CIRSE Standards of Practice Guidelines on Gastrostomy

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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.

Percutaneous Gastrostomy in Patients Who Fail or Are Unsuitable for Endoscopic Gastrostomy

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Thornton, Frank J.; Varghese, Jose C.; Haslam, Philip J.; McGrath, Frank P.; Keeling, Frank; Lee, Michael J.

2000-01-01

Purpose: Percutaneous endoscopic gastrostomy (PEG) is not possible or fails in some patients. We aimed to categorize the reasons for PEG failure, to study the success of percutaneous radiologic gastrostomy (PRG) in these patients, and to highlight the associated technical difficulties and complications.Methods: Forty-two patients (28 men, 14 women; mean age 60 years, range 18-93 years) in whom PEG failed or was not possible, underwent PRG. PEG failure or unsuitability was due to upper gastrointestinal tract obstruction or other pathology precluding PEG in 15 of the 42 patients, suboptimal transillumination in 22 of 42 patients, and advanced cardiorespiratory decompensation precluding endoscopy in five of 42 patients. T-fastener gastropexy was used in all patients and 14-18 Fr catheters were inserted.Results: PRG was successful in 41 of 42 patients (98%). CT guidance was required in four patients with altered upper gastrointestinal anatomy. PRG failed in one patient despite CT guidance. In the 16 patients with high subcostal stomachs who failed PEG because of inadequate transillumination, intercostal tube placement was required in three and cephalad angulation under the costal margin in six patients. Major complications included inadvertent placement of the tube in the peritoneal cavity. There was one case of hemorrhage at the gastrostomy site requiring transfusion and one case of superficial gastrostomy site infection requiring tube removal. Minor complications included superficial wound infection in six patients, successfully treated with routine wound toilette.Conclusion: We conclude that PRG is a safe, well-tolerated and successful method of gastrostomy and gastrojejunostomy insertion in the technically difficult group of patients who have undergone an unsuccessful PEG. In many such cases optimal clinical evaluation will suggest primary referral for PRG as the preferred option

Replacement of Dislodged Gastrostomy Tubes After Stoma Dilation in the Pediatric Emergency Department

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Shiloni Bhambani

2017-04-01

Full Text Available Introduction: A dislodged gastrostomy tube (GT is a common complaint that requires evaluation in the pediatric emergency department (ED and, on occasion, will require stoma dilation to successfully replace the GT. The objective of this study was to describe the frequency that stoma dilation is required, the success rate of replacement, complications encountered, and the techniques used to confirm placement of the GT after dilation. Methods: We conducted a retrospective medical record review of children 0–18 years who presented to the pediatric ED from February 2013 through February 2015 with a dislodged GT that required stoma dilation by pediatric emergency physicians with serially increasing Foley catheter sizes prior to successful placement of the GT. Results: We reviewed a total of 302 encounters in 215 patients, with 97 (32% of the encounters requiring stoma dilation prior to replacing a GT. The median amount of dilation was 2 French between the initial Foley catheter size and the final GT size. There was a single complication of a mal-positioned balloon that was identified at the index visit. No delayed complications were encountered. We performed confirmation of placement in all patients. The two most common forms of confirmation were aspiration of gastric contents (56/97 [58%] followed by contrast radiograph in 39 (40%. Conclusion: The practice of serial dilation of a gastrostomy stoma site to allow successful replacement of a gastrostomy tube in pediatric patients who present to the ED with a dislodged gastrostomy tube is generally successful and without increased complication. All patients received at least one form of confirmation for appropriate GT placement with the most common being aspiration of gastric contents.

Single port laparoscopic long-term tube gastrostomy in Göttingen minipigs

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Birck, Malene Muusfeldt; Vegge, Andreas; Moesgaard, S G

2015-01-01

it was evident that the catheter had entered the stomach in the fundus region in 11/12 of the animals. In one animal the catheter had entered the antrum region. None of the animals developed leakage or clinically detectable reactions to the gastrostomy tube. Histopathologically, only discrete changes were...

Perioperative management of gastrostomy tube placement in Duchenne muscular dystrophy adolescent and young adult patients: A role for a perioperative surgical home.

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Boivin, Ariane; Antonelli, Richard; Sethna, Navil F

2018-02-01

In past decades, Duchenne muscular dystrophy patients have been living longer and as the disease advances, patients experience multisystemic deterioration. Older patients often require gastrostomy tube placement for nutritional support. For optimizing the perioperative care, a practice of multidisciplinary team can better anticipate, prevent, and manage possible complications and reduce the overall perioperative morbidity and mortality. The aim of this study was to review our experience with perioperative care of adolescent and young adults with Duchenne muscular dystrophy undergoing gastrostomy by various surgical approaches in order to identify challenges and improve future perioperative care coordination to reduce morbidity. We retrospectively examined cases of gastrostomy tube placement in patients of ages 15 years and older between 2005 and 2016. We reviewed preoperative evaluation, anesthetic and surgical management, and postoperative complications. Twelve patients were identified; 1 had open gastrostomy, 3 laparoscopic gastrostomies, 5 percutaneous endoscopic guided, and 3 radiologically inserted gastrostomy tubes. All patients had preoperative cardiac evaluation with 6 patients demonstrating cardiomyopathy. Nine patients had preoperative pulmonary consultations and the pulmonary function tests reported forced vital capacity of ≤36% of predicted. Eight patients were