding tube. In this study we propose a method to predict protein size, based on protein database coordinates in silico. We tested the validity of these predictions using travelling wave ion mobility spectrometry--mass spectrometry, where predictions and measured values were within approximately 6%. We used the predictions, coupled with mass spectrometry, analytical ultracentrifugation and protein electrophoresis, to resolve previous conflicts and define the exclusion characteristics of the cyst nematode feeding tube. Heterogeneity was tested in the liquid, solid and gas phase to provide a comprehensive evaluation of three proteins of particular interest to feeding tube size exclusion, GFP, mRFP and Dual PI. The data and procedures described here could be applied to the design of plant expressed defence compounds intended for uptake into cyst nematodes. We also highlight the need to assess protein heterogeneity when creating novel fusion proteins.

Clinical application of transnasal feeding tube placement under fluoroscopic guidance

International Nuclear Information System (INIS)

Ge Kunyuan; Ni Caifang; Liu Yizhi; Zhu Xiaoli; Zou Jianwei; Jin Yonghai; Chen Long; Sun Ge; Sun Lingfang; Zhang Dong

2008-01-01

Objective: To evaluate the feasibility and effectiveness of duodenal feeding tube placement under fluoroscopic guidance and its clinical application. Methods: The transnasal duodenal nutriment tubes placement under fluoroscopic guidance were performed in 59 patients from June 3th, 2003 to August 17th, 2007. The successful placement of the feeding tube was defined as that of the tube tip was fixed at or distal to the duodenojejunal junction. Results: 57 out of 59 patients were successfully managed by feeding tube placement, with primary successful rate of 96.6% (57/59). The remaining two failures were due to overdistention of the stomach and were further managed after gastrointestinal decompression thoroughly. The mean fluoroscopy time of the procedure was 17.8 minutes with no severe immediate or delayed complications. Conclusion: The transnasal duodenal nutrient feeding tube placement under fluoroscopic guidance is a safe,economic, and effective management for enteral nutrition, providing extensive clinical utilization. (authors)

Compounded Apixaban Suspensions for Enteral Feeding Tubes.

Science.gov (United States)

Caraballo, Maria L; Donmez, Seda; Nathan, Kobi; Zhao, Fang

2017-07-01

Objective: There is limited information on compounded apixaban formulations for administration via enteral feeding tubes. This study was designed to identify a suitable apixaban suspension formulation that is easy to prepare in a pharmacy setting, is compatible with commonly used feeding tubes, and has a beyond-use date of 7 days. Methods: Apixaban suspensions were prepared from commercially available 5-mg Eliquis tablets. Several vehicles and compounding methods were screened for ease of preparation, dosage accuracy, and tube compatibility. Two tubing types, polyurethane and polyvinyl chloride, with varying lengths and diameters, were included in the study. They were mounted on a peg board during evaluation to mimic the patient body position. A 7-day stability study of the selected formulation was also conducted. Results: Vehicles containing 40% to 60% Ora-Plus in water all exhibited satisfactory flowability through the tubes. The mortar/pestle compounding method was found to produce more accurate and consistent apixaban suspensions than the pill crusher or crushing syringe method. The selected formulation, 0.25 mg/mL apixaban in 50:50 Ora-Plus:water, was compatible with both tubing types, retaining >98% drug in posttube samples. The stability study also confirmed that this formulation was stable physically and chemically over 7 days of storage at room temperature. Conclusions: A suitable apixaban suspension formulation was identified for administration via enteral feeding tubes. The formulation consisted of 0.25 mg/mL apixaban in 50:50 Ora-Plus:water. The stability study results supported a beyond-use date of 7 days at room temperature.

Current microbiology of percutaneous endoscopic gastrostomy tube (PEG tube) insertion site infections in patients with cancer.

Science.gov (United States)

Rolston, Kenneth V I; Mihu, Coralia; Tarrand, Jeffrey J

2011-08-01

Percutaneous endoscopic gastrostomy (PEG) is frequently used to provide enteral access in cancer patients who are unable to swallow. Infection is an important complication in this setting. Current microbiological data are needed to guide infection prevention and treatment strategies. The microbiological records of our institution (a 550-bed comprehensive cancer center) were retrospectively reviewed over an 8-month study period in order to identify patients who developed PEG tube insertion site infections, and review their microbiological details and susceptibility/resistance data. Fifty-eight episodes of PEG tube insertion site infections were identified. Of these, 31 (53%) were monomicrobial, and the rest were polymicrobial. The most common organisms isolated were Candida species, Staphylococcus aureus, and Pseudomonas aeruginosa. All infections were local (cellulitis, complicated skin, and skin structure infections including abdominal wall abscess) with no cases of concomitant bacteremia being documented. Most of the organisms isolated were susceptible to commonly used antimicrobial agents, although some quinolone-resistant and some multidrug-resistant organisms were isolated. This retrospective study provides descriptive data regarding PEG tube insertion site infections. These data have helped us update institutional guidelines for infection prevention and treatment as part of our focus on antimicrobial stewardship.

An anthology of advances in enteral tube feeding formulations.

Science.gov (United States)

Campbell, Sheila M

2006-08-01

This article summarizes several major advances in tube feeding formulas marketed in the United States. It traces the progress in tube feeding formulas, starting with blenderized formulas to commercially available intact-nutrient formulas and culminating in the introduction of the concept of immunonutrition. The impact of packaging is also described.

Disc-retained tubes for radiologically inserted gastrostomy (RIG): Not up to the job?

International Nuclear Information System (INIS)

Kibriya, N.; Wilbraham, L.; Mullan, D.; Puro, P.; Vasileuskaya, S.; Edwards, D.W.; Laasch, H.-U.

2013-01-01

Aim: To assess the insertion procedure and performance of disc-retained gastrostomy tubes, recording complications and accidental displacements by prospective audit, and to determine whether primary placement of the tube off-licence was feasible. Materials and methods: Disc-retained 12 F single-lumen Monarch gastrostomy tubes (Enteral UK, Selby, UK) were inserted by three gastrointestinal interventional radiologists in a supra-regional cancer centre. The 12 F tubes required a 20 F peel-away sheath with four-point gastropexy fixation and were placed under conscious sedation, using electrocardiogram (EEG) bispectral index monitoring. Follow-up was performed in an in-house gastrostomy drop-in clinic at 1 week and 1 month, supplemented with weekly telephone follow-up. Patients also had open access to the gastrostomy drop-in clinic for immediate advice and complication management. Results: Eighteen patients underwent primary insertion of a Monarch gastrostomy tube over 5 months. A total of 6/18 (33%) tubes displaced; 4/18 (22%) completely, 2/18 (11%) occult into the peritoneum. Four of 18 (22%) patients developed infection at the stoma site. Due to the unexpectedly poor performance of the tube, the study was terminated early. Conclusion: Initial experience with the Monarch disc-retained gastrostomy tube demonstrates it unsuitable for primary placement with current protocols. In view of the potentially serious complications, the Medicines and Healthcare Products Regulatory Agency (MHRA) has been informed. A request has been made to the distributer to reassess the tube design and/or review the procedure promoted for primary placement

Heat transfer behaviors in round tube with conical ring inserts

International Nuclear Information System (INIS)

Promvonge, P.

2008-01-01

To increase convection heat transfer in a uniform heat flux tube by a passive method, several conical rings used as turbulators are mounted over the test tube. The effects of the conical ring turbulator inserts on the heat transfer rate and friction factor are experimentally investigated in the present work. Conical rings with three different diameter ratios of the ring to tube diameter (d/D = 0.5, 0.6, 0.7) are introduced in the tests, and for each ratio, the rings are placed with three different arrangements (converging conical ring, referred to as CR array, diverging conical ring, DR array and converging-diverging conical ring, CDR array). In the experiment, cold air at ambient condition for Reynolds numbers in a range of 6000-26,000 is passed through the uniform heat flux circular tube. It is found that the ring to tube diameter ratio and the ring arrays provide a significant effect on the thermal performance of the test tube. The experimental results demonstrate that the use of conical ring inserts leads to a higher heat transfer rate than that of the plain surface tube, and the DR array yields a better heat transfer than the others. The results are also correlated in the form of Nusselt number as a function of Reynolds number, Prandtl number and diameter ratio. An augmentation of up to 197%, 333%, and 237% in Nusselt number is obtained in the turbulent flow for the CR, DR and CDR arrays, respectively, although the effect of using the conical ring causes a substantial increase in friction factor

Cuff depth and continuous chest auscultation method for determination of tracheal tube insertion depth in nasal intubation: observational study.

Science.gov (United States)

Ouchi, Kentaro; Sugiyama, Kazuna

2016-04-01

Incorrect endobronchial placement of the tracheal tube can lead to serious complications. Hence, it is necessary to determine the accuracy of tracheal tube positioning. Markers are included on tracheal tubes, in the process of their manufacture, as indicators of approximate intubation depth. In addition, continuous chest auscultation has been used for determining the proper position of the tube. We examined insertion depth using the cuff depth and continuous chest auscultation method (CC method), compared with insertion depth determined by the marker method, to assess the accuracy of these methods. After induction of anesthesia, tracheal intubation was performed in each patient. In the CC method, the depth of tube insertion was measured when the cuff had passed through the glottis, and again when breath sounds changed in quality; the depth of tube insertion was determined from these values. In the marker method, the depth of tube insertion was measured and determined when the marker of the tube had reached the glottis, using insertion depth according to the marker as an index. Insertion depth by the marker method was 26.6 ± 1.2 cm and by the CC method was 28.0 ± 1.2 cm (P < 0.0001). The CC method indicated a significantly greater depth than the marker method. This study determined the safe range of tracheal tube placement. Tube positions determined by the CC method were about 1 cm deeper than those determined by the marker. This information is important to prevent accidental one-lung ventilation and accidental extubation. UMIN No. UMIN000011375.

The Feasibility and Outcome of Oro-esophageal Tube Feeding in Patients with Various Etiologies.

Science.gov (United States)

Kim, Juyong; Seo, Han Gil; Lee, Goo Joo; Han, Tai Ryoon; Oh, Byung-Mo

2015-12-01

The oro-esophageal tube (OE tube) is widely used in dysphagia patients although its success rate for transition to oral feeding is reported only in stroke patients. The aim of this study was to evaluate the feasibility and outcome of OE tube feeding for patients with dysphagia resulting from various etiologies. The authors reviewed the medical records of 1995 dysphagic patients that had undergone videofluoroscopic swallowing study (VFSS) in a tertiary hospital from April 2002 through December 2009. Of these, 97 patients were recommended to use OE tube feeding based on the VFSS findings. Follow-up VFSS were performed on 54 patients. The mean duration of tube use at the time of follow-up VFSS was 274 days. We evaluated clinical information including age, sex, diet, etiology of dysphagia, location of lesions, duration of intervention, and complications of OE tube feeding. Initially, all 54 patients were fed using the OE tube. After their last follow-up evaluation, 19 patients (35.2 %) resumed full oral feeding without the OE tube, 12 patients (22.2 %) used partial OE tube feeding, and 23 patients (42.6 %) continued OE tube feeding only. Full oral feeding was achieved again most often in brain tumor, stroke, and head and neck cancer patients (54.5, 27.3, and 20.0 %, respectively). Mild adverse events, such as blood-tinged sputum, nausea, dyspepsia, and regurgitation of food, were reported in 4 patients. OE tube feeding is a feasible feeding method also in conditions other than stroke such as brain tumors, and head and neck cancers.

Nasoenteral feeding tube placement by nurses using an electromagnetic guidance system (with video)

NARCIS (Netherlands)

Mathus-Vliegen, Elisabeth M. H.; Duflou, Ann; Spanier, Marcel B. W.; Fockens, Paul

2010-01-01

BACKGROUND: The early institution of feeding in patients who need postpyloric feeding tubes is often hampered by a limited availability of endoscopists experienced in safe tube positioning. OBJECTIVE: To test the feasibility of having nurses place postpyloric feeding tubes by using a universal path

Advanced Illness: Feeding Tubes and Ventilators

Science.gov (United States)

... example), that are easier to swallow, and by avoiding thin liquids and things that require chewing. Some ... feeding tubes actually extend life in end-stage Alzheimer's disease. For many, this is a quality of ...

In Vitro Evaluation of Eslicarbazepine Delivery via Enteral Feeding Tubes.

Science.gov (United States)

Reindel, Kristin; Zhao, Fang; Hughes, Susan; Dave, Vivek S

2017-12-01

Purpose: The feasibility of preparing an eslicarbazepine acetate suspension using Aptiom tablets for administration via enteral feeding tubes was evaluated. Methods: Eslicarbazepine acetate suspension (40 mg/mL) was prepared using Aptiom tablets after optimizing the tablet crushing methods and the vehicle composition. A stability-indicating high-performance liquid chromatography (HPLC) method was developed to monitor the eslicarbazepine stability in the prepared suspension. Three enteric feeding tubes of various composition and dimensions were evaluated for the delivery of the suspensions. The suspension was evaluated for the physical and chemical stability for 48 hours. Results: The reproducibility and consistency of particle size reduction was found to be best with standard mortar/pestle. The viscosity analysis and physical stability studies showed that ORA-Plus:water (50:50 v/v) was optimal for suspending ability and flowability of suspension through the tubes. The developed HPLC method was found to be stability indicating and suitable for the assay of eslicarbazepine acetate in the prepared suspension. The eslicarbazepine concentrations in separately prepared suspensions were within acceptable range (±3%), indicating accuracy and reproducibility of the procedure. The eslicarbazepine concentrations in suspensions before and after delivery through the enteric feeding tubes were within acceptable range (±4%), indicating absence of any physical/chemical interactions of eslicarbazepine with the tubes and a successful delivery of eslicarbazepine dosage via enteric feeding tubes. The stability study results showed that eslicarbazepine concentration in the suspension remained unchanged when stored at room temperature for 48 hours. Conclusion: The study presents a convenient procedure for the preparation of a stable suspension of eslicarbazepine acetate (40 mg/mL) using Aptiom tablets, for administration via enteral feeding tubes.

Refining low protein modular feeds for children on low protein tube feeds with organic acidaemias.

Science.gov (United States)

Daly, A; Evans, S; Ashmore, C; Chahal, S; Santra, S; MacDonald, A

2017-12-01

Children with inherited metabolic disorders (IMD) who are dependent on tube feeding and require a protein restriction are commonly fed by 'modular tube feeds' consisting of several ingredients. A longitudinal, prospective two-phase study, conducted over 18 months assessed the long-term efficacy of a pre-measured protein-free composite feed. This was specifically designed to meet the non-protein nutritional requirements of children (aged over 1 year) with organic acidaemias on low protein enteral feeds and to be used as a supplement with an enteral feeding protein source. All non-protein individual feed ingredients were replaced with one protein-free composite feed supplying fat, carbohydrate, and micronutrients. Thirteen subjects, median age 7.4y (3-15.5y), all nutritionally tube dependent (supplying nutritional intake: ≥ 90%, n = 12; 75%, n = 1), and diagnosed with organic acidaemias (Propionic acidaemia, n = 6; Vitamin B 12 non-responsive methyl malonic acidaemia, n = 4; Isovaleric acidaemia, n = 2; Glutaric aciduria type1, n = 1); were studied. Nutritional intake, biochemistry and anthropometry were monitored at week - 8, 0, 12, 26 and 79. Energy intake remained unchanged, providing 76% of estimated energy requirements. Dietary intakes of vitamins, minerals and essential fatty acids significantly increased from week 0 to week 79, but sodium, potassium, magnesium, decosahexanoic acid and fibre did not meet suggested requirements. Plasma zinc, selenium, haemoglobin and MCV significantly improved, and growth remained satisfactory. Natural protein intake met WHO/FAO/UNU 2007 recommendations. A protein-free composite feed formulated to meet the non-protein nutritional requirements of children aged over 1 year improved nutritional intake, biochemical nutritional status, and simplified enteral tube feeding regimens in children with organic acidaemias.

Heat Transfer Enhancement Studies in a Circular Tube Fitted with Right-Left Helical Inserts with Spacer

OpenAIRE

P. K. Nagarajan; P. Sivashanmugam

2011-01-01

Experimental investigation of heat transfer and friction factor characteristics of circular tube fitted with 300 right-left helical screw inserts with 100 mm spacer of different twist ratio has been presented for laminar and turbulent flow.. The experimental data obtained were compared with those obtained from plain tube published data. The heat transfer coefficient enhancement for 300 RL inserts with 100 mm spacer is quite comparable with for 300 R-L inserts. Performance evalu...

Development and Technology Transfer of the Syncro Blue Tube (Gabriel) Magnetically Guided Feeding Tube

Science.gov (United States)

2017-06-01

suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188...the tube to the 110 cm mark. At the 110 cm mark, secure the tube with medical tape and remove the stylet completely allowing enough tube slack ...and it provides slack that allows tube to advance distally by the effect of natural peristalsis on the bolus-sized balloon. Results: Most feeding

Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae

Directory of Open Access Journals (Sweden)

Smith Craig

2009-09-01

Full Text Available Abstract Background The objective of this study was to determine whether neonatal nasogastric enteral feeding tubes are colonised by the opportunistic pathogen Cronobacter spp. (Enterobacter sakazakii and other Enterobacteriaceae, and whether their presence was influenced by the feeding regime. Methods One hundred and twenty-nine tubes were collected from two neonatal intensive care units (NICU. A questionnaire on feeding regime was completed with each sample. Enterobacteriaceae present in the tubes were identified using conventional and molecular methods, and their antibiograms determined. Results The neonates were fed breast milk (16%, fortified breast milk (28%, ready to feed formula (20%, reconstituted powdered infant formula (PIF, 6%, or a mixture of these (21%. Eight percent of tubes were received from neonates who were 'nil by mouth'. Organisms were isolated from 76% of enteral feeding tubes as a biofilm (up to 107 cfu/tube from neonates fed fortified breast milk and reconstituted PIF and in the residual lumen liquid (up to 107 Enterobacteriaceae cfu/ml, average volume 250 μl. The most common isolates were Enterobacter cancerogenus (41%, Serratia marcescens (36%, E. hormaechei (33%, Escherichia coli (29%, Klebsiella pneumoniae (25%, Raoultella terrigena (10%, and S. liquefaciens (12%. Other organisms isolated included C. sakazakii (2%,Yersinia enterocolitica (1%,Citrobacter freundii (1%, E. vulneris (1%, Pseudomonas fluorescens (1%, and P. luteola (1%. The enteral feeding tubes were in place between 48 h (13%. All the S. marcescens isolates from the enteral feeding tubes were resistant to amoxicillin and co-amoxiclav. Of additional importance was that a quarter of E. hormaechei isolates were resistant to the 3rd generation cephalosporins ceftazidime and cefotaxime. During the period of the study, K. pneumoniae and S. marcescens caused infections in the two NICUs. Conclusion This study shows that neonatal enteral feeding tubes

Improved Safety and Efficacy of Small-Bore Feeding Tube Confirmation Using an Electromagnetic Placement Device.

Science.gov (United States)

Powers, Jan; Luebbehusen, Michael; Aguirre, Lillian; Cluff, Julia; David, Mary Ann; Holly, Vince; Linford, Lorraine; Park, Nancy; Brunelle, Rocco

2018-04-01

Early enteral nutrition has been shown to decrease complications and improve patient outcomes. Post pyloric feeding is recommended for patients with gastric intolerance or at high risk for aspiration. Feeding tube placement can be challenging and pose risk of pulmonary complications. Reliance on radiographic confirmation for feeding tube placement exposes the patient to radiation. Electromagnetic placement device (EMPD) may offer a method to minimize pulmonary complications, increase successful placement, and decrease radiation exposure to the patient. The purpose of this study was to evaluate the safety and efficacy of using EMPD verification, instead of routine abdominal radiographic confirmation, for small-bore feeding tube placement. Variables evaluated were adverse events, utilization of radiographs for confirmation, and success rate of feeding tube placement in the ordered location. Two time frames were reviewed. In a 1-year period, 3754 small-bore feeding tubes were placed using EMPD, with zero adverse events noted. Radiographic confirmation was utilized in 0%-29.2% of the EMPD placed tubes. Successful placement of feeding tubes using EMPD ranged from 94%-99.6%. During a 5-year period, 7081 EMPD feeding tubes were evaluated. One adverse event, pneumothorax, occurred during the placement of these 7081 tubes, for a rate of 0.014%. Feeding tube placement confirmation is safe and efficacious via EMPD providing an effective method of feeding tube placement with a success rate >94% into the desired location. EMPD is an accurate verification method of distal tip location, eliminating the need for routine abdominal radiographic confirmation. © 2018 American Society for Parenteral and Enteral Nutrition.

Ahmed glaucoma valve implantation with tube insertion through the ciliary sulcus in pseudophakic/aphakic eyes.

Science.gov (United States)

Eslami, Yadolla; Mohammadi, Massood; Fakhraie, Ghasem; Zarei, Reza; Moghimi, Sasan

2014-02-01

To report the efficacy and safety of Ahmed glaucoma valve (AGV) insertion into the ciliary sulcus in pseudophakic/aphakic patients. A chart review was done on patients with uncontrolled glaucoma, who underwent AGV implantation with tube inserted into the ciliary sulcus. Baseline intraocular pressure (IOP) and number of medications were compared with that of postoperative follow-up visits. Surgical success was defined as last IOP glaucoma control, and without loss of light perception. Postoperative complications were recorded. Twenty-three eyes of 23 patients were recruited with the mean follow-up of 9 months (range, 3 to 24 mo). The mean (SD) age of patients was 49.9 (16.9) years (range, 22 to 80 years). The mean (SD) IOP (mm Hg) was reduced from 37.9 (12.4) before surgery to 16.2 (3.6) at the last follow-up visit (P<0.001). The mean (SD) number of medications was reduced from 3.3 (0.9) preoperatively to 1 (1.1) at the last follow-up (P<0.001). Success rate was 18/23 (78.6%). Complications included endophthalmitis in 1 eye, tube exposure in 1 diabetic patient, and vitreous tube occlusion in 1 eye. No case of corneal decompensation or graft failure was seen during follow-up. Ciliary sulcus placement of the tube of AGV effectively reduces IOP and medication use in short term. It has the potential to lower corneal complications of anterior chamber tube insertion and avoids the need for pars plana vitrectomy and tube insertion in patients at higher risk of corneal decompensation.

A novel method for improving chest tube insertion skills among medical interns. Using biomaterial-covered mannequin

Directory of Open Access Journals (Sweden)

Ozgur Tatli

2017-10-01

Full Text Available Objectives: To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42. Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand.

A novel method for improving chest tube insertion skills among medical interns. Using biomaterial-covered mannequin.

Science.gov (United States)

Tatli, Ozgur; Turkmen, Suha; Imamoglu, Melih; Karaca, Yunus; Cicek, Mustafa; Yadigaroglu, Metin; Bayrak, Selen T; Asik, Olgun; Topbas, Murat; Turedi, Suleyman

2017-10-01

To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42). Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand.

Reusable locking tube insertion and removal fixture and method in a reconstitutable fuel assembly

International Nuclear Information System (INIS)

Shallenberger, J.M.; Ferlan, S.J.

1987-01-01

This patent describes a locking tube insertion and removal fixture for use with a reconstitutable fuel assembly. The process includes a top nozzle with an adapter plate having at least one passageway, at least one guide thimble with an upper end portion, and an attaching structure having a hollow locking tube insertable and removable into and from a locking position in the upper end portion of the guide thimble for releasably locking the upper end portion of the guide thimble within the passageway of the top nozzle and adapter plate

How do You Select an Anesthesia Method Prior to Tympanostomy Tube Insertion for a Child?

OpenAIRE

Lee, Dong-Hee

2016-01-01

The use of general (face-mask inhalation and intravenous) anesthesia has been the method of choice for tympanostomy tube insertion in children. However, there is no exact guideline for the choice of anesthesia method and there is no evidence to support the use of one anesthesia method over another. Clinically, the anesthesia method used to be decided by old customs and the surgeon's blind faith that children cannot bear tympanostomy tube insertion under local anesthesia. Clinicians should kee...

Survival times with and without tube feeding in patients with dementia or psychiatric diseases in Japan.

Science.gov (United States)

Takayama, Keiko; Hirayama, Keisuke; Hirao, Akihiko; Kondo, Keiko; Hayashi, Hideki; Kadota, Koichi; Asaba, Hiroyuki; Ishizu, Hideki; Nakata, Kenji; Kurisu, Kairi; Oshima, Etsuko; Yokota, Osamu; Yamada, Norihito; Terada, Seishi

2017-11-01

It is widely supposed that there has been no evidence of increased survival in patients with advanced dementia receiving enteral tube feeding. However, more than a few studies have reported no harmful outcome from tube feeding in dementia patients compared to in patients without dementia. This was a retrospective study. Nine psychiatric hospitals in Okayama Prefecture participated in this survey. All inpatients fulfilling the entry criteria were evaluated. All subjects suffered from difficulty with oral intake. Attending physicians thought that the patients could not live without long-term artificial nutrition. The physicians decided whether to make use of long-term artificial nutrition between January 2012 and December 2014. We evaluated 185 patients. Their mean age was 76.6 ± 11.4 years. Of all subjects, patients with probable Alzheimer's disease (n = 78) formed the biggest group, schizophrenia patients (n = 44) the second, and those with vascular dementia (n = 30) the third. The median survival times were 711 days for patients with tube feeding and 61 days for patients without tube feeding. In a comparison different types of tube feeding, median survival times were 611 days for patients with a nasogastric tube and more than 1000 days for those with a percutaneous endoscopic gastrostomy tube. Patients with tube feeding survived longer than those without tube feeding, even among dementia patients. This study suggests that enteral nutrition for patients with dementia prolongs survival. Additionally, percutaneous endoscopic gastrostomy tube feeding may be safer than nasogastric tube feeding among patients in psychiatric hospitals. © 2017 Japanese Psychogeriatric Society.

Factors related to persisting perforations after ventilation tube insertion.

Science.gov (United States)

O'Connell Ferster, Ashley P; Tanner, April Michelle; Karikari, Kodjo; Roberts, Christopher; Wiltz, Derek; Carr, Michele M

2016-02-01

Over a million ventilation tubes are placed annually in the United States, making this one of the most commonly performed procedures in the field of medicine. Certain factors increase the risk of persistent tympanic membrane perforation following the extrusion of short term ventilation tubes. Persistent perforations may fail to heal on their own, necessitating surgical closure to avoid conductive hearing loss. It is important to detect factors that may predict children who are at increased risk for persistent perforations. This study was a retrospective chart review that involved 757 patients between 2003 and 2008. The patients studied were within the age of 2 months-17 years, and all had short term tubes placed. The chart data also included demographic information, comorbidities, and information related to tube insertion and follow-up care. Chi-square, t-test, and multivariate logistic regression were conducted to compare variables between patients with perforations and those without. Data from 757 patients was analyzed, showing that perforation rate is associated with rhinorrhea, operative tube removal, aural polyps, and otorrhea (OR 1.72, 8.16, 4.69, and 1.72 respectively). The absence of otorrhea decreased the likelihood of TM perforations and no significant differences were found in gender, total number of sets of tubes, type of tube, use of nasal steroids, adenoidectomy, or nasal congestion. Our findings suggest that children with rhinorrhea, otorrhea, aural polyps, or prolonged intubation requiring operative tube removal should be identified clinically as children at risk of persisting perforation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review

Directory of Open Access Journals (Sweden)

Pamela Sarkar

2017-05-01

Full Text Available Background/Aims With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome. Methods A retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items “percutaneous endoscopic gastrostomy” and “neurology” or “neurodegenerative disease.” Results Short-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin. Conclusions This study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.

Inadvertent chest tube insertion in congenital cystic adenomatoid malformation and congenital lobar emphysema-highlighting an important problem

International Nuclear Information System (INIS)

Prabhu, Shailesh M; Choudhury, Subhasis Roy; Solanki, Ravi S; Shetty, Gurucharan S; Agarwala, Surenderkumar

2013-01-01

Chest tube insertion in congenital cystic lung lesions is an important problem in children with acute respiratory distress having a cystic lucent lesion on chest radiograph. To evaluate the imaging findings and complications in cases of congenital cystic lung lesions with chest tube insertion and suggest the role of appropriate imaging for management of these patients. Chest radiographs and CT scans of children with congenital cystic lung lesions who had inadvertent chest tube insertion preoperatively were retrospectively reviewed for imaging appearances and complications. Fifteen patients comprising 10 cases of congenital cystic adenomatoid malformation (CCAM) and 5 cases of congenital lobar emphysema (CLE) were included. Majority of the cases were infants. CCAM was misdiagnosed as complicated pneumatocele (n = 5) and pneumothorax (n = 5), while CLE was misdiagnosed as tension pneumothorax (n = 5) on the chest radiograph findings. Final diagnosis was made on CT and operative findings with histopathology. Complications noted were pneumothorax, hydropneumothorax, and infection in cases of CCAM, and change in imaging appearance and pneumothorax in cases of CLE. Chest tube insertion in congenital cystic lesions increases the rate of associated complications. Chest CT has a definite role in early diagnosis and deciding appropriate management in these cases

Application of nasointestinal feeding tube in treatment of acute pancreatitis

Directory of Open Access Journals (Sweden)

Li Tian

2016-12-01

Full Text Available Objective: To observe the clinical effect of nasointestinal feeding tube for enteral nutrition in the treatment of acute pancreatitis. Methods: A total of 128 patients with acute pancreatitis who were admitted in our hospital were included in the study and randomized into the treatment group and the control group with 64 cases in each group. Routine pancreatitis treatments after admission in the two groups were performed. On the basis, nasointestinal feeding tube was indwelled in patients in the treatment group for nutrition support. The changes of biochemical and nutritional indicators before and after treatment in the two groups were compared. Results: LC, TP, ALB, and Hb after treatment in the two groups were significantly elevated, while AMY and Lipase were significantly reduced when compared with before treatment (P0.05. Conclusions: Adoption of nasointestinal feeding tube for enteral nutrition in the treatment of acute pancreatitis can significantly improve the nutritional status; therefore, it deserves to be widely recommended in the clinic.

Deaths associated with insertion of nasogastric tubes for enteral nutrition in the medical intensive care unit: Clinical and autopsy findings

Science.gov (United States)

Smith, Avery L.; Santa Ana, Carol A.; Fordtran, John S.; Guileyardo, Joseph M.

2018-01-01

ABSTRACT It is generally assumed that blind insertion of nasogastric tubes for enteral nutrition in patients admitted to medical intensive care units is safe; that is, does not result in life-threatening injury. If death occurs in temporal association with insertion of a nasogastric tube, caregivers typically attribute it to underlying diseases, with little or no consideration of iatrogenic death due to tube insertion. The clinical and autopsy results in three recent cases at Baylor University Medical Center challenge the validity of these notions. PMID:29904295

The Effectiveness of Self-Expandable Metallic Stent Insertion in Treating Right-Sided Colonic Obstruction: A Comparison between SEMS and Decompression Tube Placement and an Investigation of the Safety and Difficulties of SEMS Insertion in Right Colons

Directory of Open Access Journals (Sweden)

Rintaro Moroi

2014-01-01

Full Text Available Objectives. Self-expandable metallic stent (SEMS is widely used to treat malignant colonic obstruction. However, most reports about SEMS insertion have concentrated on the left colon. This study aimed to (1 investigate the effectiveness of SEMS insertion compared with conventional decompression tube for right-sided colonic obstruction and (2 compare the safety and technical success of SEMS insertion between left- and right-sided colonic obstructions. Methods. The data from thirty-seven patients who underwent SEMS or conventional decompression tube placement for malignant colonic obstruction in our hospital were analyzed retrospectively. Technical and clinical success, complications, and technical difficulties were analyzed. We compared the results between SEMS insertion and decompression tube placement in right colons and the outcomes of SEMS insertion between right- and left-sided colonic obstructions. Results. For right colons, the clinical success rate of SEMS insertion (100% was significantly higher than that of decompression tube placement (55.9%. Concerning SEMS insertion, the technical difficulty and safety of SEMS insertion were similar between right- and left-sided colonic obstructions. Conclusion. SEMS insertion for right-sided colon is significantly more effective than conventional decompression tube placement, and this procedure was safer and less technically challenging than expected. SEMS insertion should be considered for treating right-sided malignant colonic obstruction.

Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

International Nuclear Information System (INIS)

Nijs, Els L. F.; Cahill, Anne Marie

2010-01-01

Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

Experimental and numerical investigation on heat transfer augmentation in a circular tube under forced convection with annular differential blockages/inserts

Science.gov (United States)

Waghole, D. R.

2018-01-01

Investigation on heat transfer by generating turbulence in the fluid stream inside the circular tube is an innovative area of research for researchers. Hence, many techniques are been investigated and adopted for enhancement of heat transfer rate to reduce the size and the cost of the heat exchanger/circular tube. In the present study the effect of differential solid ring inserts /turbulators on heat transfer, friction factor of heat exchanger/circular tube was evaluated through experimentally and numerically. The experiments were conducted in range of 3000 ≤Re≤ 6500 and annular blockages 0 ≤ɸ≤50 %. The heat transfer rate was higher for differential combination of inserts as compared to tube fitted with uniform inserts. The maximum heat transfer was obtained by the use of differential metal circular ring inserts/blockages. From this study, Nusselt number, friction factor and enhancement factor are found as 2.5-3.5 times, 12% - 50.5% and 155% - 195%, respectively with water. Finally new possible correlations for predicting heat transfer and friction factor in the flow of water through the circular tube with differential blockages/inserts are proposed.

Retortable Laminate/Polymeric Food Tubes for Specialized Feeding

Science.gov (United States)

2012-06-01

Report STP #3010 Results and Accomplishments (June 2010 – June 2012) Report No: FTR 303 CDRL Sequence: A003 June 2012 CORANET CONTRACT #: SP4701-08-D...June 2010 - June 2012 Retortable Laminate/Polymeric Food Tubes for Specialized Feeding - STP # 3010 SP4701-08-D-0004 MANTECH (0708011S) CORANET A003...on commercial off-the-shelf materials and not military unique. A market survey of commercially available laminated tubes revealed that they are all

Percutaneous transesophageal gastro-tubing (PTEG) as an alternative long-term tube feeding procedure when gastrostomy is not feasible.

Science.gov (United States)

Toh Yoon, Ezekiel Wong; Nishihara, Kazuki

2017-12-01

Percutaneous transesophageal gastro-tubing (PTEG) is a minimally invasive technique to access the gut via an esophagostomy. However, this procedure is not well known and the literature available is still fairly limited. This observational study was conducted to evaluate our experience using this method as an alternative long-term tube feeding procedure when gastrostomy is not suitable. A total of 15 patients (10 males and 5 females) who underwent PTEG at our institution from 2012 to 2016 were observed and analyzed in this study. The average age was 80.1 (71-93) years. Underlying conditions that required PTEG were previous gastric resection in 11 patients, left diaphragm disorder in 2 patients, interposing transverse colon between the abdominal wall and anterior gastric wall in 1 patient, and severe gastrostomy site leakage in 1 patient. Tube placement was successful in all patients by approaching the left side of the neck, using a 15 Fr size tube. The mean postoperative length of stay was 22 (8-48) days. Postoperative adverse events included accidental tube dislodgement in three patients, tracheoesophageal fistula in one patient, inferior thyroid artery injury in one patient and thyroid gland mispuncture in one patient. There was no procedure-related mortality nor mortality at 30 days. Eight patients were discharged with some oral intake. PTEG is feasible in patients requiring long-term tube feeding for whom gastrostomy is unsuitable. It is an effective long-term tube feeding procedure and should be offered as a more comfortable alternative to nasogastric tubing.

Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial.

Science.gov (United States)

Haubruck, Patrick; Nickel, Felix; Ober, Julian; Walker, Tilman; Bergdolt, Christian; Friedrich, Mirco; Müller-Stich, Beat Peter; Forchheim, Franziska; Fischer, Christian; Schmidmaier, Gerhard; Tanner, Michael C

2018-05-21

The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module "Thoracocentesis" discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants' performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their

Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial

Science.gov (United States)

Ober, Julian; Walker, Tilman; Bergdolt, Christian; Friedrich, Mirco; Müller-Stich, Beat Peter; Forchheim, Franziska; Fischer, Christian; Schmidmaier, Gerhard; Tanner, Michael C

2018-01-01

Background The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. Objective The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). Methods In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module “Thoracocentesis” discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants’ performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here

Increasing rate of middle ear ventilation tube insertion in children in denmark

DEFF Research Database (Denmark)

Djurhuus, Bjarki Ditlev; Skytthe, Axel; Christensen, Kaare

2014-01-01

ventilation tube insertions distributed among 269,459 different children were identified. From 1997 to 2010 the age standardized incidence rate in 0-15-year-olds increased from 26 to 40 per 1000 person years with an estimated annual increase of 2.0% (95% confidence interval 1.9-2.1%). The largest increase...... in incidence rate was found in 1-year-olds with an annual increase of 4.5% (95% confidence interval 4.4-4.6%). Age-specific incidence rates remained at maximum around the age of 14 months throughout the period. The cumulative incidence proportion for the 2010 birth cohort by the time they reach the age of 5......OBJECTIVE: To study the incidence rates of middle ear ventilation tube insertion in children aged 0 to 15 years in Denmark from 1997 to 2010. METHODS: Using two national registers, the Danish National Health Service Register and the Danish National Patient Register, practically all cases of middle...

Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness.

Science.gov (United States)

Windle, E M; Beddow, D; Hall, E; Wright, J; Sundar, N

2010-02-01

Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust. A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the Cortrak system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed. Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was 111 pounds. This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres.

Successful use of a bulk laxative to control the diarrhea of tube feeding.

Science.gov (United States)

Frank, H A; Green, L C

1979-01-01

The greatly increased nutritional demands of the severely burned patient frequently require the use of tube feeding for enternal hyperalimentation. At a time when general patient morale is low and motivation needs to be maximally maintained, there is nothing so dispiriting as the distress of a painful perianal region and uncontrollable liquid stools. Attempts to control the diarrhea which frequently accompanies tube feeding by changing the formula or the method of administration or a wide variety of constipating drugs have all met with very limited success. Based on the clinical observation of a noted gastroenterologist (Bockus), we have administered a mucilagenous hydrophilic colloid bulk laxative (Metamucil) to patients on tube feeding formulae. The dosage and frequency are adjusted to individual patient needs, but average 7 g per liter of liquid formula. The results have been dramatic; namely, the virtual elimination of the diarrhea problem in our burn patients on enteral hyperalimentation by gastric tube feeding. Colonic transit time increases. The stools become formed but soft, cohesive but not adhesive. Perianal irritation does not occur. Neither does soilage of wound, dressings, or bed. No rebound constipation or obstructive symptoms have been encountered. We attribute this response to the same water binding mechanism that allows these colloids to prevent chronic constipation. Our patients may be given as much as 5,000 to 6,000 calories of tube feeding per day. Our patients are not distressed by diarrhea. Our nursing staff is relieved of the burden that entails.

Metabolic assessment and enteral tube feeding usage in children with acute neurological diseases

Directory of Open Access Journals (Sweden)

Heitor Pons Leite

Full Text Available OBJECTIVE: To report on acquired experience of metabolic support for children with acute neurological diseases, emphasizing enteral tube feeding usage and metabolic assessment, and also to recommend policies aimed towards improving its implementation. DESIGN: Retrospective analysis. SETTING: Pediatric Intensive Care Unit of Hospital do Servidor Público Estadual de São Paulo. SUBJECTS: 44 patients consecutively admitted to the Pediatric ICU over a period of 3 years who were given nutrition and metabolic support for at least 72 hours. Head trauma, CNS infections and craniotomy post-operative period following tumor exeresis were the main diagnoses. MEASUREMENTS: Records of protein-energy intake, nutrient supply route, nitrogen balance and length of therapy. RESULTS: From a total of 527 days of therapy, single parenteral nutrition was utilized for 34.3% and single enteral tube feeding for 79.1% of that period. 61.4% of the children were fed exclusively via enteral tube feeding, 9.1% via parenteral and 39.5 % by both routes. The enteral tube feeding was introduced upon admission and transpyloric placement was successful in 90% of the cases. Feeding was started 48 hours after ICU admission. The caloric goal was achieved on the 7th day after admission, and thereafter parenteral nutrition was interrupted. The maximum energy supply was 104.2 ± 23.15 kcal/kg. The median length of therapy was 11 days (range 4-38. None of the patients on tube feeding developed GI tract bleeding, pneumonia or bronchoaspiration episodes and, of the 4 patients who were given exclusive TPN, 2 developed peptic ulcer. The initial urinary urea nitrogen was 7.11 g/m2 and at discharge 6.44 g/m2. The protein supply increased from 1.49 g/kg to 3.65 g/kg (p< 0.01. The nitrogen balance increased from -7.05 to 2.2 g (p< 0.01. CONCLUSIONS: Children with acute neurological diseases are hypercatabolic and have high urinary nitrogen losses. The initial negative nitrogen balance can be

Heat transfer and pressure drop studies of TiO2/DI water nanofluids in helically corrugated tubes using spiraled rod inserts

Science.gov (United States)

Anbu, S.; Venkatachalapathy, S.; Suresh, S.

2018-05-01

An experimental study on the convective heat transfer and friction factor characteristics of TiO2/DI water nanofluids in uniformly heated plain and helically corrugated tubes (HCT) with and without spiraled rod inserts (SRI) under laminar flow regime is presented in this paper. TiO2 nanoparticles with an average size of 32 nm are dispersed in deionized (DI) water to form stable suspensions containing 0.1, 0.15, 0.2, and 0.25% volume concentrations of nanoparticles. It is found that the inclusion of nanoparticles to DI water ameliorated Nusselt number which increased with nanoparticles concentration upto 0.2%. Two spiraled rod inserts made of copper with different pitches (pi = 50 mm and 30 mm) are inserted in both plain and corrugated tubes and it is found that the addition of these inserts increased the Nusselt number substantially. For Helically corrugated tube with lower pitch and maximum height of corrugation (pc = 8 mm, hc = 1 mm) with 0.2% volume concentration of nanoparticles, a maximum enhancement of 15% in Nusselt number is found without insert and with insert having lower pitch (pi = 30 mm) the enhancement is 34% when compared to DI water in plain tube. The results on friction factor show a maximum penalty of about 53.56% for the above HCT.

Fluoroscopically-guided transnasal insertion of ileus tube intestinal decompression in patients with inoperable malignant bowel obstruction

International Nuclear Information System (INIS)

Fang Shiming; Li Haili; Lin Qing; Mao Aiwu; Wu Shaoqiu; Jiang Haosheng; Cao Yan; Wang Zhenlei

2011-01-01

Objective: To assess the technical feasibility and effectiveness of fluoroscopically-guided transnasal insertion of ileus tube for intestinal decompression in the treatment of inoperable malignant bowel obstruction. Methods: A total of 211 patients with inoperable malignant bowel obstruction were enrolled in this study. The median KPS scale was 40 (ranged from 20 to 60). Under fluoroscopic guidance, transnasal insertion of ileus tube by using conventional technique or guidewire-catheter exchange technique was performed in all patients. The technical success rate, the clinical effective rate, the curative rate and adverse reactions as well as complications were documented. The correlation among the obstructive sites, obstruction causes and therapeutic effectiveness was analyzed. The ileus tube used in this study was a four-cavity and double-balloon catheter with a diameter of 16 F/18 f, which is produced by Cliny Company. Results: Transnasal drainage tube was successfully inserted into the proximal jejunum in all 211 patients with malignant bowel obstruction, and the total technical success rate was 100%. The initial technical success rate of the traditional technique and the catheter-guidewire exchange method was 85.5% (65/76) and 100% (135/135) respectively, the difference between the two was significant (P<0.05). After 24 hours, the clinical remission rate in the patients with high-level intestinal obstruction, lower-level intestinal obstruction and colorectal obstruction was 95.8% (46/48), 92.9% (117/126) and 83.8% (31/37), respectively. A follow-up of 4-245 days (mean 138 days) was conducted, and the total clinical cure rate was 27.5% (58/211). The clinical cure rate in small intestine obstruction and colorectal obstruction caused by primary tumor or recurrence was 12.7% (20/157) and 59.5% (22/37), respectively (P<0.05). The adverse reactions and complications included uncomfortable pharynx feeling or pain (99.1%, 199/221), the tube obstruction (23.2%, 49

Fluoroscopy-guided insertion of nasojejunal tubes in children - setting local diagnostic reference levels

International Nuclear Information System (INIS)

Vitta, Lavanya; Raghavan, Ashok; Sprigg, Alan; Morrell, Rachel

2009-01-01

Little is known about the radiation burden from fluoroscopy-guided insertions of nasojejunal tubes (NJTs) in children. There are no recommended or published standards of diagnostic reference levels (DRLs) available. To establish reference dose area product (DAP) levels for the fluoroscopy-guided insertion of nasojejunal tubes as a basis for setting DRLs for children. In addition, we wanted to assess our local practice and determine the success and complication rates associated with this procedure. Children who had NJT insertion procedures were identified retrospectively from the fluoroscopy database. The age of the child at the time of the procedure, DAP, screening time, outcome of the procedure, and any complications were recorded for each procedure. As the radiation dose depends on the size of the child, the children were assigned to three different age groups. The sample size, mean, median and third-quartile DAPs were calculated for each group. The third-quartile values were used to establish the DRLs. Of 186 procedures performed, 172 were successful on the first attempt. These were performed in a total of 43 children with 60% having multiple insertions over time. The third-quartile DAPs were as follows for each age group: 0-12 months, 2.6 cGy cm 2 ; 1-7 years, 2.45 cGy cm 2 ; >8 years, 14.6 cGy cm 2 . High DAP readings were obtained in the 0-12 months (n = 4) and >8 years (n = 2) age groups. No immediate complications were recorded. Fluoroscopy-guided insertion of NJTs is a highly successful procedure in a selected population of children and is associated with a low complication rate. The radiation dose per procedure is relatively low. (orig.)

Hemlock woolly adelgid (Homoptera: Adelgidae): stylet bundle insertion and feeding sites

Science.gov (United States)

Rebecca F. Young; Kathleen S. Shields; Graeme P. Berlyn

1995-01-01

Stylet bundle insertion site, path traveled, and feeding site were examined for the hemlock woolly adelgid, Adelges tsugae Annand, on needles from current and previous years of eastern hemlock, Tsuga canadensis Carriere. The stylet bundle is composed of 4 individual stylets--2 outer mandibular stylets and 2 inner maxillary stylets...

Enteral tube feeding alters the oral indigenous microbiota in elderly adults.

Science.gov (United States)

Takeshita, Toru; Yasui, Masaki; Tomioka, Mikiko; Nakano, Yoshio; Shimazaki, Yoshihiro; Yamashita, Yoshihisa

2011-10-01

Enteral tube feeding is widely used to maintain nutrition for elderly adults with eating difficulties, but its long-term use alters the environment of the oral ecosystem. This study characterized the tongue microbiota of tube-fed elderly adults by analyzing the 16S rRNA gene. The terminal restriction fragment length polymorphism (T-RFLP) profiles of 44 tube-fed subjects were compared with those of 54 subjects fed orally (average age, 86.4 ± 6.9 years). Bar-coded pyrosequencing data were also obtained for a subset of the subjects from each group (15 tube-fed subjects and 16 subjects fed orally). The T-RFLP profiles demonstrated that the microbiota of the tube-fed subjects was distinct from that of the subjects fed orally (permutational multivariate analysis of variance [perMANOVA], P < 0.001). The pyrosequencing data revealed that 22 bacterial genera, including Corynebacterium, Peptostreptococcus, and Fusobacterium, were significantly more predominant in tube-fed subjects, whereas the dominant genera in the subjects fed orally, such as Streptococcus and Veillonella, were present in much lower proportions. Opportunistic pathogens rarely detected in the normal oral microbiota, such as Corynebacterium striatum and Streptococcus agalactiae, were often found in high proportions in tube-fed subjects. The oral indigenous microbiota is disrupted by the use of enteral feeding, allowing health-threatening bacteria to thrive.

Flow pattern assessment in tubes with wire coil inserts in laminar and transition regimes

International Nuclear Information System (INIS)

Garcia, A.; Solano, J.P.; Vicente, P.G.; Viedma, A.

2007-01-01

The paper presents an analysis of the flow mechanisms in tubes with wire coils using hydrogen bubble visualization and PIV techniques. Results have been contrasted with experimental data on pressure drop. The relation between the observed flow patterns and the friction factor has been analysed. The experimental analysis that has been carried out allows one to state that at low Reynolds numbers (Re < 400) the flow in tubes with wire coils is basically similar to the flow in smooth tubes. At Reynolds numbers between 500 and 700 and in short pitch wire coils a recirculating flow appears. The insertion of wires coils in a smooth tube accelerates significantly the transition to turbulence. This is produced at Reynolds numbers between 700 and 1000 depending on the wire pitch

The usefulness of levin tube inserted drip infusion spiral CT: comparison with conventional method in subtotal gastrectomy patients

International Nuclear Information System (INIS)

Park, Young Jin; Kim, Young Hwan; Yoon, Jung Hee; Cha, Soon Joo; Kim, Jeong Sook; Kim, Sung Rok; Hur, Gham; Rhim, Hyun Chul

1998-01-01

The purpose of this study is to access the usefulness of newly designed Levin tube inserted drip infusion spiral CT for the evaluation of remnant stomach and anastomosis site in patients who have undergone subtotal gastrectomy for stomach cancer. A new technique named Levin tube inserted drip infusion spiral CT was used to prospectively study 23 patients. A 16Fr Levin tube was inserted into the remnant stomach; 500 ml of tap water was drip infused just before CT scanning and an additional 500 ml of water was infused during IV contrast injection. Water was infused by gravity, using a water bottle suspended at a height of 90 cm (Group A). The 31 patients who underwent conventional spiral CT scanning immediately after the divided ingestion of 900 ml diluted gastrografin were selected as a control group (Group B). The anatomic delineation of the anastomosis site was graded by two radiologists as excellent (3), good(2), fair (1) or poor (0). To evaluate the degree of distension, the maximal diameters of remnant stomach and the anastomosis site, and the thickness of the stomach wall, were also measured. In patients who had undergone subtobal gastrectomy, Levin tube inserted drip infusion spiral CT showed excellent anatomic delineation of the site of anastomosis and remnant stomach. We found that because it increases the distension of remnant stomach and the anastomosis site, this technique is effective for the evaluation of postoperative stomach. (author). 10 refs., 2 tabs., 3 figs

Colojejunal Fistula Resulting from a D-PEJ Feeding Tube

Directory of Open Access Journals (Sweden)

Martin D. Zielinski

2008-06-01

Full Text Available Numerous procedures have been developed to provide adequate enteral nutrition to patients with gastrointestinal disorders. Previously, operative placement of a feeding gastrostomy or jejunostomy tube was the accepted means of gaining chronic enteral access. However, improved technology and experience with endoscopic techniques have quickly replaced primary operative placement of enteral access. Direct percutaneous endoscopic jejunostomy (D-PEJ is a procedure that was designed to deliver enteral feeding solutions for patients with proximal disease after unsatisfactory results from percutaneous endoscopic gastrostomy tubes with jejunal extensions (PEG-J. As with any procedure, it is associated with complications. We present the first reported case of a colojejunal fistula resulting from a D-PEJ placement. While D-PEJ has been shown to be relatively safe, complications related to the inherent limitations of the procedure need to be considered when the patient experiences unusual post-procedure symptoms and worked up appropriately.

''Push-pull'' gastrostomy: a new technique for percutaneous gastrostomy tube insertion in the neonate and young infant

International Nuclear Information System (INIS)

Cahill, A.M.; Kaye, R.D.; Fitz, C.R.; Towbin, R.B.

2001-01-01

Objective. To evaluate a newly developed method combining antegrade and retrograde techniques for percutaneous gastrostomy tube (PGT) insertion in the neonate and young infant. Materials and methods. From January 1994 to December 2000, 85 children (47 male, 38 female), mean age 4.5 months (range 0.44-9.13 months) underwent PGT insertion using the ''push-pull'' technique. With the addition, 57 children had a jejunostomy tube placed as well at or within 24 h of the PGT procedure. The mean weight was 3.74 kg, range 1.5-7.0 kg. The indications for the procedure included failure to thrive in 40 patients (25 %), static encephalopathy in 21 (25 %), neurological/congenital abnormalities in 12 (14 %), aspiration in 7 (8 %), and cardiac problems in 5 (6 %). Results. Eighty-five PGTs were successfully inserted in 85 children. One procedure was initially unsuccessful due to failed conscious sedation and was completed under general anesthesia. Four of 85 patients initially had attempted antegrade placement that failed, and the procedure was successfully completed using the ''push-pull'' method. One major complication occurred: a gastrocolic fistula at day 5 post-procedure, which was surgically repaired without sequelae. Tube-related problems included; tube dislodgement (n = 1) and procedure-related stomal infection (n = 3). Conclusion. The ''push-pull'' gastrostomy technique is a safe, effective method of percutaneous gastrostomy tube placement in neonates. It facilitates successful placement of the PGT in patients in whom the classic antegrade method is not possible. It has become the procedure of choice in this group. (orig.)

Early discharge with tube feeding at home for preterm infants is associated with longer duration of breast feeding.

Science.gov (United States)

Meerlo-Habing, Z E; Kosters-Boes, E A; Klip, H; Brand, P L P

2009-07-01

Mothers of preterm infants are more likely to discontinue breast feeding early than mothers of term infants. We evaluated the effect of early discharge with tube feeding of preterm infants under close supervision by paediatric nurse specialists on the duration of breast feeding. Case-control study. Medium/high-care neonatal unit of a large district general hospital. Preterm infants (paediatric nurse specialists or regular follow-up of preterm infants discharged with oral feeding. Duration of breast feeding assessed by telephone interview 6 months after birth. There were 50 preterm infants in the early discharge group and 78 in the control group. Mothers in the early discharge group continued to breast feed longer than mothers in the control group (log rank test, p = 0.028). Four months after discharge, 63% of preterm infants in the control group were fed formula compared to 36% in the early discharge group (95% CI for difference 9% to 43%, p = 0.04). The relative risk of breast feeding cessation 6 months after birth in the early discharge group compared to the control group was 0.63 (95% CI 0.41 to 0.96). After adjustment for smoking, gestational age and birth weight, this relative risk was 0.67 (95% CI 0.43 to 1.05). Close supervision and follow-up by paediatric nurse specialists of preterm infants discharged early with tube feeding appears to increase duration of breast feeding. A randomised controlled trial to confirm these findings is warranted.

Limited utility of plain abdominal radiographs in evaluating intussusceptions secondary to long indwelling feeding tubes

Directory of Open Access Journals (Sweden)

Albert Yang

2013-01-01

Full Text Available Adult intussusception (AI is relatively rare and can be a difficult clinical diagnosis, often requiring cross-sectional imaging for confirmation. Unfortunately, intussusceptions in the setting of indwelling long enteral feeding tubes have been predominantly characterized in the pediatric population with minimal investigation in adults. We report three cases of AI in patients with long feeding catheters serving as anatomic lead points leading to intussusception diagnosed on cross-sectional imaging. We highlight the limited utility of the supine plain films for detection of AI, and it behooves the radiologist to hold a high index of suspicion if the patient has a long enteral catheter. Since the majority of these patients tend to be fairly ill and unable to stand for upright abdominal radiographs, in the setting of percutaneous feeding tubes, decubitus abdominal radiographs should always be obtained. These cases also highlight the importance of having a high clinical suspicion of intussusceptions in a patient presenting with abdominal pain in the setting of an enteral feeding tube. In post-operative patients, other factors can predispose the patient to intussusception, including adhesions. Another interesting feature in tube related AI is the reverse intussusception that may be seen with indwelling enteral tubes. Reverse intussusception is where the distal bowel telescopes into the proximal segment over the tube.

Competence in confirming correct placement of nasogastric feeding tubes amongst FY1 doctors

OpenAIRE

Lee, Sindy; Mason, Eleanor

2013-01-01

Foundation year one (FY1) doctors are required to confirm correct placement of nasogastric (NG) feeding tubes on chest radiography on a regular basis. Many FY1s do not receive formal training during medical school or during the FY1 year. Multiple incidents of harm to patients, including death, resulting from incorrect placement of an NG feeding tube have been reported to the National Patient Safety Agency (NPSA) since 2005. Our audit assessed the confidence and knowledge of FY1 doctors in cor...

The placement of naso-jejunal feeding tube under DSA guidance: its technology and skills

International Nuclear Information System (INIS)

Song Laichang; Wang Wenhui; Li Fenqiang; Su Dongjun; Li Bo

2009-01-01

Objective: To retrospectively analyze and summarize the manipulation and skills of the placement of naso-jejunal feeding tube under DSA guidance. Methods: After performing the spraying anesthesia of nasopharynx, the naso-jejunal feeding tube, with the help of guide wire and under DSA guidance, was placed into the proximal jejunum by passing it through the nose, pharynx, esophagus, stomach, pylorus and duodenum in order. The procedure was employed in 441 cases. Results: The mean time for performing the procedure was within five minutes. The procedure was successfully accomplished in all 441 cases and no complications occurred in this series. Conclusion: Under DSA guidance the placement of naso- jejunal feeding tube can be safely and quickly carried out with high successful rate and less sufferings to patient. It is worth popularizing this technique in clinical practice. (authors)

Dilemmas for guardians of advanced dementia patients regarding tube feeding.

Science.gov (United States)

Gil, Efrat; Agmon, Maayan; Hirsch, Ayal; Ziv, Miriam; Zisberg, Anna

2018-01-01

advanced dementia is an incurable illness, its last stage marked by inability to eat. Tube feeding was deemed a helpful solution at this stage, but in recent years its inefficiency has been proved, and it is no longer practiced in many countries around the world. In Israel, however, the procedure is still accepted. In the gastroenterology department at the Bnai Zion Medical Center, a serious interaction is ongoing with patients' legal guardians, where detailed information is given about the inefficiency of the tube procedure. Nevertheless, the great majority of guardians choose to have it performed. to probe the considerations underlying the decision for gastrostomy, despite the data and the recommendations. qualitative research, including participant observation at the clinic and in-depth interviews with guardians. the families of most patients did not discuss end-of-life issues with them. The overwhelming preference for using the technology was interpreted as life-saving, in contrast to comfort feeding, which was deemed euthanasia. The reasons given for the decision to tube feed were drawn from a range of outlooks: religion, the patient's earlier survival capacity, and pragmatic considerations involving relations with nursing home staff. study of the decision-making process of advanced dementia patients' guardians sheds light on the layers of meaning of the Israeli discourse regarding end-of-life issues. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com

A virtual reality based simulator for learning nasogastric tube placement.

Science.gov (United States)

Choi, Kup-Sze; He, Xuejian; Chiang, Vico Chung-Lim; Deng, Zhaohong

2015-02-01

Nasogastric tube (NGT) placement is a common clinical procedure where a plastic tube is inserted into the stomach through the nostril for feeding or drainage. However, the placement is a blind process in which the tube may be mistakenly inserted into other locations, leading to unexpected complications or fatal incidents. The placement techniques are conventionally acquired by practising on unrealistic rubber mannequins or on humans. In this paper, a virtual reality based training simulation system is proposed to facilitate the training of NGT placement. It focuses on the simulation of tube insertion and the rendering of the feedback forces with a haptic device. A hybrid force model is developed to compute the forces analytically or numerically under different conditions, including the situations when the patient is swallowing or when the tube is buckled at the nostril. To ensure real-time interactive simulations, an offline simulation approach is adopted to obtain the relationship between the insertion depth and insertion force using a non-linear finite element method. The offline dataset is then used to generate real-time feedback forces by interpolation. The virtual training process is logged quantitatively with metrics that can be used for assessing objective performance and tracking progress. The system has been evaluated by nursing professionals. They found that the haptic feeling produced by the simulated forces is similar to their experience during real NGT insertion. The proposed system provides a new educational tool to enhance conventional training in NGT placement. Copyright © 2014 Elsevier Ltd. All rights reserved.

The effects of oral sucrose on pain due to nasogastric tube insertion in premature infants: A crossover clinical trial

Directory of Open Access Journals (Sweden)

Jebreili M

2014-11-01

Full Text Available Background and Objective: Pain in neonates may have adverse impacts. Therefore, relieving pain through harmless, simple, and applicable methods, in order to prevent its dangerous consequences, is of great importance. The aim of the present study is to determine the impact of oral sucrose on relieving nasogastric tube insertion pain in premature neonates. Materials and Method: The present study is a crossover clinical trial on 38 preterm infants (gestational age between 28-34 weeks hospitalized in Bistonoh-e-Bahman Hospital, Tabriz, Iran, in 2013. The subjects were selected by convenience sampling and divided into two groups using randomized block design. In the first group, nasogastric tube insertion was carried out in the routine way for the first time, and for the second time, by administration of oral sucrose. In the second group, the procedure was performed in the reverse order of that in the first group. In both groups the emerging pain was measured by the Premature Infant Pain Profile (PIPP tool 2 minutes before, during, and 5 minutes after the procedure. Data were analyzed using, chi-square t-test, Students' independent test, paired t-test, and repeated measures ANOVA in SPSS version 18 to examine the trend of change in pain in time. P values of less than 0.05 were considered statistically significant. Results: The results showed that oral sucrose reduces the pain response of infants. The mean pain score during the insertion of nasogastric tube and administration of oral sucrose was 5.95 ± 2.35 and during routine procedures was 9.93 ± 2.89 (P < 0.001. The mean pain score 5 minutes after insertion of nasogastric tube with administration of oral sucrose was 3.66 ± 0.57 and routine procedure was 6.38 ± 0.83 (P = 0.017. Conclusion: It was revealed that oral sucrose can relieve pain caused by nasogastric tube insertion. Therefore, its implementation as a harmless and simple method can reduce pain in preterm infants.

Definition of the minimum longitude of insert in the rebuilding of Charpy test tubes for surveillance and life extension of vessels in Mexico

International Nuclear Information System (INIS)

Romero C, J.; Hernandez C, R.; Rocamontes A, M.

2011-11-01

In the National Institute of Nuclear Research (Mexico) a welding system for the rebuilding of Charpy test tubes has been developed, automated, qualified and used for the surveillance of the mechanical properties (mainly embrittlement) of the vessel. This system uses the halves of the rehearsed Charpy test tubes of the surveillance capsules extracted of the reactors, to obtain, of a rehearsed test tube, two reconstituted test tubes. This rebuilding process is used so much in the surveillance program like in the potential extension of the operation license of the vessel. To the halves of Charpy test tubes that have been removed the deformed part by machine are called -insert- and in a very general way the rebuilding consists in weld with the welding process -Stud Welding- two metallic implants in the ends of the insert, to obtain a reconstituted test tube. The main characteristic of this welding are the achieved small dimensions, so much of the areas welded as of the areas affected by the heat. The applicable normative settles down that the minim longitude of the insert for the welding process by Stud Welding it should be of 18 mm, however according to the same normative this longitude can diminish if is demonstrated analytic or experimentally that the central volume of 1 cm 3 in the insert is not affected. In this work the measurement of the temperature profiles to different distances of the welding interface is presented, defining an equation for the maximum temperatures reached in function of the distance, on the other hand the real longitude affected in the test tube by means of metallography is determined and this way the minimum longitude of the insert for this developed rebuilding system was determined. (Author)

Evaluation of the benefits of gastric tube feeding in an elderly population.

Science.gov (United States)

Weaver, J P; Odell, P; Nelson, C

1993-09-01

To assess the benefits of gastric tube feeding in an elderly community hospital population. One hundred consecutive patients who required feeding gastrostomies from July 1984 through June 1987. Durham (NC) Regional Hospital, a 380-bed community hospital. Patients were evaluated using a quality of life scale (QL scale) adapted from Spitzer's QL Index. The evaluation was based on hospital records at the time of tube placement and interviews with patients or family members at follow-up between June 1991 and March 1992. Subjective evaluation of the benefits of gastric tube feeding were obtained in interviews with patients or their families at follow-up. Overall there was no significant change in the objective evaluation of quality of life at follow-up. Men, patients over 76 years of age, and patients with chronic illnesses such as multiple strokes or dementia showed the poorest response on the QL scale. Subjective evaluation by patients or their family members was positively correlated with objective evaluation on the QL scale. Family members of patients who showed the poorest response on the QL scale were more likely than other family members to respond no to the question, "Would you want this done to you if you were in his/her situation?" Our QL scale provides a good indication of patients' and family members' subjective evaluation of the benefits of gastrostomy tube feeding after 4 to 8 years. Thus, the scale should be helpful to physicians who must consult with patients and their families and make decisions about the use of this procedure. The significant discrepancy between family members' evaluations of the benefit of the procedure to the patient and their refusal of the procedure for themselves if they were in the patient's situation confirms the need for advance directives and the importance of conscientious implementation of the Patient Self Determination Act of 1990.

Spring/dimple instrument tube restraint

International Nuclear Information System (INIS)

DeMario, E.E.; Lawson, C.N.

1993-01-01

A nuclear fuel assembly for a pressurized water nuclear reactor has a spring and dimple structure formed in a non-radioactive insert tube placed in the top of a sensor receiving instrumentation tube thimble disposed in the fuel assembly and attached at a top nozzle, a bottom nozzle, and intermediate grids. The instrumentation tube thimble is open at the top, where the sensor or its connection extends through the cooling water for coupling to a sensor signal processor. The spring and dimple insert tube is mounted within the instrumentation tube thimble and extends downwardly adjacent the top. The springs and dimples restrain the sensor and its connections against lateral displacement causing impact with the instrumentation tube thimble due to the strong axial flow of cooling water. The instrumentation tube has a stainless steel outer sleeve and a zirconium alloy inner sleeve below the insert tube adjacent the top. The insert tube is relatively non-radioactivated inconel alloy. The opposed springs and dimples are formed on diametrically opposite inner walls of the insert tube, the springs being formed as spaced axial cuts in the insert tube, with a web of the insert tube between the cuts bowed radially inwardly for forming the spring, and the dimples being formed as radially inward protrusions opposed to the springs. 7 figures

Crashworthiness of Aluminium Tubes; Part 1: Hydroforming at Different Corner-Fill Radii and End Feeding Levels

International Nuclear Information System (INIS)

D'Amours, Guillaume; Rahem, Ahmed; Williams, Bruce; Worswick, Michael; Mayer, Robert

2007-01-01

The automotive industry, with an increasing demand to reduce vehicle weight through the adoption of lightweight materials, requires a search of efficient methods that suit these materials. One attractive concept is to use hydroforming of aluminium tubes. By using FE simulations, the process can be optimized to reduce the risk for failure while maintaining energy absorption and component integrity under crash conditions. It is important to capture the level of residual ductility after forming to allow proper design for crashworthiness. This paper presents numerical and experimental studies that have been carried out for high pressure hydroforming operations to study the influence of the tube corner radius, end feeding, material thinning, and work hardening in 76.2 mm diameter, 3 mm wall thickness AA5754 aluminium alloy tube. End feeding was used to increase the formability of the tubes. The influence of the end feed displacement versus tube forming pressure schedule was studied to optimize the forming process operation to reduce thinning. Validation of the numerical simulations was performed by comparison of the predicted strain distributions and thinning, with measured quantities. The effect of element formulation (thin shell versus solid elements) was also considered in the models

Crashworthiness of Aluminium Tubes; Part 1: Hydroforming at Different Corner-Fill Radii and End Feeding Levels

Science.gov (United States)

D'Amours, Guillaume; Rahem, Ahmed; Williams, Bruce; Worswick, Michael; Mayer, Robert

2007-05-01

The automotive industry, with an increasing demand to reduce vehicle weight through the adoption of lightweight materials, requires a search of efficient methods that suit these materials. One attractive concept is to use hydroforming of aluminium tubes. By using FE simulations, the process can be optimized to reduce the risk for failure while maintaining energy absorption and component integrity under crash conditions. It is important to capture the level of residual ductility after forming to allow proper design for crashworthiness. This paper presents numerical and experimental studies that have been carried out for high pressure hydroforming operations to study the influence of the tube corner radius, end feeding, material thinning, and work hardening in 76.2 mm diameter, 3 mm wall thickness AA5754 aluminium alloy tube. End feeding was used to increase the formability of the tubes. The influence of the end feed displacement versus tube forming pressure schedule was studied to optimize the forming process operation to reduce thinning. Validation of the numerical simulations was performed by comparison of the predicted strain distributions and thinning, with measured quantities. The effect of element formulation (thin shell versus solid elements) was also considered in the models.

Enteral Tube Feeding Alters the Oral Indigenous Microbiota in Elderly Adults ▿ †

OpenAIRE

Takeshita, Toru; Yasui, Masaki; Tomioka, Mikiko; Nakano, Yoshio; Shimazaki, Yoshihiro; Yamashita, Yoshihisa

2011-01-01

Enteral tube feeding is widely used to maintain nutrition for elderly adults with eating difficulties, but its long-term use alters the environment of the oral ecosystem. This study characterized the tongue microbiota of tube-fed elderly adults by analyzing the 16S rRNA gene. The terminal restriction fragment length polymorphism (T-RFLP) profiles of 44 tube-fed subjects were compared with those of 54 subjects fed orally (average age, 86.4 ± 6.9 years). Bar-coded pyrosequencing data were also ...

Enteral Feeding Tube Clogging: What Are the Causes and What Are the Answers? A Bench Top Analysis.

Science.gov (United States)

Garrison, Christopher M

2018-02-01

Clogged enteral feeding tubes remain a significant barrier to the delivery of nutrition, hydration, and medications to patients who cannot tolerate oral intake. There is limited research that compares the relative efficacy of different methods used to clear a clogged feeding tube. The objectives of this study were to better understand the factors that contribute to enteral feeding tube clogging and to test the efficacy of 3 methods for clearing clogged feeding tubes. Three formulations of clogs were artificially created and tested in vitro and composed of various quantities of crushed medication (ie, aspirin) and 0.15 g coagulated protein (ie, tofu). The following 3 clog clearing strategies were tested on all clog types (n = 5 clogs/formulation/treatment): warm water flushes, an enzyme treatment, and an actuated mechanical occlusion clearing device. The variable among the clog types that appears most responsible for decreased clearing success is the state of the coagulated protein. Dried-out protein appears to makes a greater difference than increasing the medication quantity. The actuated mechanical occlusion clearing device was significantly more successful (93%) when compared with warm water flushes (20%) and the commercially available enzyme treatment (33%; P Nutrition.

Radiology responsibilities post NPSA guidelines for nasogastric tube insertion: A single centre review

International Nuclear Information System (INIS)

Snaith, Beverly; Flintham, Kevin

2015-01-01

Background: There are well-recognised complications associated with malposition of nasogastric (NG) tubes. In 2011 the UK National Patient Safety Agency (NPSA) published an alert regarding their insertion and position confirmation. This alert also identified the expected radiology standards for both image acquisition and reporting. Method: This was a retrospective review of referrals over a six-month period within a multi-site NHS Trust. A consecutive sampling approach was used and radiology reports where the text included the terms “NG tube”, “nasogastric” or “feeding” were included. Data were collected from the radiology information system and NG tube visibility and image quality were confirmed by two independent reviewers. Results: 1137 examinations demonstrated an NG tube, of which 68.3% were performed to check tube position. There was statistically significant correlation between lower radiation exposure and non-visualisation (Fishers exact test, p < 0.001). The number of examinations with higher exposure index (EI) in the NG check cohort suggests that the radiographer increased the exposure to improve visualization (x 2  = 2.846; 95% CI; p = 0.046), although the utility of this is unproven. Malplaced tubes were demonstrated either in the respiratory tract (1.8%) or proximal gastrointestinal tract (8.6%) as a result of insufficient length introduced. Conclusion: The prompt acquisition and reporting of radiographs is essential to reduce the risk of NG tube complications. Respiratory tract misplacement rates were in line with the published literature, but this study does raise concern regarding the number of tubes located in the proximal GI tract. Radiology's responsibility in accurate and effective reporting of medical interventions is significant

Development of laser cladding system to repair wall thinning of 1-inch heat exchanger tube

International Nuclear Information System (INIS)

Terada, Takaya

2013-01-01

We developed a laser cladding system to repair the inner wall wastage of heat exchanger tubes. Our system, which is designed to repair thinning tube walls within 100 mm from the edge of a heat exchanger tube, consists of a fiber laser, a composite-type optical fiberscope, a coupling device, a laser processing head, and a wire-feeding device. All of these components were reconfigured from the technologies of FBR maintenance. The laser processing head, which has a 15-mm outer diameter, was designed to be inserted into a 1-inch heat exchanger tube. We mounted a heatproof broadband mirror for laser cladding and fiberscope observation with visible light inside the laser processing head. The wire-feeding device continuously supplied 0.4-mm wire to the laser irradiation spot with variable feeding speeds from 0.5 to 20 mm/s. We are planning to apply our proposed system to the maintenance of aging industrial plants. (author)

Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial.

Science.gov (United States)

Sitzwohl, Christian; Langheinrich, Angelika; Schober, Andreas; Krafft, Peter; Sessler, Daniel I; Herkner, Harald; Gonano, Christopher; Weinstabl, Christian; Kettner, Stephan C

2010-11-09

To determine which bedside method of detecting inadvertent endobronchial intubation in adults has the highest sensitivity and specificity. Prospective randomised blinded study. Department of anaesthesia in tertiary academic hospital. 160 consecutive patients (American Society of Anesthesiologists category I or II) aged 19-75 scheduled for elective gynaecological or urological surgery. Patients were randomly assigned to eight study groups. In four groups, an endotracheal tube was fibreoptically positioned 2.5-4.0 cm above the carina, whereas in the other four groups the tube was positioned in the right mainstem bronchus. The four groups differed in the bedside test used to verify the position of the endotracheal tube. To determine whether the tube was properly positioned in the trachea, in each patient first year residents and experienced anaesthetists were randomly assigned to independently perform bilateral auscultation of the chest (auscultation); observation and palpation of symmetrical chest movements (observation); estimation of the position of the tube by the insertion depth (tube depth); or a combination of all three (all three). Correct and incorrect judgments of endotracheal tube position. 160 patients underwent 320 observations by experienced and inexperienced anaesthetists. First year residents missed endobronchial intubation by auscultation in 55% of cases and performed significantly worse than experienced anaesthetists with this bedside test (odds ratio 10.0, 95% confidence interval 1.4 to 434). With a sensitivity of 88% (95% confidence interval 75% to 100%) and 100%, respectively, tube depth and the three tests combined were significantly more sensitive for detecting endobronchial intubation than auscultation (65%, 49% to 81%) or observation(43%, 25% to 60%) (Pauscultation to detect inadvertent endobronchial intubation. But even experienced physicians will benefit from inserting tubes to 20-21 cm in women and 22-23 cm in men, especially when high

Gastrostomy versus nasogastric tube feeding for chemoradiation patients with head and neck cancer: the TUBE pilot RCT.

Science.gov (United States)

Paleri, Vinidh; Patterson, Joanne; Rousseau, Nikki; Moloney, Eoin; Craig, Dawn; Tzelis, Dimitrios; Wilkinson, Nina; Franks, Jeremy; Hynes, Ann Marie; Heaven, Ben; Hamilton, David; Guerrero-Urbano, Teresa; Donnelly, Rachael; Barclay, Stewart; Rapley, Tim; Stocken, Deborah

2018-04-01

Approximately 9000 new cases of head and neck squamous cell cancers (HNSCCs) are treated by the NHS each year. Chemoradiation therapy (CRT) is a commonly used treatment for advanced HNSCC. Approximately 90% of patients undergoing CRT require nutritional support via gastrostomy or nasogastric tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date (at the time of writing), not been compared. The aim of this pilot randomised controlled trial (RCT) was to compare these two options. This was a mixed-methods multicentre study to establish the feasibility of a RCT comparing oral feeding plus pre-treatment gastrostomy with oral feeding plus as-required nasogastric tube feeding in patients with HNSCC. Patients were recruited from four tertiary centres treating cancer and randomised to the two arms of the study (using a 1 : 1 ratio). The eligibility criteria were patients with advanced-staged HNSCC who were suitable for primary CRT with curative intent and who presented with no swallowing problems. The primary outcome was the willingness to be randomised. A qualitative process evaluation was conducted alongside an economic modelling exercise. The criteria for progression to a Phase III trial were based on a hypothesised recruitment rate of at least 50%, collection of outcome measures in at least 80% of those recruited and an economic value-of-information analysis for cost-effectiveness. Of the 75 patients approached about the trial, only 17 consented to be randomised [0.23, 95% confidence interval (CI) 0.13 to 0.32]. Among those who were randomised, the compliance rate was high (0.94, 95% CI 0.83 to 1.05). Retention rates were high at completion of treatment (0.94, 95% CI 0.83 to 1.05), at the 3-month follow-up (0.88, 95% CI 0.73 to 1.04) and at the 6-month follow-up (0.88, 95% CI 0.73 to 1.04). No serious adverse

Continuous versus bolus intragastric tube feeding for preterm and low birth weight infants with gastro-oesophageal reflux disease.

Science.gov (United States)

Richards, Robyn; Foster, Jann P; Psaila, Kim

2014-07-17

Gastro-oesophageal reflux disease is a particularly common condition in preterm and low birth weight infants. These infants are also more likely to have excessive regurgitation, as they do not have a fully developed antireflux mechanism. Preterm and low birth weight infants who are unable to suck oral feeds are required to be fed via an intragastric tube for varying lengths of time. Intragastric tube feeding can be delivered by the intermittent bolus or continuous feeding method. Use of continuous or intermittent bolus intragastric feeding may have a positive or negative effect on the incidence or severity of gastro-oesophageal reflux disease. To determine whether continuous or intermittent bolus intragastric tube feeding reduces the number of episodes and the duration of gastro-oesophageal reflux disease (GORD) in preterm and low birth weight infants.We intended to perform subgroup analyses for gestational age; birth weight; age in days from birth at full enteral feeding via intragastric tube (breast vs bottle); frequency of intermittent bolus feed; and type of medication for treatment of GORD (only if medication prescribed and given similarly to both intervention groups). We used the standard search strategy of the Cochrane Neonatal Group as described in The Cochrane Library (www.thecochranelibrary.com) to search for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), MEDLINE (1966 to September 2013), EMBASE (1980 to September 2013) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to September 2013). We also searched previous reviews, including cross-references, abstracts and conference and symposia proceedings of the Perinatal Society of Australia and New Zealand and the Pediatric Academic Societies (American Pediatric Society/Society for Pediatric Research and European Society for Paediatric Research) from 1990 to 2012. Published and unpublished RCTs and quasi

Comparison between gastrostomy feeding and self-expandable metal stent insertion for patients with esophageal cancer and dysphagia.

Science.gov (United States)

Min, Yang Won; Jang, Eun Young; Jung, Ji Hey; Lee, Hyuk; Min, Byung-Hoon; Lee, Jun Haeng; Rhee, Poong-Lyul; Kim, Jae J

2017-01-01

Self-expandable metal stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding are commonly used for patients with esophageal cancer and dysphagia. This study aimed to compare outcomes between SEMS insertion and PG feeding for them. We retrospectively analyzed 308 patients with esophageal cancer who underwent fully covered SEMS insertion (stent group) or PG (gastrostomy group) for dysphagia due to tumor. Patients with other causes of dysphagia, such as radiation-induced or postoperative stricture, were excluded from the study. Clinical outcomes were compared between the two groups, including overall survival and need for additional intervention and postprocedural nutritional status. At baseline, the stent group (n = 169) had more stage IV patients, less cervical cancers, and received radiotherapy and esophagectomy less often than the gastrostomy group (n = 64). The Kaplan-Meier curves showed higher overall survival in the gastrostomy group than in the stent group. Multivariate analysis revealed that PG was associated with better survival compared with SEMS insertion (hazard ratio 0.541, 95% confidence interval 0.346-0.848, p = 0.007). In addition, the gastrostomy group needed additional intervention less often (3.1% vs. 21.9%, p esophageal cancer and dysphagia. Stabilized nutritional status by PG may play a role in improving patient survival.

Comparison of four techniques of nasogastric tube insertion in anaesthetised, intubated patients: A randomized controlled trial

Directory of Open Access Journals (Sweden)

Mohan Chandra Mandal

2014-01-01

Full Text Available Background and Aims: Insertion of nasogastric tubes (NGTs in anaesthetised, intubated patients with a conventional method is sometimes difficult. Different techniques of NGT insertion have been tried with varying degree of success. The aim of this prospective, randomised, open-label study was to evaluate three modified techniques of NGT insertion comparing with the conventional method in respect of success rate, time taken for insertion and the adverse events. Methods: In the operation theatre of general surgery, the patients were randomly allocated into four groups: Group C (control group, n = 54, Group W (ureteral guide wire group, n = 54, Group F (neck flexion with lateral pressure, n = 54 and Group R (reverse Sellick′s manoeuvre, n = 54. The number of attempts for successful NGT insertion, time taken for insertion and adverse events were noted. Results: All the three modified techniques were found more successful than the conventional method on the first attempt. The least time taken for insertion was noted in the reverse Sellick′s method. However, on intergroup analysis, neck flexion and reverse Sellick′s methods were comparable but significantly faster than the other two methods with respect to time taken for insertion. Conclusion: Reverse Sellick′s manoeuver, neck flexion with lateral neck pressure and guide wire-assisted techniques are all better alternatives to the conventional method for successful, quick and reliable NGT insertion with permissible adverse events in anaesthetised, intubated adult patients. Further studies after eliminating major limitations of the present study are warranted to establish the superiority of any one of these modified techniques.

Family Experiences With Feeding Tubes in Neurologic Impairment: A Systematic Review.

Science.gov (United States)

Nelson, Katherine E; Lacombe-Duncan, Ashley; Cohen, Eyal; Nicholas, David B; Rosella, Laura C; Guttmann, Astrid; Mahant, Sanjay

2015-07-01

Gastrostomy tubes (G-tubes) are frequently used to provide enteral nutrition for children who have neurologic impairment. Understanding the impact of G-tubes from the family's perspective will inform decision-making and improve support from health care providers. This study explored the experiences of families after G-tube placement in children with neurologic impairment. We conducted a systematic review of English-language qualitative primary research studies describing family experiences after G-tube placement. Six electronic databases were searched from inception to June 2014. Two authors independently screened and identified relevant studies, evaluated quality of reporting by using the Consolidated Criteria for Reporting Qualitative Research tool, and extracted data. Overarching concepts were developed by using thematic analysis. From 2674 screened abstracts, 84 texts were reviewed, and 13 studies met the inclusion criteria. G-tubes affect the lives of children, parents, and the family unit in many ways, both positive and negative. Improvements and challenges were described for children's health and happiness, for parental caregiving and stress, and for logistics and bonding within the family. G-tube feeding also changed relationships within the family, between the family and the medical system, and between the family and the outside world. Furthermore, experiences varied, with different families framing similar concepts as positive and negative. G-tube placement has diverse effects on daily life for children with neurologic impairment and their families. Clinicians may use the themes identified in this study to guide conversations with families about their values, experiences, and expectations before and after G-tube placement. Copyright © 2015 by the American Academy of Pediatrics.

Development and validation of a prediction model for tube feeding dependence after curative (chemo- radiation in head and neck cancer.

Directory of Open Access Journals (Sweden)

Kim Wopken

Full Text Available BACKGROUND: Curative radiotherapy or chemoradiation for head and neck cancer (HNC may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a prediction model for tube feeding dependence 6 months (TUBEM6 after curative (chemo- radiotherapy in HNC patients. PATIENTS AND METHODS: Tube feeding dependence was scored prospectively. To develop the multivariable model, a group LASSO analysis was carried out, with TUBEM6 as the primary endpoint (n = 427. The model was then validated in a test cohort (n = 183. The training cohort was divided into three groups based on the risk of TUBEM6 to test whether the model could be extrapolated to later time points (12, 18 and 24 months. RESULTS: Most important predictors for TUBEM6 were weight loss prior to treatment, advanced T-stage, positive N-stage, bilateral neck irradiation, accelerated radiotherapy and chemoradiation. Model performance was good, with an Area under the Curve of 0.86 in the training cohort and 0.82 in the test cohort. The TUBEM6-based risk groups were significantly associated with tube feeding dependence at later time points (p<0.001. CONCLUSION: We established an externally validated predictive model for tube feeding dependence after curative radiotherapy or chemoradiation, which can be used to predict TUBEM6.

Leakproof Swaged Joints in Thin-Wall Tubing

Science.gov (United States)

Stuckenberg, F. H.; Crockett, L. K.; Snyder, W. E.

1986-01-01

Tubular inserts reinforce joints, reducing incidence of leaks. In new swaging technique, tubular inserts placed inside ends of both tubes to be joined. Made from thicker-wall tubing with outside diameter that matches inside diameter of thin tubing swaged, inserts support tube ends at joint. They ensure more uniform contact between swage fitting and tubing. New swaging technique developed for Al/Ti/V-alloy hydraulic supply lines.

Comparison between gastrostomy feeding and self-expandable metal stent insertion for patients with esophageal cancer and dysphagia.

Directory of Open Access Journals (Sweden)

Yang Won Min

Full Text Available Self-expandable metal stent (SEMS insertion and percutaneous gastrostomy (PG feeding are commonly used for patients with esophageal cancer and dysphagia. This study aimed to compare outcomes between SEMS insertion and PG feeding for them.We retrospectively analyzed 308 patients with esophageal cancer who underwent fully covered SEMS insertion (stent group or PG (gastrostomy group for dysphagia due to tumor. Patients with other causes of dysphagia, such as radiation-induced or postoperative stricture, were excluded from the study. Clinical outcomes were compared between the two groups, including overall survival and need for additional intervention and postprocedural nutritional status.At baseline, the stent group (n = 169 had more stage IV patients, less cervical cancers, and received radiotherapy and esophagectomy less often than the gastrostomy group (n = 64. The Kaplan-Meier curves showed higher overall survival in the gastrostomy group than in the stent group. Multivariate analysis revealed that PG was associated with better survival compared with SEMS insertion (hazard ratio 0.541, 95% confidence interval 0.346-0.848, p = 0.007. In addition, the gastrostomy group needed additional intervention less often (3.1% vs. 21.9%, p < 0.001 and experienced less decrease in serum albumin levels (-0.15 ± 0.56 g/dL vs. -0.39 ± 0.58 g/dL, p = 0.011 than the stent group after procedure.Our data suggested that, compared with SEMS insertion, PG is associated with better overall survival in patients with esophageal cancer and dysphagia. Stabilized nutritional status by PG may play a role in improving patient survival.

Catalytic combustion of propane in a membrane reactor with separate feed of reactants—I. Operation in absence of trans-membrane pressure gradients

NARCIS (Netherlands)

Saracco, Guido; Veldsink, Jan Willem; Versteeg, Geert F.; Swaaij, Wim P.M. van

1995-01-01

A pilot plant study on propane catalytic combustion in a membrane reactor with separate reactant feeds is presented. The membrane consisted of a porous alumina tube activated by insertion into its pores of a Pt/γ-Al2O3 catalyst. The role of reactants concentration and of the feed flow rates were

Replacement of Mushroom Cage Gastrostomy Tube Using a Modified Technique to Allow Percutaneous Replacement with an Endoscopic Tube in Patients with Amyotrophic Lateral Sclerosis

International Nuclear Information System (INIS)

Ammar, Thoraya; Rio, Alan; Ampong, Mary Ann; Sidhu, Paul S.

2010-01-01

Radiologic inserted gastrostomy (RIG) is the preferred method in our institution for enteral feeding in amyotrophic lateral sclerosis (ALS). Skin-level primary-placed mushroom cage gastrostomy tubes become tight with weight gain. We describe a minimally invasive radiologic technique for replacing mushroom gastrostomy tubes with endoscopic mushroom cage tubes in ALS. All patients with ALS who underwent replacement of a RIG tube were included. Patients were selected for a modified replacement when the tube length of the primary placed RIG tube was insufficient to allow like-for-like replacement. Replacement was performed under local anesthetic and fluoroscopic guidance according to a preset technique, with modification of an endoscopic mushroom cage gastrostomy tube to allow percutaneous placement. Assessment of the success, safety, and durability of the modified technique was undertaken. Over a 60-month period, 104 primary placement mushroom cage tubes in ALS were performed. A total of 20 (19.2%) of 104 patients had a replacement tube positioned, 10 (9.6%) of 104 with the modified technique (male n = 4, female n = 6, mean age 65.5 years, range 48-85 years). All tubes were successfully replaced using this modified technique, with two minor complications (superficial wound infection and minor hemorrhage). The mean length of time of tube durability was 158.5 days (range 6-471 days), with all but one patient dying with a functional tube in place. We have devised a modification to allow percutaneous replacement of mushroom cage gastrostomy feeding tubes with minimal compromise to ALS patients. This technique allows tube replacement under local anesthetic, without the need for sedation, an important consideration in ALS.

Experimental Analysis of the Thermo-Hydraulic Performance on a Cylindrical Parabolic Concentrating Solar Water Heater with Twisted Tape Inserts in an Absorber Tube

Science.gov (United States)

Kumar, Birendra; Nayak, Rajen Kumar; Singh, S. N.

2018-05-01

A twisted tape inserted in an absorber tube may be an excellent option to enhance the performance of a cylindrical parabolic concentrating solar collector (CPC). The present work is an experimental study of the flow and heat transfer with and without twisted tape inserts in the absorber tube of a CPC. Results are presented for mass flow rates of water, ṁ=0.0198-0.0525 kg/s, twist ratio, y=5-10 and Reynolds number, Re=2577.46-6785.55. In the present study, we found that the outlet water temperature, collector efficiency and Nusselt number (Nu) are higher in the twisted tapes as compared to those without the twisted tape inserts in the absorber tube of the CPC. For fixed mass flow rate of water ṁ, the To and η increased with the decrease in twist ratio, y, and is higher in lower twist ratio, y=5, of the twisted tapes. The whole experiment was performed at the Indian Institute of Technology (ISM) in Dhanbad, India during the months of March-April 2017. Based on the experimental data, the correlations for the Nu and friction factor were also developed.

Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer

International Nuclear Information System (INIS)

Wopken, Kim; Bijl, Hendrik P.; Schaaf, Arjen van der; Laan, Hans Paul van der; Chouvalova, Olga; Steenbakkers, Roel J.H.M.; Doornaert, Patricia; Slotman, Ben J.; Oosting, Sjoukje F.; Christianen, Miranda E.M.C.; Laan, Bernard F.A.M. van der; Roodenburg, Jan L.N.; René Leemans, C.; Verdonck-de Leeuw, Irma M.; Langendijk, Johannes A.

2014-01-01

Background and purpose: Curative radiotherapy/chemo-radiotherapy for head and neck cancer (HNC) may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence 6 months (TUBE M6 ) after definitive radiotherapy, radiotherapy plus cetuximab or concurrent chemoradiation based on pre-treatment and treatment characteristics. Materials and methods: The study included 355 patients with HNC. TUBE M6 was scored prospectively in a standard follow-up program. To design the prediction model, the penalized learning method LASSO was used, with TUBE M6 as the endpoint. Results: The prevalence of TUBE M6 was 10.7%. The multivariable model with the best performance consisted of the variables: advanced T-stage, moderate to severe weight loss at baseline, accelerated radiotherapy, chemoradiation, radiotherapy plus cetuximab, the mean dose to the superior and inferior pharyngeal constrictor muscle, to the contralateral parotid gland and to the cricopharyngeal muscle. Conclusions: We developed a multivariable NTCP model for TUBE M6 to identify patients at risk for tube feeding dependence. The dosimetric variables can be used to optimize radiotherapy treatment planning aiming at prevention of tube feeding dependence and to estimate the benefit of new radiation technologies

Intercostal drainage tube or intracardiac drainage tube?

Science.gov (United States)

Anitha, N; Kamath, S Ganesh; Khymdeit, Edison; Prabhu, Manjunath

2016-01-01

Although insertion of chest drain tubes is a common medical practice, there are risks associated with this procedure, especially when inexperienced physicians perform it. Wrong insertion of the tube has been known to cause morbidity and occasional mortality. We report a case where the left ventricle was accidentally punctured leading to near-exsanguination. This report is to highlight the need for experienced physicians to supervise the procedure and train the younger physician in the safe performance of the procedure.

High aspect ratio catalytic reactor and catalyst inserts therefor

Science.gov (United States)

Lin, Jiefeng; Kelly, Sean M.

2018-04-10

The present invention relates to high efficient tubular catalytic steam reforming reactor configured from about 0.2 inch to about 2 inch inside diameter high temperature metal alloy tube or pipe and loaded with a plurality of rolled catalyst inserts comprising metallic monoliths. The catalyst insert substrate is formed from a single metal foil without a central supporting structure in the form of a spiral monolith. The single metal foil is treated to have 3-dimensional surface features that provide mechanical support and establish open gas channels between each of the rolled layers. This unique geometry accelerates gas mixing and heat transfer and provides a high catalytic active surface area. The small diameter, high aspect ratio tubular catalytic steam reforming reactors loaded with rolled catalyst inserts can be arranged in a multi-pass non-vertical parallel configuration thermally coupled with a heat source to carry out steam reforming of hydrocarbon-containing feeds. The rolled catalyst inserts are self-supported on the reactor wall and enable efficient heat transfer from the reactor wall to the reactor interior, and lower pressure drop than known particulate catalysts. The heat source can be oxygen transport membrane reactors.

Shaping oral feeding in a gastronomy tube-dependent child in natural settings.

Science.gov (United States)

Gutentag, S; Hammer, D

2000-07-01

A 3-year-old medically fragile girl who refused to eat after prolonged and frequent hospitalizations was started on a feeding program in the home and school settings. She exhibited food aversions and received all nourishment via a gastronomy tube. Preevaluation observations of her feeding behavior revealed that she refused all presented drinks and foods. Treatment was two-fold. First, food acceptance was followed by social praise and access to preferred toy play, and second, food refusal and disruptive behaviors were ignored. Gagging, vomiting, and crying occurred periodically during initial feedings. In addition, there were medical complications during the course of treatment necessitating continuous modifications of the program. Results of a multiple-phase design showed marked increases in the amount of food consumed at home, which then generalized to the school setting.

Intercostal drainage tube or intracardiac drainage tube?

Directory of Open Access Journals (Sweden)

N Anitha

2016-01-01

Full Text Available Although insertion of chest drain tubes is a common medical practice, there are risks associated with this procedure, especially when inexperienced physicians perform it. Wrong insertion of the tube has been known to cause morbidity and occasional mortality. We report a case where the left ventricle was accidentally punctured leading to near-exsanguination. This report is to highlight the need for experienced physicians to supervise the procedure and train the younger physician in the safe performance of the procedure.

Heat exchanger tube tool

International Nuclear Information System (INIS)

Gugel, G.

1976-01-01

Certain types of heat-exchangers have tubes opening through a tube sheet to a manifold having an access opening offset from alignment with the tube ends. A tool for inserting a device, such as for inspection or repair, is provided for use in such instances. The tool is formed by a flexible guide tube insertable through the access opening and having an inner end provided with a connector for connection with the opening of the tube in which the device is to be inserted, and an outer end which remains outside of the chamber, the guide tube having adequate length for this arrangement. A flexible transport hose for internally transporting the device slides inside of the guide tube. This hose is long enough to slide through the guide tube, into the heat-exchanger tube, and through the latter to the extent required for the use of the device. The guide tube must be bent to reach the end of the heat-exchanger tube and the latter may be constructed with a bend, the hose carrying anit-friction elements at interspaced locations along its length to make it possible for the hose to negotiate such bends while sliding to the location where the use of the device is required

Estimation of cobalt release from feed water heater tubes of BWRs

International Nuclear Information System (INIS)

Uchida, S.; Kitamura, M.; Ozawa, Y.

1983-01-01

To evaluate the release source of cobalt from heater tubes of the feed water line, release rate measurements were carried out by detecting 60 Co released from irradiated stainless steel in contact with neutral water at an oxygen concentration of 20 ppb. The dependences of cobalt release rate on temperature, flow velocity and exposure time were studied after 670 hours of release experiments, and an empirical equation (which is presented) was obtained in the temperature range from 150 to 240 deg C. A decrease in the cobalt release rate above 250 deg C was considered due to the formation of a protective oxide layer. From these data, the amount of cobalt released from individual feed water heaters was evaluated. It was demonstrated that low cobalt containing stainless steel was economically applied only in the higher temperature region of the heater (20% of the total surface) to reduce cobalt feed rate into the reactor (to approx. 1/2). (author)

Compounding rifampin suspensions with improved injectability for nasogastric enteral feeding tube administration.

Science.gov (United States)

de Villiers, Melgardt M; Vogel, Laura; Bogenschutz, Monica C; Fingerhut, Bonnie J; D'Silva, Joseph B; Moore, Anne

2010-01-01

Often medications that have to be administered to patients via a nasogastric enteral feeding tubes are only available as tablets and capsules with no suitable commercial liquid alternatives. In such situations, pharmacists and nurses have to compound the tablets and capsule contents into liquid suspension formulations for dosing. The risk of occlusion of the enteral tubes during administration is reduced by employing liquid suspensions that are composed of small and uniform particles, not subject to rapid rates of settling, resistant to caking, and easily and uniformly re-suspended upon agitation. Present techniques often employ a manual process, such as a mortar and pestle, to accomplish the particle size reduction and subsequent incorporation into a suitable liquid diluent. A new compounding device has been invented that employs an automated wet-milling process in a single-use disposable plastic container to compound the suspensions. The two processes were compared using Rifampin capsules and various liquid diluents. A prototype version of the new device was employed in the experiments. The physical characteristics of the compounded suspensions were evaluated by determining sedimentation rate, sedimentation volume, and particle size and shape using laser light scattering, optical microscopy, and scanning electron microscopy techniques. The use characteristic of the compounded suspensions was evaluated using a nasogastric tube inject ability test. The results indicated that suspensions prepared using the new device were more resistant to sedimentation and caking and were easier to re-disperse into a uniform mixture by gentle shaking. The results were a consequence of the particles generated by the new device which were found to be smaller and more uniform in shape and size. The suspensions prepared using the new device did not cause blockage of the enteral feeding tubes in comparison to those prepared using a mortar and pastle. In conclusion, the results indicate

Peritonitis following percutaneous gastrostomy tube insertions in children

Energy Technology Data Exchange (ETDEWEB)

Dookhoo, Leema [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada); University of Toronto, Faculty of Medicine, Toronto, ON (Canada); Mahant, Sanjay [The Hospital for Sick Children, Department of Pediatrics, Toronto, ON (Canada); Parra, Dimitri A.; John, Philip R.; Amaral, Joao G.; Connolly, Bairbre L. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2016-09-15

Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

Peritonitis following percutaneous gastrostomy tube insertions in children

International Nuclear Information System (INIS)

Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A.; John, Philip R.; Amaral, Joao G.; Connolly, Bairbre L.

2016-01-01

Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

Peritonitis following percutaneous gastrostomy tube insertions in children.

Science.gov (United States)

Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A; John, Philip R; Amaral, Joao G; Connolly, Bairbre L

2016-09-01

Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

Oral dextrose for analgesia in neonates during nasogastric tube insertion: a randomised controlled trial.

Science.gov (United States)

Ravishankar, Arjun; Thawani, Rajat; Dewan, Pooja; Das, Saurabhi; Kashyap, Archana; Batra, Prerna; Faridi, Moonis Mohammed Akbar

2014-02-01

This study aims to determine if oral dextrose solution can mitigate the pain response to nasogastric tube (NGT) insertion in neonates. The study was a double-blinded, placebo-controlled, randomised controlled trial. One hundred and fifty consecutive neonates were randomised into three groups to receive 25% dextrose (D25), or 10% dextrose (D10) or placebo (distilled water). An NGT was inserted after giving 2 mL of one of the solutions orally. Pain response was assessed using the Premature Infant Pain Profile (PIPP), and the duration of cry was noted within 60 s of the intervention. Total PIPP score, duration of cry, change in heart rate and oxygen saturation (SpO2 ) were compared among the three groups. Neonates who received D25 had significantly lesser pain response to NGT insertion in terms of lower PIPP score (P < 0.05) and duration of cry (P = 0.001) compared to D10. There was a significantly smaller increase in heart rate and decrease in SpO2 (P < 0.05). In comparison with placebo, D10 significantly decreased duration of cry (P < 0.05) but not PIPP score. Oral D25 was effective in reducing the pain response during NGT insertion in neonates when compared with oral D10 and placebo. Oral D10 was not found to have a potent analgesic effect for the same. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

A Novel Device for Accurate Chest Tube Insertion

DEFF Research Database (Denmark)

Katballe, Niels; Moeller, Lars B; Olesen, Winnie H

2016-01-01

BACKGROUND: Optimal positioning of a large-bore chest tube is in the part of the pleural cavity that needs drainage. It is recommended that the chest tube be positioned apically in pneumothorax and basally for fluids. However, targeted chest tube positioning to a specific part of the pleural cavity...... can be a challenge. METHODS: A new medical device, the KatGuide, was developed for accurate guiding of a chest tube (28F) to an intended part of the pleural cavity. The primary end point of this randomized, controlled trial was optimal position of the chest tube. The optimal position in pneumothorax...

A simple in vitro test tube method for estimating the bioavailability of phosphorus in feed ingredients for swine.

Science.gov (United States)

Bollinger, David W; Tsunoda, Atsushi; Ledoux, David R; Ellersieck, Mark R; Veum, Trygve L

2004-04-07

A simplified in vitro test tube (TT) method was developed to estimate the percentage of available P in feed ingredients for swine. The entire digestion procedure with the TT method consists of three consecutive enzymatic digestions carried out in a 50-mL conical test tube: (1) Pre-digestion with endo-xylanase and beta-glucanase for 1 h, (2) peptic digestion for 2 h, and (3) pancreatic digestion for 2 or 4 h. The TT method is simpler and much easier to perform compared to the dialysis tubing (DT) method, because dialysis tubing is not used. Reducing sample size from 1.0 to 0.25 g for the TT method improved results. In conclusion, the accuracy and validity of the TT method is equal to that of our more complicated DT method (r = 0.97, P < 0.001), designed to mimic the digestive system of swine, for estimating the availability of P in plant-origin feed ingredients.

A protocol of early aggressive acceleration of tube feeding increases ileus without perceptible benefit in severely burned patients.

Science.gov (United States)

Kesey, Jennifer; Dissanaike, Sharmila

2013-01-01

Optimal nutrition is essential to the recovery of burned patients. The authors evaluated the efficacy of an aggressive nutrition delivery protocol. The following protocol was implemented: initiation of tube feeds within 4 hours, acceleration to goal rate within 8 hours, and tolerance of gastric residual volumes of 400 ml. Patients on the protocol formed the study group whereas patients admitted immediately before implementation served as controls for a study period of 7 days after admission. Outcome variables included ileus, prokinetic medication use, intensive care unit and overall length of stay, ventilator days and mortality. Variables were compared using bivariate analysis. The 42 study subjects and 34 controls were similar at baseline. Time to initiation was similar (6.8 vs 9.4 hours; P = .226), however, goal rate was achieved much sooner in the study group (11.2 vs 20.9 hours; P protocol was successfully implemented and resulted in early achievement of goal tube feed rates. However, this resulted in tube feed intolerance as manifested by more cases of clinical ileus.

Long-term follow-up of otitis media with effusion in children: comparisons between a ventilation tube group and a non-ventilation tube group.

Science.gov (United States)

Hong, Hye Ran; Kim, Tae Su; Chung, Jong Woo

2014-06-01

The objective of this study was to investigate the long-term outcomes in children with otitis media with effusion who received either medical treatment or ventilation tubes. We retrospectively analyzed the medical records of 89 bilateral cases of otitis media with effusion in children who were recommended to receive ventilation tube insertion and were followed up for more than 5 years. Tympanic membrane was inspected by otoscopic examination. Hearing was evaluated with pure tone audiometry. The mean duration of follow-up was 8.4 years (range, 5.2-15.7 years). Twenty-three children were treated without surgery, while 22 were treated once by ventilation tube insertion and 44 were treated more than once by ventilation tube insertion. At the fifth year of follow-up, both groups of children who underwent ventilation tube insertion had more frequent tympanic membrane abnormalities than the medication group (8.7% in those treated without surgery, 72.7% in those treated once by ventilation tube insertion, and 88.6% in those treated more than once by ventilation tube insertion). Common tympanic membrane abnormalities were retraction (27.0%) and tympanosclerotic plaque (23.6%), regardless of the treatment modality. At the fifth year follow-up, the average air-conduction threshold was 10.0 dB (± 6.5 dB) in patients treated without surgery, 15.9 dB (± 11.2dB) in patients treated once by ventilation tube insertion, and 17.8 dB (± 7.6 dB) in those treated more than once by ventilation tube insertion. The audiological difference was significant when we compared the hearing level of children treated by medication without surgery to the two ventilation tube groups. Though ventilation tube insertion can resolve hearing loss quickly, there were more tympanic membrane abnormalities and a decline in hearing levels in our ventilation tube insertion group vs. the observation group measured 5 years later. Physicians should therefore be cautious when applying a ventilation tube in

Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

Directory of Open Access Journals (Sweden)

Yomi Fashola

2018-01-01

Full Text Available We present the case of an elderly patient who became bradycardic after chest tube insertion for spontaneous pneumothorax. Arrhythmia is a rare complication of tube thoracostomy. Unlike other reported cases of chest tube induced arrhythmias, the bradycardia in our patient responded to resuscitative measures without removal or repositioning of the tube. Our patient, who had COPD, presented with shortness of breath due to spontaneous pneumothorax. Moments after tube insertion, patient developed severe bradycardia that responded to Atropine. In patients requiring chest tube insertion, it is important to be prepared to provide cardiopulmonary resuscitative therapy in case the patient develops a life-threatening arrhythmia.

Comparative Study of Esophageal Self-expandable Metallic Stent Insertion and Gastrostomy Feeding for Dysphagia Caused by Lung Cancer.

Science.gov (United States)

Kim, Jihye; Min, Yang Won; Lee, Hyuk; Min, Byung Hoon; Lee, Joon Haeng; Rhee, Poong Lyul; Kim, Jae J

2018-03-25

Dysphagia is encountered in a large proportion of patients with lung cancer and is associated with malnutrition and a poor quality of life. This study compared the clinical outcomes of self-expandable metallic stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding for patients with lung cancer and dysphagia. A total of 261 patients with lung cancer, who underwent either SEMS insertion (stent group) or PG (gastrostomy group) as an initial treatment procedure for dysphagia between July 1997 and July 2015 at the Samsung Medical Center, were reviewed retrospectively, and 84 patients with esophageal obstruction were identified. The clinical outcomes, including the overall survival, additional intervention, complications, and post-procedural nutritional status in the two groups, were compared. Among the 84 patients finally analyzed, 68 patients received SEMS insertion and 16 had PG. The stent group had less cervical obstruction and more mid-esophageal obstruction than the gastrostomy group. The Kaplan-Meier curves revealed similar overall survival in the two groups. Multivariate analysis showed that the two modalities had similar survival rates (PG compared with SEMS insertion, hazard ratio 0.682, p=0.219). Fifteen patients (22.1%) in the stent group received additional intervention, whereas there was no case in the gastrostomy group (p=0.063). The decrease in the serum albumin level after the procedure was lower in the gastrostomy group than in the stent group (-0.20±0.54 g/dL vs. -0.65±0.57 g/dL, p=0.013). SEMS insertion and PG feeding for relieving dysphagia by lung cancer had a comparable survival outcome. On the other hand, PG was associated with a better nutritional status.

Managing a chest tube and drainage system.

Science.gov (United States)

Durai, Rajaraman; Hoque, Happy; Davies, Tony W

2010-02-01

Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes. Copyright 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

The effect of a natural food based tube feeding in minimizing diarrhea in critically ill neurological patients.

Science.gov (United States)

Schmidt, Simone B; Kulig, Willibald; Winter, Ralph; Vasold, Antje S; Knoll, Anette E; Rollnik, Jens D

2018-01-09

Diarrhea has negative consequences for patients, health care staff and health care costs when neurological patients are fed enterally over long periods. We examined the effect of tube feeding with natural foods in reducing the number of fluid stool evacuations and diarrhea in critically ill neurological patients. A multicenter, prospective, open-label and randomized controlled trial (RCT) was conducted at facilities in Germany specializing in early rehabilitation after neurological damage. Patients of the INTERVENTION group were fed by tube using a commercially available product based on real foods such as milk, meat, carrots, whereas CONTROL patients received a standard tube-feed made of powdered raw materials. All received enteral nutrition over a maximum of 30 days. The number of defecations and the consistency of each stool according to the Bristol Stool Chart (BSC) were monitored. In addition, daily calories, liquids and antibiotic-use were recorded. 118 Patients who had suffered ischemic stroke, intracerebral hemorrhage, traumatic brain injury or hypoxic brain damage and requiring enteral nutrition were enrolled; 59 were randomized to receive the intervention and 59 control feed. There were no significant differences in clinical screening data, age, sex, observation period or days under enteral nutrition between the groups. Patients in both groups received equivalent amount of calories and fluids. In both groups antibiotics were frequently prescribed (69.5% in the INTERVENTION group and 75.7% in the CONTROL group) for 10-11 days on average. In comparison to the CONTROL group, patients in the INTERVENTION group had a significant reduction of the number of watery stool evacuations (type 7 BSC) (minus 61%, IRR = 0.39, p natural based food was effective in reducing the number of watery defecations and diarrhea in long term tube-fed critically ill neurological patients, compared to those fed with standard tube feeding. Copyright © 2018 The Authors. Published

Cooperative learning using simulation to achieve mastery of nasogastric tube insertion.

Science.gov (United States)

Cason, Melanie Leigh; Gilbert, Gregory E; Schmoll, Heidi H; Dolinar, Susan M; Anderson, Jane; Nickles, Barbara Marshburn; Pufpaff, Laurie A; Henderson, Ruth; Lee, Frances Wickham; Schaefer, John J

2015-03-01

Traditionally, psychomotor skills training for nursing students involves didactic instruction followed by procedural review and practice with a task trainer, manikin, or classmates. This article describes a novel method of teaching psychomotor skills to associate degree and baccalaureate nursing students, Cooperative Learning Simulation Skills Training (CLSST), in the context of nasogastric tube insertion using a deliberate practice-to-mastery learning model. Student dyads served as operator and student learner. Automatic scoring was recorded in the debriefing log. Student pairs alternated roles until they achieved mastery, after which they were assessed individually. Median checklist scores of 100% were achieved by students in both programs after one practice session and through evaluation. Students and faculty provided positive feedback regarding this educational innovation. CLSST in a deliberate practice-to-mastery learning paradigm offers a novel way to teach psychomotor skills in nursing curricula and decreases the instructor-to-student ratio. Copyright 2015, SLACK Incorporated.

Tube plug

International Nuclear Information System (INIS)

Zafred, P. R.

1985-01-01

The tube plug comprises a one piece mechanical plug having one open end and one closed end which is capable of being inserted in a heat exchange tube and internally expanded into contact with the inside surface of the heat exchange tube for preventing flow of a coolant through the heat exchange tube. The tube plug also comprises a groove extending around the outside circumference thereof which has an elastomeric material disposed in the groove for enhancing the seal between the tube plug and the tube

Enteral Feeding Tubes in Patients Undergoing Definitive Chemoradiation Therapy for Head-and-Neck Cancer: A Critical Review

Energy Technology Data Exchange (ETDEWEB)

Koyfman, Shlomo A., E-mail: koyfmas@ccf.org [Departments of Radiation and Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Adelstein, David J. [Departments of Radiation and Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States)

2012-11-01

Definitive chemoradiation therapy has evolved as the preferred organ preservation strategy in the treatment of locally advanced head-and-neck cancer (LA-HNC). Dry mouth and dysphagia are among the most common and most debilitating treatment-related toxicities that frequently necessitate the placement of enteral feeding tubes (FT) in these patients to help them meet their nutritional requirements. The use of either a percutaneous endoscopic gastrostomy tube or a nasogastric tube, the choice of using a prophylactic vs a reactive approach, and the effects of FTs on weight loss, hospitalization, quality of life, and long-term functional outcomes are areas of continued controversy. Considerable variations in practice patterns exist in the United States and abroad. This critical review synthesizes the current data for the use of enteral FTs in this patient population and clarifies the relative advantages of different types of FTs and the timing of their use. Recent developments in the biologic understanding and treatment approaches for LA-HNC appear to be favorably impacting the frequency and severity of treatment-related dysphagia and may reduce the need for enteral tube feeding in the future.

Association of a Proactive Swallowing Rehabilitation Program With Feeding Tube Placement in Patients Treated for Pharyngeal Cancer.

Science.gov (United States)

Ajmani, Gaurav S; Nocon, Cheryl C; Brockstein, Bruce E; Campbell, Nicholas P; Kelly, Amy B; Allison, Jamie; Bhayani, Mihir K

2018-04-19

A proactive speech and language pathology (SLP) program is an important component of the multidisciplinary care of patients with head and neck squamous cell carcinoma (HNSCC). Swallowing rehabilitation can reduce the rate of feeding tube placement, thereby significantly improving quality of life. To evaluate the initiation of a proactive SLP rehabilitation program at a single institution and its association with rates of feeding tube placement and dietary intake in patients with HNSCC. Cohort study at a tertiary care and referral center for patients with HNSCC serving the northern Chicago region. Patients were treated for squamous cell carcinomas of the hypopharynx, oropharynx, and nasopharynx from 2004 to 2015 with radiation or chemoradiation therapy in the definitive or adjuvant setting. Patients who received less than 5000 cGy radiation or underwent reirradiation were excluded. A proactive SLP program for patients with HNSCC was initiated in 2011. Study cohorts were divided into 2 groups: 2004 through 2010 and 2011 through 2015. Primary outcome variables were SLP referral placement and timing of the referral. Secondary outcomes were feeding tube placement and ability to tolerate any oral intake. A total of 254 patients met inclusion criteria (135 before and 119 after implementation of SLP program; median age, 60 years [range, 14-94 years]; 77% male). With the initiation of a proactive SLP program, pretreatment evaluations increased from 29 (21.5%) to 70 (58.8%; risk ratio [RR], 2.74; 95% CI, 1.92-3.91), and rate of referral overall at any time increased from 60.0% to 79.8% (RR, 1.33; 95% CI, 1.13-1.57). Feeding tube placement rates decreased from 45.9% (n = 62) to 29.4% (n = 35; RR, 0.64; 95% CI, 0.46-0.89). Among patients receiving a swallow evaluation, feeding tube requirements were less frequent for those receiving a pretreatment evaluation (31 of 99 [31%]) than for those referred during (11 of 18 [61%]) or after (38 of 59 [64%]) treatment. The rate

Apparatus for securing structural tubes in nuclear reactor fuel assemblies

International Nuclear Information System (INIS)

Kerry, J.S.

1987-01-01

This patent describes a nuclear reactor fuel assembly having a structural tube with a predetermined inside diameter, a generally cylindrical insert of an axial length substantially smaller than the axial length of the structural tube and having a generally cylindrical passageway of a predetermined diameter smaller than the predetermined inside diameter for providing an effectively reduced inside diameter for the structural tube. The insert comprises: means, having an outside diameter approximately equal to the predetermined inside diameter, for coaxially centering the insert within the structural tube; forming lobes, operable when expanded to locally deform against the structural tube thereby locking the insert within the structural tube

Compression device for feeding a waste material to a reactor

Science.gov (United States)

Williams, Paul M.; Faller, Kenneth M.; Bauer, Edward J.

2001-08-21

A compression device for feeding a waste material to a reactor includes a waste material feed assembly having a hopper, a supply tube and a compression tube. Each of the supply and compression tubes includes feed-inlet and feed-outlet ends. A feed-discharge valve assembly is located between the feed-outlet end of the compression tube and the reactor. A feed auger-screw extends axially in the supply tube between the feed-inlet and feed-outlet ends thereof. A compression auger-screw extends axially in the compression tube between the feed-inlet and feed-outlet ends thereof. The compression tube is sloped downwardly towards the reactor to drain fluid from the waste material to the reactor and is oriented at generally right angle to the supply tube such that the feed-outlet end of the supply tube is adjacent to the feed-inlet end of the compression tube. A programmable logic controller is provided for controlling the rotational speed of the feed and compression auger-screws for selectively varying the compression of the waste material and for overcoming jamming conditions within either the supply tube or the compression tube.

Feed rate affecting surface roughness and tool wear in dry hard turning of AISI 4140 steel automotive parts using TiN+AlCrN coated inserts

Science.gov (United States)

Paengchit, Phacharadit; Saikaew, Charnnarong

2018-02-01

This work aims to investigate the effects of feed rate on surface roughness (Ra) and tool wear (VB) and to obtain the optimal operating condition of the feed rate in dry hard turning of AISI 4140 chromium molybdenum steel for automotive industry applications using TiN+AlCrN coated inserts. AISI 4140 steel bars were employed in order to carry out the dry hard turning experiments by varying the feed rates of 0.06, 0.08 and 0.1 mm/rev based on experimental design technique that can be analyzed by analysis of variance (ANOVA). In addition, the cutting tool inserts were examined after machining experiments by SEM to evaluate the effect of turning operations on tool wear. The results showed that averages Ra and VB were significantly affected by the feed rate at the level of significance of 0.05. Averages Ra and VB values at the feed rate of 0.06 mm/rev were lowest compared to average values at the feed rates of 0.08 and 0.1 mm/rev, based on the main effect plot.

Nasogastric feeding tube located in the lung. SENSAR case of the trimester.

Science.gov (United States)

2017-01-01

A clinical case is presented that was communicated to Spanish Notification System on Safety in Anaesthesia and Recovery (SENSAR). Using this communication and its analysis, a strategy is obtained in order to reduce the risks associated with the insertion of a nasogastric tube (NST) for enteral nutrition in adult patients in the post-surgical recovery unit. A description of the incident is presented, an analysis of its causes, and the measures that were introduced in order to avoid similar incidents in the future, as well as to promote a safety culture in the organisation. A description of associated incidents registered in SENSAR is also given. The aim of this work is to describe, analyse and introduce safety measures arising from incidents notified to SENSAR, associated with the insertion and checking of the nutrition NST in adult patients in the post-surgical recovery unit. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Patient and Family Caregivers’ Experiences of Living With a Jejunostomy Feeding Tube After Surgery for Esophagogastric Cancer

OpenAIRE

Halliday, V.; Baker, M.; Thomas, A.L.; Bowrey, D.

2017-01-01

BACKGROUND: Jejunostomy feeding tubes (JFTs) can be used to provide nutrition support to patients who have had surgery for esophagogastric cancer. Although previous research reports how patients cope with a gastrostomy tube, little is known about the impact of having a JFT. The aim of this qualitative study was to explore how patients and their informal caregivers experience living with a JFT in the first months following surgery. METHODS: Participants were purposively sampled from a cohort o...

Clinical tube weaning supported by hunger provocation in fully-tube-fed children.

Science.gov (United States)

Hartdorff, Caroline M; Kneepkens, C M Frank; Stok-Akerboom, Anita M; van Dijk-Lokkart, Elisabeth M; Engels, Michelle A H; Kindermann, Angelika

2015-04-01

Children with congenital malformations, mental retardation, and complex early medical history frequently have feeding problems. Although tube feeding is effective in providing the necessary energy and nutrients, it decreases the child's motivation to eat and may lead to oral aversion. In this study, we sought to confirm our previous results, showing that a multidisciplinary clinical hunger provocation program may lead to quick resumption of oral feeding. In a crossover study, 22 children of 9 to 24 months of age who were fully dependent on tube feeding were randomly assigned to one of two groups: group A, intervention group (2-week multidisciplinary clinical hunger provocation program); and group B, control group (4-week outpatient treatment by the same multidisciplinary team). Patients failing one treatment were reassigned to the other treatment group. Primary outcome measures were at least 75% orally fed at the conclusion of the intervention and fully orally fed and gaining weight 6 months after the intervention. In group A, 9/11 patients were successfully weaned from tube feeding (2 failures: 1 developed ulcerative colitis, 1 drop-out). In group B, only 1 patient was weaned successfully; 10/11 were reassigned to the clinical hunger provocation program, all being weaned successfully. Six months after the intervention, 1 patient had to resume tube feeding. In total, in the control group, 1/11 (9%) was weaned successfully as compared with 18/21 (86%) in the hunger provocation group (P hunger provocation is an effective short-term intervention for weaning young children from tube feeding.

Influences of the wavy surface inserted in the middle of a circular tube heat exchanger on thermal performance

Energy Technology Data Exchange (ETDEWEB)

Jedsadaratanancai, Withada [King Mongkut' s Institute of Technology Ladkrabang, Bangkok (Thailand); Boonloi, Amnart [King Mongkut' s University of Technology North Bangkok, Bangkok (Thailand)

2015-09-15

Numerical investigations on flow topology, heat transfer behavior and performance evaluation in a circular tube inserted with various configurations of wavy surfaces, Inclined wavy surface (IWS), V-downstream wavy surface (VDWS), V-Upstream wavy surface (VUWS) are presented. The effects of the flow attack angles; 20 .deg., 30 .deg., 45.deg. and 60.deg. are studied for the Reynolds numbers, Re = 100-2000. The numerical results are compared with the smooth circular tube with no wavy surface and the previous works. It is found that the IWS, VDWS and VUWS can produce longitudinal vortex flow and impinging jet of the fluid flow like inclined baffle, V-downstream baffle and V-Upstream baffle, respectively, but give lower friction loss. The flow phenomena created by the wavy surfaces help to augment the heat transfer rate and thermal performance in the test tube. In the range studied, the order of enhancement for heat transfer rate is around 1.40-3.75, 1.60-6.25 and 1.30-5.80 times higher than the smooth tube for IWS, VDWS and VUWS, respectively. Moreover, the maximum thermal performance, presented in terms of the Thermal enhancement factor (TEF), is found to be about 1.60, 2.40 and 2.10, respectively, for IWS, VUWS and VDWS.

Attachment of and biofilm formation by Enterobacter sakazakii on stainless steel and enteral feeding tubes.

Science.gov (United States)

Kim, Hoikyung; Ryu, Jee-Hoon; Beuchat, Larry R

2006-09-01

Enterobacter sakazakii has been reported to form biofilms, but environmental conditions affecting attachment to and biofilm formation on abiotic surfaces have not been described. We did a study to determine the effects of temperature and nutrient availability on attachment and biofilm formation by E. sakazakii on stainless steel and enteral feeding tubes. Five strains grown to stationary phase in tryptic soy broth (TSB), infant formula broth (IFB), or lettuce juice broth (LJB) at 12 and 25 degrees C were examined for the extent to which they attach to these materials. Higher populations attached at 25 degrees C than at 12 degrees C. Stainless steel coupons and enteral feeding tubes were immersed for 24 h at 4 degrees C in phosphate-buffered saline suspensions (7 log CFU/ml) to facilitate the attachment of 5.33 to 5.51 and 5.03 to 5.12 log CFU/cm(2), respectively, before they were immersed in TSB, IFB, or LJB, followed by incubation at 12 or 25 degrees C for up to 10 days. Biofilms were not produced at 12 degrees C. The number of cells of test strains increased by 1.42 to 1.67 log CFU/cm(2) and 1.16 to 1.31 log CFU/cm(2) in biofilms formed on stainless steel and feeding tubes, respectively, immersed in IFB at 25 degrees C; biofilms were not formed on TSB and LJB at 25 degrees C, indicating that nutrient availability plays a major role in processes leading to biofilm formation on the surfaces of these inert materials. These observations emphasize the importance of temperature control in reconstituted infant formula preparation and storage areas in preventing attachment and biofilm formation by E. sakazakii.

Plugging of feed inlet tube upstands with Ni/Ti shape memory alloy plugs - Heysham 1 power station

International Nuclear Information System (INIS)

Mathews, A.J.

1988-01-01

The paper contains a description of a new approach for Plugging feed inlet tubes of Gas-Cooled Reactors. Instead of utilizing the original explosive method plugging by fitting a shape memory alloy plug into the upstand is being described. (author)

Pump element for a tube pump

DEFF Research Database (Denmark)

2011-01-01

The invention relates to a tube pump comprising a tube and a pump element inserted in the tube, where the pump element comprises a rod element and a first and a second non-return valve member positioned a distance apart on the rod element. The valve members are oriented in the same direction...... relative to the rod element so as to allow for a fluid flow in the tube through the first valve member, along the rod element, and through the second valve member. The tube comprises an at least partly flexible tube portion between the valve members such that a repeated deformation of the flexible tube...... portion acts to alternately close and open the valve members thereby generating a fluid flow through the tube. The invention further relates to a pump element comprising at least two non-return valve members connected by a rod element, and for insertion in an at least partly flexible tube in such tube...

Conversion of choledochojejunostomy stents to jejunal feeding tubes for postoperative enteral alimentation.

Science.gov (United States)

Burke, D R; Torosian, M H; McLean, G K; Meranze, S G; Rosato, E F

1988-01-01

The problem of protein calorie malnutrition following major gastrointestinal surgery can be treated with central venous or enteric alimentation, with the latter being preferred. The authors describe a simple technique for the conversion of biliary stents placed after pancreaticoduodenal surgery into jejunal feeding tubes when the stenting function is no longer needed. Three illustrative cases are presented. In each case, the procedure took less than 30 min and had no associated morbidity. This technique allows early conversion from central venous to enteric alimentation without the need to create a second surgical enterostomy.

Complications of ventilation tube insertion in children with and without cleft palate: a nested case-control comparison.

Science.gov (United States)

Smillie, Ian; Robertson, Sophie; Yule, Anna; Wynne, David M; Russell, Craig J H

2014-10-01

Optimizing hearing in patients with cleft lip and/or palate (CLP) by early recognition and management of otitis media with effusion is essential for speech development. Some evidence has suggested higher complication rates from ventilation tube (VT) insertion in patients with CLP and has led to a trend not to treat these patients surgically. However, studies have failed to match comparison groups for age and sex. To compare complication rates from VT insertion in pediatric patients with and without CLP. The study used a nested case-control design to evaluate 60 pediatric patients with CLP who underwent VT insertion at a children's hospital. The control group of age- and sex-matched patients was selected from a database of 2943 VT insertions. All patients were administered general anesthesia and underwent VT insertion by a pediatric otorhinolaryngology (ENT) team. The primary outcomes were numbers of otorrhea complications. Secondarily, rates of attendance at an ENT clinic specifically for complications were evaluated. Finally, numbers of complications other than otorrhea were assessed but not statistically analyzed owing to the varied types and low numbers in each group. The control cohort had 151 documented cases of otorrhea compared with 121 in the CLP group (ratio 1.25:1); the difference between groups was not statistically significant (P = .52). There was no significant difference in mean ENT clinic visits per patient for complications between groups (0.80 in the CLP group, 0.78 for controls) (P = .66). Regarding complications other than otorrhea, the control group reported more than the CLP group (43 vs 25; ratio, 1.7:1). Complication rates of VT placement among patients with CLP were not higher than those among patients without CLP. Therefore, treatment with VT insertion should be administered to patients with CLP under the same guidelines as for those without CLP. Indeed, there could be an argument for a shift in practice toward more aggressive

Technique employed to seal a tube leaking in a heat exchanger of the tube type by explosives with supporting means for the adjacent tubes

International Nuclear Information System (INIS)

Larson, G.C.

1978-01-01

This invention concerns the technique employed to seal a tube leaking in a heat exchanger of the tube and tube plate type by detonating metal plugs activated by an explosive and inserted in both ends of the tube. It refers in particular to an apparatus and process in which the deformation or distortion of the adjacent tubes and tube plate ties under the effect of the explosive forces is significantly reduced [fr

Risk of bleeding in patients undergoing percutaneous endoscopic gastrotrostomy (PEG tube insertion under antiplatelet therapy: a systematic review with a meta-analysis

Directory of Open Access Journals (Sweden)

Alfredo J. Lucendo

2015-03-01

Full Text Available Background and aim: Patients undergoing percutaneous endoscopic gastrostomy (PEG tube placement often are under antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. This systematic review aims to assess if maintaining aspirin and/or clopidogrel treatment increases the risk of bleeding following PEG placement. Methods: A systematic search of the MEDLINE, EMBASE, and SCOPUS databases was developed for studies investigating the risk of bleeding in patients on antiplatelet therapy undergoing PEG tube insertion. Summary estimates, including 95 % confidence intervals (CI, were calculated. A fixed or random effects model was used depending on heterogeneity (I². Publication bias risks were assessed by means of funnel plot analysis. Results: Eleven studies with a total of 6,233 patients (among whom 3,665 were undergoing antiplatelet treatment, met the inclusion criteria and were included in the quantitative summary. Any PEG tube placement-related bleeding was found in 2.67 % (95 % CI 1.66 %, 3.91 % of the entire population and in 2.7 % (95 % CI 1.5 %, 4.1 % of patients not receiving antiplatelet therapy. Pooled relative risk (RR for bleeding in patients under aspirin, when compared to controls, was 1.43 (95 % CI 0.89, 2.29; I² = 0 %; pooled RR for clopidogrel was 1.21 (95 % CI 0.48, 3.04; I² = 0 % and for dual antiplatelet therapy, 2.13; (95 % CI 0.77, 5.91; I² = 47 %. No significant publication bias was evident for the different medications analyzed. Conclusion: Antiplatelet therapy was safe among patients undergoing PEG tube insertion. Future prospective and randomized studies with larger sample sizes are required to confirm the results of this study.

Vacuum guidelines for ISA insertions

International Nuclear Information System (INIS)

Edwards, D. Jr.

1976-01-01

Vacuum requirements place design restrictions on the ISA insertions. The vacuum tube diameter, given a distance L between pumps, is determined by the desorption of molecules from the wall under the impact of ions created by the beam, whereas the thickness of the tube must be sufficient to prevent collapse. In addition, the entire vacuum chamber must be able to be baked out at approximately 200 0 C

Advantages of Direct Insertion of a Straight Probe Without a Guide Tube During Anterior Odontoid Screw Fixation of Odontoid Fractures.

Science.gov (United States)

Park, Jin Hoon; Kang, Dong-Ho; Lee, Moon Kyu; Yoo, Byoungwoo; Jung, Sang Ku; Hwang, Soo-Hyun; Kim, Jeoung Hee; Oh, Sunkyu; Lee, Eun Jung; Jeon, Sang Ryong; Roh, Sung Woo; Rhim, Seung Chul

2016-05-01

A retrospective cohort study. The aim of this study was to compare the anterior odontoid screw fixation (AOSF) with a guide tube or with a straight probe. AOSF associates with several complications, including malpositioning, fixation loss, and screw breakage. Screw pull-out from the C2 body is the most common complication. All consecutive patients with type II or rostral shallow type III odontoid fractures who underwent AOSFs during the study period were enrolled retrospectively. The guide-tube AOSF method followed the standard published method except C3 body and C2-3 disc annulus rimming was omitted to prevent disc injury; instead, the guide tube was anchored at the anterior inferior C2 vertebra corner. After 2 screw pull-outs, the guide-tube cohort was analyzed to identify the cause of instrument failure. Thereafter, the straight-probe method was developed. A guide tube was not used. A small pilot hole was made on the most anterior side of the inferior endplate, followed by insertion of a 2.5 mm straight probe through the C2 body. Non-union and instrument failure rates and screw-direction angles of the guide-tube and straight-probe groups were recorded. The guide-tube group (n = 13) had 2 screw pull-outs and 1 non-union. The straight-probe group (n = 8) had no complications and significantly larger screw-direction angles than the guide-tube group (60.5 ± 4.63 vs. 54.8 ± 3.82 degrees; P = 0.047). Straight-probe AOSF yielded larger direction angles without injuring bone and disc. Complications were absent. The procedure was easier than guide-tube AOSF and assured sufficient engagement, even in horizontal fracture orientation cases. 3.

A retrospective matched cohort study evaluating the effects of percutaneous endoscopic gastrostomy feeding tubes on nutritional status and survival in patients with advanced gastroesophageal malignancies undergoing systemic anti-cancer therapy.

Science.gov (United States)

Mitchell, Scott; Williams, John P; Bhatti, Harsimrandeep; Kachaamy, Toufic; Weber, Jeffrey; Weiss, Glen J

2017-01-01

Many patients with cancer or other systemic illnesses can experience malnutrition. One way to mitigate malnutrition is by insertion of a percutaneous endoscopic gastrostomy feeding tube (PEG tube). The goal of this retrospective matched cohort study is to evaluate if PEG tube placement improved nutritional status and overall survival (OS) in advanced gastroesophageal (GE) cancer patients who are undergoing anti-neoplastic therapy. GE cancer patients who were treated and evaluated by a nutritionist and had at least 2 nutritionist follow-up visits were identified. Patients with PEG tube were matched to patients that did not undergo PEG placement (non-PEG). Clinical characteristics, GE symptoms reported at nutrition follow-up visits, and OS were recorded. 20 PEG and 18 non-PEG cases met criteria for further analyses. After correction for multiple testing, there were no OS differences between PEG and non-PEG, treatment naive and previously treated. However, PEG esophageal carcinoma has statistically significant inferior OS compared with non-PEG esophageal carcinoma. PEG placement did not significantly reduce the proportion of patients with weight loss between the initial nutrition assessment and 12-week follow-up. In this small study, PEG placement had inferior OS outcome for GE esophageal carcinoma, no improvement in OS for other evaluated groups, and did not reduce weight loss between baseline and 12-week follow-up. Unless there is prospective randomized trial that can show superiority of PEG placement in this population, PEG placement in this group cannot be endorsed.

Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for patients with head and neck cancer. A systematic review

International Nuclear Information System (INIS)

Wang Jinfeng; Liu Minjie; Ye Yun; Liu Chao; Huang Guanhong

2014-01-01

There are two main enteral feeding strategies—namely nasogastric (NG) tube feeding and percutaneous gastrostomy—used to improve the nutritional status of patients with head and neck cancer (HNC). But up till now there has been no consistent evidence about which method of enteral feeding is the optimal method for this patient group. To compare the effectiveness of percutaneous gastrostomy and NGT feeding in patients with HNC, relevant literature was identified through Medline, Embase, Pubmed, Cochrane, Wiley and manual searches. We included randomized controlled trials (RCTs) and non-experimental studies comparing percutaneous gastrostomy—including percutaneous endoscopic gastrostomy (PEG) and percutaneous fluoroscopic gastrostomy (PFG)—with NG for HNC patients. Data extraction recorded characteristics of intervention, type of study and factors that contributed to the methodological quality of the individual studies. Data were then compared with respect to nutritional status, duration of feeding, complications, radiotherapy delays, disease-free survival and overall survival. Methodological quality of RCTs and non-experimental studies were assessed with separate standard grading scales. It became apparent from our studies that both feeding strategies have advantages and disadvantages. (author)

Procedure and device for extracting the end of a tube inserted into a hole in a tube plate

International Nuclear Information System (INIS)

1980-01-01

When constructing heat exchangers and steam generators, particularly in the construction of steam generators for nuclear power stations, many small diameter tubes have to be secured into a very thick tube plate for instance 600 mm thick. This crimping or expanding of the tube is generally performed by rolling the internal surface of the tube inside a hole drilled right through the tube plate and slightly greater in diameter than the external diameter of the tube before the tube is rolled. To check the tubes for defects, it is necessary to extract certain tubes from the tube plate in order to move the tube to a testing and inspection point and examine the part of it that was secured in the plate hole. The invention concerns the uncrimping of these tubes [fr

Loss of feed flow, steam generator tube rupture and steam line break thermohydraulic experiments

International Nuclear Information System (INIS)

Mendler, O.J.; Takeuchi, K.; Young, M.Y.

1986-10-01

The Westinghouse Model Boiler No. 2 (MB-2) steam generator test model at the Engineering Test Facility in Tampa, Florida, was reinstrumented and modified for performing a series of tests simulating steam generator accident transients. The transients simulated were: loss of feed flow, steam generator tube rupture, and steam line break events. This document presents a description of (1) the model boiler and the associated test facility, (2) the tests performed, and (3) the analyses of the test results

Loss of feed flow, steam generator tube rupture and steam line break thermohydraulic experiments

Energy Technology Data Exchange (ETDEWEB)

Mendler, O J; Takeuchi, K; Young, M Y

1986-10-01

The Westinghouse Model Boiler No. 2 (MB-2) steam generator test model at the Engineering Test Facility in Tampa, Florida, was reinstrumented and modified for performing a series of tests simulating steam generator accident transients. The transients simulated were: loss of feed flow, steam generator tube rupture, and steam line break events. This document presents a description of (1) the model boiler and the associated test facility, (2) the tests performed, and (3) the analyses of the test results.

Combination of helical ferritic-steel inserts and flux-tube-expansion divertor for the heat control in tokamak DEMO reactor

International Nuclear Information System (INIS)

Takizuka, T.; Tokunaga, S.; Hoshino, K.; Shimizu, K.; Asakura, N.

2015-01-01

Edge localized modes (ELMs) in the H-mode operation of tokamak reactors may be suppressed/mitigated by the resonant magnetic perturbation (RMP), but RMP coils are considered incompatible with DEMO reactors under the strong neutron flux. We propose an innovative concept of the RMP without installing coils but inserting ferritic steels of the helical configuration. Helically perturbed field is naturally formed in the axisymmetric toroidal field through the helical ferritic steel inserts (FSIs). When ELMs are avoided, large stationary heat load on divertor plates can be reduced by adopting a flux-tube-expansion (FTE) divertor like an X divertor. Separatrix shape and divertor-plate inclination are similar to those of a simple long-leg divertor configuration. Combination of the helical FSIs and the FTE divertor is a suitable method for the heat control to avoid transient ELM heat pulse and to reduce stationary divertor heat load in a tokamak DEMO reactor

Technique for joining metal tubing

Science.gov (United States)

Wright, H. W.

1976-01-01

Uniform wall thickness and uninterrupted heat transfer is achieved by using shaped metal insert as wall material for joint. Insert acts as support during brazing, after which excess material is ground away to bring joint to original tubing size.

Horizontal beam tubes in FRM-II

International Nuclear Information System (INIS)

Coors, D.; Vanvor, D.

2001-01-01

The new research reactor in Garching FRM-II is equipped with 10 leak tight horizontal beam tubes (BT1 - BT10), each of them consisting of a beam tube structure taking an insert with neutron channels. The design of all beam tube structures is similar whereas the inserts are adapted to the special requirements of the using of each beam tube. Inside the reflector tank the beam tube structures are shaped by the inner cones which are made of Al-alloy with circular and rectangular cross sections. They are located in the region of maximum neutron flux (exception BT10), they are directly connected to the flanges of the reflector tank, their lengths are about 1.5 m (exception BT10) and their axes are directed tagentially to the core centre thus contributing to a low γ-noise at the experiments. (orig.)

Enhancement of heat transfer using varying width twisted tape inserts

African Journals Online (AJOL)

user

enhancement of heat transfer with twisted tape inserts as compared to plain ... studies for heat transfer and pressure drop of laminar flow in horizontal tubes ... flow in rectangular and square plain ducts and ducts with twisted-tape inserts .... presence of the insert in the pipe causes resistance to flow and increases turbulence.

Myringotomy versus ventilation tubes in secretory otitis media: eardrum pathology, hearing, and eustachian tube function 25 years after treatment

DEFF Research Database (Denmark)

Caye-Thomasen, P.; Stangerup, S.E.; Jorgensen, G.

2008-01-01

OBJECTIVE: This report documents the dynamics of eardrum pathology, hearing acuity, and eustachian tube function during 25 years after treatment of bilateral secretory otitis media. The included children were treated by myringotomy on the left ear and ventilation tube insertion on the right ear....... MATERIALS AND METHODS: Two hundred twenty-four children with bilateral secretory otitis media were treated by bilateral myringotomy and insertion of a ventilation tube on the right side only. The children were reexamined by otomicroscopy, tympanometry, and pure tone audiometry after 3, 7, and 25 years...

Tube pancreatico-duodenostomy for management of a severe penetrating pancreaticoduodenal injury.

Science.gov (United States)

Hatzigeorgiadis, Anestis; Boulas, Konstantinos A; Barettas, Nikolaos; Papageorgiou, Irene; Blouhos, Konstantinos

2014-05-27

Optimal management of penetrating pancreaticoduodenal injuries and better outcomes are associated with simple, fast damage control surgery and shorter operative time. The performance of pyloric exclusion and tube duodenostomy has markedly decreased. However, there is still a trend toward their performance in cases of delay duodenal repair or severe pancreaticoduodenal injury. The present report describes a case of a hemodynamically stable patient with a single penetrating gunshot trauma causing an AAST-OIS grade III pancreatic head injury and grade IV injury of the second portion of the duodenum. The patient was treated in our Level IV rural trauma center and submitted to primary closure of the posterolateral duodenal wall (the laceration of the contralateral inner medial duodenal wall could not be repaired), external duodenal and pancreatic drainage, and duodenal decompression by tube pancreatico-duodenostomy (insertion of a 18 Fr Foley catheter through the laceration of the pancreatic head toward the duodenal lumen), tube cholangiostomy, and pyloric exclusion accompanied with a feeding jejunostomy. Tube pancreatico-duodenostomy, which is described for the first time in the literature, turned out to be effective and can be considered as an option in pancreaticoduodenal trauma when the inner medial duodenal wall cannot be repaired.

Effect of kinetic parameters on simultaneous ramp reactivity insertion plus beam tube flooding accident in a typical low enriched U{sub 3}Si{sub 2}-Al fuel-based material testing reactor-type research reactor

Energy Technology Data Exchange (ETDEWEB)

Nasir, Rubina; Mirza, Nasir M. [Dept. of, Physics, Air University, Islamabad (Pakistan); Mirza, Sikander M. [Dept. of, Physics and Applied Mathematics, Pakistan Institute of Engineering and Applied Sciences, Post Office Nilore, Islamabad (Pakistan)

2017-06-15

This work looks at the effect of changes in kinetic parameters on simultaneous reactivity insertions and beam tube flooding in a typical material testing reactor-type research reactor with low enriched high density (U{sub 3}Si{sub 2}-Al) fuel. Using a modified PARET code, various ramp reactivity insertions (from $0.1/0.5 s to $1.3/0.5 s) plus beam tube flooding ($0.5/0.25 s) accidents under uncontrolled conditions were analyzed to find their effects on peak power, net reactivity, and temperature. Then, the effects of changes in kinetic parameters including the Doppler coefficient, prompt neutron lifetime, and delayed neutron fractions on simultaneous reactivity insertion and beam tube flooding accidents were analyzed. Results show that the power peak values are significantly sensitive to the Doppler coefficient of the system in coupled accidents. The material testing reactor-type system under such a coupled accident is not very sensitive to changes in the prompt neutron life time; the core under such a coupled transient is not very sensitive to changes in the effective delayed neutron fraction.

Graft-free Ahmed tube insertion: a modified method at 5 mm from limbus

Directory of Open Access Journals (Sweden)

Juan Carlos Mesa-Gutiérrez

2010-04-01

Full Text Available Juan Carlos Mesa-Gutiérrez, Juan Lillo-Sopena, Anna Monés-Llivina, Silvia Sanz-Moreno, Jorge Arruga-GinebredaDepartment of Ophthalmology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, SpainObjective: To determine the medium-term outcome of Ahmed implants inserted through a needle tract at 5 mm from limbus that eliminates the need for a donor scleral graft.Methods: A retrospective case series of 19 patients undergoing Ahmed implant surgery for refractory glaucoma with a mean follow-up of 12 months. Primary outcome measures included control of intraocular pressure after surgery. Secondary outcome measure included the frequency of intraoperative and postoperative complications.Results: Intraocular pressure was maintained between 6 and 21 mmHg throughout the study. There was no postoperative hypotony. There were no complications related to this modified technique.Conclusion: Needle tract at 5 mm from limbus maintains implant’s ability to control intraocular pressure and eliminates the need for a donor scleral graft or heterologous material.Keywords: surgical technique, Ahmed implant, refractory glaucoma, donor scleral graft, tube shunt device

Gastrostomy feeding tube - pump

Science.gov (United States)

... button, close the clamp on the feeding set, disconnect the extension set from the button, and close ... Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for EHRs For Developers U.S. National Library of ...

A comparison of the test tube and the dialysis tubing in vitro methods for estimating the bioavailability of phosphorus in feed ingredients for swine.

Science.gov (United States)

Bollinger, David W; Tsunoda, Atsushi; Ledoux, David R; Ellersieck, Mark R; Veum, Trygve L

2005-05-04

The validity of a simplified in vitro test tube (TT) method was compared with a more complicated dialysis tubing (DT) method to estimate the percentage of available phosphorus (P) in 41 plant origin and five animal origin feed ingredients for swine. The TT method using 1.0 or 0.25 g samples was compared with the DT method using 1.0 g samples at two pancreatic incubation times (2 vs 4 h) in a 3 x 2 factorial arrangement of treatments. Each DT and TT method treatment was replicated three and six times, respectively. Both methods utilize three enzymatic digestions: (i) predigestion with endoxylanase and beta-glucanase for 1 h, (ii) pepsin digestion for 2 h, and (iii) pancreatin digestion for 2 or 4 h. For the TT method, the entire procedure was conducted in a 50 mL conical centrifuge tube and replicated six times. For the DT method, the first two digestions were conducted in a 10 mL plastic syringe before the contents were quantitatively transferred into a segment of DT for the pancreatic digestion. The percentages of hydrolyzed P for plant origin ingredients measured by the DT method using 1.0 g samples and the TT method using 0.25 g samples were highly correlated (r = 0.94-0.97, P or = 0.4) with published in vivo available P values. In conclusion, the accuracy and validity of the TT method using 0.25 g samples with a 2 h pancreatic digestion time was equal to or superior to the DT method using 1.0 g samples with a 4 h pancreatic digestion time for estimating P availability in plant origin feed ingredients.

21 CFR 888.4230 - Cement ventilation tube.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cement ventilation tube. 888.4230 Section 888.4230...) MEDICAL DEVICES ORTHOPEDIC DEVICES Surgical Devices § 888.4230 Cement ventilation tube. (a) Identification. A cement ventilation tube is a tube-like device usually made of plastic intended to be inserted into...

Incidence of Complications Developed after the Insertion of Ventilation Tube in Children under 6 years old in 2008-2009

Directory of Open Access Journals (Sweden)

Nader Saki

2012-01-01

Full Text Available Introduction: One of the main treatments of chronic otitis media with effusion is ventilation of the middle ear with a ventilation tube (VT. The objective of this study was to determine the incidence and the types of VT complications in children with otitis media with effusion in Ahwaz. Materials and Methods: In this prospective study, the medical records of 208 children (52 male and 35 female in Imam Khomeini and Apadana hospitals were reviewed. The children were between 10 months and 6 years old. The patients were followed up 12-18 months after ventilation tube insertion. We reviewed age, sex, postoperative otorrhea, eardrum atrophy, tympanosclerosis and persistent perforation. In all these patients, the indication for surgery was chronic middle ear effusion. The data were analyzed and presented as numbers and percentages using SPSS17.0. Results: Transient otorrhea occurred in 12.5% and delayed otorrhea in 8.2%. Otorrhea non-responsive to medical treatment was seen in 1.9%. Complications after tympanostomy tube extrusion included atrophy (27.8% myringosclerosis (37.9%, and persistent perforation (2.4%.The average extrusion time was 10.5 ±5 months (ranging between 3-22 months. Conclusion: After extrusion of the ventilation tube, patients should be followed up regularly for recurrence of OME. Myringosclerosis, tympanic membrane atrophy and otorrhea are the most common complications of otitis media with effusion. However, they are generally insignificant. Consequently, in the majority of these complications, there is no need for any treatment.

Vertical steam generator with slab-type tube-plate with even tube bundle washing

International Nuclear Information System (INIS)

Manek, O.; Masek, V.; Motejl, V.; Quitta, R.

1980-01-01

A shielding plate supporting the tubes attached to the tube plate of a vertical steam generator is mounted above the tube plate. Tube sleeves are designed with a dimensional tolerance relative to the heat transfer tubes and the sleeve end and the tube plate end. A separate space is thus formed above the tube plate in which circulation or feed water is introduced to flow between the branch and the heat transfer tube. This provides intensive washing of heat transfer tubes at a critical point and prevents deposit formation, thus excluding heat transfer tube failures. (J.B.)

Clinical Experience of Percutaneous Endoscopic Gastrostomy in Taiwanese Patients—310 Cases in 8 Years

Directory of Open Access Journals (Sweden)

Tzong-Hsi Lee

2007-08-01

Full Text Available Although percutaneous endoscopic gastrostomy (PEG has become a popular method for long-term tube feeding worldwide, there are only a few reports about its application in Taiwan. From May 1997 to May 2005, we performed 302 PEG insertions successfully in 310 attempts (97.4% success rate using modified Ponsky's pull method with 24-Fr feeding tubes. All the patients received PEG for tube feeding except for two patients with cancerous peritonitis for decompression. The underlying diseases in these 308 patients who received PEG for tube feeding were 161 cerebrovascular accidents (52.3%, 62 head and neck cancers (20.1%, 21 cases of Parkinsonism (6.8%, and others. There were 11 major complications (3.6% and 57 minor complications (18.9%. Ten patients (3.3% died within 30 days after PEG insertion. However, no procedure-related mortality occurred. In conclusion, PEG is an effective method for tube feeding and drainage with a high success rate. PEG insertion was often indicated for patients with dysphagia caused by cerebrovascular accident, head and neck cancer, and Parkinsonism in Taiwan. It is a relatively safe procedure, with a 3.6% rate of major complications and 18.9% rate of minor complications.

Repairing a steam generator tube by inserting a sheath

International Nuclear Information System (INIS)

Gaudin, J.P.

1986-01-01

According to the invention, the mechanical deformation of the sheath, realized by expansion in its end part opposite to the expanded end within the tube plate, is situated along a limited height, and the parameters of the said mechanical deformation are calculated according to the welding parameters applied consecutively. Besides, the said welding parameters are determined according to the initial mechanical deformation to obtain stress relaxation more particularly in the singular zones of the mechanical deformation. The present invention applies to the repair of PWR steam generator tubes [fr

Use of Noninvasive Ventilation During Feeding Tube Placement.

Science.gov (United States)

Banfi, Paolo; Volpato, Eleonora; Valota, Chiara; D'Ascenzo, Salvatore; Alunno, Chiara Bani; Lax, Agata; Nicolini, Antonello; Ticozzi, Nicola; Silani, Vincenzo; Bach, John R

2017-11-01

Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tube (RIG), and percutaneous radiologic gastrostomy (PRG) in patients with ALS, performed with or without noninvasive ventilation (NIV). We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the EBSCO Online Research Database, and Scopus up to December 2015. A priori selection included all randomized controlled trials (RCTs), quasi-randomized trials, and prospective and retrospective studies. The primary outcome was 30-d survival. We found no RCTs or quasi-RCTs. Seven studies about the implementation of the PEG/RIG procedure during the use of NIV and 5 studies without NIV were included. In another study of 59 subjects undergoing open gastrostomy, all with vital capacity NIV at full ventilatory support settings, there were no respiratory complications. Thus, the use of NIV during the implementation of these procedures, especially when used at full ventilatory support settings of pressure preset 18-25 cm H 2 O, can support alveolar ventilation before, during, and after the procedures and prevent respiratory complications. The procedures investigated appear equivalent, but the methodological quality of the studies could be improved. Possible benefits with regard to nutrition parameters, quality of life, and psychological features need to be further investigated. Copyright © 2017 by Daedalus Enterprises.

Chest tube drainage of pleural effusions--an audit of current practice and complications at Hutt Hospital.

Science.gov (United States)

Epstein, Erica; Jayathissa, Sisira; Dee, Stephen

2012-05-11

The aims of the study were to review small-bore chest tube insertion practices for drainage of pleural fluid at Hutt Valley District Health Board (HVDHB), to assess complications, and compare the findings with international data. Retrospective analysis of clinical records was completed on all chest tube insertions for drainage of pleural fluid at HVDHB from December 2008 to November 2009. Descriptive statistics were used to present demographics and tube-associated complications. Comparison was made to available similar international data. Small-bore tubes comprised 59/65 (91%) chest tube insertions and 23/25 (92%) complications. Available comparative data was limited. Ultrasound was used in 36% of insertions. Nearly half of chest drains placed for empyema required subsequent cardiothoracic surgical intervention. Chest drain complication rates at HVDHB were comparable to those seen internationally. Referral rates to cardiothoracic surgery for empyema were within described ranges. The importance of procedural training for junior medical staff, optimising safety of drain insertions with ultrasound guidance, and clear clinical governance for chest tube insertions are important in minimising harm from this procedure. Specialist societies need to take a leadership in providing guidance on chest drain insertions to secondary and tertiary hospitals in Australia and New Zealand.

Heat transfer experiments in a wire-inserted tube at supercritical pressures

Energy Technology Data Exchange (ETDEWEB)

Bae, Yoon Yeong; Kim, Hwan Yeol; Yoo, Tae Ho

2009-07-15

The hydraulic diameter of a subchannel in a core concept developed at KAERI is 6.5 mm. The sub-channel is much smaller than that of the conventional PWR, and naturally a helical wire was considered as one of the candidates for a spacer. For simplicity the subchannel is simulated by a commercially available Inconel 625 tube of 6.32 mm ID with a helically-coiled spring steel wire insert of 1.3 mm OD. The medium is CO{sub 2}. The test pressures are 7.75 and 8.12 MPa corresponding to 1.05 and 1.1 times the critical pressure of CO{sub 2}, respectively. The mass flux and heat flux, which were in the range of 400 {approx} 1200 kg/m{sup 2}s and 30 {approx} 90 kW/m{sup 2} respectively, were varied at a given system pressure. The corresponding Reynolds numbers at the inlet spans between 2.5 x 10{sup 4} and 7.5 x 10{sup 4}. It was observed that the heat transfer was enhanced by almost twice in most of the tested enthalpy range except for in the the region far from the pseudocritical point. The test results revealed that the wire effect was sustained in the downstream up to 40-60 times the wire diameter. The temperature decreased in the first half of the span between contact points and it increased in the second half of the span.

Hand-actuated spring clip insertion tool

International Nuclear Information System (INIS)

Cuba, G.W.

1993-01-01

A hand-actuated insertion tool includes a handle assembly, an elongated hollow tubular outer support tube, an elongated inner pull rod, and a coupling arrangement. The handle assembly has a first handle member and a second handle member pivoted to a member for movement between unactuated and actuated positions. The tube is attached in a fixed relation to a handle member. The rod is mounted within the tube for sliding movement relative thereto between home and retracted positions. The coupling arrangement pivotally connects the rod to the second handle member such that the rod will undergo sliding movement from the home position to the retracted positions relative to the tube as the second handle member is moved from the unactuated position to the actuated position adjacent to the first handle member. (author)

Body Weight and Body Mass Index in Patients with End-Stage Cystic Fibrosis Stabilize After the Start of Enteral Tube Feeding

NARCIS (Netherlands)

Kraaijeveld, FM; de Roos, N.M.; Belle-van Meerkerk, Gerdien; Teding van Berkhout, F; Heijerman, HGM; van de Graaf, EA

2017-01-01

Abstract BACKGROUND: Enteral tube feeding (ETF) is widely used in patients with cystic fibrosis (CF) and end-stage lung disease, but previous studies have been limited to investigating whether ETF improves outcomes in patients with moderately or mildly impaired pulmonary function. OBJECTIVE: This

Body Weight and Body Mass Index in Patients with End-Stage Cystic Fibrosis Stabilize After the Start of Enteral Tube Feeding

NARCIS (Netherlands)

Hollander, Francis M.; Roos, de Nicole M.; Belle-Van Meerkerk, Gerdien; Teding van Berkhout, Ferdinand; Heijerman, Harry G.M.; Graaf, van de Ed A.

2017-01-01

Background: Enteral tube feeding (ETF) is widely used in patients with cystic fibrosis (CF) and end-stage lung disease, but previous studies have been limited to investigating whether ETF improves outcomes in patients with moderately or mildly impaired pulmonary function. Objective: This study

Prevalence, Outcomes, and Management of Enteral Tube Feeding Intolerance: A Retrospective Cohort Study in a Tertiary Center.

Science.gov (United States)

Wang, Kailun; McIlroy, Kerry; Plank, Lindsay D; Petrov, Max S; Windsor, John A

2017-08-01

Enteral tube feeding (ETF) is the most common form of artificial feeding in hospitalized patients, and the development of intolerance (ETFI) is the most common complication. This study aimed to determine the prevalence of ETFI, the clinical consequences, and the current management approach to ETFI in hospitalized adult patients. Adult patients receiving ETF were identified from a prospective database in the Nutrition Services at Auckland City Hospital. Further information was obtained by the review of clinical records for a 12-month period, up to December 2014. The prevalence of ETFI was 33% among 754 patients. ETFI more frequently occurred in the intensive care unit ( P ETF were also frequently attempted. ETFI is a frequent problem in adult hospitalized patients receiving ETF, and it is associated with poor clinical outcomes such as inadequate nutrition and complications of feeding. While the pathophysiology is poorly understood, there also appears to be no standard evidence-based treatment. Studies investigating the mechanisms and optimized management are therefore indicated.

Definition of the minimum longitude of insert in the rebuilding of Charpy test tubes for surveillance and life extension of vessels in Mexico; Definicion de la longitud minima de inserto en la reconstitucion de probetas Charpy para vigilancia y extension de vida de vasijas en Mexico

Energy Technology Data Exchange (ETDEWEB)

Romero C, J.; Hernandez C, R.; Rocamontes A, M., E-mail: jesus.romero@inin.gob.mx [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico)

2011-11-15

In the National Institute of Nuclear Research (Mexico) a welding system for the rebuilding of Charpy test tubes has been developed, automated, qualified and used for the surveillance of the mechanical properties (mainly embrittlement) of the vessel. This system uses the halves of the rehearsed Charpy test tubes of the surveillance capsules extracted of the reactors, to obtain, of a rehearsed test tube, two reconstituted test tubes. This rebuilding process is used so much in the surveillance program like in the potential extension of the operation license of the vessel. To the halves of Charpy test tubes that have been removed the deformed part by machine are called -insert- and in a very general way the rebuilding consists in weld with the welding process -Stud Welding- two metallic implants in the ends of the insert, to obtain a reconstituted test tube. The main characteristic of this welding are the achieved small dimensions, so much of the areas welded as of the areas affected by the heat. The applicable normative settles down that the minim longitude of the insert for the welding process by Stud Welding it should be of 18 mm, however according to the same normative this longitude can diminish if is demonstrated analytic or experimentally that the central volume of 1 cm{sup 3} in the insert is not affected. In this work the measurement of the temperature profiles to different distances of the welding interface is presented, defining an equation for the maximum temperatures reached in function of the distance, on the other hand the real longitude affected in the test tube by means of metallography is determined and this way the minimum longitude of the insert for this developed rebuilding system was determined. (Author)

Motor Neuron Diseases

Science.gov (United States)

... feeding tube. In ALS, insertion of a percutaneous gastronomy tube (to help with feeding) is frequently carried ... individuals with SMA. Scientists are using advanced sequencing technologies to identify new gene mutations that are associated ...

The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy.

Science.gov (United States)

de Abreu, Emanuelle Maria Sávio; Machado, Carla Jorge; Pastore Neto, Mario; de Rezende Neto, João Baptista; Sanches, Marcelo Dias

2015-01-01

to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention. A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes. Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (pchest tube days. Respiratory therapy was independently linked to significant reduction (pchest tube insertion was associated with significant (ptrauma patients.

Use of proton pump inhibitors is associated with increased mortality due to nosocomial pneumonia in bedridden patients receiving tube feeding.

Science.gov (United States)

Hamai, Kosuke; Iwamoto, Hiroshi; Ohshimo, Shinichiro; Wakabayashi, Yu; Ihara, Daisuke; Fujitaka, Kazunori; Hamada, Hironobu; Ono, Koichi; Hattori, Noboru

2018-05-22

To investigate the association between the use of proton pump inhibitors (PPI) and nosocomial pneumonia and gastrointestinal bleeding in bedridden patients receiving tube feeding. A total of 116 bedridden hospitalized patients receiving tube feeding, of which 80 were supported by percutaneous endoscopic gastrostomy and 36 by nasogastric tube, were included in the present study. The patients were divided into two groups: 62 patients treated with PPI (PPI group) and 54 patients without PPI (non-PPI group). Mortality due to nosocomial pneumonia was evaluated using the Kaplan-Meier approach and the log-rank test. A total of 36 patients (31%) died of nosocomial pneumonia during the observation period; the mortality rate due to nosocomial pneumonia was significantly higher in the PPI group than in the non-PPI group (P = 0.0395). Cox proportional hazard analysis showed that the use of PPI and lower levels of serum albumin were independent predictors of 2-year mortality due to nosocomial pneumonia. Gastrointestinal bleeding was observed in four patients in the non-PPI group (7.7%) and in one patient in the PPI group (1.6%); there was no significant difference between the two groups. The use of PPI in bedridden tube-fed patients was independently associated with mortality due to nosocomial pneumonia, and the PPI group had a non-significant lower incidence of gastrointestinal bleeding than the non-PPI group. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

Test manufacturing of copper canisters with cast inserts. Assessment report

Energy Technology Data Exchange (ETDEWEB)

Andersson, C.G

1998-08-01

The current design of canisters for the deep repository for spent nuclear fuel consists of an outer corrosion-protective copper casing in the form of a tubular section with lid and bottom and an inner pressure-resistant insert. The insert is designed to be manufactured by casting and inside are channels in which the fuel assemblies are to be placed. Over the last years, a number of full-scale manufacturing tests of all canister components have been carried out. The purpose has been to determine and develop the best manufacturing technique and to establish long-term contacts with the best suppliers of material and technology. Part of the work has involved the developing and implementing of a quality assurance system in accordance with ISO 9001, covering the whole chain from suppliers of material up to and including the delivery of assembled canisters. This report consists of a description of the design of the canister together with current drawings and complementary technical specifications stipulating, among other things, requirements placed on different materials. The different manufacturing methods that have been used are also described and commented on in both text and illustrations. For the manufacturing of copper tubes, the roll-forming of rolled plate to tube halves and longitudinal welding is a method that has been tested on a relatively large number of tubes by now, and that probably can be developed into a functioning production method. However, the very promising outcome of performed tests on seamless tube manufacturing, has resulted in a change in direction in tube manufacturing, focusing on continued testing of extrusion as well as pierce and draw processing in the immediate future. In connection with ongoing operations, new manufacturing tests of tubes with less material thickness will be carried out. Test manufacturing of cast inserts has resulted in the choice of nodular iron as material in the continued work. This improvement in design has resulted

Test manufacturing of copper canisters with cast inserts. Assessment report

International Nuclear Information System (INIS)

Andersson, C.G.

1998-08-01

The current design of canisters for the deep repository for spent nuclear fuel consists of an outer corrosion-protective copper casing in the form of a tubular section with lid and bottom and an inner pressure-resistant insert. The insert is designed to be manufactured by casting and inside are channels in which the fuel assemblies are to be placed. Over the last years, a number of full-scale manufacturing tests of all canister components have been carried out. The purpose has been to determine and develop the best manufacturing technique and to establish long-term contacts with the best suppliers of material and technology. Part of the work has involved the developing and implementing of a quality assurance system in accordance with ISO 9001, covering the whole chain from suppliers of material up to and including the delivery of assembled canisters. This report consists of a description of the design of the canister together with current drawings and complementary technical specifications stipulating, among other things, requirements placed on different materials. The different manufacturing methods that have been used are also described and commented on in both text and illustrations. For the manufacturing of copper tubes, the roll-forming of rolled plate to tube halves and longitudinal welding is a method that has been tested on a relatively large number of tubes by now, and that probably can be developed into a functioning production method. However, the very promising outcome of performed tests on seamless tube manufacturing, has resulted in a change in direction in tube manufacturing, focusing on continued testing of extrusion as well as pierce and draw processing in the immediate future. In connection with ongoing operations, new manufacturing tests of tubes with less material thickness will be carried out. Test manufacturing of cast inserts has resulted in the choice of nodular iron as material in the continued work. This improvement in design has resulted

Quality of Life Issues for Families Who Make the Decision to Use a Feeding Tube for Their Child with Disabilities.

Science.gov (United States)

Brotherson, Mary Jane; And Others

1995-01-01

Eight families deciding to use a feeding tube to meet the nutrition needs of their children with disabilities were interviewed over a two-year period. Family decision making in the context of quality of life was examined using a theoretical family systems model. Implications for future interventions are addressed. (Author/SW)

A Peer-Reviewed Instructional Video is as Effective as a Standard Recorded Didactic Lecture in Medical Trainees Performing Chest Tube Insertion: A Randomized Control Trial.

Science.gov (United States)

Saun, Tomas J; Odorizzi, Scott; Yeung, Celine; Johnson, Marjorie; Bandiera, Glen; Dev, Shelly P

Online medical education resources are becoming an increasingly used modality and many studies have demonstrated their efficacy in procedural instruction. This study sought to determine whether a standardized online procedural video is as effective as a standard recorded didactic teaching session for chest tube insertion. A randomized control trial was conducted. Participants were taught how to insert a chest tube with either a recorded didactic teaching session, or a New England Journal of Medicine (NEJM) video. Participants filled out a questionnaire before and after performing the procedure on a cadaver, which was filmed and assessed by 2 blinded evaluators using a standardized tool. Western University, London, Ontario. Level of clinical care: institutional. A total of 30 fourth-year medical students from 2 graduating classes at the Schulich School of Medicine & Dentistry were screened for eligibility. Two students did not complete the study and were excluded. There were 13 students in the NEJM group, and 15 students in the didactic group. The NEJM group׳s average score was 45.2% (±9.56) on the prequestionnaire, 67.7% (±12.9) for the procedure, and 60.1% (±7.65) on the postquestionnaire. The didactic group׳s average score was 42.8% (±10.9) on the prequestionnaire, 73.7% (±9.90) for the procedure, and 46.5% (±7.46) on the postquestionnaire. There was no difference between the groups on the prequestionnaire (Δ + 2.4%; 95% CI: -5.16 to 9.99), or the procedure (Δ -6.0%; 95% CI: -14.6 to 2.65). The NEJM group had better scores on the postquestionnaire (Δ + 11.15%; 95% CI: 3.74-18.6). The NEJM video was as effective as video-recorded didactic training for teaching the knowledge and technical skills essential for chest tube insertion. Participants expressed high satisfaction with this modality. It may prove to be a helpful adjunct to standard instruction on the topic. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc

Numerical investigation of heat transfer and friction factor characteristics in a circular tube fitted with V-cut twisted tape inserts.

Science.gov (United States)

Salman, Sami D; Kadhum, Abdul Amir H; Takriff, Mohd S; Mohamad, Abu Bakar

2013-01-01

Numerical investigation of the heat transfer and friction factor characteristics of a circular fitted with V-cut twisted tape (VCT) insert with twist ratio (y = 2.93) and different cut depths (w = 0.5, 1, and 1.5 cm) were studied for laminar flow using CFD package (FLUENT-6.3.26). The data obtained from plain tube were verified with the literature correlation to ensure the validation of simulation results. Classical twisted tape (CTT) with different twist ratios (y = 2.93, 3.91, 4.89) were also studied for comparison. The results show that the enhancement of heat transfer rate induced by the classical and V-cut twisted tape inserts increases with the Reynolds number and decreases with twist ratio. The results also revealed that the V-cut twisted tape with twist ratio y = 2.93 and cut depth w = 0.5 cm offered higher heat transfer rate with significant increases in friction factor than other tapes. In addition the results of V-cut twist tape compared with experimental and simulated data of right-left helical tape inserts (RLT), it is found that the V-cut twist tape offered better thermal contact between the surface and the fluid which ultimately leads to a high heat transfer coefficient. Consequently, 107% of maximum heat transfer was obtained by using this configuration.

Attachment of iron corrosion products on steam generator tube and feed-water pump in PWRs secondary system

International Nuclear Information System (INIS)

Shoda, Y.; Ishihara, N.; Miyata, H.; Ohira, T.; Watanabe, Y.; Nonaka, Y.

2010-01-01

Operating experience of the secondary systems in PWRs indicates that scale attachment distinctly have an effect on the performance of water-steam cycle. Attached scale on outer surface of steam generator (SG) tube could induce many problems such as decrease heat efficiency of plant, corrosion of tube by intergranular attack (IGA), and choke of flow channel. Scale attached on rotor blade of feed water pump increases the driving steam consumption to keep the constant flow rate, and results in the thermal efficiency decrease of the plant. In this study, two types of test about scale deposition on equipment were executed in the conditions simulating the secondary system of PWR. One is SG model test, which simulated the circulating boiler composed of single SG tube and blow down line. The deposition rate under AVT condition was equivalent to plants revealed with extended period. High-AVT test provided useful reference, because the deposition rate of power plant is too small to measure in a short period after the beginning of High-AVT operation in Japan. The other is feed water pump model test. The mock-up pump is composed of a rotating stainless steel disk. As a result, it is confirmed that the deposition rate depends mostly on iron concentration in water and the exfoliation rate depends mainly on pH. Applying this information, the scale deposition-growth behavior on the equipment is quantitatively expressed by the model combined of scale deposition behavior and exfoliation behavior couples with the former. These results bring effective estimation for suppressing deposition-growth by the selection of water chemistry management and/or equipment improvement in the PWR secondary system. (author)

Improved drainage with active chest tube clearance.

Science.gov (United States)

Shiose, Akira; Takaseya, Tohru; Fumoto, Hideyuki; Arakawa, Yoko; Horai, Tetsuya; Boyle, Edward M; Gillinov, A Marc; Fukamachi, Kiyotaka

2010-05-01

This study was performed to evaluate the efficacy of a novel chest drainage system. This system employs guide wire-based active chest tube clearance to improve drainage and maintain patency. A 32 Fr chest tube was inserted into pleural cavities of five pigs. On the left, a tube was connected to the chest canister, and on the right, the new system was inserted between the chest tube and chest canister. Acute bleeding was mimicked by periodic infusion of blood. The amount of blood drained from each chest cavity was recorded every 15 min for 2 h. After completion of the procedure, all residual blood and clots in each chest cavity were assessed. The new system remained widely patent, and the amount of drainage achieved with this system (670+/-105 ml) was significantly (P=0.01) higher than that with the standard tube (239+/-131 ml). The amount of retained pleural blood and clots with this system (150+/-107 ml) was significantly (P=0.04) lower than that with the standard tube (571+/-248 ml). In conclusion, a novel chest drainage system with active tube clearance significantly improved drainage without tube manipulations. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Kinked and retained nasogastric tube in polytrauma patient; a case report

Directory of Open Access Journals (Sweden)

Kumar Ashok

2017-06-01

Full Text Available Enteral feeding is an important and preferred technique of feeding in head injury patient to provide nutrition. As inadequate nutrition causes decrease in physical ability, neurological impairment and takes a long time for improvement or delayed deterioratation. With our best knowledge kinked and retained nasogastric tube in stomach is a very rare complication of feeding in head injuries patients. Predisposing factors that can cause kinking is excess tube length, tube in situ for long time and small bore tube. We are reporting one such case of kinked and retained nasogastric tube in the stomach of a polytrauma patient which was retrieved by upper GI endoscope.

Endoscopically placed guide wire assisted nasogastric tube insertion for palliation of absolute dysphagia in patients with incurable esophageal cancer

Directory of Open Access Journals (Sweden)

Purkayastha Joydeep

2006-01-01

Full Text Available Carcinoma of the esophagus is a dreadful disease because it causes a lot of distress to the patient due to its adverse effects on swallowing. Many patients present with large incurable disease or undergo disease progression and become incurable. Such patients are advised palliative and symptomatic care. The most distressing symptom that requires palliation in such patients is dysphagia. Many procedures are available for relief of dysphagia, but these are not readily available or are costly. We describe a simple, safe, cost effective and easy to do procedure for palliation of malignant dysphagia by insertion of Ryle′s tube over a endoscopically placed guide wire especially suitable for patients of the poor socio-economic strata.

Carnitine deficiency presenting with a decreased mental state in a patient with amyotrophic lateral sclerosis receiving long-term tube feeding: a case report.

Science.gov (United States)

Isse, Naohi; Miura, Yoh; Obata, Toshiyuki; Takahara, Noriko

2013-12-30

L-carnitine is an important metabolic mediator involved in fatty acid transport. It is obtained from the diet, particularly from animal products, such as red meat. Previous reports have revealed that long-term tube feeding with a commercial product containing no or low levels of carnitine can lead to an altered mental state caused by hyperammonemia. A 72-year-old Japanese man had a 12-year history of amyotrophic lateral sclerosis. He was bedridden and had required mechanical ventilation and enteral tube feeding for 10 years at home. His main enteral solution was a commercial product that contained low carnitine levels, and he sometimes received coffee and homemade products such as miso soup. Our patient's ability to communicate gradually deteriorated over a period of one year. His serum total carnitine level was abnormally low, at 26.7μmol/L (normal range, 45 to 91μmol/L), but his ammonium level was normal. His mental state improved dramatically after starting L-carnitine supplementation (600mg twice daily). This case highlights the importance of avoiding carnitine deficiency in patients with amyotrophic lateral sclerosis undergoing long-term tube feeding. These patients experience progressive muscle atrophy that might cause impaired carnitine storage and might manifest as communication difficulties. Carnitine deficiency can be misdiagnosed as a progression of systemic muscle atrophy. Clinicians should be aware of this disorder and should consider periodically measuring carnitine levels, regardless of the patient's serum ammonium levels.

Staking solutions to tube vibration problems (developed by Technos et Compagnie - FRANCE)

International Nuclear Information System (INIS)

Hewitt, E.W.; Bizard, A.; Horn, M.J.

1989-01-01

Electric generating plant steam surface condensers have been prone to vibration induced tube failures. One common and effective method for stopping this vibration has been to insert stakes into the bundle to provide additional support. Stakes have been fabricated of a variety of rigid and semi-rigid materials of fixed dimensions. Installation difficulties and problems of incomplete tube support have been associated with this approach. New developments in the application of plastic technology has offered another approach. Stakes made of plastic tubes which are flattened, by evacuation, at the time of manufacture may now be easily inserted into the tube bundle. After insertion, the vacuum is released and the memory of the plastic causes the stakes to expand and assume their original form. The spring force of the plastic cradles the adjacent condenser tubes and stops the vibration. Developed for Electricite de France (EDF), the stakes are currently installed in 19 units of the French utility system, and two units in the United States

Enteral feeding without pancreatic stimulation

DEFF Research Database (Denmark)

Kaushik, Neeraj; Pietraszewski, Marie; Holst, Jens Juul

2005-01-01

OBJECTIVE: All forms of commonly practiced enteral feeding techniques stimulate pancreatic secretion, and only intravenous feeding avoids it. In this study, we explored the possibility of more distal enteral infusions of tube feeds to see whether activation of the ileal brake mechanism can result...

Predictors of Enteral Tube Feeding in Hospitalized Older Adults.

Science.gov (United States)

Crenitte, Milton Roberto Furst; Avelino-Silva, Thiago Junqueira; Apolinario, Daniel; Curiati, Jose Antonio Esper; Campora, Flavia; Jacob-Filho, Wilson

2017-11-01

Despite general recognition that enteral tube feeding (ETF) is frequently employed in long-term care facilities and patients with dementia, remarkably little research has determined which factors are associated with its use in acutely ill older adults. In this study, we aimed to investigate determinants of ETF introduction in hospitalized older adults. We examined a retrospective cohort of acutely ill patients, aged 60 years and older, admitted to a university hospital's geriatric ward from 2014-2015, in São Paulo, Brazil. The main outcome was the introduction of ETF during hospitalization. Predictors of interest included age, sex, referring unit, comorbidity burden, functional status, malnutrition, depression, dementia severity, and delirium. Multivariate analysis was performed using backward stepwise logistic regression. A total of 214 cases were included. Mean age was 81 years, and 63% were women. Malnutrition was detected in 47% of the cases, dementia in 46%, and delirium in 36%. ETF was initiated in 44 (21%) admissions. Independent predictors of ETF were delirium (odds ratio [OR], 4.83; 95% CI, 2.12-11.01; P ETF. One in five acutely ill older adults used ETF while hospitalized. Delirium and functional dependency were independent predictors of its introduction. Risks and benefits of enteral nutrition in this particular context need to be further explored.

An in vitro comparison of tracheostomy tube cuffs

Directory of Open Access Journals (Sweden)

Maguire S

2015-04-01

Full Text Available Seamus Maguire,1 Frances Haury,2 Korinne Jew2 1Research and Development, Covidien Respiratory and Monitoring Solutions, Athlone, Ireland; 2Medical Affairs, Covidien Respiratory and Monitoring Solutions, Boulder, CO, USA Introduction: The Shiley™ Flexible adult tracheostomy tube with TaperGuard™ cuff has been designed through its geometry, materials, diameter, and wall thickness to minimize micro-aspiration of fluids past the cuff and to provide an effective air seal in the trachea while also minimizing the risk of excessive contact pressure on the tracheal mucosa. The cuff also has a deflated profile that may allow for easier insertion through the stoma site. This unique design is known as the TaperGuard™ cuff. The purpose of the observational, in vitro study reported here was to compare the TaperGuard™ taper-shaped cuff to a conventional high-volume low-pressure cylindrical-shaped cuff (Shiley™ Disposable Inner Cannula Tracheostomy Tube [DCT] with respect to applied tracheal wall pressure, air and fluid sealing efficacy, and insertion force.Methods: Three sizes of tracheostomy tubes with the two cuff types were placed in appropriately sized tracheal models and lateral wall pressure was measured via pressure-sensing elements on the inner surface. Fluid sealing performance was assessed by inflating the cuffs within the tracheal models (25 cmH2O, instilling water above the cuff, and measuring fluid leakage past the cuff. To measure air leak, tubes were attached to a test lung and ventilator, and leak was calculated by subtracting the average exhaled tidal volume from the average delivered tidal volume. A tensile test machine was used to measure insertion force for each tube with the cuff deflated to simulate clinical insertion through a stoma site.Results: The average pressure exerted on the lateral wall of the model trachea was lower for the taper-shaped cuff than for the cylindrical cuff under all test conditions (P<0.05. The taper

Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway

Directory of Open Access Journals (Sweden)

Sunde Geir A

2012-12-01

Full Text Available Abstract Background Although there are numerous supraglottic airway alternatives to endotracheal intubation, it remains unclear which airway technique is optimal for use in prehospital cardiac arrests. We evaluated the use of the laryngeal tube (LT as an airway management tool among adult out-of-hospital cardiac arrest (OHCA patients treated by our ambulance services in the Haukeland and Innlandet hospital districts. Methods Post-resuscitation forms and data concerning airway management in 347 adult OHCA victims were retrospectively assessed with regard to LT insertion success rates, ease and speed of insertion and insertion-related problems. Results A total of 402 insertions were performed on 347 OHCA patients. Overall, LT insertion was successful in 85.3% of the patients, with a 74.4% first-attempt success rate. In the minority of patients (n = 46, 13.3%, the LT insertion time exceeded 30 seconds. Insertion-related problems were recorded in 52.7% of the patients. Lack of respiratory sounds on auscultation (n = 100, 28.8%, problematic initial tube positioning (n = 85, 24.5%, air leakage (n = 61, 17.6%, vomitus/aspiration (n = 44, 12.7%, and tube dislocation (n = 17, 4.9% were the most common problems reported. Insertion difficulty was graded and documented for 95.4% of the patients, with the majority of insertions assessed as being “Easy” (62.5% or “Intermediate” (24.8%. Only 8.1% of the insertions were considered to be “Difficult”. Conclusions We found a high number of insertion related problems, indicating that supraglottic airway devices offering promising results in manikin studies may be less reliable in real-life resuscitations. Still, we consider the laryngeal tube to be an important alternative for airway management in prehospital cardiac arrest victims.

Remotised sliver sample removal from irradiated pressure tube

Energy Technology Data Exchange (ETDEWEB)

Rupani, B B; Sharma, B S.V.G.; Shyam, T V; Sinha, R K [Bhabha Atomic Research Centre, Bombay (India). Reactor Engineering Div.

1994-12-31

The life of irradiated pressure tubes of Pressurised Heavy Water Reactor (PHWR) can be assessed by analysing hydrogen content in sliver samples of pressure tube material. The sample can be obtained in the form of small slivers by scraping at any specified locations within the bore of the pressure tube of operating reactor. A tool namely Hydride Scraping Tool (HST) has been developed to obtain very thin slivers of hydride bearing samples from irradiated pressure tube. In order to save man-rem consumption during scraping operation, a feeding mechanism has also been designed and developed for axial positioning of scraping tool in the channel remotely. This paper covers general details about constructional features of the scraping tool, feeding mechanism and their control system. It also highlights the operational salient features and capabilities of the system. Possible applications of the feeding mechanism in other fields are also indicated. (author). 4 figs.

Remotised sliver sample removal from irradiated pressure tube

International Nuclear Information System (INIS)

Rupani, B.B.; Sharma, B.S.V.G.; Shyam, T.V.; Sinha, R.K.

1994-01-01

The life of irradiated pressure tubes of Pressurised Heavy Water Reactor (PHWR) can be assessed by analysing hydrogen content in sliver samples of pressure tube material. The sample can be obtained in the form of small slivers by scraping at any specified locations within the bore of the pressure tube of operating reactor. A tool namely Hydride Scraping Tool (HST) has been developed to obtain very thin slivers of hydride bearing samples from irradiated pressure tube. In order to save man-rem consumption during scraping operation, a feeding mechanism has also been designed and developed for axial positioning of scraping tool in the channel remotely. This paper covers general details about constructional features of the scraping tool, feeding mechanism and their control system. It also highlights the operational salient features and capabilities of the system. Possible applications of the feeding mechanism in other fields are also indicated. (author). 4 figs

Disc-Donut-Tube wear test report, Phase I

International Nuclear Information System (INIS)

Kowal, K.; Knaus, S.E.

1976-06-01

The report describes a test program which simulated the wear-inducing conditions in the AI Prototype CRBR Steam Generator. This was accomplished by simulating the wear inducing loading and motion of a steam tube against ''disc-donut'' tube spacer plates. It was found that 2- 1 / 4 Cr-1 Mo tubes, wearing against 2- 1 / 4 Cr-l Mo tube spacer plates, seized and galled as deep as .017 inches. Inconel 718 tube spacer plates uniformly wore the tubes as deep as .012 in. Aluminum bronze inserts wore as deep as .003 inches into the tube

[Prehospital airway management of laryngeal tubes. Should the laryngeal tube S with gastric drain tube be preferred in emergency medicine?].

Science.gov (United States)

Dengler, V; Wilde, P; Byhahn, C; Mack, M G; Schalk, R

2011-02-01

Laryngeal tubes (LT) are increasingly being used for emergency airway management. This article reports on two patients in whom out-of-hospital intubation with a single-lumen LT was associated with massive pulmonary aspiration in one patient and gastric overinflation in the other. In both cases peak inspiratory pressures exceeded the LT leak pressure of approximately 35 mbar. This resulted in gastric inflation and decreased pulmonary compliance and increased inspiratory pressure further, thereby creating a vicious circle. It is therefore recommended that laryngeal tube suction (LTS) should be used in all cases of emergency airway management and a gastric drain tube be inserted through the dedicated second lumen. Apart from gastric overinflation, incorrect LT/LTS placement must be detected and immediately corrected, e.g. in cases of difficult or impossible gastric tube placement, permanent drainage of air from the gastric tube, decreasing minute ventilation or an ascending capnography curve.

Metallographic study of reconstitution welding in inserts of 1 cm3

International Nuclear Information System (INIS)

Romero C, J.; Garcia R, R.; Fernandez T, F.; Perez R, N.; Rocamontes A, M.

2007-01-01

In this article, the welding metallographic study carried out in Charpy test tubes reconstituted with notch in 'V', used in the surveillance programs of the vessel in nucleo electric plants is described. Inserts of 1 cm 3 are used, where the inserts are usually rectangular of minimum 18 millimeters of length. The importance of using inserts of 1 cm 3 is that the mechanical properties can be measured in another direction of the vessel steel, when changing the direction or sense of the notch in 'V' or the face where this notch is made in the insert. (Author)

Human factors related to time-dependent infection control measures: "Scrub the hub" for venous catheters and feeding tubes.

Science.gov (United States)

Caspari, Lindsay; Epstein, Elizabeth; Blackman, Amy; Jin, Li; Kaufman, David A

2017-06-01

The use of catheter hub decontamination protocols is a common practice to reduce central line-associated bloodstream infections. However, few data exist on the most effective disinfection procedure prior to hub access accounting for human factors and time-dependent practices in real time in the clinical setting. An observational design with a multimodal intervention was used in this study in a neonatal intensive care unit. Direct observations on nurse compliance of scrub times with decontamination when accessing of venous catheter and feeding tube hubs were conducted during 3 phases: (1) baseline period prior to any interventions; (2) during an educational intervention phase; and (3) during a timer intervention period when using a timing device, either an actual timer or music button. Overall, both education and the timing device interventions increased the mean scrub time ± SD of venous catheter hubs. Mean baseline scrub times of 10 ± 5 seconds were lower compared with 23 ± 12 seconds after educational intervention (P music button use (P observed with scrub times of feeding tubes. Time-based infection control measures, such as scrubbing the hub, must be implemented with aids that qualify specific times to account for human factors, to ensure adherence to time-dependent measures aimed at decreasing nosocomial infections. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Process and device for locating a defective tube, particularly in the tube bundle of a steam generator

International Nuclear Information System (INIS)

Denis, Jean.

1977-01-01

A process is described for locating a defective tube, particularly in the tube bundle of a steam generator of the reversed U tube kind with the ends connected to a tube plate, marking with the bottom of the generator casing a space separated into two adjacent collectors, respectively for the inlet and outlet of a primary fluid flowing inside the tubes of the bundle, these being externally washed by a secondary vaporizing fluid. In this process a television camera that can be inserted into the casing is used. This process consists in transmitting to a display system outside the generator an image of the tube plate in each collector by means of a directional television camera and then to place over this image a luminous marker to locate the end or the faulty tube [fr

Device for facilitating the insertion and withdrawal of fuel assemblies from a nuclear reactor

International Nuclear Information System (INIS)

Andrea, C.; Siegel, E.A.

1976-01-01

A device is provided which is installed in a reactor prior to carrying out refueling operations and which accurately locates and isolates a selected core location to permit rapid withdrawal and insertion of fuel subassemblies at that location. A shielded plug designed to cooperate with the refueling apparatus is inserted into an access port in the reactor head. A structural shroud extends down from the plug and carries at its lower end a radially floating, hexagonal spreader tube with mechanisms to rotate it for angular alignment purposes and a linear drive for inserting it into the core. The upper end of the spreader tube serves as a guide for leading the fuel handling apparatus into alignment with the chosen subassembly

Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax.

Science.gov (United States)

Kulvatunyou, N; Erickson, L; Vijayasekaran, A; Gries, L; Joseph, B; Friese, R F; O'Keeffe, T; Tang, A L; Wynne, J L; Rhee, P

2014-01-01

Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax. This prospective randomized trial compared 14-Fr pigtail catheters and 28-Fr chest tubes in patients with traumatic pneumothorax presenting to a level I trauma centre from July 2010 to February 2012. Patients who required emergency tube placement, those who refused and those who could not respond to pain assessment were excluded. Primary outcomes were tube-site pain, as assessed by a numerical rating scale, and total pain medication use. Secondary outcomes included the success rate of pneumothorax resolution and insertion-related complications. Forty patients were enrolled. Baseline characteristics of 20 patients in the pigtail catheter group were similar to those of 20 patients in the chest tube group. No patient had a flail chest or haemothorax. Pain scores related to chest wall trauma were similar in the two groups. Patients with a pigtail catheter had significantly lower mean(s.d.) tube-site pain scores than those with a chest tube, at baseline after tube insertion (3.2(0.6) versus 7.7(0.6); P pneumothorax, use of a 14-Fr pigtail catheter is associated with reduced pain at the site of insertion, with no other clinically important differences noted compared with chest tubes. NCT01537289 (http://clinicaltrials.gov). © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Nutritional status and feeding-tube placement in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy-based larynx preservation program.

Science.gov (United States)

Bozec, Alexandre; Benezery, Karen; Chamorey, Emmanuel; Ettaiche, Marc; Vandersteen, Clair; Dassonville, Olivier; Poissonnet, Gilles; Riss, Jean-Christophe; Hannoun-Lévi, Jean-Michel; Chand, Marie-Eve; Leysalle, Axel; Saada, Esma; Sudaka, Anne; Haudebourg, Juliette; Hebert, Christophe; Falewee, Marie-Noelle; Demard, François; Santini, José; Peyrade, Frédéric

2016-09-01

The objective of the study is to evaluate the nutritional status and determine its impact on clinical outcomes in patients with locally advanced hypopharyngeal cancer included in an induction chemotherapy (ICT)-based larynx preservation program without prophylactic feeding-tube placement. All patients with locally advanced (T3/4, N0-3, M0) hypopharyngeal squamous cell carcinoma, technically suitable for total pharyngolaryngectomy, treated by docetaxel, cisplatin and 5-fluorouracil (TPF)-ICT for larynx preservation at our institution between 2004 and 2013, were included in this retrospective study. Patients' nutritional status was closely monitored. Enteral nutrition was used if and when a patient was unable to sustain per-oral nutrition and hydration. The impact of nutritional status on clinical outcomes was investigated in univariate and multivariate analysis. A total of 53 patients (42 men and 11 women, mean age = 58.6 ± 8.2 years) were included in this study. Six (11.3 %) patients had lost more than 10 % of their usual body weight before therapy. Compared with patients' usual weight, the mean maximum patient weight loss during therapeutic management was 8.7 ± 4.5 kg. Enteral nutrition was required in 17 patients (32 %). We found no influence of the tested nutritional status-related factors on response to ICT, toxicity of ICT, overall, cause-specific and recurrence-free survival, and on post-therapeutic swallowing outcome. Maximum weight loss was significantly associated with a higher risk of enteral tube feeding during therapy (p = 0.03) and of complications (grade ≥3, p = 0.006) during RT. Without prophylactic feeding-tube placement, approximately one-third of the patients required enteral nutrition. There was no significant impact of nutritional status on oncologic or functional outcomes.

Method of fabricating a poision tube for reactor control rods

Energy Technology Data Exchange (ETDEWEB)

Mori, Yasuhiko; Yoshida, Toshimi; Masaoka, Isao; Naruse, Akisuke

1983-04-28

A method to unify the neutron absorbing performance, enhance the workability in the insertion of neutron absorber tube and further decrease the stresses acting on the neutron absorber coating tube is described. The neutron absorber coated rod comprising neutron absorbing substance and a metal pipe is fabricated by compressing a metal pipe filled with the neutron absorber. Specifically, neutron absorbing substance such as boron carbide powder or the like is filled in a metal pipe such as made of stainless steel tube by way of vibration packing or the like. Then, after heating the metal pipe, it is applied with compression working such as swaging into a fine tube to increase the packing density of the absorbing substance filled in the pipe to greater than 60% of the theoretical density and completely contacted closely to the inner wall of the pipe. The neutron absorber coated rod thus fabricated can be inserted to an external coating tube with ease at a predetermined gap.

Pressure tube reactor

International Nuclear Information System (INIS)

Seki, Osamu; Kumasaka, Katsuyuki.

1988-01-01

Purpose: To remove the heat of reactor core using a great amount of moderators at the periphery of the reactor core as coolants. Constitution: Heat of a reactor core is removed by disposing a spontaneous recycling cooling device for cooling moderators in a moderator tank, without using additional power driven equipments. That is, a spontaneous recycling cooling device for cooling the moderators in the moderator tank is disposed. Further, the gap between the inner wall of a pressure tube guide pipe disposed through the vertical direction of a moderator tank and the outer wall of a pressure tube inserted through the guide pipe is made smaller than the rupture distortion caused by the thermal expansion upon overheating of the pressure tube and greater than the minimum gap required for heat shiels between the pressure tube and the pressure tube guide pipe during usual operation. In this way, even if such an accident as can not using a coolant cooling device comprising power driven equipment should occur in the pressure tube type reactor, the rise in the temperature of the reactor core can be retarded to obtain a margin with time. (Kamimura, M.)

Comparison of endoscopic Nd:YAG laser therapy and oesophageal tube in palliation of oesophagogastric malignancy

Energy Technology Data Exchange (ETDEWEB)

Hahl, J.; Salo, T.; Ovaska, J.; Haapiainen, R.; Kalima, T.; Schroeder, T. (Helsinki Univ. Central Hospital (Finland). Meilahti Clinic)

1991-01-01

The clinical results of 96 patients with upper gastrointestinal malignancy have been evaluated retrospectively. 69 patients with a mean age of 72 years (35 men and 34 women) were treated with endoscopic laser therapy, and 27 patients with a mean age of 67 years (16 men and 11 women) with insertion of an oesophageal tube. After laser therapy the bulk of the tumour was reduced in 87%, and in 55% clear signs of relieved dysphagia were seen. The insertion of an esophageal tube was successful in 89%. In the laser group no fatal complications occurred, and the overall complication risk was 8.7%. The first-year survival in all laser patients was 12%, and in patients with impassable tumour stenosis the survival was 6%. The mortality related to the insertion of an oesophageal tube was 11%, and complications occurred in 48% of the patients. The first-year survival of the tube group was nil. It is concluded that endoscopic laser therapy and insertion of oesophageal tube are both effective methods in palliation of oesophagogastric malignancy, but the mortality and risk for complications were markedly lower after laser therapy. 20 refs., 1 fig., 3 tabs.

Enhancement of heat transfer using varying width twisted tape inserts

African Journals Online (AJOL)

International Journal of Engineering, Science and Technology ... experimental investigations of the augmentation of turbulent flow heat transfer in a horizontal tube by means of varying width twisted tape inserts with air as the working fluid.

Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital.

Science.gov (United States)

Tho, Poh Chi; Mordiffi, Siti; Ang, Emily; Chen, Helen

2011-03-01

Nasogastric (NG) tube is a device passed through the gastrointestinal tract of patients for the purpose of feeding, gastric decompression and medication administration. However, a small risk involved in the process is that the tube may be misplaced into the trachea during insertion or may get displaced at a later stage, leading to disastrous results. Recent adverse incidences arising out of the misplacement of NG tube raised concerns among the nursing and medical community and the Patient Safety Officer of the hospital. The Evidence Based Nursing Unit, in collaboration with some of the key nursing leaders in nursing administration, was tasked to explore and institute the current best practice in confirming the correct placement of NG tube. The aim of this project was to institute the best practice to confirm the correct placement of NG tube in patients in an acute care hospital setting. The project comprised of a few stages. The first stage involved reviewing the existing recommendations and guidelines on the methods for checking correct NG tube placement. The second stage involved incorporation of the change of practice into the clinical setting. The final stage was to monitor and evaluate the impact of the new practice on the patients, nurses and other healthcare professionals. Evidence search from guidelines and journals supported the test that used pH indicator instead of the litmus test. There is no evidence that supports the method of auscultation and bubbling to confirm correct NG tube placement in the absence of aspirate. Radiology remains the 'gold standard' for checking correct NG tube placement. The revised method of NG tube placement and workflow was incorporated in the revised Standard Operating Procedures. A total of 17 roadshows were conducted to create awareness regarding the new method amongst the nurses, and the implementation of the revised method and workflow was commenced on 3 November 2008. The initial audit conducted 1 month after the

Blenderized feeding formulas with nutritious and inexpensive foods

Directory of Open Access Journals (Sweden)

Ana Paula Lança BENTO

Full Text Available ABSTRACT Objective: To propose an inexpensive blenderized tube feeding formula consisting of foods with standard nutritional composition that meets the nutritional requirements of individuals aged more than 51 years. Methods: The enteral diets were formulated mainly with fresh foods and tested for their physical (homogeneity, stability, osmolality, pH, and flow rate and chemical (moisture, ash, protein, lipids, energy, crude fiber, vitamin C, calcium, iron, magnesium, and zinc characteristics. The cost was determined by surveying item prices in supermarkets and stores that specialize in nutritional support. Results: The blenderized tube feeding formula was stable and homogeneous, and had slightly acidic pH, hypertonic osmolality (603mOsm/kg, and flow rate comparable with gravity drip (21 minutes. Proximate composition analysis indicated appropriate levels of proteins, lipids, vitamin C, and zinc. The mean cost of 2000kcal of the standard blenderized tube feeding formula was R$ 12.3±1.4, which is 70% cheaper than the mean cost of similar commercial enteral formulas. Conclusion: The planned diet can be an excellent choice for patients using blenderized tube feeding formulas as it consisted of habitual food items, had physical and nutritional quality, and was inexpensive.

The computational design of junctions by carbon nanotube insertion into a graphene matrix

International Nuclear Information System (INIS)

Mao Yuliang; Zhong Jianxin

2009-01-01

Using first-principles density functional theory calculations, two types of junction models constructed from armchair and zigzag carbon nanotube (CNT) insertion into a graphene matrix have been envisioned. It has been found that the insertion of the CNT into the graphene matrix leads to the formation of C-C covalent bonds between graphene and the CNT that distort the CNT geometry. However, the hydrogenation of the suspended carbon bonds on the graphene resumes the graphene-like structure of the pristine tube. The calculated band structure of armchair CNT insertion into graphene or hydrogenation graphene opens up a band gap and converts the metallic CNT into a semiconductor. For the zigzag CNT, the sp 3 hybridization between the graphene and nanotube alters the band structure of the tube significantly, whereas saturating the dangling bonds of terminal carbon atoms of graphene makes the CNT almost keep the same character of the bands as that in the pristine tube. The synthesis of our designed hybrid structures must be increasingly driven by an interest in molecules that not only have intriguing structures but also have special functions such as hydrogen storage.

The Effect of an Intervention Aimed at Reducing Errors when Administering Medication through Enteral Feeding Tubes in an Institution for Individuals with Intellectual Disability

Science.gov (United States)

Idzinga, J. C.; de Jong, A. L.; van den Bemt, P. M. L. A.

2009-01-01

Background: Previous studies, both in hospitals and in institutions for clients with an intellectual disability (ID), have shown that medication errors at the administration stage are frequent, especially when medication has to be administered through an enteral feeding tube. In hospitals a specially designed intervention programme has proven to…

Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers

Directory of Open Access Journals (Sweden)

Ortner Clemens M

2012-02-01

Full Text Available Abstract Background Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%. In principle, chest tube insertion can be performed by using Trocar or Non-trocar techniques. If using trocar technique, two different chest tubes (equipped with sharp or blunt tip are currently commercially available. This study was performed to detect any difference with respect to time until tube insertion, to success and to misplacement rate. Methods Twenty emergency physicians performed five tube thoracostomies using both blunt and sharp tipped tube kits in 100 fresh human cadavers (100 thoracostomies with each kit. Time until tube insertion served as primary outcome. Complications and success rate were examined by pathological dissection and served as further outcomes parameters. Results Difference in mean time until tube insertion (63s vs. 59s was statistically not significant. In both groups, time for insertion decreased from the 1st to the 5th attempt and showed dependency on the cadaver's BMI and on the individual physician. Success rate differed between both groups (92% using blunt vs. 86% using sharp tipped kits and injuries and misplacements occurred significantly more frequently using chest tubes with sharp tips (p = 0.04. Conclusion Data suggest that chest drain insertion with trocars is associated with a 6-14% operator-related complication rate. No difference in average time could be found. However, misplacements and organ injuries occurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is recommended.

Observation of double loop insertion of silicone rubber tube anastomosis method combined with "Z" flap repair in the treatment of lacrimal ductule laceration

Directory of Open Access Journals (Sweden)

Rui Hou

2017-03-01

Full Text Available AIM: To investigate the clinical curative effect of double loop insertion of silicone rubber tube combined with "Z" flap repair in the treatment of laceration of eyelid with canaliculus laceration. METHODS: The paper reviewed 45 cases of laceration of eyelid with laceration canaliculus, caused by trauma, which were treated in my hospital from January 2014 to January 2016. In the process of anastomosis of lacrimal duct and suture of eyelid laceration, either the method of single spinal anesthesia tube placement on skin contraposition suture or the method of dual annular silicone tube placement combined with the word "Z" flap repair was used. We compared the two methods and studied the possible complications like eyelid varus and valgus, lacrimal point valgus, eyelid scar, anastomotic dehiscence again. RESULTS: Out of the 22 cases in which the patients chose the single spinal anesthesia tube implantation on skin suture, 21 cases succeeded and patients received lacrimal duct patency results after extubation; and 1 case anastomosis failed. Complications: 20 cases had different degree of complications and the impact on their appearances were significant. Out of the 23 cases in which the patients chose double passage annular silicone tube joint prosthesis implantation Z flap, 23 received extubation results lacrimal patency or almost patency, the anastomosis of patients was successful. Complications: in two cases, patients had mild eyelid entropion and pomatum varus. Both eyelid deformity and severe wound tear did not occur in all cases again. Scar was not obvious. The success rate of anastomosis between the two groups was not significantly different(P=0.4889. To compare the rate of complications, there were significant differences(χ2=30.42, PCONCLUSION: The application of dual ring implantation silicon tube combined with the word "Z" flap repair in the treatment of lacrimal canaliculi laceration of eyelid laceration ensured the success rate of

A nationwide study on the impact of pneumococcal conjugate vaccination on antibiotic use and ventilation tube insertion in Denmark 2000-2014

DEFF Research Database (Denmark)

Howitz, Michael Frantz; Harboe, Zitta Barrella; Ingels, Helene

2017-01-01

Introduction of Pneumococcal Conjugated Vaccines (PCV) in national immunization programs have been successful in reducing the number of invasive and lower respiratory pneumococcal infections. The impact of the vaccines on upper respiratory infections caused by pneumococci is less clear although...... these account for most pneumococcal infections. In this study, we used likely proxies for respiratory infections in children, such as antibiotic use and ventilation tube insertions (VTI), to estimate the impact of the vaccine on a national level. The study was designed as a population-based retrospective...... reversed to near year 2000 levels after the introduction of PCV. This indicates that implementation of pneumococcal vaccines in the Childhood Vaccination Programme has likely reduced the incidence of upper respiratory diseases due to pneumococci in Denmark....

Establishing Decision Trees for Predicting Successful Postpyloric Nasoenteric Tube Placement in Critically Ill Patients.

Science.gov (United States)

Chen, Weisheng; Sun, Cheng; Wei, Ru; Zhang, Yanlin; Ye, Heng; Chi, Ruibin; Zhang, Yichen; Hu, Bei; Lv, Bo; Chen, Lifang; Zhang, Xiunong; Lan, Huilan; Chen, Chunbo

2018-01-01

Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self-propelled spiral nasoenteric tube is quite low. This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self-propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x-ray scan 24 hours after tube insertion. Chi-square automatic interaction detection (CHAID), simple classification and regression trees (SimpleCart), and J48 methodologies were used to develop decision tree models, and multiple logistic regression (LR) methodology was used to develop an LR model for predicting successful postpyloric nasoenteric tube placement. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models. Successful postpyloric nasoenteric tube placement was confirmed in 427 of 939 patients enrolled. For predicting successful postpyloric nasoenteric tube placement, the performance of the 3 decision trees was similar in terms of the AUCs: 0.715 for the CHAID model, 0.682 for the SimpleCart model, and 0.671 for the J48 model. The AUC of the LR model was 0.729, which outperformed the J48 model. Both the CHAID and LR models achieved an acceptable discrimination for predicting successful postpyloric nasoenteric tube placement and were useful for intensivists in the setting of self-propelled spiral nasoenteric tube insertion. © 2016 American Society for Parenteral and Enteral Nutrition.

Root cause of incomplete control rod insertions at Westinghouse reactors

International Nuclear Information System (INIS)

Ray, S.

1997-01-01

Within the past year, incomplete RCCA insertions have been observed on high burnup fuel assemblies at two Westinghouse PWRs. Initial tests at the Wolf Creek site indicated that the direct cause of the incomplete insertions observed at Wolf Creek was excessive fuel assembly thimble tube distortion. Westinghouse committed to the NRC to perform a root cause analysis by the end of August, 1996. The root cause analysis process used by Westinghouse included testing at ten sites to obtain drag, growth and other characteristics of high burnup fuel assemblies. It also included testing at the Westinghouse hot cell of two of the Wolf Creek incomplete insertion assemblies. A mechanical model was developed to calculate the response of fuel assemblies when subjected to compressive loads. Detailed manufacturing reviews were conducted to determine if this was a manufacturing related issue. In addition, a review of available worldwide experience was performed. Based on the above, it was concluded that the thimble tube distortion observed on the Wolf Creek incomplete insertion assemblies was caused by unusual fuel assembly growth over and above what would typically be expected as a result of irradiation exposure. It was determined that the unusual growth component is a combination of growth due to oxide accumulation and accelerated growth, and would only be expected in high temperature plants on fuel assemblies that see long residence times and high power duties

Tests of compressed geometry NEC acceleration tubes

International Nuclear Information System (INIS)

Raatz, J.E.; Rathmell, R.D.; Stelson, P.H.; Ziegler, N.F.

1985-01-01

Tests have been performed in the 3 MV Pelletron test machine at NEC on a compressed geometry tube which increases the insulating length of the tube by eliminating the heated electrode assemblies (approx.2.5 cm thick) at the end of each tube section. Some insert electrodes are changed to provide some trapping of secondary ions. The geometry tested provided an 18% increase in live ceramic in the tube. The compressed geometry tube allowed a terminal voltage of 3.55 MV on the 3 MV column at normal gradients of 30.3 kv/tube gap. The tube was also conditioned to more than 4 MV and remained stable in voltage with few sparks and with low x-ray levels for days at about 4 MV. This same performance could be achieved with or without arc discharge cleaning. 4 refs., 4 figs

Fuel assembly and fuel cladding tube

International Nuclear Information System (INIS)

Tsutsumi, Shinro; Ito, Ken-ichi; Inagaki, Masatoshi; Nakajima, Junjiro.

1996-01-01

A fuel cladding tube is a zirconium liner tube formed by lining a pure zirconium layer on the inner side of a zirconium alloy tube. The fuel cladding tube is formed by extrusion molding of a composite billet formed by inserting a pure zirconium billet into a zirconium alloy billet. Accordingly, the pure zirconium layer and the zirconium alloy tube are strongly joined by metal bond. The fuel cladding tube has an external oxide film on the outer surface of the zirconium alloy tube and an internal oxide film on the inner side of the pure zirconium layer. The external oxide film has a thickness preferably of about 1μm. The internal oxide film has a thickness of not more than 10μm, preferably, from 1 to 5μm. With such a constitution, flaws to be formed on both inner and outer surfaces of the cladding tube upon assembling a fuel assembly can be reduced thereby enabling to reduce the amount of hydrogen absorbed to the cladding tube. (I.N.)

Laser Myringotomy Versus Ventilation Tubes In Otitis Media With Effusion.

Science.gov (United States)

Yousaf, Mohammad; Malik, Suhail Ahmad; Haroon, Tahir

2016-01-01

Otitis media with effusion (OME) is a leading cause of difficulty in hearing in paediatric population. Otitis media with effusion must be detected and managed early to prevent conductive hearing loss in children. It was aimed to compare results of laser myringotomy and ventilation tube insertion, in terms of hearing improvement and recurrence of Middle ear effusion (MEE). This randomized controlled trial was conducted from February 2012 to January 2015. Children of 4- 12 years of age with decreased hearing due to OME were included in the study. These children were investigated with pure tone audiometry (PTA) and tympanometry to confirm conductive hearing loss. Patients were put in 2 groups, group one comprised of patients treated with laser myringotomy and group 2, treated with ventilation tube insertion. The objective was to evaluate and compare results of the two procedures in terms of resolution of middle ear effusion (MEE) and improvement of hearing. The two procedures were also compared in terms of complications like otorrhea, persistence of perforation, hypertrophic scar and thinning of tympanic membrane (TM). Middle ear effusion cleared in 35 out of 68 ears with laser myringotomy (LM) as compared to 52 out of 62 ears with ventilation tubes (VT). The myringotomy was still patent in 21 ears treated with LM while tube was in site in 50 years with VT after 3 months. The hearing level improved with LM by 10-15 dB after first 3 months. The aim in Otitis media with effusion is ventilation of tympanic cavity. Laser myringotomy can be substitute to ventilation tube insertion (VT). But it remains patent for shorter time and less effective than VT. The ears with refractory or recurrent MEE should have VT insertion.

Sleeve type repair of degraded nuclear steam generator tubes

International Nuclear Information System (INIS)

Ayres, P.S.; Stark, L.E.; Feldstein, J.G.; Fu, T.

1986-01-01

A sealable sleeve is described for insertion into the repair of a degraded tube which consists of: a hollow core inner member of the same material as the degraded tube; a thinner outer member of substantially pure nickel and resistant to corrosive attack, the outer member being metallurgically bonded with the inner member; an expanded portion of the sleeve at one end for positioning in the tube within a tube sheet; a multiplicity of grooves formed in and adjacent to the other end of the sleeve which extends into the free-standing portion of the tube beyond the tube sheet, and a noble metal braze material contained in the grooves

The Challenges of Home Enteral Tube Feeding: A Global Perspective

Directory of Open Access Journals (Sweden)

Omorogieva Ojo

2015-04-01

Full Text Available The aim of this review is to provide a global perspective of Home Enteral Tube Feeding (HETF and to outline some of the challenges of home enteral nutrition (HEN provisions. It is well established that the number of patients on HETF is on the increase worldwide due to advances in technology, development of percutaneous endoscopic gastrostomy techniques, and the shift in care provisions from acute to community settings. While the significance of home enteral nutrition in meeting the nutritional requirements of patients with poor swallowing reflexes and those with poor nutritional status is not in doubt, differences exist in terms of funding, standards, management approaches and the level of infrastructural development across the world. Strategies for alleviating some of the challenges militating against the effective delivery of HETF including the development of national and international standards, guidelines and policies for HETF, increased awareness and funding by government at all levels were discussed. Others, including development of HEN services, which should create the enabling environment for multidisciplinary team work, clinical audit and research, recruitment and retention of specialist staff, and improvement in patient outcomes have been outlined. However, more research is required to fully establish the cost effectiveness of the HEN service especially in developing countries and to compare the organization of HEN service between developing and developed countries.

Fixed mask assembly research for APS insertion devices

International Nuclear Information System (INIS)

Kuzay, T.M.

1992-01-01

The Fixed Mask Assembly (FMA) is the first component to interact with the photon beam. Two sets of a pair of FMA channels, vertically and horizontally disposed, contain the beam rather than define it. They are subject to very large heat fluxes during containment. In current practice, the FMA channels are made of heavy, seamless copper, have rectangular cross-sections, and are cooled internally with water. Channels are set at grazing angles ranging from I to 6 degrees with respect to the beam, depending on the type of insertion device. APS insertion devices will impose higher heat fluxes on FMAS. Therefore, a need exists to improve the FMA engineering, keeping in mind the current design criteria and philosophy of FMAS. Preliminary analysis of current heat transfer practice indicates that the major resistance to heat transfer is on the coolant side. Therefore, FMA cooling would benefit from enhanced heat transfer on the coolant side. With this principle in mind, an experimental program has been undertaken to explore the feasibility of using high-performance copper tube configurations which are expected to yield heat transfer coefficients, open-quotes hclose quotes, in single phase flow systems 2 to 5(?) times higher than equivalent plain tubes. In this report, the experimental scope and a preliminary analysis of high-performance copper tube configurations are described

Laparoscopic feeding jejunostomy: also a simple technique.

Science.gov (United States)

Albrink, M H; Foster, J; Rosemurgy, A S; Carey, L C

1992-01-01

Placement of feeding tubes is a common procedure for general surgeons. While the advent of percutaneous endoscopic gastrostomy has changed and improved surgical practice, this technique is contraindicated in many circumstances. In some patients placement of feeding tubes in the stomach may be contraindicated due to the risks of aspiration, gastric paresis, or gastric dysmotility. We describe a technique of laparoscopic jejunostomy tube placement which is easy and effective. It is noteworthy that this method may be used in patients who have had previous abdominal operations, and it has the added advantage of a direct peritoneal view of the viscera. We suggest that qualified laparoscopic surgeons learn the technique of laparoscopic jejunostomy.

Feeding practice in acute stroke patients in a tertiary care hospital.

Science.gov (United States)

Miah, Md Titu; Al-Amin, Mohammad; Khan, Mohammad Ashik Imran; Ayaz, K F M; Zakaria, M H; Ahmed, Srijoni; Ahasan, H A M Nazmul

2010-12-01

Feeding is a basic component of care and it is the most common and difficult management issue for stroke patients. Objective of this study was to know the practice of feeding (oral & nasogastric tube feeding), different types of food used and their caloric value in stroke patients. This direct observational study was done from June 2010 to November 2010, in different medicine wards of Dhaka Medical College Hospital, and included 100 acute stroke patients confirmed by CT scan or MRI of brain and duration of hospital stay for at least 24 hours. Out of 100 cases, 22% took their feeding orally and 78% cases through nasogastric tube. Artificial milk powder 66% cases (NG tube vs. Orally, 58% vs. 8%), juice 18% (NG tube 13% vs. orally 5%), horlicks & juice & soup 10% (NG tube vs. Orally, 7% vs. 3%), khichury 2% orally, bread & egg & shuji 4% cases orally. In 100 cases studied, none of them fulfilled the calorie requirement up to the standard level according to the guideline of Nutrition & Food Science Institute, of Dhaka University, Bangladesh. Though this study was small scale but the magnitude of under nutrition among stroke patients revealed is alarming and needs urgent attention.

[How to do - the chest tube drainage].

Science.gov (United States)

Klopp, Michael; Hoffmann, Hans; Dienemann, Hendrik

2015-03-01

A chest tube is used to drain the contents of the pleural space to reconstitute the physiologic pressures within the pleural space and to allow the lungs to fully expand. Indications for chest tube placement include pneumothorax, hemothorax, pleural effusion, pleural empyema, and major thoracic surgery. The most appropriate site for chest tube placement is the 4th or 5th intercostal space in the mid- or anterior- axillary line. Attention to technique in placing the chest tube is vital to avoid complications from the procedure. Applying the step-by-step technique presented, placement of a chest tube is a quick and safe procedure. Complications - frequently occurring when the tube is inserted with a steel trocar - include hemothorax, dislocation, lung lacerations, and injury to organs in the thoracic or abdominal cavity." © Georg Thieme Verlag KG Stuttgart · New York.

Numerical simulation of fluid flow and heat transfer in a concentric tube heat exchanger

International Nuclear Information System (INIS)

Mokamati, S.V.; Prasad, R.C.

2003-01-01

In this paper, numerical simulation of a concentric tube heat exchanger is presented to determine the convective heat transfer coefficient and friction factor in a smooth tube. Increasing the convective heat transfer coefficient can increase heat transfer rate in a concentric tube heat exchanger from a given tubular surface area. This can be achieved by using heat transfer augmentation devices. This work constitutes the initial phase of the numerical simulation of heat transfer from tubes employing augmentation devices, such as twisted tapes, wire-coil inserts, for heat transfer enhancement. A computational fluid dynamics (CFD) simulation tool was developed with CFX software and the results obtained from the simulations are validated with the empirical correlations for a smooth tube heat exchanger. The difficulties associated with the simulation of a heat exchanger augmented with wire-coil inserts are discussed. (author)

Use of a Nasal Speculum for Chest-Drain Insertion: A Simple Technique

OpenAIRE

Saxena, Pankaj; Konstantinov, Igor E.; Newman, Mark A.J.

2006-01-01

Tube thoracostomy is a very commonly performed procedure in cardiothoracic surgery. Insertion of a chest drain requires expertise to minimize complications. We describe a simple technique of using a nasal speculum to perform this procedure.

Method of repairing pressure tube type reactors

International Nuclear Information System (INIS)

Asada, Takashi.

1983-01-01

Purpose: To enable to re-start the reactor operation in a short time, upon occurrence of failures in a pressure tube, as well as directly examine the cause for the failures in the pressure tube. Method: The pressure tube reactor main body comprises a calandria tank of a briquette form, pressure tubes, fuel assemblies and an iron-water shielding body. If failure is resulted to a pressure tube, the reactor operation is at first shutdown and nuclear fuel assemblies are extracted to withdraw from the pressure tube. Then, to an inlet pipe way and an outlet pipeway connected to the failed pressure tube, are attached plugs by means of welding or the like at the appropriate position where the radiation exposure dose is lower and the repairing work can be performed with ease. The pressure tube is disconnected to withdraw from the inlet pipeway and the outlet pipeway and, instead, radiation shielding plug tube is inserted and shield cooling device is actuated if required, wherein the reactor is actuated to re-start the operation. (Yoshino, Y.)

Tube-in-shell heat exchangers

International Nuclear Information System (INIS)

Richardson, J.

1976-01-01

Tube-in-shell heat exchangers normally comprise a bundle of parallel tubes within a shell container, with a fluid arranged to flow through the tubes in heat exchange with a second fluid flowing through the shell. The tubes are usually end supported by the tube plates that separate the two fluids, and in use the tube attachments to the tube plates and the tube plates can be subject to severe stress by thermal shock and frequent inspection and servicing are required. Where the heat exchangers are immersed in a coolant such as liquid Na such inspection is difficult. In the arrangement described a longitudinally extending central tube is provided incorporating axially spaced cylindrical tube plates to which the opposite ends of the tubes are attached. Within this tube there is a tubular baffle that slidably seals against the wall of the tube between the cylindrical tube plates to define two co-axial flow ducts. These ducts are interconnected at the closed end of the tube by the heat exchange tubes and the baffle comprises inner and outer spaced walls with the interspace containing Ar. The baffle is easily removable and can be withdrawn to enable insertion of equipment for inspecting the wall of the tube and tube attachments and to facilitate plugging of defective tubes. Cylindrical tube plates are believed to be superior for carrying pressure loads and resisting the effects of thermal shock. Some protection against thermal shock can be effected by arranging that the secondary heat exchange fluid is on the tube side, and by providing a thermal baffle to prevent direct impingement of hot primary fluid on to the cylindrical tube plates. The inner wall of the tubular baffle may have flexible expansible region. Some nuclear reactor constructions incorporating such an arrangement are described, including liquid metal reactors. (U.K.)

[Percutaneous tubing and drainage for the diagnosis and treatment of malignant pericardial effusion].

Science.gov (United States)

Li, Y; Zhou, J; Zhang, J

2000-01-01

To insert a tube into pericardial cavity as an emergent measure of diagnosis and treatment in patients with malignant pericardial effusion. Pericardial puncture was followed by insertion of drainage tube (diameter = 1.8 mm) through the puncture needle. The effusion collected was examined for cancer cells. After drainage, chemotherapeutic agents were administered. Four hours later, drainage was continued for 2 days (drained in 24 hr) and the tube was removed. In 34 cases with malignant pericardial effusion, tube draining was successful to relieve cardiac temponade within 15-60 minutes. Clots were present in 91.2% of the cases and cancer diagnosis was confirmed in all of them. The cytologic diagnosis of effusion was positive in 61.8%, and the cyto-pathologic typing of clots was 81.0%. The difference was statistically significant. When the results of the 2 examinations were put together, the positive rate increased to 94.1%. Tube drainage of malignant pericardial effusion is useful in diagnosis and emergency treatment.

Face and content validity of a virtual-reality simulator for myringotomy with tube placement.

Science.gov (United States)

Huang, Caiwen; Cheng, Horace; Bureau, Yves; Agrawal, Sumit K; Ladak, Hanif M

2015-10-20

Myringotomy with tube insertion can be challenging for junior Otolaryngology residents as it is one of the first microscopic procedures they encounter. The Western myringotomy simulator was developed to allow trainees to practice microscope positioning, myringotomy, and tube placement. This virtual-reality simulator is viewed in stereoscopic 3D, and a haptic device is used to manipulate the digital ear model and surgical tools. To assess the face and content validity of the Western myringotomy simulator. The myringotomy simulator was integrated with new modules to allow speculum placement, manipulation of an operative microscope, and insertion of the ventilation tube through a deformable tympanic membrane. A questionnaire was developed in consultation with instructing surgeons. Fourteen face validity questions focused on the anatomy of the ear, simulation of the operative microscope, appearance and movement of the surgical instruments, deformation and cutting of the eardrum, and myringotomy tube insertion. Six content validity questions focused on training potential on surgical tasks such as speculum placement, microscope positioning, tool navigation, ear anatomy, myringotomy creation and tube insertion. A total of 12 participants from the Department of Otolaryngology-Head and Neck Surgery were recruited for the study. Prior to completing the questionnaire, participants were oriented to the simulator and given unlimited time to practice until they were comfortable with all of its aspects. Responses to 12 of the 14 questions on face validity were predominantly positive. One issue of concern was with contact modeling related to tube insertion into the eardrum, and the second was with the movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64% of the responses

Occam paradox? A variation of tapia syndrome and an unreported complication of guidewire-assisted pedicle screw insertion.

Science.gov (United States)

Emohare, Osa; Peterson, Erik; Slinkard, Nathaniel; Janus, Seth; Morgan, Robert

2013-10-01

Study Design Case report. Clinical Question The clinical aim is to report on a previously unknown association between guidewire-assisted pedicle screw insertion and neuropraxia of the recurrent laryngeal nerve (RLN), and how this may overlap with the signs of Tapia syndrome; we also report our approach to the clinical management of this patient. Methods A 17-year-old male patient with idiopathic scoliosis experienced Tapia syndrome after posterior instrumentation and arthrodesis at the level of T1-L1. After extubation, the patient had a hoarse voice and difficulty in swallowing. Imaging showed a breach in the cortex of the anterior body of T1 corresponding to the RLN on the right. Results Otolaryngological examination noted right vocal fold immobility, decreased sensation of the endolarynx, and pooling of secretions on flexible laryngoscopy that indicated right-sided cranial nerve X injury and left-sided tongue deviation. Aspiration during a modified barium swallow prompted insertion of a percutaneous endoscopic gastrostomy tube before the patient was sent home. On postoperative day 20, a barium swallow demonstrated reduced aspiration, and the patient reported complete resolution of symptoms. The feeding tube was removed, and the patient resumed a normal diet 1 month later. Tapia syndrome, or persistent unilateral laryngeal and hypoglossal paralysis, is an uncommon neuropraxia, which has previously not been observed in association with a breached vertebral body at T1 along the course of the RLN. Conclusion Tapia syndrome should be a differential diagnostic consideration whenever these symptoms persist postoperatively and spine surgeons should be aware of this as a potential complication of guidewires in spinal instrumentation.

Comparison of bougie-guided insertion of Proseal tm laryngeal mask airway with digital technique in adults

Directory of Open Access Journals (Sweden)

Anand Kuppusamy

2010-01-01

Full Text Available The Proseal TM laryngeal mask airway (PLMA TM , Laryngeal Mask Company, UK was designed to improve ventilatory characteristics and offer protection against regurgitation and gastric insufflation. The PLMA is a modified laryngeal mask airway with large ventral cuff, dorsal cuff and a drain tube. These modifications improve seal around glottis and enable better ventilatory characteristics. The drain tube prevents gastric distension and offers protection against aspiration. There were occasional problems, like failed insertion and inadequate ventilation, in placing PLMA TM using the classical digital technique. To overcome these problems, newer placement techniques like thumb insertion technique, introducer tool placement and gum elastic bougie (GEB-aided placement were devised. We compared classical digital placement of PLMA TM with gum elastic bougie-aided technique in 60 anaesthetised adult patients (with 30 patients in each group with respect to number of attempts to successful placement, effective airway time, airway trauma during insertion, postoperative airway morbidity and haemodynamic response to insertion. The number of attempts to successful placement, airway trauma during insertion and haemodynamic response to insertion were comparable among the two groups, while effective airway time and oropharyngeal leak pressure were significantly higher in bougie- guided insertion of PLMA. Postoperatively, sore throat was more frequent with digital technique while dysphagia was more frequent with bougie-guided technique. Hence gum elastic bougie guided, laryngoscope aided insertion of PLMA is an excellent alternate to classical digital technique.

Process to repair a steam generator tube by inserting a tubular sleeve and the associated sleeve

International Nuclear Information System (INIS)

Gaudin, J.P.

1986-01-01

The tubular sleeve is introduced in the tube and is mechanically expanded inside the tube plate, and is diametrally expanded at its upper part within the tube and outside the tube plate. Tightness is ensured by brazing the end part of the sleeve within the tube. The end part of the sleeve is brazed by melting of brazing metal previously applied to the outer surface of the sleeve of its end region. The invention applies more particularly to steam generators of pressurized water nuclear reactors [fr

Support tube of in-core instruments

International Nuclear Information System (INIS)

Suzumura, Takeshi; Saito, Shozo; Yasuda, Tetsuo; Shirosaki, Kiyotaka.

1975-01-01

Object: To permit satisfactory output measurement by preventing the bending of a in-core instrument tube within a reactor due to vibrations by means of a spring and thereby preventing mechanical damage of an adjacent fuel channel box. Structure: At a corner of a channel box of a fuel assembly, a in-core instrument tube is arranged along a channel box and has its surface provided with a plurality of removable leaf springs arranged in the direction of axis of the in-core instrument tube and each having an arcular tip. Thus, when the in-core instrument tube is inserted into the reactor, the arcular tip portions of the leaf springs are brought into plane contact with the corner of the channel box so that the in-core instrument tube is elastically supported on the channel box. Thus, there is no possibility of causing damage to the adjacent fuel channel box. (Kamimura, M.)

Failure analysis of boiler tube

International Nuclear Information System (INIS)

Mehmood, K.; Siddiqui, A.R.

2007-01-01

Boiler tubes are energy conversion components where heat energy is used to convert water into high pressure superheated steam, which is then delivered to a turbine for electric power generation in thermal power plants or to run plant and machineries in a process or manufacturing industry. It was reported that one of the tubes of a fire-tube boiler used in a local industry had leakage after the formation of pits at the external surface of the tube. The inner side of the fire tube was working with hot flue gasses with a pressure of 10 Kg/cm/sup 2/ and temperature 225 degree C. The outside of the tube was surrounded by feed water. The purpose of this study was to determine the cause of pits developed at the external surface of the failed boiler tube sample. In the present work boiler tube samples of steel grade ASTM AI61/ASTM A192 were analyzed using metallographic analysis, chemical analysis, and mechanical testing. It was concluded that the appearance of defects on the boiler tube sample indicates cavitation type corrosion failure. Cavitation damage superficially resembled pitting, but surface appeared considerably rougher and had many closely spaced pits. (author)

Development of fabrication technology for copper canisters with cast inserts. Status report in August 2001

Energy Technology Data Exchange (ETDEWEB)

Andersson, Claes-Goeran

2002-04-01

This report contains an account of the results of trial fabrication of copper canisters with cast inserts carried out during the period 1998 - 2001. The work of testing of fabrication methods is being focused on a copper thickness of 50 mm. Occasional canisters with 30 mm copper thickness are being fabricated for the purpose of gaining experience and evaluating fabrication and inspection methods for such canisters. For the fabrication of copper tubes, SKB has concentrated its efforts on seamless tubes made by extrusion and pierce and draw processing. Five tubes have been extruded and two have been pierced and drawn during the period. Materials testing has shown that the resultant structure and mechanical properties of these tubes are good. Despite certain problems with dimensional accuracy, it can be concluded that both of these methods can be developed for use in the serial production of SKB' copper tubes. No new trial fabrication with roll forming of copper plate and longitudinal welding has been done. This method is nevertheless regarded as a potential alternative. Copper lids and bottoms are made by forging of continuous-cast bars. The forged blanks are machined to the desired dimensions. Due to the Canister Laboratory's need for lids to develop the technique for sealing welding, a relatively large number of forged blanks have been fabricated. It is noted in the report that the grain size obtained in lids and bottoms is much coarser than in fabricated copper tubes. Development work has been commenced for the purpose of optimizing the forging process. Nine cast inserts have been cast during the three-year period. The results of completed material testing of test pieces taken at different places along the length of the inserts have in several cases shown an unacceptable range of variation in strength properties and structure. In the continued work, insert fabrication will be developed in terms of both casting technique and iron composition. Development

Development of fabrication technology for copper canisters with cast inserts. Status report in August 2001

International Nuclear Information System (INIS)

Andersson, Claes-Goeran

2002-04-01

This report contains an account of the results of trial fabrication of copper canisters with cast inserts carried out during the period 1998 - 2001. The work of testing of fabrication methods is being focused on a copper thickness of 50 mm. Occasional canisters with 30 mm copper thickness are being fabricated for the purpose of gaining experience and evaluating fabrication and inspection methods for such canisters. For the fabrication of copper tubes, SKB has concentrated its efforts on seamless tubes made by extrusion and pierce and draw processing. Five tubes have been extruded and two have been pierced and drawn during the period. Materials testing has shown that the resultant structure and mechanical properties of these tubes are good. Despite certain problems with dimensional accuracy, it can be concluded that both of these methods can be developed for use in the serial production of SKB' copper tubes. No new trial fabrication with roll forming of copper plate and longitudinal welding has been done. This method is nevertheless regarded as a potential alternative. Copper lids and bottoms are made by forging of continuous-cast bars. The forged blanks are machined to the desired dimensions. Due to the Canister Laboratory's need for lids to develop the technique for sealing welding, a relatively large number of forged blanks have been fabricated. It is noted in the report that the grain size obtained in lids and bottoms is much coarser than in fabricated copper tubes. Development work has been commenced for the purpose of optimizing the forging process. Nine cast inserts have been cast during the three-year period. The results of completed material testing of test pieces taken at different places along the length of the inserts have in several cases shown an unacceptable range of variation in strength properties and structure. In the continued work, insert fabrication will be developed in terms of both casting technique and iron composition. Development work on

PEG tubes: dealing with complications.

Science.gov (United States)

Malhi, Hardip; Thompson, Rosie

A percutaneous endoscopic gastronomy tube can be used to deliver nutrition, hydration and medicines directly into the patient's stomach. Patients will require a tube if they are unable to swallow safely, putting them at risk of aspiration of food, drink and medicines into their lungs. It is vital that nurses are aware of the complications that may arise when caring for a patient with a PEG tube. It is equally important that nurses know how to deal with these complications or from where tc seek advice. This article provides a quick troubleshooting guide to help nurses deal with complications that can arise with PEG feeding.

Heat transfer intensification within tube recuperator by inserting secondary emitters inside air channels

International Nuclear Information System (INIS)

Sandor, P.; Soroka, B.; Kudryavtsev, V.; Zgurskyy, V.

2009-01-01

The research program was stipulated by reduction the service life of the tube recuperators of reheating furnaces at DUNAFERR metallurgical works in Dunaujvaros (Hungary) while replacement the natural gas by coke - oven gas as a furnace fuel took place and air preheating temperature was increased. The tests procedure consists in comparison of temperature and pressure distributions by air flows preheating under air moving inside the tube loops. Advantages of new recuperator design compared to ordinary one have been proven by validation of concept for adequacy to the testing results. The first tests have demonstrated enhancement of local specific and total heat fluxes transferred from flue gases to air flow within the MD tube loops in comparison with those for BD loops by 25 to 45% - dependence on temperature level within the heating (furnace) chamber and on preheated air flow rate. (author)

Age most significant predictor of requiring enteral feeding in head-and-neck cancer patients

International Nuclear Information System (INIS)

Sachdev, Sean; Refaat, Tamer; Bacchus, Ian D; Sathiaseelan, Vythialinga; Mittal, Bharat B

2015-01-01

A significant number of patients treated for head and neck squamous cell cancer (HNSCC) undergo enteral tube feeding. Data suggest that avoiding enteral feeding can prevent long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction. We examined detailed dosimetric and clinical parameters to better identify those at risk of requiring enteral feeding. One hundred patients with advanced stage HNSCC were retrospectively analyzed after intensity-modulated radiation therapy (IMRT) to a median dose of 70 Gy (range: 60-75 Gy) with concurrent chemotherapy in nearly all cases (97%). Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube. Detailed DVH parameters were collected for several structures. Univariate and multivariate analyses using logistic regression were used to determine clinical and dosimetric factors associated with needing enteral feeding. Dichotomous outcomes were tested using Fisher’s exact test and continuous variables between groups using the Wilcoxon rank-sum test. Thirty-three percent of patients required placement of an enteral feeding tube. The median time to tube placement was 25 days from start of treatment, after a median dose of 38 Gy. On univariate analysis, age (p = 0.0008), the DFH (Docetaxel/5-FU/Hydroxyurea) chemotherapy regimen (p = .042) and b.i.d treatment (P = 0.040) (used in limited cases on protocol) predicted need for enteral feeding. On multivariate analysis, age remained the single statistically significant factor (p = 0.003) regardless of other clinical features (e.g. BMI) and all radiation planning parameters. For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p = 0.0019). Older age was found to be the most significant risk factor for needing enteral feeding in

Tube Thoracostomy: Complications and Its Management

Directory of Open Access Journals (Sweden)

Emeka B. Kesieme

2012-01-01

Full Text Available Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended.

Tube Thoracostomy: Complications and Its Management

Science.gov (United States)

Kesieme, Emeka B.; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

2012-01-01

Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

Method and apparatus for testing closed-end tubes in heat exchangers of nuclear reactors and the like

International Nuclear Information System (INIS)

Seyd, G.; Bergbauer, A.; Paulsen, U.

1975-01-01

A description is given of a test stopper which is insertable into a tube closed at one end for testing the tightness of the tube with a fluid under pressure, the tube being in a heat exchanger of a nuclear reactor or the like. The test stopper includes a tubular outer jacket that is expandable outwardly to tightly seat the stopper in the tube. The stopper also has front and back end-face members joined to the ends of the outer jacket to define a closed space within the jacket. With the stopper inserted into the tube, the front end-face member and the closed end portion of the tube define a closed inner region of the tube. An inner tubular member, disposed within the outer jacket, partitions the closed space within the jacket into an annular outer chamber and a cylindrical inner chamber. A pressure-fluid supply selectively supplies fluid to the chambers. The outer jacket expands in response to fluid admitted to the annular chamber and the front end-face member has a through bore to admit fluid under pressure to the inner region of the tube. A method of testing of such a tube with a fluid under pressure includes inserting the test stopper into the tube and then expanding the outer jacket of the stopper to seat the stopper firmly in the tube. A fluid under pressure is directed through the stopper and into the closed region defined by the front end-face member of the stopper and the closed end portion of the tube. The pressure of the fluid introduced into this closed region is monitored for detecting a leak in the closed-end tube

The effects of an inserted linear carbon chain on the vibration of a carbon nanotube

International Nuclear Information System (INIS)

Hu, Z L; Guo, X M; Ru, C Q

2007-01-01

An elastic string-elastic shell model is developed to study the coupled vibration of a carbon nanowire made of a linear carbon chain (C-chain) inserted inside a carbon nanotube (CNT). It is shown that the vibration of the inserted C-chain is coupled with vibration of the CNT only for vibration modes with circumferential wavenumber n = 1. In other cases, such as axisymmetric modes (n = 0) or higher-order vibration modes with n≥2, total resultant van der Waals (vdW) force acting on the C-chain due to the innermost tube always vanishes, and therefore vibration of the CNT does not cause vibration of the inserted C-chain, although the existence of the C-chain does have an effect on the vibration of the CNT through the chain-CNT vdW forces acting on the innermost tube. The present model predicts that non-coaxial vibration between the C-chain and the innermost tube does not occur due to negligible bending rigidity of the C-chain. In addition, it is found that the C-chain has most significant effect on the lowest frequency associated with the radial vibration mode for circumferential wavenumber 2 (n = 2). In particular, the effect of the C-chain on the axisymmetric radial breathing frequencies (n = 0) predicted by the present model is found to be in reasonable agreement with known experimental and modeling results available in the literature. The present work offers systematic modeling results on the effects of an inserted C-chain on the vibration of CNTs

Treating mediastinoesophageal fistula with covered stent through nasal esophagus drainage tube

International Nuclear Information System (INIS)

Han Xinwei; Wu Gang; Li Yongdong; Ma Nan; Wang Yanli; Gao Xuemei

2005-01-01

Objective: To investigate the value of treating mediastinoesophageal fistula with covered stent through nasal esophagus drainage tube. Methods: Ten patients with mediastinoesophageal fistula were treated by 5F catheter inserting into the abscess cavities through nasal esophageal fistula, with stent placement in the esophagus. The abscess cavities were washed and angiograghied through drainage tube and the sites of the drainage tube were adjusted in time until withdrawal of the tube. Results: The drainage tubes were pulled out within 10-25 days with disappearance of the abscess cavities and normal diet intake without difficulty. Conclusions: Treating mediastinoesophageal fistula with covered stent through nasal esophagus drainage tube is safe, microinvasive economic and acceptable, worth to be recommended. (authors)

Antroduodenal motility in neurologically handicapped children with feeding intolerance

Directory of Open Access Journals (Sweden)

Werlin Steven L

2004-09-01

Full Text Available Abstract Background Dysphagia and feeding intolerance are common in neurologically handicapped children. The aim is to determine the etiologies of feeding intolerance in neurologically handicapped children who are intolerant of tube feedings. Methods Eighteen neurologically handicapped children, followed in the Tube Feeding Clinic at the Children's Hospital of Wisconsin who were intolerant of gastrostomy feedings. The charts of these 18 patients were reviewed. Past medical history, diagnoses, history of fundoplication and results of various tests of gastrointestinal function including barium contrast radiography, endoscopy and antroduodenal manometry were documented. Results Five of 11 children had abnormal barium upper gastrointestinal series. Seven of 14 had abnormal liquid phase gastric emptying tests. Two of 16 had esophagitis on endoscopy. All 18 children had abnormal antroduodenal motility. Conclusions In neurologically handicapped children foregut dysmotility may be more common than is generally recognized and can explain many of the upper gastrointestinal symptoms in neurologically handicapped children.

Insertion of Balloon Retained Gastrostomy Buttons: A 5-Year Retrospective Review of 260 Patients

International Nuclear Information System (INIS)

Power, Sarah; Kavanagh, Liam N.; Shields, Mary C.; Given, Mark F.; Keeling, Aoife N.; McGrath, Frank P.; Lee, Michael J.

2013-01-01

Radiologically inserted gastrostomy (RIG) is an established way of maintaining enteral nutrition in patients who cannot maintain nutrition orally. The purpose of this study was to evaluate the safety and efficacy of primary placement of a wide bore button gastrostomy in a large, varied patient population through retrospective review. All patients who underwent gastrostomy placement from January 1, 2004 to January 1, 2009 were identified. 18-Fr gastrostomy buttons (MIC-Key G) were inserted in the majority. Follow-up ranged from 6 months to 4.5 years. A total of 260 patients (M:F 140:120, average age 59.2 years) underwent gastrostomy during the study period. Overall success rate for RIG placement was 99.6 %, with success rate of 95.3 % for primary button insertion. Indications included neurological disorders (70 %), esophageal/head and neck malignancy (21 %), and other indications (9 %). Major and minor complication rates were 1.2 and 12.8 %, respectively. Thirty-day mortality rate was 6.8 %. One third of patients underwent gastrostomy reinsertion during the study period, the main indication for which was inadvertent catheter removal. Patency rate was high at 99.5 %. The maximum number of procedures in any patient was 8 (n = 2), and the average tube dwell time was 125 days. Primary radiological insertion of a wide bore button gastrostomy is a safe technique, with high success rate, high patency rate, and low major complication rate. We believe that it is feasible to attempt button gastrostomy placement in all patients, once tract length is within limits of tube length. If difficulty is encountered, then a standard tube may simply be placed instead.

Insertion of Balloon Retained Gastrostomy Buttons: A 5-Year Retrospective Review of 260 Patients

Energy Technology Data Exchange (ETDEWEB)

Power, Sarah, E-mail: sarahpower28@yahoo.co.uk; Kavanagh, Liam N.; Shields, Mary C.; Given, Mark F.; Keeling, Aoife N.; McGrath, Frank P.; Lee, Michael J., E-mail: mlee@rcsi.ie [Beaumont Hospital, Department of Radiology (Ireland)

2013-04-15

Radiologically inserted gastrostomy (RIG) is an established way of maintaining enteral nutrition in patients who cannot maintain nutrition orally. The purpose of this study was to evaluate the safety and efficacy of primary placement of a wide bore button gastrostomy in a large, varied patient population through retrospective review. All patients who underwent gastrostomy placement from January 1, 2004 to January 1, 2009 were identified. 18-Fr gastrostomy buttons (MIC-Key G) were inserted in the majority. Follow-up ranged from 6 months to 4.5 years. A total of 260 patients (M:F 140:120, average age 59.2 years) underwent gastrostomy during the study period. Overall success rate for RIG placement was 99.6 %, with success rate of 95.3 % for primary button insertion. Indications included neurological disorders (70 %), esophageal/head and neck malignancy (21 %), and other indications (9 %). Major and minor complication rates were 1.2 and 12.8 %, respectively. Thirty-day mortality rate was 6.8 %. One third of patients underwent gastrostomy reinsertion during the study period, the main indication for which was inadvertent catheter removal. Patency rate was high at 99.5 %. The maximum number of procedures in any patient was 8 (n = 2), and the average tube dwell time was 125 days. Primary radiological insertion of a wide bore button gastrostomy is a safe technique, with high success rate, high patency rate, and low major complication rate. We believe that it is feasible to attempt button gastrostomy placement in all patients, once tract length is within limits of tube length. If difficulty is encountered, then a standard tube may simply be placed instead.

Process and device for detecting and localizing leaks in a tube bundle heat exchanger when it is stopped

International Nuclear Information System (INIS)

Germain, J.L.; Jeanneteau, E.; Loisy, F.

1986-01-01

The device can be used to detect the tubes presenting leaks in a tube bundle exchanger of a light water reactor. This device comprises a feeding point to fill the secondary part of the exchanger, in which the tubes are immersed, with a pressure mixture of vector gas (air) and helium. It has also a feeding point to establish in the tube a sweeping air flow. An analysis apparatus, such as a spectrograph, measures the helium content of air at the outlet of each tube [fr

Apparatus for inspecting and repairing a pressurized-water reactor's steam generator heat exchanger tubes

International Nuclear Information System (INIS)

Mueller, O.; Roettger, H.; Kasti, H.; Hagen, H.G.

1976-01-01

Described is an apparatus provided for use with a pressurized-water reactor' steam generator having a manifold chamber enclosing the bottom side of a horizontal tube sheet having holes therethrough in which are mounted the tubes of a heat exchanger tube bundle. The manifold chamber has a manhole giving access to the tube's bottom side to permit internal inspection or repair of the tubes by registration of an end of a flexible guide conduit with the tube sheet holes and through which a flexible carrier can be guided for insertion via these holes in the tube sheet and through the tubes extending from the tube sheet's other side

[Nasogastric tube feeding in bulimia. Controlled study with follow-up at 3 months].

Science.gov (United States)

Rigaud, Daniel; Brayer, Véronique; Biton-Jélic, Violaine; Païs, Vanessa; Pennacchio, Hélène; Brun, Jean-Marcel

2007-10-01

Few effective treatments are available for severe forms of bulimia nervosa, which are accompanied by malnutrition, anxiety, and depressive mood. We previously showed in an open study that nasogastric tube feeding (TF) reduced binges and purging in patients with anorexia nervosa. This prospective randomized trial compared bulimia patients in two treatment groups: one group received TF at home, together with psychotherapy, nutritional counseling and a support group while the control group received only psychotherapy, nutritional counseling, and a support group. Patients in the first group underwent TF for 8 weeks (exclusively for 10 days and associated with meals thereafter). Assessment was based on clinical examination, laboratory results, and a variety of questionnaires (our in-house instrument for measuring binge and vomiting episodes, eating disorder inventory, Beck's depression inventory and the Hamilton rating scale for anxiety), all performed at the onset of treatment and at 8 days, 8 weeks (i.e., the end of TF), and 3 months after treatment began. Binges and vomiting disappeared faster and more frequently in TF patients than in the control group: 65% versus 29% (pbulimia nervosa, reducing the number of binge and vomiting episodes and improving nutritional status and mood.

Peristaltic pumping in an elastic tube: feeding the hungry python

Science.gov (United States)

Takagi, Daisuke; Balmforth, Neil

2010-11-01

Biological ducts convey contents like food in the digestive system by peristaltic action, propagating waves of muscular contraction and relaxation. The motion is investigated theoretically by considering a radial force of sinusoidal or Gaussian form moving steadily down a fluid-filled axisymmetric tube. Effects of the prescribed force on the resultant fluid flow and elastic deformation of the tube wall are presented. The flow can induce a rigid object suspended in the fluid to propel in different ways, as demonstrated in numerous examples.

What is the yield of routine chest radiography following tube thoracostomy for trauma?

Science.gov (United States)

Kong, Victor Y; Oosthuizen, George V; Clarke, Damian L

2015-01-01

Routine chest radiography (CXR) following tube thoracostomy (TT) is a standard practice in most trauma centres worldwide. Evidence supporting this routine practice is lacking and the actual yield is unknown. We performed a retrospective review of 1042 patients over a 4-year period who had a routine post-insertion CXR performed in accordance with current ATLS® recommendations. A total 1042 TTs were performed on 1004 patients. Ninety-one per cent of patients (913/1004) were males, and the median age for all patients was 24 years. Seventy-five per cent of all injuries (756/1004) were from penetrating trauma, and the remaining 25% (248/1004) were from blunt. The initial pathologies requiring TT were: haemopneumothorax: 34% (339/1042), haemothroax: 31% (314/1042), simple pneumothorax: 25% (256/1042), tension pneumothorax: 8% (77/1042) and open pneumothorax: 5% (54/1042). One hundred and three patients had TTs performed on clinical grounds alone without a pre-insertion CXR [Group A]. One hundred and ninety-one patients had a pre-insertion CXR but had persistent clinical concerns following insertion [Group B]. Seven hundred and ten patients had pre-insertion CXR but no clinical concerns following insertion [Group C]. Overall, 15% (152/1004) [9 from Group A, 111 from Group B and 32 from Group C] of all patients had their clinical management influenced as a direct result of the post-insertion CXR. Despite the widely accepted practice of routine CXR following tube thoracostomy, the yield is relatively low. In many cases, good clinical examination post tube insertion will provide warnings as to whether problems are likely to result. However, in the more rural setting, and in resource challenged environments, there is a relatively high yield from the CXR, which alters management. Further prospective studies are needed to establish or refute the role of the existing ATLS® guidelines in these specific environments. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pressure vessels and methods of sealing leaky tubes disposed in pressure vessels

International Nuclear Information System (INIS)

Larson, G.C.

1980-01-01

This invention relates to pressure vessels and to methods of sealing leaky tubes in them and is especially applicable to pressure vessels in the form of sheet-and-tube type heat exchangers constructed with a large number of relatively small diameter tubes grouped in a bundle. To seal off a leaky tube in such a heat exchanger an explosive activated plug in the form of a hollow metal body is used, inserted at each end of the tube to be sealed. Using the arrangement of pressure vessel and associated tube sheets and the explosive activated plug method of sealing a leaky tube as described in this invention it is claimed that distortion of the adjacent tubes and the tube sheets is reduced when the explosive activated plugs are detonated. (U.K.)

Cotton transformation via pollen tube pathway.

Science.gov (United States)

Wang, Min; Zhang, Baohong; Wang, Qinglian

2013-01-01

Although many gene transfer methods have been employed for successfully obtaining transgenic cotton, the major constraint in cotton improvement is the limitation of genotype because the majority of transgenic methods require plant regeneration from a single transformed cell which is limited by cotton tissue culture. Comparing with other plant species, it is difficult to induce plant regeneration from cotton; currently, only a limited number of cotton cultivars can be cultured for obtaining regenerated plants. Thus, development of a simple and genotype-independent genetic transformation method is particularly important for cotton community. In this chapter, we present a simple, cost-efficient, and genotype-independent cotton transformation method-pollen tube pathway-mediated transformation. This method uses pollen tube pathway to deliver transgene into cotton embryo sacs and then insert foreign genes into cotton genome. There are three major steps for pollen tube pathway-mediated genetic transformation, which include injection of -foreign genes into pollen tube, integration of foreign genes into plant genome, and selection of transgenic plants.

Conductive sub-layer of twisted-tape-induced swirl-flow heat transfer in vertical circular tubes with various twisted-tape inserts

Science.gov (United States)

Hata, K.; Fukuda, K.; Masuzaki, S.

2018-04-01

conductive sub-layer δ CSL and the nondimensional thickness of the conductive sub-layer y + CSL on the circular tubes with various twisted-tape inserts were determined on the basis of numerical solutions for the swirl velocities u sw ranging from 5.23 to 21.18 m/s. Correlations between the conductive sub-layer thickness δ CSL and the nondimensional thickness of the conductive sub-layer y + CSL for twisted-tape-induced swirl-flow heat transfer in a vertical circular tube were derived.

Flexible deep brain neural probes based on a parylene tube structure

Science.gov (United States)

Zhao, Zhiguo; Kim, Eric; Luo, Hao; Zhang, Jinsheng; Xu, Yong

2018-01-01

Most microfabricated neural probes have limited shank length, which prevents them from reaching many deep brain structures. This paper reports deep brain neural probes with ultra-long penetrating shanks based on a simple but novel parylene tube structure. The mechanical strength of the parylene tube shank is temporarily enhanced during implantation by inserting a metal wire. The metal wire can be removed after implantation, making the implanted probe very flexible and thus minimizing the stress caused by micromotions of brain tissues. Optogenetic stimulation and chemical delivery capabilities can be potentially integrated by taking advantage of the tube structure. Single-shank prototypes with a shank length of 18.2 mm have been developed. The microfabrication process comprises of deep reactive ion etching (DRIE) of silicon, parylene conformal coating/refilling, and XeF2 isotropic silicon etching. In addition to bench-top insertion characterization, the functionality of developed probes has been preliminarily demonstrated by implanting into the amygdala of a rat and recording neural signals.

Tube Plugging Criteria for the High-pressure Heaters of Nuclear Power Plant

Energy Technology Data Exchange (ETDEWEB)

Kim, Hyungnam; Cho, Nam-Cheoul; Lee, Kuk-hee [KHNP Central Research Institute, Daejeon (Korea, Republic of)

2015-10-15

In this paper, a method to establish the tube plugging criteria of BOP heat exchangers is introduced and the tube plugging criteria for the high pressure heaters of a nuclear power plant. This method relies on the similar plugging criteria used in the steam generator tubes. Power generation field urges nuclear power plants to reduce operating and maintaining costs to remain competitive. To reduce the cost by means of preventing the lowering thermal efficiency, the inspection of balance-of-plant heat exchanger, which was treated as not important work, becomes important. The tubing materials and tube thickness of heat exchangers in nuclear power plants are selected to withstand system temperature, pressure, and corrosion. But tubes have experienced leaks and failures and plugged based upon eddy current testing (ET) results. There are some problems for plugging the heat exchanger tubes since the criterion and its basis are not clearly described. For this reason, the criteria for the tube wall thickness are addressed in order to operate the heat exchangers in nuclear power plant without trouble during the cycle. The feed water heater is a kind of heat exchanger which raises the temperature of water supplied from the condenser. The heat source of high-pressure heaters is the extraction steam from the high-pressure turbine and moisture separator re-heater. If the tube wall of the heater is broken, the feed water flowing inside the tube intrudes to shell side. This forces the turbine to be stop in order to protect it. There are many codes and standards to be referred for calculating the minimum thickness of the heat exchanger tube in the designing stage. However, the codes and standards related to show the tube plugging criteria may not exist currently. A method to establish the tube plugging criteria of BOP heat exchangers is introduced and the tube plugging criteria for the high pressure heaters of Ulchin NPP No. 3 and 4. This method relies on the similar plugging

CIRSE Standards of Practice Guidelines on Gastrostomy

Energy Technology Data Exchange (ETDEWEB)

Sutcliffe, James, E-mail: jasutcliffe@gmail.com; Wigham, Andrew, E-mail: a.wigham@doctors.org.uk [Oxford University Hospitals NHS Trust, Radiology Department (United Kingdom); Mceniff, Niall, E-mail: nmceniff@stjames.ie [St. James’s Hospital, Radiology (DiagIm) (Ireland); Dvorak, Petr, E-mail: petr-dvorak@email.cz [Faculty Hospital Charles University, Radiology Department (Czech Republic); Crocetti, Laura, E-mail: laura.crocetti@med.unipi.it [University of Pisa, Diagnostic Imaging and Intervention, Department of Hepatology and Liver Transplants (Italy); Uberoi, Raman, E-mail: Raman.Uberoi@ouh.nhs.uk [Oxford University Hospitals NHS Trust, Radiology Department (United Kingdom)

2016-07-15

PurposeSurgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults.Material and MethodWe performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion.ResultsStudies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention.ConclusionRadiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.

Role of clamping tube thoracostomy prior to removal in non-cardiac thoracic trauma

International Nuclear Information System (INIS)

Rasheed, M.A.; Majeed, F.A.; Naz, A.

2016-01-01

The frequently encountered thoracic trauma in surgical emergencies is a major cause of mortality and morbidity. Eighty percent of thoracic trauma can be managed by simple insertion of tube thoracostomy. Though guidelines for insertion are comprehensively explained in literature, an ideal algorithm for discontinuation is not available. A standard and safe defined protocol would eliminate hesitancy in confident removal among general surgeons. The objective of this study was to determine role of clamping trial prior to removal in terms of frequency of recurrent pneumothorax. Methods: This study was conducted in department of Surgery Combined military hospital/Military Hospital Rawalpindi from April 2013 to March 2014. Total 180 patients with blunt or penetrating thoracic trauma were included in the study. Chest tube (28-36 Fr) was inserted in Trauma centre under strict asepsis. Tubes were then connected to under water seal for minimum six hours. Patients were randomly divided in two equal groups (90 in each). In Group A, Clamping trial was given before attempting removal while in Group B, tube was removed immediately without clamping trial. Patients of both groups were observed two hourly for development of recurrent pneumothorax. Data was analysed using SPSS-18. Results: The comparison of frequency of recurrent pneumothorax in Group A (9 patients, 10%) and in Group B (4 patients, 4.5%) was not found to be statistically significant. (p-value 2.073). Conclusion: Clamping trial is unnecessary prior to removal of tube thoracostomy in blunt and penetrating non-cardiac thoracic trauma in terms of recurrent pneumothorax. (author)

Frequency of changing enteral alimentation bags and tubing, and adverse clinical outcomes in patients in a long term care facility.

Science.gov (United States)

Graham, S; McIntyre, M; Chicoine, J; Gerard, B; Laughren, R; Cowley, G; Morrison, J; Aoki, F Y; Nicolle, L E

1993-01-01

Enteral alimentation, given via nasogastric or gastrostomy tubes, is a well established practice to provide nutrition for patients with significant neurological injury. The frequency with which enteral feeding bags and tubes require change and potential adverse effects associated with bacterial contamination of tube feeds remain controversial. The authors studied different times between enteral feeding bag and tube changes, and the effect on adverse clinical outcomes in residents of a long term care facility. In the first study, residents were randomized to 24 h (n = 2), 48 h (n = 3) or 72 h (n = 6) tube feeding and bag changes with clinical status monitored in a standardized fashion for six months. In the second study, patients were randomized to 24 h (n = 6) or 72 h (n = 6) changes. Patient-days of follow-up were 382, 574 and 1000 for the three arms of the first study period and 556 and 496 for the two arms of the second study. No differences in potential clinical adverse events--including fever, gastrointestinal symptoms or pneumonia--were observed with different durations of tubing change. This study suggests it is appropriate to change alimentation tube and feeding bags every 72 h (rather than every 24 h). The less frequent changes will decrease supply costs and free nursing time for other activities.

Gastrostomy Tube Feeding in Children With Developmental or Acquired Disorders: A Longitudinal Comparison on Healthcare Provision and Eating Outcomes 4 Years After Gastrostomy.

Science.gov (United States)

Backman, Ellen; Karlsson, Ann-Kristin; Sjögreen, Lotta

2018-03-30

Studies on long-term feeding and eating outcomes in children requiring gastrostomy tube feeding (GT) are scarce. The aim of this study was to describe children with developmental or acquired disorders receiving GT and to compare longitudinal eating and feeding outcomes. A secondary aim was to explore healthcare provision related to eating and feeding. This retrospective cohort study reviewed medical records of children in 1 administrative region of Sweden with GT placement between 2005 and 2012. Patient demographics, primary diagnoses, age at GT placement, and professional healthcare contacts prior to and after GT placement were recorded and compared. Feeding and eating outcomes were assessed 4 years after GT placement. The medical records of 51 children, 28 boys and 23 girls, were analyzed and grouped according to "acquired" (n = 13) or "developmental" (n = 38) primary diagnoses. At 4 years after GT placement, 67% were still using GT. Only 6 of 37 (16%) children with developmental disorders transferred to eating all orally, as opposed to 10 of 11 (91%) children with acquired disorders. Children with developmental disorders were younger at the time of GT placement and displayed a longer duration of GT activity when compared with children with acquired disorders. This study demonstrates a clear difference between children with developmental or acquired disorders in duration of GT activity and age at GT placement. The study further shows that healthcare provided to children with GT is in some cases multidisciplinary, but primarily focuses on feeding rather than eating. © 2018 American Society for Parenteral and Enteral Nutrition.

Feeding outcomes in infants after supraglottoplasty.

Science.gov (United States)

Eustaquio, Marcia; Lee, Erika Nevin; Digoy, G Paul

2011-11-01

Review the impact of bilateral supraglottoplasty on feeding and compare the risk of postoperative feeding difficulties between infants with and without additional comorbidities. Case series with chart review. Children's hospital. The medical records of all patients between birth and 12 months of age treated for laryngomalacia with bilateral supraglottoplasty by a single surgeon (GPD) between December 2005 and September 2009 and followed for a minimum of 1 month were reviewed. Infants with significant comorbidities were evaluated separately. Nutritional intake before and after surgery, as well as speech and language pathology reports, was reviewed to qualify any feeding difficulties. Age at the time of surgery, additional surgical interventions, medical comorbidities, and length of follow-up were also noted during chart review. Of 81 infants who underwent bilateral supraglottoplasty, 75 were eligible for this review. In the cohort of infants without comorbidities, 46 of 48 (96%) had no change or an improvement in their oral intake after surgery. Of the 2 patients with initial worsening of feeding, all resumed oral intake within 2 months. In the group of patients with additional medical comorbidities, 22% required further interventions such as nasogastric tube, dietary modification, or gastrostomy tube placement. Supraglottoplasty in infants has a low incidence of persistent postoperative dysphagia. Infants with additional comorbidities are at a higher risk of feeding difficulty than otherwise healthy infants.

Reversible and irreversible wrinkling in tube hydroforming process

Science.gov (United States)

El-Aty, Ali Abd; Ahmed, Tauseef; Farooq, Ahmed

2017-07-01

The aim of this research is to analyzeandoptimize the hydroforming process parameters in order to achieve a sound bulged tube without failure. Theoretical constitutive model is formulated to develop a working diagram including process window, which represents the optimize region to carry out the hydroforming process and predict the type of tube failure during the process accurately. The model is applied into different bulging ratios for low carbon steel (C1010). From this study, it is concluded that the tubes with bulging ratios up to 50% and 70% are successfully formed without defects. The tubes with bulging ratio of 90% are successfully formed by hydroforming with optimized the loading path (axial feed versus internal pressure) within the process window. The working diagram is modified due to different types of formation of wrinkling during the hydroforming process. The formation of wrinkles with increasing axial feed can be useful in terms of the achievement of higher bulging ratio and/or less thinning and this type of wrinkles can be overcome through the internal pressure in the later stage of the hydroforming process. On the other hand, the formation of wrinkles may be harmful, if it cannot be reversed.

Heat transfer analysis and effects of feeding tubes arrangement, falling film behavior and backsplash on ice formation around horizontal tubes bundles

International Nuclear Information System (INIS)

Sait, Hani Hussain

2013-01-01

Highlights: • Ice shape around the tubes. • Effects of accumulation of ice around the tubes. • Effects of parallel and series tubes arrangements. • Effects of ice accumulated around the tube surfaces. • Effects of backsplash on ice formation. - Abstract: Excessive electrical load has recently get a lot of attention from electric companies specially in hot countries like Saudi Arabia, where air-conditioning load represents about 75% from the total electrical load. Energy storage by freezing is one of the methods that used to tackle this issue. Ice is formed around horizontal cold tubes that are subjected to falling film of water. Ice quantity is measured, photographed and studied. In this studied the coolant inside the tubes flows in series tube arrangement. The results are compared with previous study in which parallel arrangement was used. In addition the falling film behavior and the resulted backsplash are also investigated. A mathematical model to predict ice formation around the tube is proposed. Comparison of the results of the model with that of the experiments showed that the agreement between the two is acceptable. The results also show a quite reasonable quantity of ice is formed in a short time and the series arrangement is more efficient than parallel one. The falling film shapes and its backsplash has also affected the ice formation

Computation and measurement of calandria tube sag in PHWR

International Nuclear Information System (INIS)

Kim, Tae Ryong; Sohn, Seok Man

2003-01-01

Calandria tubes and liquid injection shutdown system (LISS) tubes in a pressurized heavy water reactor (PHWR) is known to sag due to irradiation creep and growth during plant operation. When the sag of calandria tube becomes bigger, the calandria tube possibly comes in contact with LISS tube crossing beneath and calandria tube. The contact subsequently may cause the damage on the calandria tube resulting in unpredicted outage of the plant. It is therefore necessary to check the gap between the two tubes in order to periodically confirm no contact by using a proper measure during the plant life. An ultrasonic gap measuring probe assembly which can be inserted into two viewing ports of the calandria was developed in Korea and utilized to measure the sags of both tubes in the PHWR. It was found that the centerlines of calandria tubes and liquid injection shutdown system tubes can be precisely detected by ultrasonic wave. The gaps between two tubes were easily obtained from the relative distance of the measured centerline elevations of the tubes. Based on the irradiation creep equation and the measurement data, a computer program to calculate the sags was also developed. With the computer program, the sag at the end of plant life was predicted. (author)

Feed water pre-heater with two steam spaces

International Nuclear Information System (INIS)

Tratz, H.; Kelp, F.; Netsch, E.

1976-01-01

A feed water pre-heater for the two stage heating of feed water by condensing steam, having a low installed height is described, which can be installed in the steam ducts of turbines of large output, as in LWRs in nuclear power stations. The inner steam space is closed on one side by the water vessel, while the tubes of the inner steam space go straight from the water vessel, and the tubes of the outer steam space are bent into a U shape and open out into the water vessel. The two-stage preheater is thus surrounded by feedwater in two ways. (UWI) [de

Experiments on vibration of heat exchanger tube arrays in cross flow

International Nuclear Information System (INIS)

Blevins, R.D.; Gibert, R.J.; Villard, B.

1981-08-01

A series of tests have been made at the Commissariat a l'Energie Atomique, in cooperation with General Atomic Company, SAN DIEGO (U.S.A.) on the flow-induced vibration of heat exchanger tube bundles in cross flow. These tests were made in air on tube bundles which simulated heat exchangers in the high temperature gas cooled reactors. The tests were of two types. In the first type, an instrumented tube was inserted at various locations into a tube bundle. Measurements were made of pressure at a number of points along the tube and about the circumference of the tube. These measurements were processed to obtain the spectra of turbulent pressure fluctuations on the tube, the spanwise correlation and the lift force. The second set of tests was made on tube bundles with flexible tubes. As the flow velocity was increased, these tests clearly show an instability. Nine tube configurations were tested with both plastic and metallic tubes and the effect of tube-to-tube difference in natural frequency was investigated

Visual beam tube inspection at the TRIGA reactor Vienna

International Nuclear Information System (INIS)

Boeck, H.; Musilek, A.; Villa, M.

2006-01-01

Of the four TRIGA beam tubes two have been visually inspected in 1985. Prior to the inspection the reactor was shut down for 3 weeks. The fuel elements around the beam tubes were removed. Stainless steel dummy elements were inserted in the fuel positions to shield the core radiation. The active part of the Fast Rabbit Tube was removed into the beam tube loading device and transferred to an interim storage: Front dose rate was ∼ 50 mSv/h. Generally the beam tube was very clean, after the last inspection about 30 years ago. A1 cm cut was observed at the beam tube front end. A rigid endoscope was used to check the beam tube's inner surface using a 90 degree deflection objective and photo- and video equipment. The direct dose rate in front of the beam tube was about 30 mSv/h. The beam tube was vacuum cleaned. A corroded shielding tank containing boric acid has leaked. A wooden collimator partially disintegrating due to extreme temperature was removed from beam tube D. Documentation of the inspection for visible defects is produced for later comparison

Tubing misconnections: normalization of deviance.

Science.gov (United States)

Simmons, Debora; Symes, Lene; Guenter, Peggi; Graves, Krisanne

2011-06-01

Accidental connection of an enteral system to an intravenous (IV) system frequently results in the death of the patient. Misconnections are commonly attributed to the presence of universal connectors found in the majority of patient care tubing systems. Universal connectors allow for tubing misconnections between physiologically incompatible systems. The purpose of this review of case studies of tubing misconnections and of current expert recommendations for safe tubing connections was to answer the following questions: In tubing connections that have the potential for misconnections between enteral and IV tubing, what are the threats to safety? What are patient outcomes following misconnections between enteral and IV tubing? What are the current recommendations for preventing misconnections between enteral and IV tubing? Following an extensive literature search and guided by 2 models of threats and errors, the authors analyzed case studies and expert opinions to identify technical, organizational, and human errors; patient-related threats; patient outcomes; and recommendations. A total of 116 case studies were found in 34 publications. Each involved misconnections of tubes carrying feedings, intended for enteral routes, to IV lines. Overwhelmingly, the recommendations were for redesign to eliminate universal connectors and prevent misconnections. Other recommendations were made, but the analysis indicates they would not prevent all misconnections. This review of the published case studies and current expert recommendations supports a redesign of connectors to ensure incompatibility between enteral and IV systems. Despite the cumulative evidence, little progress has been made to safeguard patients from tubing misconnections.

[Rare problem with the insertion of a Supreme™ laryngeal mask airway device. Case of the trimester].

Science.gov (United States)

2014-03-01

A breast tumor was resected under general anesthesia. After induction, the airway was managed with a Supreme™ laryngeal mask airway device. The insertion of the laryngeal mask airway device, the insertion of the orogastric tube through the drain tube, as well as the mechanical ventilation, were very difficult from the beginning. On removing the laryngeal mask airway device to solve the problem, it was observed that the drain tube was broken, and the orogastric tube had passed into the anterior, laryngeal part of the device through the split. It was later found out that the laryngeal mask airway device, as well as the whole manufacturing batch, had suffered a design modification: the cuff was constructed with a softer material without reinforcement in the tip, and the drain tube had a heat-sealing defect that facilitated the break. The incident was reported to the local supplier and the manufacturer, and the defective batch of laryngeal mask airway devices was recalled. The incident was also reported to other hospitals via SENSAR, to warn other users of the potential dangers of the design modification in the Supreme™ laryngeal mask airway. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

The effect of enteral tube feeding in cystic fibrosis: A registry based study.

Science.gov (United States)

Libeert, Denis; Declercq, Dimitri; Wanyama, Simeon; Thomas, Muriel; Van Daele, Sabine; De Baets, Frans; Van Biervliet, Stephanie

2018-03-01

Long-term effect of enteral tube feeding (ETF) in cystic fibrosis (CF) remains equivocal. A Belgian CF registry based, retrospective, longitudinal study, evaluated the pre- and post- ETF (n = 113) clinical evolution and compared each patient with 2 age, gender, pancreatic status and genotype class-matched controls. At baseline ETF had a worse BMI z-score (p ETF, had already a significant worse nutritional status and pulmonary function at first entry in the registry. Both parameters displayed a significant decline before ETF-introduction. ETF had more hospitalization and intravenous antibiotic (IVAB) treatment days (p ETF introduction hospitalizations and IVAB decreased significantly. After ETF-introduction BMI z-score recuperated towards the original curve before the decline, but remained below the controls. Starting ETF had no effect on rate of height gain in children. The pre-index FEV1 decline (-1.52%/year (p = 0.002)) stabilized to +0.39%/year afterwards. Controls displayed decline of -0.48%/year (p ETF introduction improved BMI z-score and stabilized FEV1, associated with less hospitalizations and IVAB treatments. Higher mortality and transplantation in the ETF cases, leading to drop-outs, made determination of the effect size difficult. Copyright © 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Enteral Tube Feeding Nutritional Protein Hydrolysate Production Under Different Factors By Enzymatic Hydrolysis

Directory of Open Access Journals (Sweden)

Nguyen ThiQuynhHoa

2015-01-01

Full Text Available Abstract Hydrolysis of proteins involves the cleavage of peptide bonds to give peptides of varying sizes and amino acid composition. There are a number of types of hydrolysis enzymatic acid or alkali hydrolysis. Chemical hydrolysis is difficult to control and reduces the nutritional quality of products destroying L-form amino acids and producing toxic substances such as lysino-alanine. Enzymatic hydrolysis works without destructing amino acids and by avoiding the extreme temperatures and pH levels required for chemical hydrolysis the nutritional properties of the protein hydrolysates remain largely unaffected. In this research we investigate the fat removal and protein hydrolysis from pork meat to produce the enteral tube feeding nutritional protein hydrolysate for patient. Our results are as follows meat moisture 75.1 protein 22.6 lipid 1.71 ash 0.5 vitamin B1 1.384mg100g n hexantreatment at 80oCin 45 minutes and drying 30 minutes in 90oC.Viscosity of the hydrolysate is very low 2.240 0.092 cPand high degree of hydrolysis 31.390 0.138 . The final protein powder has balance nutritional components and acid amines low microorganisms which are safety for human consumption.

Proposed examination of defect detection of magnetic tube where alternating probe in type of insertion is used

International Nuclear Information System (INIS)

Kiya, Atsushi; Gotoh, Yuji; Sakurai, Kenta

2008-01-01

In various plants in the thermal power plant and the nuclear plant, a lot of steel tubes are used for various places such as heat exchangers, and these steel tubes should inspect regular for a healthy securing of the plant. Then, the outer side defect inspection of the magnetic substance steel tube using an electromagnetic phenomenon was examined in this research. It is shown that the inspection of the outer side defect on a steel tube with baffle is possible using the proposed method. (author)

Effects of hunger level and tube diameter on thefeeding behavior of teat-fed dairy calves

DEFF Research Database (Denmark)

Herskin, Mette S; Skjøth, Flemming; Jensen, Margit Bak

2010-01-01

Behavioral changes caused by variation in hunger have a great potential in health monitoring in dairy cattle. The present experiment used 48 Danish Holstein bull calves with a median age of 33 d. We examined the effect of different levels of hunger (reduced, in which calves were fed 1.5 L of milk...... via esophageal tube before feeding; increased, in which calves were fed half milk ration at the previous feeding, or control, in which calves were fed normal ration at the previous feeding) on feeding behavior of calves fed via different tube diameters (6.0, 3.0, or 1.5 mm). Behavior observed during...... levels. The present results show that only a rather high reduction in tube diameter led to reduced drinking rate. Neither reduced nor increased hunger levels led to changes in drinking rate, but calves showed reduced nonnutritive sucking and butting when they were less hungry and increased nonnutritive...

INFLUENCE OF THE TYPE OF INSERTS ON DIMENSIONAL ACCURACY IN TURNING PROCESS

Directory of Open Access Journals (Sweden)

Pavel POLÁK

2015-07-01

Full Text Available This article is aimed to demonstrate the effect of cutting material and geometry of inserts chip breaker for dimensional accuracy in turning. The experiment is aimed on measuring compliance with dimensional accuracy in turning of samples from steel 11 523 at a constant feed rate and depth of cut, with varying spindle speeds. Machining was performed by using a different types of replaceable inserts. The measurement results will be evaluated in terms of the impact of differ-ent geometry characteristics and changing speeds spindle.

In vivo laser-based imaging of the human fallopian tube for future cancer detection

Science.gov (United States)

Seibel, Eric J.; Melville, C. David; Johnston, Richard S.; Gong, Yuanzheng; Agnew, Kathy; Chiang, Seine; Swisher, Elizabeth M.

2015-03-01

Inherited mutations in BRCA1 and BRCA2 lead to 20-50% lifetime risk of ovarian, tubal, or peritoneal carcinoma. Clinical recommendations for women with these genetic mutations include the prophylactic removal of ovaries and fallopian tubes by age 40 after child-bearing. Recent findings suggest that many presumed ovarian or peritoneal carcinomas arise in fallopian tube epithelium. Although survival rate is screening techniques have mistakenly focused on the ovary as origin of ovarian carcinoma. Unlike ovaries, the fallopian tubes are amenable to direct visual imaging without invasive surgery, using access through the cervix. To develop future screening protocols, we investigated using our 1.2- mm diameter, forward-viewing, scanning fiber endoscope (SFE) to image luminal surfaces of the fallopian tube before laparoscopic surgical removal. Three anesthetized human subjects participated in our protocol development which eventually led to 70-80% of the length of fallopian tubes being imaged in scanning reflectance, using red (632nm), green (532nm), and blue (442nm) laser light. A hysteroscope with saline uterine distention was used to locate the tubal ostia. To facilitate passage of the SFE through the interstitial portion of the fallopian tube, an introducer catheter was inserted 1- cm through each ostia. During insertion, saline was flushed to reduce friction and provide clearer viewing. This is likely the first high-resolution intraluminal visualization of fallopian tubes.

Wear plates control rod guide tubes top internal reactor vessel C. N. VANDELLOS II

International Nuclear Information System (INIS)

2010-01-01

The guide tubes for control rods forming part of the upper internals of the reactor vessel, its function is to guide the control rod to permit its insertion in the reactor core. These guide tubes are suspended from the upper support plate which are fixed by bolts and extending to the upper core plate which is fastened by clamping bolts (split pin) to prevent lateral displacement of the guide tubes, while allowing axial expansion.

Early oral feeding after elective abdominal surgery--what are the issues?

DEFF Research Database (Denmark)

Bisgaard, Thue; Kehlet, Henrik

2002-01-01

This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdomin...... surgical programs in abdominal surgery provide a rational basis for future studies to investigate and facilitate enforced oral feeding after major abdominal procedures.......This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdominal...... procedures. It appears that several factors may promote postoperative oral feeding such as thoracic epidural analgesia, multimodal anti-emetic treatment, opioid-sparing analgesia, selective peripheral opioid antagonists, and enforced oral nutrition. Recent data from multimodal fast-track rehabilitation...

Fracture inspection by BHTV logging through a vinyl chloride tube; Enbi pipe ga sonyusareta kosei deno BHTV ni yoru kiretsu chosa

Energy Technology Data Exchange (ETDEWEB)

Horikawa, H.; Okabe, T.; Takasugi, S. [GERD Geothermal Energy Research and Development Co. Ltd., Tokyo (Japan); Yamauchi, Y.; Imanishi, H. [Osaka Soil Test, Osaka (Japan)

1997-05-27

A borehole televiewer (BHTV) logging was conducted to investigate cracks in bored wells. The logging process shoots ultrasonic waves onto bore walls and utilizes reflection waves from the bore walls. If the bores are filled with muddy water, or the ultrasonic waves can pass through even if vinyl chloride tubes have been inserted after excavation, the state of the bore walls can be investigated in principle. Conventional optical scanners are, however, incapable of making this investigation. The BHTV logging can be used for identifying lithofacies from reflection intensities from bore walls (it depends on sound impedance of rocks), not to speak of finding cracks. As a result of making logging upon setting time windows from 105 to 145 {mu} sec in a bored well inserted with a vinyl chloride tube, cracks in the bore wall were identified clearly through the vinyl chloride tube. If the distance between the bore wall and the vinyl chloride tube becomes smaller, setting the time window becomes difficult, making reflection data acquisition more difficult. Impacts of decentering in the vinyl chloride tube on the data and the crack analysis result are small. The reflection intensity has decreased by about half as a result of having the circular vinyl chloride tube inserted. 5 refs., 9 figs., 1 tab.

Biliary peritonitis caused by a leaking T-tube fistula disconnected at the point of contact with the anterior abdominal wall: a case report

Directory of Open Access Journals (Sweden)

Nikolić Marko

2008-09-01

Full Text Available Abstract Introduction Operations on the common bile duct may lead to potentially serious complications such as biliary peritonitis. T-tube insertion is performed to reduce the risk of this occurring postoperatively. Biliary leakage at the point of insertion into the common bile duct, or along the fistula, can sometimes occur after T-tube removal and this has been reported extensively in the literature. We report a case where the site at which the T-tube fistula leaked proved to be the point of contact between the fistula and the anterior abdominal wall, a previously unreported complication. Case presentation A 36-year-old sub-Saharan African woman presented with gallstone-induced pancreatitis and, once her symptoms settled, laparoscopic cholecystectomy was performed, common bile duct stones were removed and a T-tube was inserted. Three weeks later, T-tube removal led to biliary peritonitis due to the disconnection of the T-tube fistula which was recannulated laparoscopically using a Latex drain. Conclusion This case highlights a previously unreported mechanism for bile leak following T-tube removal caused by detachment of a fistula tract at its contact point with the anterior abdominal wall. Hepatobiliary surgeons should be aware of this mechanism of biliary leakage and the use of laparoscopy to recannulate the fistula.

Performance Study of a Cylindrical Parabolic Concentrating Solar Water Heater with Nail Type Twisted Tape Inserts in the Copper Absorber Tube

Directory of Open Access Journals (Sweden)

Amit K. Bhakta

2018-01-01

Full Text Available This paper reports the overall thermal performance of a cylindrical parabolic concentrating solar water heater (CPCSWH with inserting nail type twisted tape (NTT in the copper absorber tube for the nail twist pitch ratios, 4.787, 6.914 and 9.042, respectively. The experiments are conducted for a constant volumetric water flow rate and during the time period 9:00 a.m. to 15:00 p.m. The useful heat gain, hourly solar energy collected and hourly solar energy stored in this solar water heater were found to be higher for the nail twist pitch ratio 4.787. The above said parameters were found to be at a peak at noon and observed to follow the path of variation of solar intensity. At the start of the experiment, the value of charging efficiency was observed to be maximum, whereas the maximum values of instantaneous efficiency and overall thermal efficiency were observed at noon. The key finding is that the nail twist pitch ratio enhances the overall thermal performance of the CPCSWH.

Leucine pulses enhance skeletal muscle protein synthesis during continuous feeding in neonatal pigs

Science.gov (United States)

Infants unable to maintain oral feeding can be nourished by orogastric tube. We have shown that orogastric continuous feeding restricts muscle protein synthesis compared with intermittent bolus feeding in neonatal pigs. To determine whether leucine leu infusion can be used to enhance protein synthes...

CONCENTRIC TUBE-FOULING RIG FOR INVESTIGATION OF FOULING DEPOSIT FORMATION FROM PASTEURISER OF VISCOUS FOOD LIQUID

Directory of Open Access Journals (Sweden)

N. I. KHALID

2013-02-01

Full Text Available This paper reports the work on developing concentric tube-fouling rig, a new fouling deposit monitoring device. This device can detect and quantify the level of fouling deposit formation. It can also functioning as sampler for fouling deposit study, which can be attached at any food processing equipment. The design is initiated with conceptual design. The rig is designed with inner diameter of 7 cm and with tube length of 37 cm. A spiral insert with 34.5 cm length and with 5.4 cm diameter is fitted inside the tube to ensure the fluid flows around the tube. In this work, the rig is attached to the lab-scale concentric tube-pasteurizer to test its effectiveness and to collect a fouling sample after pasteurization of pink guava puree. Temperature changes are recorded during the pasteurization and the data is used to plot the heat transfer profile. Thickness of the fouling deposit is also measured. The trends for thickness, heat resistance profile and heat transfer profile for concentric tube-fouling rig matched the trends obtained from lab-scale concentric tube-pasteurizer very well. The findings from this work have shown a good potential of this rig however there is a limitation with spiral insert, which is discussed in this paper.

Characterization of Friction Stir Welded Tubes by Means of Tube Bulge Test

International Nuclear Information System (INIS)

D'Urso, G.; Longo, M.; Giardini, C.

2011-01-01

Mechanical properties of friction stir welded joints are generally evaluated by means of conventional tensile test. This testing method might provide insufficient information because maximum strain obtained in tensile test before necking is small; moreover, the application of tensile test is limited when the joint path is not linear or even when the welds are executed on curved surfaces. Therefore, in some cases, it would be preferable to obtain the joints properties from other testing methods. Tube bulge test can be a valid solution for testing circumferential or longitudinal welds executed on tubular workpieces. The present work investigates the mechanical properties and the formability of friction stir welded tubes by means of tube bulge tests. The experimental campaign was performed on tubular specimens having a thickness of 3 mm and an external diameter of 40 mm, obtained starting from two semi-tubes longitudinally friction stir welded. The first step, regarding the fabrication of tubes, was performed combining a conventional forming process and friction stir welding. Sheets in Al-Mg-Si-Cu alloy AA6060 T6 were adopted for this purpose. Plates having a dimension of 225x60 mm were bent (with a bending axis parallel to the main dimension) in order to obtain semi-tubes. A particular care was devoted to the fabrication of forming devices (punch and die) in order to minimize the springback effects. Semi-tubes were then friction stir welded by means of a CNC machine tool. Some preliminary tests were carried out by varying the welding parameters, namely feed rate and rotational speed. A very simple tool having flat shoulder and cylindrical pin was used. The second step of the research was based on testing the welded tubes by means of tube bulge test. A specific equipment having axial actuators with a conical shape was adopted for this study. Some analyses were carried out on the tubes bulged up to a certain pressure level. In particular, the burst pressure and the

Mortality after nasogastric tube feeding initiation in long-term care elderly with oropharyngeal dysphagia--the contribution of refeeding syndrome.

Science.gov (United States)

Lubart, Emilia; Leibovitz, Arthur; Dror, Yosef; Katz, Elena; Segal, Refael

2009-01-01

The refeeding syndrome (RS) is an underappreciated but clinically important entity characterized by acute electrolyte abnormalities, mainly hypophosphatemia, fluid retention and dysfunction of various organs and systems, which can result in significant morbidity and occasionally death. To examine the incidence of death cases and death causes following nasogastric tube (NGT) feeding initiation in frail elderly with particular reference to RS. Forty patients with feeding problems for at least 72 h before restarting of alimentation by NGT were included. Excluded were those in any critical clinical situation. Clinical parameters and nutritional assessment were recorded before and after refeeding. Blood samples were taken before, daily for the first 3 days and 1 week after refeeding initiation. During the 1st week of refeeding, 9 patients (22.5%) died and within 1 month 10 more, summing to 47.5%. Most deaths were due to infectious causes [15 out of 19, (79%)]; some were due to no obvious reason [4 out of 19, (21%)]. Significant electrolyte changes were observed in the 2-3 days following refeeding. Significant were the decreases in phosphorus and elevations in potassium and lymphocytes (day 7). We found no correlations between the severity of decreases in levels of phosphorus and mortality. Mortality after NGT feeding initiation was high, mainly due to infectious complications. However, in a considerable number of patients hypophosphatemia was noted, suggesting that RS could be a contributory factor of mortality. Since this is a treatable condition, more attention should be paid to detecting and coping with this problem. Copyright 2009 S. Karger AG, Basel.

Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

Energy Technology Data Exchange (ETDEWEB)

Nahum, E.; Ben-Ari, J.; Schonfeld, T. [Pediatric Intensive Care Unit, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Horev, G. [Dept. of Diagnostic Radiology, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)

2001-06-01

A 3{sup 1}/{sub 2}-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

International Nuclear Information System (INIS)

Nahum, E.; Ben-Ari, J.; Schonfeld, T.; Horev, G.

2001-01-01

A 3 1 / 2 -year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

Evaluation and Management of Neonatal Dysphagia: Impact of Pharyngoesophageal Motility Studies and Multidisciplinary Feeding Strategy

Science.gov (United States)

Jadcherla, Sudarshan R.; Stoner, Erin; Gupta, Alankar; Bates, D. Gregory; Fernandez, Soledad; Di Lorenzo, Carlo; Linscheid, Thomas

2013-01-01

Background and objectives Abnormal swallowing (dysphagia) among neonates is commonly evaluated using the videofluoroscopic swallow study (VSS). Radiological findings considered high risk for administration of oral feeding include nasopharyngeal reflux, laryngeal penetration, aspiration, or pooling. Our aims were to determine pharyngoesophageal motility correlates in neonates with dysphagia and the impact of multidisciplinary feeding strategy. Methods Twenty dysphagic neonates (mean gestation ± standard deviation [SD] = 30.9 ± 4.9 weeks; median 31.1 weeks; range = 23.7–38.6 weeks) with abnormal VSS results were evaluated at 49.9 ± 16.5 weeks (median 41.36 weeks) postmenstrual age. The subjects underwent a swallow-integrated pharyngoesophageal motility assessment of basal and adaptive swallowing reflexes using a micromanometry catheter and pneumohydraulic water perfusion system. Based on observations during the motility study, multidisciplinary feeding strategies were applied and included postural adaptation, sensory modification, hunger manipulation, and operant conditioning methods. To discriminate pharyngoesophageal manometry correlates between oral feeders and tube feeders, data were stratified based on the primary feeding method at discharge, oral feeding versus tube feeding. Results At discharge, 15 of 20 dysphagic neonates achieved oral feeding success, and the rest required chronic tube feeding. Pharyngoesophageal manometry correlates were significantly different (P dysphagia or its consequences. Manometry may be a better predictor than VSS in identifying patients who are likely to succeed in vigorous intervention programs. PMID:19179881

Comparison of lipid and calorie loss from donor human milk among 3 methods of simulated gavage feeding: one-hour, 2-hour, and intermittent gravity feedings.

Science.gov (United States)

Brooks, Christine; Vickers, Amy Manning; Aryal, Subhash

2013-04-01

The objective of this study was to compare the differences in lipid loss from 24 samples of banked donor human milk (DHM) among 3 feeding methods: DHM given by syringe pump over 1 hour, 2 hours, and by bolus/gravity gavage. Comparative, descriptive. There were no human subjects. Twenty-four samples of 8 oz of DHM were divided into four 60-mL aliquots. Timed feedings were given by Medfusion 2001 syringe pumps with syringes connected to narrow-lumened extension sets designed for enteral feedings and connected to standard silastic enteral feeding tubes. Gravity feedings were given using the identical syringes connected to the same silastic feeding tubes. All aliquots were analyzed with the York Dairy Analyzer. Univariate repeated-measures analyses of variance were used for the omnibus testing for overall differences between the feeding methods. Lipid content expressed as grams per deciliter at the end of each feeding method was compared with the prefed control samples using the Dunnett's test. The Tukey correction was used for other pairwise multiple comparisons. The univariate repeated-measures analysis of variance conducted to test for overall differences between feeding methods showed a significant difference between the methods (F = 58.57, df = 3, 69, P gravity feeding methods (P = .3296). Pairwise comparison using the Tukey correction revealed a significant difference between both gravity and 1-hour feeding methods (P gravity and 2-hour feeding method (P gravity feedings, the timed feedings resulted in a statistically significant loss of fat as compared with their controls. These findings should raise questions about how those infants in the neonatal intensive care unit are routinely gavage fed.

Study on heat transfer and friction factor characteristics of γ-Al2O3/water through circular tube with twisted tape inserts with different thicknesses

International Nuclear Information System (INIS)

Esmaeilzadeh, E.; Almohammadi, H.; Nokhosteen, A.; Motezaker, A.; Omrani, A.N.

2014-01-01

An experimental study was carried out to investigate heat transfer and friction factor characteristics of γ-Al 2 O 3 /water nano-fluid through circular tube with twisted tape inserts with various thicknesses at constant heat flux. In this work, γ-Al 2 O 3 /water nano-fluids with two volume concentrations of 0.5% and 1% were used as the working fluid. The twist ratio of twisted tape remained constant at 3.21, while the thicknesses were changed through three values of 0.5 mm, 1 mm and 2 mm. The experiments were performed in laminar flow regime from 150 to 1600 Reynolds numbers. Results indicated that twisted tape inserts enhanced the average convective heat transfer coefficient, and also more the thickness of twisted tape is more the enhancement of convective heat transfer coefficient is. Also, the highest enhancement was achieved at maximum volume concentration. Results showed that nano-fluids have better heat transfer performance when utilized with thicker twisted tapes. At the same time, the increase in twisted tape thickness leads to an increase in friction factor. In the end, the combined results of these two phenomena result in enhanced convective heat transfer coefficient and thermal performance. Finally, two new correlations were offered for Nusselt number and thermal performance based on our experimental observation. (authors)

Glytube: a conical tube and parafilm M-based method as a simplified device to artificially blood-feed the dengue vector mosquito, Aedes aegypti.

Directory of Open Access Journals (Sweden)

André Luis Costa-da-Silva

Full Text Available Aedes aegypti, the main vector of dengue virus, requires a blood meal to produce eggs. Although live animals are still the main blood source for laboratory colonies, many artificial feeders are available. These feeders are also the best method for experimental oral infection of Ae. aegypti with Dengue viruses. However, most of them are expensive or laborious to construct. Based on principle of Rutledge-type feeder, a conventional conical tube, glycerol and Parafilm-M were used to develop a simple in-house feeder device. The blood feeding efficiency of this apparatus was compared to a live blood source, mice, and no significant differences (p = 0.1189 were observed between artificial-fed (51.3% of engorgement and mice-fed groups (40.6%. Thus, an easy to assemble and cost-effective artificial feeder, designated "Glytube" was developed in this report. This simple and efficient feeding device can be built with common laboratory materials for research on Ae. aegypti.

Prolonged Barium-Impaction Ileus in Two Lung Transplant Recipients With Systemic Sclerosis: Case Report.

Science.gov (United States)

Tokman, S; Hays, S R; Leard, L E; Bush, E L; Kukreja, J; Kleinhenz, M E; Golden, J A; Singer, J P

2015-12-01

Lung transplantation can be a life-saving measure for people with end-stage lung disease from systemic sclerosis. However, outcomes of lung transplantation may be compromised by gastrointestinal manifestations of systemic sclerosis, which can involve any part of the gastrointestinal tract. Esophageal and gastric disease can be managed by enteral feeding with the use of a gastrojejunal feeding tube. In this report, we describe the clinical courses of 2 lung transplant recipients with systemic sclerosis who experienced severe and prolonged barium-impaction ileus after insertion of a percutaneous gastrojejunal feeding tube. Copyright © 2015 Elsevier Inc. All rights reserved.

Stapling and Section of the Nasogastric Tube during Sleeve Gastrectomy: How to Prevent and Recover

Directory of Open Access Journals (Sweden)

A. Péquignot

2011-07-01

Full Text Available Bariatric surgery has become an integral part of morbid obesity treatment with well-defined indications. Some complications, specific or not, due to laparoscopic sleeve gastrectomy (LSG procedure have recently been described. We report a rare complication unpublished to date: a nasogastric section during great gastric curve stapling. A 44-year-old woman suffered of severe obesity (BMI 36.6 kg/m2 with failure of medical treatments for years. According to already published technique, a LSG was performed. Six hours postoperatively, a nurse removed the nasogastric tube according to the local protocol and the nasogastric tube was abnormally short, with staples at its extremity. Surgery was performed with peroperative endoscopy. In conclusion, this is the first publication of a nasogastric section during LSG. Therefore we report this case and propose a solution to prevent its occurrence. To avoid this kind of accident, we now systematically insert the nasogastric tube by mouth through a Guedel cannula. Then, to insert the calibrating bougie, we entirely withdraw the nasogastric tube.

A miniature X-ray tube based on carbon nanotube for an intraoral dental radiography

International Nuclear Information System (INIS)

Kim, Hyun Jin; Park, Han Beom; Lee, Ju Hyuk; Cho, Sung Oh

2016-01-01

The number of human teeth that can be radiographically taken is limited. Moreover, at least two X-ray shots are required to get images of teeth from both sides of the mouth. In order to overcome the disadvantages of conventional dental radiography, a dental radiograph has been proposed in which an X-ray tube is inserted into the mouth while an X-ray detector is placed outside the mouth. The miniature X-ray tube is required small size to insert into the mouth. Recently, we have fabricated a miniature x-ray tube with the diameter of 7 mm using a carbon nanotube (CNT) field. But, commercialized miniature X-ray tube were adopted a thermionic type using tungsten filament. The X-ray tubes adopted thermionic emission has a disadvantage of increasing temperature of x-ray tube. So it need to cooling system to cool x-ray tube. On the other hands, X-ray tubes adopted CNT field emitters don't need cooling systems because electrons are emitted from CNT by applying high voltage without heating. We have developed the miniature x-ray tube that produce x-ray with uniform spatial distribution based on carbon nanotube field emitters. The fabricated miniature x-ray tube can be stably and reliably operated at 50kV without any vacuum pump. The developed miniature X-ray tube was applied for intraoral dental radiography that employs an intra-oral CNT-based miniature X-ray tube and extra-oral X-ray detectors. An X-ray image of many teeth was successfully obtained by a single X-ray shot using the intra-oral miniature X-ray tube system. Furthermore, images of both molar teeth of pig were simultaneously obtained by a single X-ray shot. These results show that the intraoral dental radiography, which employs an intraoral miniature X-ray tube and an extraoral X-ray detector, performs better than conventional dental radiography

A miniature X-ray tube based on carbon nanotube for an intraoral dental radiography

Energy Technology Data Exchange (ETDEWEB)

Kim, Hyun Jin; Park, Han Beom; Lee, Ju Hyuk; Cho, Sung Oh [KAIST, Daejeon (Korea, Republic of)

2016-05-15

The number of human teeth that can be radiographically taken is limited. Moreover, at least two X-ray shots are required to get images of teeth from both sides of the mouth. In order to overcome the disadvantages of conventional dental radiography, a dental radiograph has been proposed in which an X-ray tube is inserted into the mouth while an X-ray detector is placed outside the mouth. The miniature X-ray tube is required small size to insert into the mouth. Recently, we have fabricated a miniature x-ray tube with the diameter of 7 mm using a carbon nanotube (CNT) field. But, commercialized miniature X-ray tube were adopted a thermionic type using tungsten filament. The X-ray tubes adopted thermionic emission has a disadvantage of increasing temperature of x-ray tube. So it need to cooling system to cool x-ray tube. On the other hands, X-ray tubes adopted CNT field emitters don't need cooling systems because electrons are emitted from CNT by applying high voltage without heating. We have developed the miniature x-ray tube that produce x-ray with uniform spatial distribution based on carbon nanotube field emitters. The fabricated miniature x-ray tube can be stably and reliably operated at 50kV without any vacuum pump. The developed miniature X-ray tube was applied for intraoral dental radiography that employs an intra-oral CNT-based miniature X-ray tube and extra-oral X-ray detectors. An X-ray image of many teeth was successfully obtained by a single X-ray shot using the intra-oral miniature X-ray tube system. Furthermore, images of both molar teeth of pig were simultaneously obtained by a single X-ray shot. These results show that the intraoral dental radiography, which employs an intraoral miniature X-ray tube and an extraoral X-ray detector, performs better than conventional dental radiography.

Reliable experimental setup to test the pressure modulation of Baerveldt Implant tubes for reducing post-operative hypotony

Science.gov (United States)

Ramani, Ajay

Glaucoma encompasses a group of conditions that result in damage to the optic nerve and can cause loss of vision and blindness. The nerve is damaged due to an increase in the eye's internal (intraocular) pressure (IOP) above the nominal range of 15 -- 20 mm Hg. There are many treatments available for this group of diseases depending on the complexity and stage of nerve degradation. In extreme cases where drugs or laser surgery do not create better conditions for the patient, ophthalmologists use glaucoma drainage devices to help alleviate the IOP. Many drainage implants have been developed over the years and are in use; but two popular implants are the Baerveldt Glaucoma Implant and the Ahmed Glaucoma Valve Implant. Baerveldt Implants are non-valved and provide low initial resistance to outflow of fluid, resulting in post-operative complications such as hypotony, where the IOP drops below 5 mm of Hg. Ahmed Glaucoma Valve Implants are valved implants which initially restrict the amount of fluid flowing out of the eye. The long term success rates of Baerveldt Implants surpass those of Ahmed Valve Implants because of post-surgical issues; but Baerveldt Implants' initial effectiveness is poor without proper flow restriction. This drives the need to develop new ways to improve the initial effectiveness of Baerveldt Implants. A possible solution proposed by our research team is to place an insert in the Baerveldt Implant tube of inner diameter 305 microns. The insert must be designed to provide flow resistance for the early time frame [e.g., first 30 -- 60 post-operative days] until sufficient scar tissue has formed on the implant. After that initial stage with the insert, the scar tissue will provide the necessary flow resistance to maintain the IOP above 5 mm Hg. The main objective of this project was to develop and validate an experimental apparatus to measure pressure drop across a Baerveldt Implant tube, with and without inserts. This setup will be used in the

Middle finger length-based tracheal intubation depth improves the rate of appropriate tube placement in children.

Science.gov (United States)

Zhou, Qing-he; Xiao, Wang-pin; Zhou, Hong-mei

2015-11-01

It is challenging for anesthetists to determine the optimal tracheal intubation depth in children. We hypothesize that a measure three times the length of the middle finger can be used for predicting tracheal tube depth in children. Eighty-six children (4-14 years of age) were included in this study. After the children were anesthetized, a fiberoptic bronchoscope (FOB) was inserted into the trachea, the lengths from the upper incisor teeth to carina and vocal cords were measured, and a suitably sized cuffed tracheal tube was inserted into the trachea. Age-based and middle finger length-based formulas were used to determine the tracheal intubation depth. All 86 children enrolled were included in this study. Compared with the age-based intubation, the rate of appropriate tube placement was higher for middle finger length-based intubation (88.37% vs 66.28%, P = 0.001). The proximal intubation rate was lower in middle finger length-based intubation (4.65% vs 32.56%, P tube depth was larger than that between age and optimal tracheal tube depth (0.883 vs 0.845). Our data indicate that the appropriate tube placement rate can be improved by using three times the middle finger length as the tracheal intubation depth in children. © 2015 John Wiley & Sons Ltd.

Radiation-resistant device with tubes for the introduction of a liquid, e.g., blood into a container holding a radioactive source

International Nuclear Information System (INIS)

Rasmussen, I.

1978-01-01

The invention concerns a radiation-resistant device with tubing for the introduction/removal of a liquid (e.g. blood to and from a patient) via an at least partly curved channel into and out of a container holding a radioactive source. A break is made with the idea that it is necessary to use a circular-cylindrical tube as introduction device for the material to be irradiated. If made of materials suitable for the purpose, such tubing is safe and compressible in the longitudinal direction. The disadvantages and limitations of earlier constructions can be ascribed to this circumstance. A characteristic of the present invention is an elongated, pressure-resistant insertion ''cage'', flexible in at least one direction, used for the introduction of a minimum of one tubing into the container through the channel. The tubing enters and leaves at the same end of the insert cage. (BP)

DWPF Sample Vial Insert Study-Statistical Analysis of DWPF Mock-Up Test Data

International Nuclear Information System (INIS)

Harris, S.P.

1997-01-01

This report is prepared as part of Technical/QA Task Plan WSRC-RP-97-351 which was issued in response to Technical Task Request HLW/DWPF/TTR-970132 submitted by DWPF. Presented in this report is a statistical analysis of DWPF Mock-up test data for evaluation of two new analytical methods which use insert samples from the existing HydragardTM sampler. The first is a new hydrofluoric acid based method called the Cold Chemical Method (Cold Chem) and the second is a modified fusion method.Both new methods use the existing HydragardTM sampler to collect a smaller insert sample from the process sampling system. The insert testing methodology applies to the DWPF Slurry Mix Evaporator (SME) and the Melter Feed Tank (MFT) samples. Samples in small 3 ml containers (Inserts) are analyzed by either the cold chemical method or a modified fusion method. The current analytical method uses a HydragardTM sample station to obtain nearly full 15 ml peanut vials. The samples are prepared by a multi-step process for Inductively Coupled Plasma (ICP) analysis by drying, vitrification, grinding and finally dissolution by either mixed acid or fusion. In contrast, the insert sample is placed directly in the dissolution vessel, thus eliminating the drying, vitrification and grinding operations for the Cold chem method. Although the modified fusion still requires drying and calcine conversion, the process is rapid due to the decreased sample size and that no vitrification step is required.A slurry feed simulant material was acquired from the TNX pilot facility from the test run designated as PX-7.The Mock-up test data were gathered on the basis of a statistical design presented in SRT-SCS-97004 (Rev. 0). Simulant PX-7 samples were taken in the DWPF Analytical Cell Mock-up Facility using 3 ml inserts and 15 ml peanut vials. A number of the insert samples were analyzed by Cold Chem and compared with full peanut vial samples analyzed by the current methods. The remaining inserts were analyzed by

Attitudes of Health Care Professionals Towards Gastrostomy Feeding in Older Adults in Malaysia

Directory of Open Access Journals (Sweden)

Mohamad Hasif Jaafar

2015-03-01

Conclusion: This survey indicated that most HCPs involved in the care of geriatric patients would advocate PEG feeding. Important factors inhibiting the use of PEG tube feeding in Malaysia were identified. Future studies should explore the barriers to acceptance in order to identify potential solutions to improving PEG feeding use in Malaysia.

Device for the selective positioning of a component on a tube plate

International Nuclear Information System (INIS)

1974-01-01

The invention relates to a device for the selective positioning of a component on a tube plate. It particularly applies to the positioning of a guide tube head successively opposite all the tubes of the tube bundle of a nuclear reactor steam generator. The large number of tubes in the tube bundle of the steam generator in a pressure water nuclear power station must be checked periodically for any likely corrosion. This check is effected with a Foucault current probe which is inserted in each tube in turn and is connected to a probe signal processing unit. The probe is placed in a flexible guide tube brought in turn in front of each tube of the bundle to be checked. The invention concerns a device to move the opening of a tube guide for a Foucault current detector over the entire surface of the tube plate, thereby providing access to all the tubes whilst limiting the interventions to a single positioning and a single withdrawal of the apparatus for testing all the bundle. Between the two interventions at the beginning and end of the operation, all displacements are remote controlled from outside the dangerous radioacive area [fr

Influence of tiamulin concentration in feed on its bioavailability in piglets.

Science.gov (United States)

Riond, J L; Schreiber, F; Wanner, M

1993-01-01

Tiamulin pharmacokinetic parameters were determined in 8 2-month-old male improved Swiss Landrace piglets after intake of 2,000 mg/kg feed, 500 mg/kg feed, 12.5 mg/ml aqueous solution administered via a stomach tube and 180 mg/kg feed offered ad libitum. In all cases, the total tiamulin dose received was 10 mg/kg body weight (bw) per day. For the 2,000 mg/kg and 500 mg/kg treatments, animals were restrictively fed a commercial mix in amounts corresponding to 3-fold their maintenance requirement of digestible energy. The piglets first individually received the amount of medicated feed and immediately thereafter the rest of the daily ration. The highest tiamulin serum concentrations (Cmax), the largest area under the curve (AUC0-->infinity), the largest absorption rate constant (Ka), and the shortest time at which the maximum serum concentration occurred (tmax) were obtained after administration via stomach tube followed in the respective order by the 2,000 mg/kg, 500 mg/kg and 180 mg/kg treatments. Ad libitum feeding of the medicated mix at 180 mg/kg failed to provide tiamulin serum concentration above minimum inhibitory concentrations (MIC) of some representative microorganisms. In conclusion, tiamulin concentration in medicated feed strongly influences its rate and extent of absorption and consequently serum concentrations. Larger tiamulin concentration in feed enhances its bioavailability. The common practice adopted by national regulatory agencies for the registration of a new drug is to conduct pharmacokinetic studies after administration agencies for the registration of a new drug is to conduct pharmacokinetic studies after administration via a stomach tube. This practice should be reevaluated because this mode of administration does not correspond to that in routine use.

Risks of Using Bedside Tests to Verify Nasogastric Tube Position in Adult Patients

Directory of Open Access Journals (Sweden)

Melody Ni

2014-12-01

Full Text Available Nasogastric (NG tubes are commonly used for enteral feeding. Complications of feeding tube misplacement include malnutrition, pulmonary aspiration, and even death. We built a Bayesian network (BN to analyse the risks associated with available bedside tests to verify tube position. Evidence on test validity (sensitivity and specificity was retrieved from a systematic review. Likelihood ratios were used to select the best tests for detecting tubes misplaced in the lung or oesophagus. Five bedside tests were analysed including magnetic guidance, aspirate pH, auscultation, aspirate appearance, and capnography/colourimetry. Among these, auscultation and appearance are non-diagnostic towards lung or oesophagus placements. Capnography/ colourimetry can confirm but cannot rule out lung placement. Magnetic guidance can rule out both lung and oesophageal placement. However, as a relatively new technology, further validation studies are needed. The pH test with a cut-off at 5.5 or lower can rule out lung intubation. Lowering the cut-off to 4 not only minimises oesophageal intubation but also provides extra safety as the sensitivity of pH measurement is reduced by feeding, antacid medication, or the use of less accurate pH paper. BN is an effective tool for representing and analysing multi-layered uncertainties in test validity and reliability for the verification of NG tube position. Aspirate pH with a cut-off of 4 is the safest bedside method to minimise lung and oesophageal misplacement.

Therapeutic amnioinfusion for intrapartum fetal distress using a pediatric feeding tube.

Science.gov (United States)

Abdel-Aleem, H; Amin, A F; Shokry, M; Radwan, R A

2005-08-01

To evaluate the role of therapeutic amnioinfusion using a pediatric feeding tube in cases of intrapartum fetal distress. A randomized clinical trial including 438 women admitted in labor at Assiut University Hospital with nonreassuring fetal heart rate tracing. Using sealed opaque envelopes, the women were randomized to 2 groups. In the amnioinfusion group they underwent transcervical amnioinfusion (1000 mL of warmed sterile saline solution) in addition to conventional treatment. In the control group they received conventional treatment only. The primary outcome was cesarean section rate for fetal distress. The secondary outcomes were neonatal and maternal complications. The amnioinfusion group showed a significant reduction in the rate of cesarean section for fetal distress (relative risk [RR], 0.7; 95% confidence interval [CI], 0.6-0.83), and a 30% reduction in abnormal fetal heart rate patterns (RR, 0.7; 95% CI, 0.6-0.83). Significantly fewer newborns had Apgar scores less than 7 at 1 and 5 min in the amnioinfusion group than in the control group (RR, 0.38; 95% CI, 0.26-0.55 and RR, 0.31; 95% CI, 0.15-0.64, respectively). Significantly fewer newborns had meconium below the vocal cords in the amnioinfusion group than in the control group (RR, 0.36; 95% CI, 0.13-0.97). Moreover, 14 newborns in the amnioinfusion group needed admission to the intensive care unit vs. 31 newborns in the control group. There were no significant differences between the 2 groups regarding the incidence rates of uterine hypertonus and maternal temperature higher than 38 degrees C. Therapeutic amnioinfusion is a simple and effective intervention that reduces the rates of cesarean section for intrapartum nonreassuring fetal heart tracing. In under-resourced settings, it can be performed using inexpensive catheters.

Comparison of three methods of feeding colostrum to dairy calves.

Science.gov (United States)

Besser, T E; Gay, C C; Pritchett, L

1991-02-01

Absorption of colostral immunoglobulins by Holstein calves was studied in 3 herds in which 3 methods of colostrum feeding were used. Failure of passive transfer, as determined by calf serum immunoglobulin G1 (IgG1) concentration less than 10 mg/ml at 48 hours of age, was diagnosed in 61.4% of calves from a dairy in which calves were nursed by their dams, 19.3% of calves from a dairy using nipple-bottle feeding, and 10.8% of calves from a dairy using tube feeding. The management factor determined to have the greatest influence on the probability of failure of passive transfer in the herds using artificial methods of colostrum feeding (bottle feeding or tube feeding) was the volume of colostrum fed as it affected the amount of IgG1 received by the calf. In dairies that used artificial feeding methods, failure of passive transfer was infrequent in calves fed greater than or equal to 100 g IgG1 in the first colostrum feeding. In the dairy that allowed calves to suckle, prevalence of failure of passive transfer was greater than 50% even among calves nursed by cows with above-average colostral IgG1 concentration. Analysis of the effect of other management factors on calf immunoglobulin absorption revealed small negative effects associated with the use of previously frozen colostrum and the use of colostrum from cows with long nonlactating intervals.

Stress analysis of HTR-10 steam generator heat exchanging tubes

International Nuclear Information System (INIS)

Dong Jianling; Zhang Xiaohang; Yin Dejian; Fu Jiyang

2001-01-01

Steam Generator (SG) heat exchanging tubes of 10 MW High Temperature Gas Cooled Reactor (HTR-10) are protective screens between the primary loop of helium with radioactivity and the secondary loop of feeding water and steam without radioactivity. Water and steam will enter into the primary loop when rupture of the heat exchanging tubes occurs, which lead to increase of the primary loop pressure and discharge of radioactive materials. Therefore it is important to guarantee the integrity of the tubes. The tube structure is spiral tube with small bending radius, which make it impossible to test with volumetric in-service detection. For such kind of spiral tube, using LBB concept to guarantee the integrity of the tubes is an important option. The author conducts stress analysis and calculation of HTR-10 SG heat exchanging tubes using the FEM code of piping stress analysis, PIPESTRESS. The maximum stress and the dangerous positions are obtained

Treatment and Management

Science.gov (United States)

... a mild dose of diuretics to relieve venous congestion. Beta-blockers and diuretics are also often prescribed. ... may also need to have a gastrointestinal feeding tube inserted to prevent episodes of hypoglycemia during illness ...

Methods for batch fabrication of cold cathode vacuum switch tubes

Science.gov (United States)

Walker, Charles A [Albuquerque, NM; Trowbridge, Frank R [Albuquerque, NM

2011-05-10

Methods are disclosed for batch fabrication of vacuum switch tubes that reduce manufacturing costs and improve tube to tube uniformity. The disclosed methods comprise creating a stacked assembly of layers containing a plurality of adjacently spaced switch tube sub-assemblies aligned and registered through common layers. The layers include trigger electrode layer, cathode layer including a metallic support/contact with graphite cathode inserts, trigger probe sub-assembly layer, ceramic (e.g. tube body) insulator layer, and metallic anode sub-assembly layer. Braze alloy layers are incorporated into the stacked assembly of layers, and can include active metal braze alloys or direct braze alloys, to eliminate costs associated with traditional metallization of the ceramic insulator layers. The entire stacked assembly is then heated to braze/join/bond the stack-up into a cohesive body, after which individual switch tubes are singulated by methods such as sawing. The inventive methods provide for simultaneously fabricating a plurality of devices as opposed to traditional methods that rely on skilled craftsman to essentially hand build individual devices.

Medication Errors in Patients with Enteral Feeding Tubes in the Intensive Care Unit.

Science.gov (United States)

Sohrevardi, Seyed Mojtaba; Jarahzadeh, Mohammad Hossein; Mirzaei, Ehsan; Mirjalili, Mahtabalsadat; Tafti, Arefeh Dehghani; Heydari, Behrooz

2017-01-01

Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems. A cross-sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines. Ninety-four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty-one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively. In this study, at least three-fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients' pharmacotherapy, and more attention should be paid to this issue.

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists.

Science.gov (United States)

Porcel, José M

2018-04-01

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

What are the Advantages? A Prospective Analysis of 16 versus 28 French Chest Tube Sizes in Video-assisted Thoracoscopic Surgery Lobectomy of Lung Cancer

Directory of Open Access Journals (Sweden)

Mei YANG

2015-08-01

Full Text Available Background and objective Post-operation management of minimally invasive thoracic surgery is similar to that of open surgery, especially on the drainage tube of the chest. The aim of this study is to compare the advantages of using 16 F versus 28 F chest tubes in video-assisted thoracoscopic surgery (VATS lobectomy of lung cancer. Methods Data from 163 patients (February-May 2014 who underwent VATS lobectomy of lung cancer with insertion of one chest drain (16 F or 28 F were analyzed. The following post-operative data were evaluated: primary healing of tube incision, CXR abnormalities (pneumothorax, fluid, atelectasis, subcutaneous emphysema, and hematoma, drainage time, new drain insertion, and wound healing at the site of insertion. Results A total of 75 patients received 28 F chest tubes, and 88 patients received 16 F chest tubes. Both groups were similar in age, gender, comorbidities, and pathological evaluation of resection specimens. After adjustment, no statistically significant difference was found between the two groups in relation to tube-related complications including residual pneumothoraces (4.00% vs 4.44%; P=0.999, subcutaneous emphysema (8.00% vs 6.67%; P=0.789, retained hemothorax (0 vs 41%, P=0.253, and drainage time [(28.4±16.12 h vs (22.1±11.8 h; P=0.120] The average total drainage volume and rrhythmia rates of the 16 F group [(365±106 mL, 14.67%] was less than that of the 28 F group [(665±217 mL, 4.5%; P=0.030, P=0.047]. The rates of primary healing at the site of insertion in the 16 F group (95.45% was higher than that in the 28 F group (77.73%, P=0.039. A significant difference was found on the post-operative length of stay of the two groups [(4.23±0.05 d vs (4.57±0.16 d, P=0.078]. Conclusion The use of 16 F chest tube for VATS lobectomy of patients with lung cancer did not affect the clinically relevant outcomes tested. However, 16 F chest tube facilitated faster wound healing at the site of insertion.

Speaking Tracheostomy Tube and Modified Mouthstick Stylus in a Ventilator-Dependent Patient with Spinal Cord Injury

OpenAIRE

Mitate, Eiji; Kubota, Kensuke; Ueki, Kenji; Inoue, Rumi; Inoue, Ryosuke; Momii, Kenta; Sugimori, Hiroshi; Maehara, Yoshihiko; Nakamura, Seiji

2015-01-01

Communication is a serious problem for patients with ventilator-dependent tetraplegia. A 73-year-old man was presented at the emergency room in cardiopulmonary arrest after falling from a height of 2 m. After successful resuscitation, fractures of the cervical spine and cervical spinal cord injury were found. Due to paralysis of the respiratory muscles, a mechanical ventilator with a tracheostomy tube was required. First, a cuffed tracheostomy tube and a speaking tracheostomy tube were insert...

Treatment of Snoring with a Nasopharyngeal Airway Tube

Directory of Open Access Journals (Sweden)

Macario Camacho

2016-01-01

Full Text Available Objective. To study the feasibility of a standard nasopharyngeal airway tube (NPAT as treatment for snoring. Methods. An obese 35-year-old man, who is a chronic, heroic snorer, used NPATs while (1 the patient’s bedpartner scored the snoring and (2 the patient recorded himself with the smartphone snoring app “Quit Snoring.” Baseline snoring was 8–10/10 (10 = snoring that could be heard through a closed door and interrupted the bedpartner’s sleep to the point where they would sometimes have to sleep separately and 60–200 snores/hr. Several standard NPATs were tested, consisting of soft polyvinyl chloride material raging between 24- and 36-French (Fr tubes. Results. The 24 Fr tube did not abate snoring. The 26 Fr tube was able to abate the snoring sound most of the night (smartphone app: 11.4 snores/hr, bedpartner VAS = 2/10. The 28 and 30 Fr tubes abated the snoring sound the entire time worn (smartphone app: 0 snores, bedpartner VAS 0/10 but could not be tolerated more than 2.5 hours. The tube of 36 Fr size could not be inserted, despite several attempts bilaterally. Conclusion. Appropriately sized nasopharyngeal airway tubes may abate the snoring sound; however, as in this patient, they may be too painful and intolerable for daily use.

Tube sheet design for PFBR steam generator

International Nuclear Information System (INIS)

Chellapandi, P.; Chetal, S.C.; Bhoje, S.B.

1991-01-01

Top and bottom tube sheets of PFBR Steam Generators have been analysed with 3D and axisymmetric models using CASTEM Programs. Analysis indicates that the effects of piping reactions at the inlet/outlet nozzles on the primary stresses in the tube sheets are negligible and the asymmetricity of the deformation pattern introduced in the tube sheet by the presence of inlet/outlet and manhole nozzles is insignificant. The minimum tube sheet thicknesses for evaporator and reheater are 135 mm and 75 mm respectively. Further analysis has indicated the minimum fillet radius at the junction of tube sheet and dished end should be 20 mm. Simplified methodology has been developed to arrive at the number of thermal baffles required to protect the tube sheet against fatigue damage due to thermal transient. This method has been applied to PFBR steam generators to determine the required number of thermal baffles. For protecting the bottom tube sheet of evaporator against the thermal shock due to feed water and secondary pump trip, one thermal shield is found to be sufficient. Further analysis is required to decide upon the actual number to take care of the severe thermal transient, following the event of sudden dumping of water/steam, immediately after the sodium-water reaction. (author)

Occult pneumothorax in blunt trauma: is there a need for tube thoracostomy?

Science.gov (United States)

Zhang, M; Teo, L T; Goh, M H; Leow, J; Go, K T S

2016-12-01

Occult pneumothorax (OPTX) is defined as air within the pleural cavity that is undetectable on normal chest X-rays, but identifiable on computed tomography. Currently, consensus is divided between tube thoracostomy and conservative management for OPTX. The aim of this retrospective study is to determine whether OPTX can be managed conservatively and whether any adverse events occur under conservative management. Data on all trauma patients from 1 Jan 2010 to 31 December 2012 were obtained from our hospital's trauma registry. All patients with occult pneumothorax who had chest X-ray (CXR) and any CT scan visualizing the thorax were included. The exclusion criteria included those with penetrating wounds; CXR showing pneumothorax, hemothorax, or hemopneumothorax; those with prophylactic chest tube insertion before CT; and those with no CT diagnosis of OPTX. The complications of these patients were analyzed to determine if tube thoracostomy is necessary for OPTX and whether not inserting it would alter the outcome significantly. A total of 1564 cases were reviewed and 83 patients were included. Of these 83 patients, 35 (42.2 %) had tube thoracostomy after OPTX detection and 48 (57.8 %) were observed initially. Patients who had tube thoracostomy had similar ISS compared to those without (median ISS 17 vs. 18.5, p = 0.436). Out of the 48 patients who did not have tube thoracostomy on detection of an OPTX, 4 (8.3 %) had complications. In the group of 35 patients who had tube thoracostomy on detection of an OPTX, 7 (20 %) had complications. Of the 83 patients, a total of 12 patients had IPPV, of which 7 (58.3 %) had tube thoracostomy and 5 (41.7 %) did not. Patients who had tube thoracostomy under our care have a statistically significant likelihood of experiencing any complication compared to those without tube thoracostomy (odds ratio 9.92. The median length of stay was also longer (13 days) in those who had tube thoracostomy compared to those without (5�

Simplified feeding appliance for an infant with cleft palate

Directory of Open Access Journals (Sweden)

Shaila Masih

2014-01-01

Full Text Available A child born with cleft palate may experience difficulties while feeding. Early surgical treatment may need to be postponed until certain age and weight gain of the infant. The case presented here is of a 1-month-old neonate born with cleft palate, assisted with a new feeding appliance made with ethylene vinyl acetate using pressure molding technique to aid in proper feeding. The patient′s weight and health significantly improved after the insertion of obturator. The advantages of this material included being lightweight, moldability, good palatal fit and decreased soft tissue injury.

Enteral feeding via jejunostomy as a cause of intestinal perforation and necrosis

Directory of Open Access Journals (Sweden)

María Victoria Vieiro-Medina

Full Text Available Background: Jejunostomy for enteral feeding is excellent for patients who cannot manage oral intake, with a low complication rate. A Foley catheter, Ryle tube, Kerh tube or needle-catheter (Jejuno-Cath® are commonly used. It is a safe procedure but it can lead to severe complications. Case report: We present two cases: firstly, an 80 year old male who was admitted to the Emergency Room with a bowel perforation secondary to Jejuno-Cath® for enteral feeding after a subtotal gastrectomy with Roux-en-Y reconstruction; and secondly, a 53 year old male who was admitted to the Emergency Room due to gastric perforation developing multiple complications, including bowel necrosis and enteral feeding impaction. Discussion: We have reviewed the recent literature with regard to this rare complication.

Method of reactivity control in pressure tube reactor

International Nuclear Information System (INIS)

Fukumura, Nobuo.

1988-01-01

Purpose: To provide a method of controlling reactivity in a pressure tube reactor at high conversion ratio intended for high burn-up degree. Method: Control tubes are inserted in heavy water moderator. Light water is filled in the tubes at the initial burning stage. Along with the advance of the burning, the light water is gradually removed and replaced with gases of less reactive nuclear reactivity with neutrons such as air or gaseous carbon dioxide. The tubes are made of less neutron absorbing material such as aluminum. By filling light water, infinite multiplication factor is reduced to suppress the reactivity at the initial burning stage. As light water is gradually removed and replaced with air, etc., it provides an effect like that elimination of heavy water moderator to increase the conversion ratio. Accordingly, nuclear fission materials are produced additionally by so much to extend the burn-up degree. In this way, it can provide excellent effect in realizing high burn-up ratio and high conversion ratio. (Kamimura, M.)

The Effects of Glucose Therapy Agents-Apple Juice, Orange Juice, and Cola-on Enteral Tube Flow and Patency.

Science.gov (United States)

Steinberg, Daphna J; Montreuil, Jasmine; Santoro, Andrea L; Zettas, Antonia; Lowe, Julia

2016-06-01

To develop evidence-based hypoglycemia treatment protocols in patients receiving total enteral nutrition, this study determined the effect on enteral tube flow of glucose therapy agents: apple juice, orange juice, and cola, and it also examined the effects of tube type and feed type with these glucose therapy agents. For this study, 12 gastrostomy tubes (6 polyethylene and 6 silicone) were set at 50 mL/h. Each feeding set was filled with Isosource HN with fibre or Novasource Renal. Each tube was irrigated with 1 glucose therapy agent, providing approximately 20 g of carbohydrate every 4 h. Flow-rate measurements were collected at 2 h intervals. The results showed that the glucose therapy agent choice affected flow rates: apple juice and cola had higher average flow rates than orange juice (P = 0.01). A significant difference was found between tube type and enteral formula: polyethylene tubes had higher average flow rates than silicone tubes (P orange juice, and thus may be considered as primary treatment options for hypoglycemia in enterally fed patients. Polyethylene tubes and Isosource HN with fibre were less likely to clog than silicone tubes and Novasource Renal.

Comparative Assessment of Cutting Inserts and Optimization during Hard Turning: Taguchi-Based Grey Relational Analysis

Science.gov (United States)

Venkata Subbaiah, K.; Raju, Ch.; Suresh, Ch.

2017-08-01

The present study aims to compare the conventional cutting inserts with wiper cutting inserts during the hard turning of AISI 4340 steel at different workpiece hardness. Type of insert, hardness, cutting speed, feed, and depth of cut are taken as process parameters. Taguchi’s L18 orthogonal array was used to conduct the experimental tests. Parametric analysis carried in order to know the influence of each process parameter on the three important Surface Roughness Characteristics (Ra, Rz, and Rt) and Material Removal Rate. Taguchi based Grey Relational Analysis (GRA) used to optimize the process parameters for individual response and multi-response outputs. Additionally, the analysis of variance (ANOVA) is also applied to identify the most significant factor.

Chest tube placement in thorax trauma - comparison chest X-ray and computed tomography (CT)

International Nuclear Information System (INIS)

Heim, P.; Maas, R.; Buecheler, E.; Tesch, C.

1998-01-01

Estimation of chest tube placement in patients with thoracic trauma with regard to chest tube malposition in chest radiography in the supine position compared to additional computed tomography of the thorax. Material and methods: Apart from compulsory chest radiography after one or multiple chest tube insertions, 31 severely injured patients with thoracic trauma underwent a CT scan of the thorax. These 31 patients with 40 chest tubes constituted the basis for the present analysis. Results: In chest radiography in the supine position there were no chest tube malpositions (n=40); In the CT scans 25 correct positions, 7 pseudo-malpositions, 6 intrafissural and 2 intrapulmonary malpositions were identified. Moreover 16 sufficient, 18 insufficient and 6 indifferent functions of the chest tubes were seen. Conclusion: In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a CT scan of the thorax in order to estimate the position of the chest tube. (orig.) [de

Flow induced vibrations in gas tube assembly of centrifuge

International Nuclear Information System (INIS)

Alam, M.; Atta, M.A.; Mirza, J.A.; Khan, A.Q.

1986-01-01

A centrifuge essentially consists of a rotor rotating at very high speed. Gas tube assembly, located at the center of the rotor, is used to introduce feed gas into the rotor and remove product and waste streams from it. The gas tube assembly is thus a static component, the product and waste scoops of which are lying in the high pressure region of a fluid rotating at very high speed. This can cause flow induced vibrations in the gas tube assembly. Such vibrations affect not only the mechanical stability of the gas tube assembly but may also reduce the separative power of the centrifuge. In a cascade, if some of the centrifuges have gas tube vibration, then cascade performance will be affected. A theoretical analysis of the effect of waste tube vibrations on product and waste flow rates and pressures in the centrifuge is presented. A simple stage consisting of two centrifuges, in which one has tube vibration, is considered for this purpose. The results are compared with experiment. It is shown that waste tube vibration generates oscillations in waste and product flow rates that are observable outside the centrifuge. (author)

A Note regarding Problems with Interaction and Varying Block Sizes in a Comparison of Endotracheal Tubes

Directory of Open Access Journals (Sweden)

Richard L. Einsporn

2014-01-01

Full Text Available A randomized clinical experiment to compare two types of endotracheal tubes utilized a block design where each of the six participating anesthesiologists performed tube insertions for an equal number of patients for each type of tube. Five anesthesiologists intubated at least three patients with each tube type, but one anesthesiologist intubated only one patient per tube type. Overall, one type of tube outperformed the other on all three effectiveness measures. However, analysis of the data using an interaction model gave conflicting and misleading results, making the tube with the better performance appear to perform worse. This surprising result was caused by the undue influence of the data for the anesthesiologist who intubated only two patients. We therefore urge caution in interpreting results from interaction models with designs containing small blocks.

TRACY transient experiment databook. 3) Ramp feed experiment

Energy Technology Data Exchange (ETDEWEB)

Nakajima, Ken; Yamane, Yuichi; Ogawa, Kazuhiko; Aizawa, Eiju; Yanagisawa, Hiroshi; Miyoshi, Yoshinori [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

2002-03-01

This is a databook of TRACY ''ramp feed'' experiments. TRACY is a reactor to perform supercritical experiments using low-enriched uranyl nitrate aqueous solution. The excess reactivity of TRACY is 3$ at maximum, and it is inserted by feeding the solution to a core tank or by withdrawing a control rod, which is called as the transient rod, from the core. In the ramp feed experiment, the supercritical experiment is initiated by feeding the fuel solution to the core tank in a constant feed rate. The data in the present databook consist of datasheets and graphs. Experimental conditions and typical values of measured parameters are tabulated in the datasheet. In the graph, power and temperature profiles are plotted. Those data are useful for the investigation of criticality accidents with fissile solutions, and for validation of criticality accident analysis codes. (author)

Medical image of the week: Dobhoff tube placement with Roux-en-Y gastric bypass

Directory of Open Access Journals (Sweden)

Ali H

2018-04-01

Full Text Available No abstract available. Article truncated after 150 words. Roux-en-Y gastric bypass is one of the most commonly performed bariatric operations in the United States. It involves partitioning a small gastric pouch off the proximal stomach and attaching that pouch directly to the intestine, thereby bypassing the large remainder of the stomach (1,2. Placing a Dobhoff tube (DHT and confirming its placement can be challenging due to the change in anatomy after the procedure. Here, we have a 65-year-old woman who presented to the hospital with acute encephalopathy and acute hypoxic respiratory failure due to multifocal pneumonia requiring intubation and prolonged ICU stay. A DHT was inserted after intubation for feeding purposes. An abdominal X-ray was obtained to confirm placement of the DHT (Figure 1. Normally the DHT tip should be placed in the 2nd to 3rd portion of the duodenum and would create a C-shaped tracing on the X-ray. However, in our patient who had history of Roux-en-Y …

Continuous nasogastric tube feeding: monitoring by combined use of refractometry and traditional gastric residual volumes.

Science.gov (United States)

Chang, W-K; McClave, S-A; Chao, Y-C

2004-02-01

Traditional use of gastric residual volumes (GRVs) is insensitive and cannot distinguish retained enteral formula from the large volume of endogenous secretions. We designed this prospective study to determine whether refractometry and Brix value (BV) measurements could be used to monitor gastric emptying and tolerance in patients receiving continuous enteral feeding. Thirty-six patients on continuous nasogastric tube feeding were divided into two groups; patients with lower GRVs (75 ml) in Group 2. Upon entry, all gastric contents were aspirated, the volume was recorded (Asp GRV), BV measurements were made by refractometry, and then the contents were reinstilled but diluted with 30 ml additional water. Finally, a small amount was reaspirated and repeat BV measurements were made. Three hours later, the entire procedure was repeated a second time. The BV ratio, calculated (Cal) GRV, and volume of formula remaining were calculated by derived equations. Mean BV ratios were significantly higher for those patients in Group 2 compared to those in Group 1. All but one of the 22 patients (95%) in Group 1 had a volume of formula remaining in the stomach estimated on both measurements to be less than the hourly infusion rate (all these patients had BV ratios 70%). Three of the Group 2 patients (21%) whose initial measurement showed evidence for retention of formula, improved on repeat follow-up measurement assuring adequate gastric emptying. The remaining five patients from Group 2 (35%) had a volume of formula remaining that was less than the hourly infusion rate on both measurements. The pattern of Asp GRVs and serial pre- and post-dilution BVs failed to differentiate these patients in Group 2 with potential emptying problems from those with sufficient gastric emptying. Refractometry and measurement of the BV may improve the clinical utilization of GRVs, by its ability to identify the component of formula within gastric contents and track changes in that component related

Estimation of optimal nasotracheal tube depth in adult patients.

Science.gov (United States)

Ji, Sung-Mi

2017-12-01

The aim of this study was to estimate the optimal depth of nasotracheal tube placement. We enrolled 110 patients scheduled to undergo oral and maxillofacial surgery, requiring nasotracheal intubation. After intubation, the depth of tube insertion was measured. The neck circumference and distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch were measured. To estimate optimal tube depth, correlation and regression analyses were performed using clinical and anthropometric parameters. The mean tube depth was 28.9 ± 1.3 cm in men (n = 62), and 26.6 ± 1.5 cm in women (n = 48). Tube depth significantly correlated with height (r = 0.735, P < 0.001). Distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch correlated with depth of the endotracheal tube (r = 0.363, r = 0.362, and r = 0.546, P < 0.05). The tube depth also correlated with the sum of these distances (r = 0.646, P < 0.001). We devised the following formula for estimating tube depth: 19.856 + 0.267 × sum of the three distances (R 2 = 0.432, P < 0.001). The optimal tube depth for nasotracheally intubated adult patients correlated with height and sum of the distances from nares to tragus, tragus to angle of the mandible, and angle of the mandible to sternal notch. The proposed equation would be a useful guide to determine optimal nasotracheal tube placement.

Application of small intestine decompression combined with oral feeding in middle and late period of malignant small bowel obstruction.

Science.gov (United States)

Li, Dechun; Du, Hongtao; Shao, Guoqing; Guo, Yongtuan; Lu, Wan; Li, Ruihong

2017-07-01

The application value of small intestine decompression combined with oral feeding in the middle and late period of malignant small bowel obstruction was examined. A total of 22 patients with advanced malignant small bowel obstruction were included in the present study. An ileus tube was inserted via the nose under fluoroscopy into the obstructed small intestine of each patient. At the same time, the insertion depth the of the catheter was adjusted. When the catheter was blocked, small bowel selective angiography was performed to determine the location and cause of the obstruction and the extent of the obstruction, and to determine the length of the small intestine in the site of obstruction, and to select the variety and tolerance of enteral nutrition. We observed the decompression tube flow and ease of intestinal obstruction. In total, 20 patients were treated with oral enteral nutrition after abdominal distension, and 22 cases were treated by the nose to observe the drainage and the relief of intestinal obstruction. The distal end of the catheter was placed in a predetermined position. The symptoms of intestinal obstruction were relieved 1-4 days after decompression. The 22 patients with selective angiography of the small intestine showed positive X-ray signs: 18 patients with oral enteral nutrition therapy had improved the nutritional situation 2 weeks later. In 12 cases, where there was anal defecation exhaust, 2 had transient removal of intestinal obstruction catheter. In conclusion, this comprehensive treatment based on small intestine decompression combined with enteral nutrition is expected to become a new therapeutic approach and method for the treatment of patients with advanced tumor small bowel obstruction.

Thoracostomy tubes: A comprehensive review of complications and related topics

Science.gov (United States)

Kwiatt, Michael; Tarbox, Abigail; Seamon, Mark J.; Swaroop, Mamta; Cipolla, James; Allen, Charles; Hallenbeck, Stacinoel; Davido, H. Tracy; Lindsey, David E.; Doraiswamy, Vijay A.; Galwankar, Sagar; Tulman, David; Latchana, Nicholas; Papadimos, Thomas J.; Cook, Charles H.; Stawicki, Stanislaw P.

2014-01-01

Tube thoracostomy (TT) placement belongs among the most commonly performed procedures. Despite many benefits of TT drainage, potential for significant morbidity and mortality exists. Abdominal or thoracic injury, fistula formation and vascular trauma are among the most serious, but more common complications such as recurrent pneumothorax, insertion site infection and nonfunctioning or malpositioned TT also represent a significant source of morbidity and treatment cost. Awareness of potential complications and familiarity with associated preventive, diagnostic and treatment strategies are fundamental to satisfactory patient outcomes. This review focuses on chest tube complications and related topics, with emphasis on prevention and problem-oriented approaches to diagnosis and treatment. The authors hope that this manuscript will serve as a valuable foundation for those who wish to become adept at the management of chest tubes. PMID:25024942

Sampling of high molecular weight hydrocarbons with adsorbent tubes

International Nuclear Information System (INIS)

Stroemberg, B.

1996-12-01

Adsorption tubes have been used to determine the content of hydrocarbons in gas samples from small scale combustion and gasification of biomass. Compounds from benzene (mw 78) to indeno (1,2,3-cd) pyrene (mw 276) have been examined. The results show that it is possible to analyze polyaromatic hydrocarbons (PAH) with 4 aromatic rings (mw 202). Detection limits for these compounds are 3 . PAH with higher molecule weight can be identified and quantified in samples with high amounts of PAH e.g. at gasification of biomass. Sampling on adsorption tubes is extremely quick and easy. The tube is inserted in the gas of interest and the sample is sucked through the tube with a pump. Sampling times of 2-10 minutes are often sufficient. High moisture content in the gas may result in losses of the most volatile compounds, when drying. Even very low concentrations of water in the tube may cause ice formation in the cold-trap and the sample will be destroyed. The analysis is unfortunately time-consuming because the desorption oven must be cooled between every analysis. This will reduce the number of samples which can be analyzed per day. The tubes can be stored for several weeks before analysis without deterioration. 4 refs, 5 figs, 3 tabs

DWPF Sample Vial Insert Study-Statistical Analysis of DWPF Mock-Up Test Data

Energy Technology Data Exchange (ETDEWEB)

Harris, S.P. [Westinghouse Savannah River Company, AIKEN, SC (United States)

1997-09-18

This report is prepared as part of Technical/QA Task Plan WSRC-RP-97-351 which was issued in response to Technical Task Request HLW/DWPF/TTR-970132 submitted by DWPF. Presented in this report is a statistical analysis of DWPF Mock-up test data for evaluation of two new analytical methods which use insert samples from the existing HydragardTM sampler. The first is a new hydrofluoric acid based method called the Cold Chemical Method (Cold Chem) and the second is a modified fusion method.Either new DWPF analytical method could result in a two to three fold improvement in sample analysis time.Both new methods use the existing HydragardTM sampler to collect a smaller insert sample from the process sampling system. The insert testing methodology applies to the DWPF Slurry Mix Evaporator (SME) and the Melter Feed Tank (MFT) samples.The insert sample is named after the initial trials which placed the container inside the sample (peanut) vials. Samples in small 3 ml containers (Inserts) are analyzed by either the cold chemical method or a modified fusion method. The current analytical method uses a HydragardTM sample station to obtain nearly full 15 ml peanut vials. The samples are prepared by a multi-step process for Inductively Coupled Plasma (ICP) analysis by drying, vitrification, grinding and finally dissolution by either mixed acid or fusion. In contrast, the insert sample is placed directly in the dissolution vessel, thus eliminating the drying, vitrification and grinding operations for the Cold chem method. Although the modified fusion still requires drying and calcine conversion, the process is rapid due to the decreased sample size and that no vitrification step is required.A slurry feed simulant material was acquired from the TNX pilot facility from the test run designated as PX-7.The Mock-up test data were gathered on the basis of a statistical design presented in SRT-SCS-97004 (Rev. 0). Simulant PX-7 samples were taken in the DWPF Analytical Cell Mock

Enhancement of acoustical performance of hollow tube sound absorber

International Nuclear Information System (INIS)

Putra, Azma; Khair, Fazlin Abd; Nor, Mohd Jailani Mohd

2016-01-01

This paper presents acoustical performance of hollow structures utilizing the recycled lollipop sticks as acoustic absorbers. The hollow cross section of the structures is arranged facing the sound incidence. The effects of different length of the sticks and air gap on the acoustical performance are studied. The absorption coefficient was measured using impedance tube method. Here it is found that improvement on the sound absorption performance is achieved by introducing natural kapok fiber inserted into the void between the hollow structures. Results reveal that by inserting the kapok fibers, both the absorption bandwidth and the absorption coefficient increase. For test sample backed by a rigid surface, best performance of sound absorption is obtained for fibers inserted at the front and back sides of the absorber. And for the case of test sample with air gap, this is achieved for fibers introduced only at the back side of the absorber.

Enhancement of acoustical performance of hollow tube sound absorber

Energy Technology Data Exchange (ETDEWEB)

Putra, Azma, E-mail: azma.putra@utem.edu.my; Khair, Fazlin Abd, E-mail: fazlinabdkhair@student.utem.edu.my; Nor, Mohd Jailani Mohd, E-mail: jai@utem.edu.my [Centre for Advanced Research on Energy, Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya, Durian Tunggal Melaka 76100 Malaysia (Malaysia)

2016-03-29

This paper presents acoustical performance of hollow structures utilizing the recycled lollipop sticks as acoustic absorbers. The hollow cross section of the structures is arranged facing the sound incidence. The effects of different length of the sticks and air gap on the acoustical performance are studied. The absorption coefficient was measured using impedance tube method. Here it is found that improvement on the sound absorption performance is achieved by introducing natural kapok fiber inserted into the void between the hollow structures. Results reveal that by inserting the kapok fibers, both the absorption bandwidth and the absorption coefficient increase. For test sample backed by a rigid surface, best performance of sound absorption is obtained for fibers inserted at the front and back sides of the absorber. And for the case of test sample with air gap, this is achieved for fibers introduced only at the back side of the absorber.

Optimizing the Thermoacoustic Pulse Tube Refrigerator Performances

Directory of Open Access Journals (Sweden)

E. V. Blagin

2014-01-01

Full Text Available The article deals with research and optimization of the thermoacoustic pulse tube refrigerator to reach a cryogenic temperature level. The refrigerator is considered as a thermoacoustic converter based on the modified Stirling cycle with helium working fluid. A sound pressure generator runs as a compressor. Plant model comprises an inner heat exchanger, a regenerative heat exchanger, a pulse tube, hot and cold heat exchangers at its ends, an inertial tube with the throttle, and a reservoir. A model to calculate the pulse tube thermoacoustic refrigerator using the DeltaEC software package has been developed to be a basis for calculation techniques of the pulse tube refrigerator. Momentum, continuity, and energy equations for helium refrigerant are solved according to calculation algorithm taking into account the porosity of regenerator and heat exchangers. Optimization of the main geometric parameters resulted in decreasing temperature of cold heat exchanger by 41,7 K. After optimization this value became equal to 115,01 K. The following parameters have been optimized: diameters of the feeding and pulse tube and heat exchangers, regenerator, lengths of the regenerator and pulse and inertial tubes, as well as initial pressure. Besides, global minimum of temperatures has been searched at a point of local minima corresponding to the optimal values of abovementioned parameters. A global-local minima difference is 0,1%. Optimized geometric and working parameters of the thermoacoustic pulse tube refrigerator are presented.

Tube thoracostomy in the management of pleural fluid collections.

Science.gov (United States)

Nwofor, A M E; Ekwunife, C N

2006-06-01

To determine the demographic pattern, indications and complications associated with tube thoracostomy in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. A 5-year review of case records of patients who underwent tube thoracostomy at NAUTH Nnewi between January 1999 and December 2003. Demographic data, clinical features, duration of drainage, complications and outcomes were analyzed. A total of 65 cases were studied, male: female ratio was 2.4:1. Eighteen patients (27.7%) were below 10 years of age. Infective cases accounted for 63.1% (41) of the cases that had tube thoracostomy. Forty-one patients (63.1%) had tube drainage for 10 days or less. Complication rate was 41.5% (27), mostly mild, with dislodgement of the tube accounting for about half. Failure rate of 13.7% (9) was recorded for the procedure. A mortality of 6.2% (4) was recorded but there was no procedure related death. Seven patients (10.8%) required further surgery. Tube thoracostomy is a simple and efficacious procedure for the treatment of pleural space collections. The safety of the procedure can be improved upon by adequate training in the insertion procedure, while proper selection of cases will reduce failure rate and unnecessary morbidity. Early resort to thoracoscopic or open surgery when tube thoracostomy is considered inappropriate or has failed will improve the success rate in the overall management of pleural fluid collections.

Chest tube care in critically ill patient: A comprehensive review

Directory of Open Access Journals (Sweden)

Hanan Mohammed Mohammed

2015-10-01

Full Text Available Breathing is automatic. We don’t usually think too much about it unless we develop a problem. Lack of adequate ventilation and impairment of our respiratory system can quickly become life-threatening. There are many clinical conditions that may necessitate the use of chest tubes. When there is an accumulation of positive pressure in the chest cavity (where it should normally be negative pressure between pleurae, a patient will require chest drainage. Chest tubes may be inserted to drain body fluids or to facilitate the re-expansion of a lung. It is important for the clinician to determine the most appropriate tube size to use prior to intubation. The position of the chest tube is related to the function that the chest tube performs. When managing the care of patients who have chest tubes it is important to fully understand what to do in case problems arise. It is also important to be able to assess when the chest tube is ready to be discontinued. Nurses and other healthcare professionals who are responsible for the safe delivery of care should be knowledgeable about respiratory pathophysiology, signs of respiratory compromise, and the care and management of interventions that may be utilized to ensure adequate respiration.

An Intraoral Miniature X-ray Tube Based on Carbon Nanotubes for Dental Radiography

Directory of Open Access Journals (Sweden)

Hyun Jin Kim

2016-06-01

Full Text Available A miniature X-ray tube based on a carbon-nanotube electron emitter has been employed for the application to a dental radiography. The miniature X-ray tube has an outer diameter of 7 mm and a length of 47 mm. The miniature X-ray tube is operated in a negative high-voltage mode in which the X-ray target is electrically grounded. In addition, X-rays are generated only to the teeth directions using a collimator while X-rays generated to other directions are shielded. Hence, the X-ray tube can be safely inserted into a human mouth. Using the intra-oral X-ray tube, a dental radiography is demonstrated where the positions of an X-ray source and a sensor are reversed compared with a conventional dental radiography system. X-ray images of five neighboring teeth are obtained and, furthermore, both left and right molar images are achieved by a single X-ray shot of the miniature X-ray tube.

An intraoral miniature x-ray tube based on carbon nanotubes for dental radiography

International Nuclear Information System (INIS)

Kim, Hyun Jin; Kim, Hyun Nam; Raza, Hamid Saeed; Park, Han Beom; Cho, Sung Oh

2016-01-01

A miniature X-ray tube based on a carbon-nanotube electron emitter has been employed for the application to a dental radiography. The miniature X-ray tube has an outer diameter of 7 mm and a length of 47 mm. The miniature X-ray tube is operated in a negative high-voltage mode in which the X-ray target is electrically grounded. In addition, X-rays are generated only to the teeth directions using a collimator while X-rays generated to other directions are shielded. Hence, the X-ray tube can be safely inserted into a human mouth. Using the intra-oral X-ray tube, a dental radiography is demonstrated where the positions of an X-ray source and a sensor are reversed compared with a conventional dental radiography system. X-ray images of five neighboring teeth are obtained and, furthermore, both left and right molar images are achieved by a single X-ray shot of the miniature X-ray tube

An intraoral miniature x-ray tube based on carbon nanotubes for dental radiography

Energy Technology Data Exchange (ETDEWEB)

Kim, Hyun Jin; Kim, Hyun Nam; Raza, Hamid Saeed; Park, Han Beom; Cho, Sung Oh [Dept. of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

2016-06-15

A miniature X-ray tube based on a carbon-nanotube electron emitter has been employed for the application to a dental radiography. The miniature X-ray tube has an outer diameter of 7 mm and a length of 47 mm. The miniature X-ray tube is operated in a negative high-voltage mode in which the X-ray target is electrically grounded. In addition, X-rays are generated only to the teeth directions using a collimator while X-rays generated to other directions are shielded. Hence, the X-ray tube can be safely inserted into a human mouth. Using the intra-oral X-ray tube, a dental radiography is demonstrated where the positions of an X-ray source and a sensor are reversed compared with a conventional dental radiography system. X-ray images of five neighboring teeth are obtained and, furthermore, both left and right molar images are achieved by a single X-ray shot of the miniature X-ray tube.

[Use of the Pentax-AWS videolaryngoscope for bougie-assisted exchange of tracheal tubes].

Science.gov (United States)

Kishii, Miki; Asai, Takashi; Nagata, Atsushi; Shingu, Koh

2009-06-01

A gum elastic bougie can be useful for tube exchange. One major problem with this technique is that it may not possible to pass a new tube over the bougie into the trachea, because the tip of the tube can collide with tissues around the glottis. We report a case in which tube exchange using the bougie was difficult, but the Pentax-AWS videolaryngoscope enabled tracheal intubation. In a 62-year-old trauma patient with head and neck stabilized using a Halo vest, was scheduled for emergency fixation of the neck. Exchange of a polyvinylchloride tube to a reinforced tube was planned. A bougie was passed through the old tube, removing the tube, and a new tube was advanced over the bougie, but it was impossible to advance the tube into the trachea. Insertion of a Macintosh laryngoscope did not enable intubation. The new tube was removed from the bougie, attached to the Pentax-AWS videolaryngoscope, and the tube (with the Pentax-AWS) was passed over the bougie. Although it was not possible to see the glottis with the Pentax-AWS, the tube was easily advanced over the bougie into the trachea. Operation went on uneventfully. We believe that, when it is difficult to advance a tracheal tube over a tube exchanger, the use of the Pentax-AWS may facilitate intubation.

The use of radiologically placed gastroctomy tubes in head and neck cancer patients receiving radiotherapy

International Nuclear Information System (INIS)

Tyldesley, Scott; Sheehan, Finbarr; Munk, Peter; Tsang, Victor; Skarsgard, David; Bowman, Carol A.; Hobenshield, Shirley E.

1996-01-01

Purpose: Patients undergoing radiotherapy to the head and neck area frequently experience radiation reactions that can markedly restrict oral intake, require hospitalization, and occasionally cause treatment interruptions. The Vancouver Cancer Center (VCC) has recently employed radiologically placed gastrostomy tubes (G-tubes) in the management of this problem. A review of the patients on whom this procedure had been performed is the subject of this review. Methods and Materials: Thirty-four patients had gastrostomy tubes inserted under radiologic guidance. This group is compared to a control group matched for age, sex, irradiated volume, and radiation dose, who did not have gastrostomy tubes. Patients with gastrostomy tubes were divided into two categories: (a) patients who had tubes inserted in anticipation of severe reactions, and (b) patients who developed severe radiation reactions necessitating nutritional support. Results: The gastrostomy group consisted of 65% males with an average age of 59 years and stage range of II (12%), III (24%), and IV (65%). In both the elective group and the nonelective group, patients maintained their weight at 95 to 97% of the pretreatment weight, at follow-up of 6 weeks and 3 months. This compared with an average weight loss in the control group of 9% at 6 weeks and 12% at 3 months. The length of hospitalization was a mean of 4.9 days in the elective group and 19 days in the nonelective group. Complication were low compared to those documented in the literature, but included two tube migrations, two aspirations, and one gastrointestinal bleed. Conclusions: We believe that gastrostomy tubes contribute significantly to the management of patients with head and neck cancer, particularly in maintenance of nutrition, and they may decrease the need for hospitalization

18-gauge needle cap as adjunct to prevent kinking of endotracheal tube.

Science.gov (United States)

Chan, Fuan Chiang; Kawamoto, Henry K; Bradley, James P

2012-11-01

A self-retaining Dingman mouth retractor is widely used to keep the mouth open during cleft palate and intraoral surgery. The airway is at risk of being crushed or occluded as the gag (tongue plate) of the Dingman mouth retractor is being pushed against the endotracheal tube.Kinking of the endotracheal tube between the teeth and Dingman mouth retractor has been reported even with the oral Ring-Adair-Elwyn or flexometallic or armored endotracheal tubes. To minimize kinking of the endotracheal tube and its consequent complications, we routinely insert an 18-gauge needle cap at the potential space between the teeth and the tongue plate (gag) of the Dingman mouth retractor, which is situated lateral to the endotracheal tube. In our experience of approximately 5000 intraoral cases using a Dingman mouth retractor and 18-gauge needle cap, we have not had any tooth avulsion or aspiration of the 18-gauge foreign body while maintaining a consistent and secured airway during cleft palate and intraoral surgery.

Difficulty with cuff deflation of reinforced tracheal tube caused by inflation line occlusion with silk thread ligation and fixation.

Science.gov (United States)

Gotoh, Sayoko; Sugiyama, Daisuke; Imai, Eriko; Kawamata, Mikito

2015-03-05

A reinforced tracheal tube, ligated with silk threads, was inserted into a tracheostomy orifice and fixed to the skin. The cuff inflation line of the reinforced tracheal tube became occluded. Reinforced 'armoured' tracheal tubes have a spiral of wire embedded into the wall of the tube to give strength and flexibility, and may be sharply bent without compromising the tube lumen. The tracheal cuff attached to the tube is inflated by injecting air through a narrow-diameter tube welded to the outside of the tracheal tube. When a reinforced tracheal tube is ligated and fixed with silk threads, it should be confirmed whether the tracheal tube cuff can be deflated and inflated after fixation. Moreover, because occlusion can be eliminated by removing all silk threads used to ligate a tracheal tube, they should be removed before extubation. 2015 BMJ Publishing Group Ltd.

TJC: plan and prepare for the transition to new tubing connectors to minimize the risk of dangerous misconnections, clinician frustration.

Science.gov (United States)

2014-12-01

To reduce the risk of dangerous tubing misconnections, the ISO is rolling out new tubing connector standards that will eventually make it nearly impossible for tubing associated with one delivery system to be connected to a delivery system that serves a different purpose. Experts welcome the change, noting that tubing misconnections that cause injury and even death have been happening for years. However, TJC has issued a Sentinel Event Alert, warning that health care organizations need to be vigilant in managing the risk posed by these misconnections during the phased-in transition to the new connectors. Experts explain that tubing misconnections occur because many different types of tubing utilize the same Leur connector, making it possible for a clinician to mistakenly connect a tube to the wrong delivery system. The most common type of tubing misconnection reported to the ISMP is when a clinician wants to administer something to a patient through a feeding tube, but accidently administers the substance through an IV tube instead. The first new connector, called the ENFit, is going to be for enteral feeding tubes. It will not connect to IV tubing, making that type of misconnection unlikely. The new connector should be available early next year. Since hospitals will continue to use older tubing until their supplies are exhausted, manufacturers will temporarily provide adapters capable of making new administration sets compatible with older tubing.

Effect of the collector tube profile on Pitot pump performances

Science.gov (United States)

Komaki, K.; Kanemoto, T.; Sagara, K.; Umekage, T.

2013-12-01

The pitot pump is composed of the rotating casing with the impeller channel and the pitot tube type collector as the discharge line. The radial impeller feeds water to the rotating casing. The water rotating together with the casing is caught by the stationary pitot tube type collector, and then discharges to the outside. This type pump, as the extra high head pump, is provided mainly for boiler feed systems, and has been designed by trial and error. To optimize the pump profiles, it is desirable to investigate not only performances but also internal flow conditions. This paper discusses experimentally and numerically the relation between the pump performances and the flow conditions in the rotating casing. The moderately larger dimensions of the collector make the pump head and the discharge high with the higher hydraulic efficiency. The flow in the casing is almost the forced vortex type whose velocity is in proportion to the radius but the core velocity is affected with the drag force of the stationary collector. Based upon the above results, the profile of the pitot tube type collector was optimized with the numerical simulation.

Effect of the collector tube profile on Pitot pump performances

International Nuclear Information System (INIS)

Komaki, K; Sagara, K; Kanemoto, T; Umekage, T

2013-01-01

The pitot pump is composed of the rotating casing with the impeller channel and the pitot tube type collector as the discharge line. The radial impeller feeds water to the rotating casing. The water rotating together with the casing is caught by the stationary pitot tube type collector, and then discharges to the outside. This type pump, as the extra high head pump, is provided mainly for boiler feed systems, and has been designed by trial and error. To optimize the pump profiles, it is desirable to investigate not only performances but also internal flow conditions. This paper discusses experimentally and numerically the relation between the pump performances and the flow conditions in the rotating casing. The moderately larger dimensions of the collector make the pump head and the discharge high with the higher hydraulic efficiency. The flow in the casing is almost the forced vortex type whose velocity is in proportion to the radius but the core velocity is affected with the drag force of the stationary collector. Based upon the above results, the profile of the pitot tube type collector was optimized with the numerical simulation

Propellant Feed System for Swirl-Coaxial Injection

Science.gov (United States)

Reynolds, David Christopher (Inventor)

2015-01-01

A propellant feed system for swirl-coaxial injection of a liquid propellant includes a reservoir having a bottom plate and at least one tube originating in the bottom plate and extending therefrom. The tube has rectangular slits defined in and distributed tangentially and evenly about a portion of the tube that is disposed in the bottom plate. Drain holes are provided in the bottom plate and tunnels are defined in the bottom plate. Each tunnel fluidly couples one of the drain holes to a corresponding one of the rectangular slits. Each tunnel includes (i) a bend of at least 90.degree., and (ii) a straight portion leading to its corresponding rectangular slit wherein the straight portion is at least five times as long as a hydraulic diameter of the corresponding rectangular slit.

Performance of Silicon carbide whisker reinforced ceramic inserts on Inconel 718 in end milling process

International Nuclear Information System (INIS)

Reddy, M M; Joshua, C X H

2016-01-01

An experimental investigation is planned in order to study the machinability of Inconel 718 with silicon carbide whisker reinforced ceramic inserts in end milling process. The relationship between the cutting speed, feed rate, and depth of cut against the response factors are studied to show the level of significance of each parameter. The cutting parameters are optimized by using Taguchi method. Implementing analysis of variance, the parameter which influences the surface roughness the most is determined to be the cutting speed, followed by the feed rate and depth of cut. Meanwhile, the optimal cutting condition is determined to have high cutting speed, low feed rate, and high depth of cut in the range of selected parameters. (paper)

Responsive versus scheduled feeding for preterm infants.

Science.gov (United States)

Watson, Julie; McGuire, William

2015-10-13

Feeding preterm infants in response to their hunger and satiation cues (responsive, cue-based, or infant-led feeding) rather than at scheduled intervals might enhance infants' and parents' experience and satisfaction, help in the establishment of independent oral feeding, increase nutrient intake and growth rates, and allow earlier hospital discharge. To assess the effect of feeding preterm infants on a responsive basis versus feeding prescribed volumes at scheduled intervals on growth, duration of hospital stay, and parental satisfaction. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 9, 2015), MEDLINE (1966 to September 2015), EMBASE (1980 to September 2015), and CINAHL (1982 to September 2015), conference proceedings, previous reviews, and trial registries. Randomised controlled trials (RCTs) or quasi-RCTs that compared a policy of feeding preterm infants on a responsive basis versus feeding at scheduled intervals. Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio and risk difference for dichotomous data and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in sensitivity analyses. We found nine eligible RCTs including 593 infants in total. These trials compared responsive with scheduled interval regimens in preterm infants in the transition phase from intragastric tube to oral feeding. The trials were generally small and contained various methodological weaknesses including lack of blinding and incomplete assessment of all randomised participants. Meta-analyses, although limited by data quality and availability, suggest that responsive feeding

Measurement and computation for sag of calandria tube due to irradiation creep in PHWR

International Nuclear Information System (INIS)

Son, S. M.; Lee, W. R.; Lee, S. K.; Lee, J. S.; Kim, T. R.; Na, B. K.; Namgung I.

2003-01-01

Calandria tubes and Liquid Injection Shutdown System(LISS) tubes in a Pressurized Heavy Water Reactor(PHWR) are to sag due to irradiation creep and growth during plant operation. When the sag of calandria tube becomes bigger, the calandria tube possibly comes in contact with LISS tube crossing beneath the calandria tube. The contact subsequently may cause the damage on the calandria tube resulting in unpredicted outage of the plant. It is therefore necessary to check the gap between the two tubes in order to periodically confirm no contact by using a proper measure during the plant life. An ultrasonic gap measuring probe assembly which can be inserted into two viewing ports of the calandria was developed in Korea and utilized to measure the sags of both tubes in the PHWR. It was found that the centerlines of calandria tubes and liquid injection shutdown system tubes can be precisely detected by ultrasonic wave. The gaps between two tubes were easily obtained from the relative distance of the measured centerline elevations of the tubes. Based on the irradiation creep equation and the measurement data, a computer program to calculate the sags was also developed. With the computer program, the sag at the end of plant life was predicted

Hydrogen adsorption in microporous alkali-doped carbons (single-wall carbon nano-tubes and activated carbons)

International Nuclear Information System (INIS)

Laurent Duclaux; Szymon Los; Michel Letellier; Philippe Azais; Roland Pellenq; Thomas Roussel; Xavier Fuhr

2006-01-01

Doping of microporous carbon by Li or K leads to an increase in the energy of adsorption of H 2 or D 2 molecules. Thus, the room temperature sorption capacities (at P≤3 MPa) can be higher than the ones of the raw materials after slight doping. However, the maximum H 2 (or D 2 ) storage uptake measured at T≤ 77 K is lower than the one of pristine materials as the sites of adsorption are occupied by alkali ions inserted in the micropores. The microporous adsorption sites of doped single-walled carbon nano-tubes, identified by neutron diffraction, are both the interstitial voids (in electric-arc or HiPCO tubes) in between the tubes and the central canals of the tubes (only in HiPCO tubes). (authors)

Gastric Outlet Obstruction Caused by Foley Catheter: A Complication when Substituting for Commercial Gastrostomy Tubes

Directory of Open Access Journals (Sweden)

Amanda B. Lewis

2018-01-01

Full Text Available The technique of using percutaneous endoscopic gastrostomy (PEG for long-term enteral feeding is well established and commonly used. While the technique is relatively safe and simple, the gastrostomy tube itself may deteriorate or malfunction, requiring a replacement tube. We present a case of a 58-year-old woman who was found to have gastric outlet obstruction from the inflated balloon of a Foley catheter being used as a replacement for her PEG tube. This case illustrates a potential complication of using a Foley catheter in place of commercially available gastrostomy tubes.

Noninvasive verification of nasogastric tube placement using a magnet-tracking system: a pilot study in healthy subjects.

Science.gov (United States)

Bercik, Premysl; Schlageter, Vincent; Mauro, Marina; Rawlinson, John; Kucera, Pavel; Armstrong, David

2005-01-01

Fluoroscopic verification of nasogastric (NG) feeding tube placement is inconvenient and involves radiation exposure. We tested whether the position of an NG tube can be assessed reliably by a recently introduced magnet-tracking system. A small permanent magnet was attached at the end of an NG tube and its position was monitored using an external sensor array connected to a computer. NG tube trajectory, spontaneous movements of the magnet, and its position relative to the lower esophageal sphincter (LES) and xiphisternum were assessed in 22 healthy subjects and compared with esophageal manometry. In 12 subjects, localization of the magnet was also compared with fluoroscopy. Magnet-tracking displayed NG tube tip movement reproducibly as it moved vertically in the esophagus and then laterally into the stomach. Compared with manometry, the accuracy and sensitivity of magnet tracking for localization of the NG tube tip, above or below the diaphragm, were 100%. Compared with fluoroscopy, the accuracy of NG tube localization by magnet tracking was 100%. With the magnet in the stomach, but not in the esophagus or LES, low amplitude displacements at a frequency of 3 per minute, consistent with gastric slow wave activity, were observed. Magnet tracking allows accurate, real-time, 3-dimensional localization of an NG tube with respect to anatomic landmarks. Recorded motor patterns are indicative of the position of the NG tube. Magnet tracking may be a useful tool for bedside placement of nasogastric and enteral feeding tubes.

Influence of iodine insertion on the YBaCuO superconducting properties

Energy Technology Data Exchange (ETDEWEB)

Mokhtari, M.; Perrin, C.; Pena, O.; Sergent, M. (Lab. de Chimie du Solide et Inorganique Moleculaire, Univ. de Rennes 1, 35 (France))

1992-11-01

YBa[sub 2]Cu[sub 3]O[sub x] (x=6, 6.7 and 7) have been treated under iodine vapours, in evacuated silica tubes. After iodination, YBa[sub 2]Cu[sub 3]O[sub 6] exhibits a tetragonal/orthorhombic structural transition and becomes superconducting with T[sub c] increasing up to 70 K; the T[sub c] of YBa[sub 2]Cu[sub 3]O[sub 6.7] increases progressively from 63 K up to 80 K while the inductive amplitude decreases correlatively; for YBa[sub 2]Cu[sub 3]O[sub 7] only a slight quantity of iodine is inserted in the sample, which does not change the T[sub c] of 91 K, but provokes an important decrease of the inductive amplitude. EDS and SEM observations are used to test the homogeneity of the bromine insertion in the pellets and in the microcrystals. (orig.).

Tube introducer and modified Celestin tube for use in palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy.

Science.gov (United States)

Atkinson, M; Ferguson, R; Parker, G C

1978-01-01

A new method for palliative intubation of inoperable neoplasms at or near the cardia is described. A guidewire is passed through the stricture, which is dilated using Eder Puestow metal olive dilators. The tube to be inserted is mounted on an introducer, which grips its distal end from inside, and is slid into position along the wire under radiological control. Twenty-five patients have been intubated with one death directly resulting from the procedure. The method provides a simple and relatively safe means of relieving dysphagia and improving nutrition. Images Fig. 2 PMID:79517

A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery

Directory of Open Access Journals (Sweden)

Ahmet Dag

2011-01-01

Full Text Available OBJECTIVE: This prospective randomized clinical study was conducted to evaluate the safety and tolerability of early oral feeding after colorectal operations. METHODS: A total of 199 patients underwent colorectal surgery and were randomly assigned to early feeding (n = 99 or a regular diet (n = 100. Patients’ characteristics, diagnoses, surgical procedures, comorbidity, bowel movements, defecation, nasogastric tube reinsertion, time of tolerance of solid diet, complications, and length of hospitalization were assessed. RESULTS: The two groups were similar in terms of gender, age, diagnosis, surgical procedures, and comorbidity. In the early feeding group, 85.9% of patients tolerated the early feeding schedule. Bowel movements (1.7±0.89 vs. 3.27±1.3, defecation (3.4±0.77 vs. 4.38±1.18 and time of tolerance of solid diet (2.48±0.85 vs. 4.77±1.81 were significantly earlier in the early feeding group. There was no change between the groups in terms of nasogastric tube reinsertion, overall complication or anastomotic leakage. Hospitalization (5.55±2.35 vs. 9.0±6.5 was shorter in the early feeding group. CONCLUSIONS: The present study indicated that early oral feeding after elective colorectal surgery was not only well tolerated by patients but also affected the postoperative outcomes positively. Early postoperative feeding is safe and leads to the early recovery of gastrointestinal functions.

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial.

Science.gov (United States)

Mirmohammad-Sadeghi, Mohsen; Pourazari, Pejman; Akbari, Mojtaba

2017-01-01

Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group ( P = 0.001), but the trend of pain score between groups was not significantly different ( P = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group ( P drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

Effects of tubing length and coupling method on hearing threshold and real-ear to coupler difference measures.

Science.gov (United States)

Gustafson, Samantha; Pittman, Andrea; Fanning, Robert

2013-06-01

This tutorial demonstrates the effects of tubing length and coupling type (i.e., foam tip or personal earmold) on hearing threshold and real-ear-to-coupler difference (RECD) measures. Hearing thresholds from 0.25 kHz through 8 kHz are reported at various tubing lengths for 28 normal-hearing adults between the ages of 22 and 31 years. RECD values are reported for 14 of the adults. All measures were made with an insert earphone coupled to a standard foam tip and with an insert earphone coupled to each participant's personal earmold. Threshold and RECD measures obtained with a personal earmold were significantly different from those obtained with a foam tip on repeated measures analyses of variance. One-sample t tests showed these differences to vary systematically with increasing tubing length, with the largest average differences (7-8 dB) occurring at 4 kHz. This systematic examination demonstrates the equal and opposite effects of tubing length on threshold and acoustic measures. Specifically, as tubing length increased, sound pressure level in the ear canal decreased, affecting both hearing thresholds and the real-ear portion of the RECDs. This demonstration shows that when the same coupling method is used to obtain the hearing thresholds and RECD, equal and accurate estimates of real-ear sound pressure level are obtained.

Thermal analysis on x-ray tube for exhaust process

Science.gov (United States)

Kumar, Rakesh; Rao Ratnala, Srinivas; Veeresh Kumar, G. B.; Shivakumar Gouda, P. S.

2018-02-01

It is great importance in the use of X-rays for medical purposes that the dose given to both the patient and the operator is carefully controlled. There are many types of the X- ray tubes used for different applications based on their capacity and power supplied. In present thesis maxi ray 165 tube is analysed for thermal exhaust processes with ±5% accuracy. Exhaust process is usually done to remove all the air particles and to degasify the insert under high vacuum at 2e-05Torr. The tube glass is made up of Pyrex material, 95%Tungsten and 5%rhenium is used as target material for which the melting point temperature is 3350°C. Various materials are used for various parts; during the operation of X- ray tube these waste gases are released due to high temperature which in turn disturbs the flow of electrons. Thus, before using the X-ray tube for practical applications it has to undergo exhaust processes. Initially we build MX 165 model to carry out thermal analysis, and then we simulate the bearing temperature profiles with FE model to match with test results with ±5%accuracy. At last implement the critical protocols required for manufacturing processes like MF Heating, E-beam, Seasoning and FT.

Evaluation of the tightness of contact between 
limbal sclera tunnel and tube following Ahmed 
glaucoma valve implantation.

Science.gov (United States)

Holló, Gábor; Naghizadeh, Farzaneh

2013-01-01

To investigate whether the tightness of contact between the tube and the limbal sclera tunnel can be evaluated with high-magnification anterior segment optical coherence tomography (OCT) imaging following Ahmed glaucoma valve implantation. Tightness between the tube and the limbal sclera tunnel was investigated with the CAM-L cornea lens adapter of the Optovue Fourier-domain OCT (RTVue-OCT) for 21 uncomplicated Ahmed glaucoma valves implanted in 20 eyes of 19 patients with glaucoma. Nineteen valves were implanted 4 to 124 months earlier (late postoperative cases) and 2 valves 1 day prior to the imaging (early postoperative cases). All valves were introduced into the anterior chamber via a limbal sclera tunnel. The limbal intratunnel part of the tube was successfully imaged in all but 2 cases where an additional full-thickness sclera patch was used. In 14 cases, the contact was tight without tube compression. In 
5 cases, the tube was partially compressed but remained open in the limbal sclera tunnel, and redilated behind the limbus. No case with loose contact or peritubular filtration was seen. The posterior run of the tube was successfully imaged in all 19 cases without a full-thickness sclera patch. High-magnification imaging with the CAM- L anterior segment adapter of the RTVue-OCT allows detailed examination of the limbal insertion area of tubes in both the early and late postoperative periods. Therefore this method may potentially be applied for detection of complications related to tube insertion after glaucoma drainage device surgery.

Obstruction of endotracheal tube with relevant respiratory acidosis during pediatric cardiac surgery

NARCIS (Netherlands)

Morei, N.M.; Mungroop, H. E.; Michielon, Guido; Scheeren, Thomas

2014-01-01

We describe a case of pediatric cardiac surgery in a 21- days old baby, in whom a nasal endotracheal tube (ETT) was inserted. At the end of surgery both ventilatory pressures and end-tidal CO2 increased suggesting airway obstruction. Suctioning of the ETT lumen did not relieve the problem, only ETT

Feed-Back Moisture Sensor Control for the Delivery of Water to Plants Cultivated in Space

Science.gov (United States)

Levine, Howard G.; Prenger, Jessica J.; Rouzan, Donna T.; Spinale, April C.; Murdoch, Trevor; Burtness, Kevin A.

2005-01-01

The development of a spaceflight-rated Porous Tube Insert Module (PTIM) nutrient delivery tray has facilitated a series of studies evaluating various aspects of water and nutrient delivery to plants as they would be cultivated in space. We report here on our first experiment using the PTIM with a software-driven feedback moisture sensor control strategy for maintaining root zone wetness level set-points. One-day-old wheat seedlings (Tritium aestivum cv Apogee; N=15) were inserted into each of three Substrate Compartments (SCs) pre-packed with 0.25-1 . mm Profile(TradeMark) substrate and maintained at root zone relative water content levels of 70, 80 and 90%. The SCs contained a bottom-situated porous tube around which a capillary mat was wrapped. Three Porous Tubes. were planted using similar protocols (but without the substrate) and also maintained at these three moisture level set-points. Half-strength modified Hoagland's nutrient solution was used to supply water and nutrients. Results on hardware performance, water usage rates and wheat developmental differences between the different experimental treatments are presented.

Measurement of impulse peak insertion loss from two acoustic test fixtures and four hearing protector conditions with an acoustic shock tube

Science.gov (United States)

Murphy, William J.; Fackler, Cameron J.; Berger, Elliott H.; Shaw, Peter B.; Stergar, Mike

2015-01-01

Impulse peak insertion loss (IPIL) was studied with two acoustic test fixtures and four hearing protector conditions at the E-A-RCAL Laboratory. IPIL is the difference between the maximum estimated pressure for the open-ear condition and the maximum pressure measured when a hearing protector is placed on an acoustic test fixture (ATF). Two models of an ATF manufactured by the French-German Research Institute of Saint-Louis (ISL) were evaluated with high-level acoustic impulses created by an acoustic shock tube at levels of 134 decibels (dB), 150 dB, and 168 dB. The fixtures were identical except that the E-A-RCAL ISL fixture had ear canals that were 3 mm longer than the National Institute for Occupational Safety and Health (NIOSH) ISL fixture. Four hearing protection conditions were tested: Combat Arms earplug with the valve open, ETYPlugs® earplug, TacticalPro headset, and a dual-protector ETYPlugs earplug with TacticalPro earmuff. The IPILs measured for the E-A-RCAL fixture were 1.4 dB greater than the National Institute for Occupational Safety and Health (NIOSH) ISL ATF. For the E-A-RCAL ISL ATF, the left ear IPIL was 2.0 dB greater than the right ear IPIL. For the NIOSH ATF, the right ear IPIL was 0.3 dB greater than the left ear IPIL. PMID:26356380

Plugger guide for aligning an end plug and a fuel rod tube end

International Nuclear Information System (INIS)

Klapper, K.K.; Boatwright, D.A.

1987-01-01

A pin driving tool is described for inserting or removing pins from teeth on a digging means, comprising: fuel rod tube toward an end plug for application of the end plug into the tube end, the apparatus comprising: (a) a guide housing having an elongated central longitudinal bore with one end for receiving the end plug and an opposite end for receiving the fuel rod tube end; (b) sets of rolling elements disposed in the housing at axially spaced positions along and about the bore thereof. The rolling elements in each set are positioned in fixed relation with respect to one another to receive the fuel rod tube end therebetween and align the tube end with the end plug as the tube end is moved through the bore and into engagement with the end plug; and (c) retaining means disposed adjacent to the open end of the housing bore for engaging the end plug so as to maintain it in a stationary seated position at the one end of the housing bore

Metallographic study of reconstitution welding in inserts of 1 cm{sup 3}; Estudio metalografico de soldaduras de reconstitucion en insertos de 1 cm{sup 3}

Energy Technology Data Exchange (ETDEWEB)

Romero C, J.; Garcia R, R.; Fernandez T, F.; Perez R, N.; Rocamontes A, M. [ININ, 52750 La Marquesa, Estado de Mexico (Mexico)

2007-07-01

In this article, the welding metallographic study carried out in Charpy test tubes reconstituted with notch in 'V', used in the surveillance programs of the vessel in nucleo electric plants is described. Inserts of 1 cm{sup 3} are used, where the inserts are usually rectangular of minimum 18 millimeters of length. The importance of using inserts of 1 cm{sup 3} is that the mechanical properties can be measured in another direction of the vessel steel, when changing the direction or sense of the notch in 'V' or the face where this notch is made in the insert. (Author)

The effect of dental overbite on eustachian tube dysfunction in Iranian children.

Science.gov (United States)

Azadani, Peyman Nejatbakhsh; Jafarimehr, Elnaz; Shokatbakhsh, Abdorahman; Pourhoseingholi, Mohamad Amin; Ghougeghi, Aman

2007-02-01

To investigate the association between deep dental overbite and eustachian tube dysfunction. It was designed as a case-control study. Among hospitalized patients in otolaryngology department at Taleghani Hospital in Tehran, Iran, from January to December 2005, 132 patients between the ages of 2 and 6 years were recruited. Dental overbite, overjet, and occlusal relationships were measured by one observer. Eustachian tube dysfunction was defined as having ventilation tubes with an abnormal tympanometry. In addition, demographic information, medical and social histories were prospectively recorded. Univariate and multivariate logistic regression model were used. In a multivariate model, children with deep bites were 10.6 times more likely to have eustachian tube dysfunction than those without deep bites (Pmedia, daycare exposure, and non-breast-feeding. Children with deep dental overbites are at a significantly increased risk for developing eustachian tube dysfunction.

SU-G-IeP2-15: Virtual Insertion of Digital Kidney Stones Into Dual-Source, Dual- Energy CT Projection Data

International Nuclear Information System (INIS)

Ferrero, A; Chen, B; Huang, A; Montoya, J; Yu, L; McCollough, C

2016-01-01

Purpose: In order to investigate novel methods to more accurately estimate the mineral composition of kidney stones using dual energy CT, it is desirable to be able to combine digital stones of known composition with actual phantom and patient scan data. In this work, we developed and validated a method to insert digital kidney stones into projection data acquired on a dual-source, dual-energy CT system. Methods: Attenuation properties of stones of different mineral composition were computed using tabulated mass attenuation coefficients, the chemical formula for each stone type, and the effective beam energy at each evaluated tube potential. A previously developed method to insert lesions into x-ray CT projection data was extended to include simultaneous dual-energy CT projections acquired on a dual-source gantry (Siemens Somatom Flash). Digital stones were forward projected onto both detectors and the resulting projections added to the physically acquired sinogram data. To validate the accuracy of the technique, digital stones were inserted into different locations in the ACR CT accreditation phantom; low and high contrast resolution, CT number accuracy and noise properties were compared before and after stone insertion. The procedure was repeated for two dual-energy tube potential pairs in clinical use on the scanner, 80/Sn140 kV and 100/Sn140 kV, respectively. Results: The images reconstructed after the insertion of digital kidney stones were consistent with the images reconstructed from the scanner. The largest average CT number difference for the 4 insert in the CT number accuracy module of the phantom was 3 HU. Conclusion: A framework was developed and validated for the creation of digital kidney stones of known mineral composition, and their projection-domain insertion into commercial dual-source, dual-energy CT projection data. This will allow a systematic investigation of the impact of scan and reconstruction parameters on stone attenuation and dual

Condensation heat transfer of a feed-water heater and improvement of its performance

International Nuclear Information System (INIS)

Takamori, Kazuhide; Murase, Michio; Baba, Yoshikazu; Aihara, Tsuyoshi

1995-01-01

In this study, a condensation heat transfer model, coupled with a three-dimensional two-phase flow analysis, was developed. In the heat transfer model, the liquid film flow rate on the heat transfer tubes was calculated by a mass balance equation and the liquid film thickness was calculated from the liquid film flow rate using Nusselt's laminar flow model and Fujii's equation for the steam velocity effect. The model was verified by condensation heat transfer experiments. In the experiments, 112 horizontal, staggered tubes with an outer diameter of 16mm and length of 0.55m were used. The calculated over-all heat transfer coefficients agreed with the data within ±5% under the inlet quality conditions of 13-100%. Based on a three-dimensional two-phase flow analysis, an improved feed-water heater with support plates, which have flow holes between the upper and lower tube bundles, was designed. The total heat exchange capacity of the improved feed-water heater increased about 6%. (author)

Realistic thermal transient margin analysis of 'MONJU' based on plant performance measurements. Reactor vessel outlet nozzle and evaporator feed water inlet tube sheet of the manual reactor plant trip

International Nuclear Information System (INIS)

Yamada, Fumiaki; Mori, Takero

2005-01-01

In order to develop technologies and achieve safe and stable operation of Monju' as well as realize optimized design and construction of safe and economically competitive fast breeder reactors, the authors are evaluating design approach applied to 'Monju' based on actually measured behavioral data during plant operations. This report uses actual measured characteristic data of 'Monju' during a plant trip test obtained at a commissioning stage with up to 40% power output and introduces plant thermal hydraulic behavior analysis in a representative thermal transient event, i.e. a manual plant trip. Thermal transient driven loads incurred by the reactor vessel outlet nozzle and by the evaporator feed water inlet tube sheet were further derived by structural analyses and were compared with the previously derived values in the design stage and with the limit values. Though the reactor vessel outlet nozzle was exposed to larger temperature change in the trip test than the analytical prediction, the newly calculated mechanical load was about 50% of the previous evaluation in the design stage. Also, the newly analyzed mechanical load incurred by the evaporator feed water inlet tube sheet in this event had a large margin against the limit value of cumulative damage cycle fraction, although the observed temperature disturbance in a steam blow test was wilder than the analytical prediction. Thus we concluded that the Monju' plant has an assured safety margin against thermal transient in plant trip events. (author)

Comparison of intraoperative versus delayed enteral feeding tube placement in patients undergoing a Whipple procedure.

Science.gov (United States)

Scaife, Courtney L; Hewitt, Kelly C; Mone, Mary C; Hansen, Heidi J; Nelson, Edward T; Mulvihill, Sean J

2014-01-01

The intraoperative placement of an enteral feeding tube (FT) during pancreaticoduodenectomy (PD) is based on the surgeon's perception of need for postoperative nutrition. Published preoperative risk factors predicting postoperative morbidity may be used to predict FT need and associated intraoperative placement. A retrospective review of patients who underwent PD during 2005-2011 was performed by querying the National Surgical Quality Improvement Program (NSQIP) database with specific procedure codes. Patients were categorized based on how many of 10 possible preoperative risk factors they demonstrated. Groups of patients with scores of ≤ 1 (low) and ≥ 2 (high), respectively, were compared for FT need, length of stay (LoS) and organ space surgical site infections (SSIs). Of 138 PD patients, 82 did not have an FT placed intraoperatively, and, of those, 16 (19.5%) required delayed FT placement. High-risk patients were more likely to require a delayed FT (29.3%) compared with low-risk patients (9.8%) (P = 0.026). The 16 patients who required a delayed FT had a median LoS of 15.5 days, whereas the 66 patients who did not require an FT had a median LoS of 8 days (P < 0.001). In this analysis, subjects considered as high-risk patients were more likely to require an FT than low-risk patients. Assessment of preoperative risk factors may improve decision making for selective intraoperative FT placement. © 2013 International Hepato-Pancreato-Biliary Association.

Evaluating Factors for Prophylactic Feeding Tube Placement in Gastroesophageal Cancer Patients Undergoing Chemoradiotherapy

Directory of Open Access Journals (Sweden)

Vivek Verma

2017-09-01

Full Text Available PurposeThough better studied in head/neck cancers, there are currently no studies on timing of feeding tube (FT placement in patients with gastroesophageal cancer. This study sought to discern characteristics of patients who used versus did not use a prophylactic FT (pFT, and also analyzed factors associated with placement of FTs during chemoradiotherapy (CRT.Methods/materialsFrom 1998 to 2013, 1,329 patients underwent neoadjuvant CRT, of which 323 received an FT. Patients for whom FTs were placed prior to treatment due to tumor occlusion or substantial weight loss (n = 130, and those with FTs placed following treatment (n = 43 were excluded. One hundred patients had pFTs placed, and 50 underwent placement during CRT. The following was collected for each patient: demographic/patient information, oncologic/treatment characteristics, and CRT tolerance.ResultsNo significant differences were found in any parameter between cohorts that used (n = 66 versus did not use a pFT (n = 34; on univariate and multivariate analyses, no pretreatment characteristic associated with using a pFT. When compared with patients who used a pFT (n = 66, those who required an FT during CRT (n = 50 had lower body mass index (p = 0.045, underwent higher-dose radiotherapy (p = 0.003, and received induction chemotherapy (p = 0.031. On multivariate analysis, receipt of induction chemotherapy and greater weight loss and esophagitis during treatment were associated with placement of FTs during CRT (p < 0.05.ConclusionOf our cohort who received pFTs, there were no clinical factors that predicted for their use. Patients must be closely monitored for weight loss and esophagitis when receiving CRT in order to intervene prior to further worsening of toxicities.

Outcomes of percutaneous endoscopic gastrostomy tube insertion in respiratory impaired amyotrophic lateral sclerosis patients under noninvasive ventilation.

Science.gov (United States)

Czell, David; Bauer, Matthias; Binek, Janek; Schoch, Otto D; Weber, Markus

2013-05-01

Percutaneous endoscopic gastrostomy (PEG) tube placement in amyotrophic lateral sclerosis (ALS) patients with impaired respiratory function is associated with an increased risk of peri-procedural and post-interventional complications. It was the aim of the study to analyze peri- and post-interventional complications and survival after PEG tube placement under noninvasive ventilation (NIV) in ALS patients with various degrees of respiratory impairment. Twenty-six subjects were included in this retrospective case study. Prior to PEG tube placement, training with ventilatory support via an oronasal mask was performed with ALS subjects on the pneumology ward. PEG placement was then performed under continuous NIV. FVC, sniff nasal inspiratory pressure, and demographic data were assessed. Complication rates and 1-month and overall survival rates were analyzed. There were no deaths within 24 hours after PEG placement. One subject died within the first month. The mean survival rate after PEG was 12 ± 10 months (range 0.6-42 months). There was no difference in post-PEG survival between subjects with moderately (> 50%) and severely (NIV in ALS subjects.

Use of the Crawford tube for symptomatic epiphora without nasolacrimal obstruction

Directory of Open Access Journals (Sweden)

Nyu-Xia Tong

2016-02-01

Full Text Available AIM: To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS: A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS: Thirty-seven adult patients (37 eyes underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8±4.8mo. The procedure was an overall success in 28 eyes (75.7%, with symptoms improving significantly. Two eyes (5.4% were relieved of indoor epiphora, two (5.4% had minimal epiphora outdoors, but only with wind or cold, and five (13.5% continued to experience tearing both indoors and outdoors. Thirty of the patients (81% expressed satisfaction with the procedure. CONCLUSION: Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction.

LAMINAR FLOW THROUGH A TUBE WITH AN EASILY PENETRABLE ROUGHNESS NEAR AXIS

Directory of Open Access Journals (Sweden)

Є.О. Гаєв

2012-12-01

Full Text Available  Mathematical model has been suggested and investigation carried out of laminar flow through a round tube with a porous insertion (easily penetrable roughness, EPR in its middle along the axis. Velocity and shear fields have been found analytically for stable flow region, as well as hydraulic resistance as functions of EPR density and its height.

Heat transfer enhancement in a tube using circular cross sectional rings separated from wall

International Nuclear Information System (INIS)

Ozceyhan, Veysel; Gunes, Sibel; Buyukalaca, Orhan; Altuntop, Necdet

2008-01-01

A numerical study was undertaken for investigating the heat transfer enhancement in a tube with the circular cross sectional rings. The rings were inserted near the tube wall. Five different spacings between the rings were considered as p = d/2, p = d, p = 3d/2, p = 2d and p = 3d. Uniform heat flux was applied to the external surface of the tube and air was selected as working fluid. Numerical calculations were performed with FLUENT 6.1.22 code, in the range of Reynolds number 4475-43725. The results obtained from a smooth tube were compared with those from the studies in literature in order to validate the numerical method. Consequently, the variation of Nusselt number, friction factor and overall enhancement ratios for the tube with rings were presented and the best overall enhancement of 18% was achieved for Re = 15,600 for which the spacing between the rings is 3d

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial

Directory of Open Access Journals (Sweden)

Mohsen Mirmohammad-Sadeghi

2017-01-01

Full Text Available Background: Chest tubes are used in every case of coronary artery bypass grafting (CABG to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. Materials and Methods: This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. Results: The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group (P = 0.001, but the trend of pain score between groups was not significantly different (P = 0.097. The frequency of tamponade and atrial fibrillation (AF were significantly lower in Jackson-Pratt drain group (P < 0.05. Conclusion: The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

Use of scanning electron microscopy to monitor nanofibre/cell interaction in digestive epithelial cells

Energy Technology Data Exchange (ETDEWEB)

Millaku, Agron, E-mail: agron.mi@hotmail.com [Limnos-Company for Applied Ecology Ltd, Podlimbarskega 31, 1000 Ljubljana (Slovenia); Drobne, Damjana [University of Ljubljana, Biotechnical Faculty, Department of Biology, Večna pot 111, 1000 Ljubljana (Slovenia); Centre of Excellence, Advanced Materials and Technologies for the Future (CO NAMASTE), Jamova cesta 39, 1000 Ljubljana (Slovenia); Centre of Excellence, Nanoscience and Nanotechnology (Nanocentre), Jamova cesta 39, 1000 Ljubljana (Slovenia); Torkar, Matjaz [Institute of Metals and Technology IMT, Lepi pot 11, 1000 Ljubljana (Slovenia); Jožef Stefan Institute, Condensed Matter Physics Department, Jamova cesta 39, 1000 Ljubljana (Slovenia); Novak, Sara [University of Ljubljana, Biotechnical Faculty, Department of Biology, Večna pot 111, 1000 Ljubljana (Slovenia); Remškar, Maja [Jožef Stefan Institute, Condensed Matter Physics Department, Jamova cesta 39, 1000 Ljubljana (Slovenia); Pipan-Tkalec, Živa [University of Ljubljana, Biotechnical Faculty, Department of Biology, Večna pot 111, 1000 Ljubljana (Slovenia)

2013-09-15

Graphical abstract: Scanning electron microscopy is particularly well suited to the observation of nanofibre/cell interaction in the endothelial cells lining the hepatopancreas. (a) Tungsten oxide nanofibres, (b) test organism Porcellio scaber and schematic appearance of digestive tubes, (c) digestive tube (hepatopancreas) prepared for SEM investigation, (d) digestive gland cells (C) with nanofibres (NF) embedded in the cell membrane and (e) nanofibres inserted deeply in the cells and damaged nanofibres due to peristalsis. -- Highlights: • Tungsten oxide nanofibres react physically with digestive gland epithelial cells in Porcellio scaber. • Physical peristaltic forces of lead to insertion of nanofibres into the cells. • No toxic responses as measured by conventional toxicity biomarkers were detected. • Physical interactions were observed in a majority of the investigated animals. -- Abstract: We provide data obtained by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) on the interaction of ingested tungsten nanofibers with epithelial cells of the digestive tubes of a test organism Porcellio scaber. Conventional toxicity endpoints including feeding behaviour, weight loss and mortality were also measured in each investigated animal. No toxicity was detected in any of exposed animals after 14 days of feeding on tungsten nanofiber dosed food, but when nanofibers enter the digestive system they can react with epithelial cells of the digestive tubes, becoming physically inserted into the cells. In this way, nanofibers can injure the epithelial cells of digestive gland tubes when they are ingested with food. Our SEM data suggest that peristaltic forces may have an important role, not predicted by in vitro experiments, in the interactions of nanomaterials with digestive intestinal cells.

Use of scanning electron microscopy to monitor nanofibre/cell interaction in digestive epithelial cells

International Nuclear Information System (INIS)

Millaku, Agron; Drobne, Damjana; Torkar, Matjaz; Novak, Sara; Remškar, Maja; Pipan-Tkalec, Živa

2013-01-01

Graphical abstract: Scanning electron microscopy is particularly well suited to the observation of nanofibre/cell interaction in the endothelial cells lining the hepatopancreas. (a) Tungsten oxide nanofibres, (b) test organism Porcellio scaber and schematic appearance of digestive tubes, (c) digestive tube (hepatopancreas) prepared for SEM investigation, (d) digestive gland cells (C) with nanofibres (NF) embedded in the cell membrane and (e) nanofibres inserted deeply in the cells and damaged nanofibres due to peristalsis. -- Highlights: • Tungsten oxide nanofibres react physically with digestive gland epithelial cells in Porcellio scaber. • Physical peristaltic forces of lead to insertion of nanofibres into the cells. • No toxic responses as measured by conventional toxicity biomarkers were detected. • Physical interactions were observed in a majority of the investigated animals. -- Abstract: We provide data obtained by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) on the interaction of ingested tungsten nanofibers with epithelial cells of the digestive tubes of a test organism Porcellio scaber. Conventional toxicity endpoints including feeding behaviour, weight loss and mortality were also measured in each investigated animal. No toxicity was detected in any of exposed animals after 14 days of feeding on tungsten nanofiber dosed food, but when nanofibers enter the digestive system they can react with epithelial cells of the digestive tubes, becoming physically inserted into the cells. In this way, nanofibers can injure the epithelial cells of digestive gland tubes when they are ingested with food. Our SEM data suggest that peristaltic forces may have an important role, not predicted by in vitro experiments, in the interactions of nanomaterials with digestive intestinal cells

Pre-hysterectomy assessment of immediate tubal occlusion with the third-generation ESSURE insert (ESS505).

Science.gov (United States)

Thiel, John; Rattray, Darrien; Cher, Daniel J

2014-01-01

To assess the ability of a new iteration of the ESSURE insert (ESS505) to achieve short-term fallopian tube occlusion. Prospective, single center, interventional cohort (Canadian Task Force classification II-1). Tertiary care hospital. Women scheduled to undergo hysterectomy. Patients underwent placement of the ESS505 in the right fallopian tube and ESS305 (the commercially approved previous version of the device) in the left fallopian tube at 30 (n = 10), 60 (n = 10), or 90 (n = 10) days before a planned hysterectomy. Tubal occlusion was assessed via hysterosalpingography (HSG) both at the time of placement and just before hysterectomy. Ultrasound was used to evaluate acute device placement. Thirty-five women (mean age, 39.7 years) were enrolled from July 2012 to January 2013, and 30 underwent both ESSURE placement and scheduled hysterectomy. Mean (SD) placement time for the ESS305 and ESS505 devices was 1.4 (0.65) minutes and 1.3 (0.42) minutes, respectively (p = .36). At 1 hour after ESS505 placement, 29 of 30 tubes (97%) exhibited complete occlusion at HSG, compared with only 4 of 30 tubes (13%) after ESS305 placement (p ESSURE placement. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

Using a Bedside Video-assisted Test Tube Test to Assess Stoma Viability: A Report of 4 Cases.

Science.gov (United States)

Ahmad, Sarwat; Turner, Keli; Shah, Paulesh; Diaz, Jose

2016-07-01

Mucosal discoloration of an intestinal stoma may indicate self-limited venous congestion or necrosis necessitating operative revision. A common bedside technique to assess stoma viability is the "test tube test". A clear tube is inserted into the stoma and a hand-held light is used to assess the color of the stoma. A technique (video-assisted test tube test [VATTT]) developed by the authors utilizes a standard video bronchoscope inserted into a clear plastic blood collection tube to visually inspect and assess the mucosa. This technique was evaluated in 4 patients (age range 49-72 years, all critically ill) with a discolored stoma after emergency surgery. In each case, physical exam revealed ischemic mucosa at the surface either immediately after surgery or after worsening hypotension weeks later. Serial test tube test assessments were ambiguous when trying to assess deeper mucosa. The VATTT assessment showed viable pink mucosa beneath the surface and until the fascia was revealed in 3 patients. One (1) patient had mucosal ischemia down to the fascia, which prompted operative revision of the stoma. The new stoma was assessed with a VATTT and was viable for the entire length of the stoma. VATTT provided an enhanced, magnified, and clearer way to visually assess stoma viability in the postoperative period that can be performed at the bedside with no adverse events. It may prevent unnecessary relaparotomy or enable earlier diagnosis of deep ostomy necrosis. Validity and reliability studies are warranted.

Partial body irradiation of small laboratory animals with an industrial X-ray tube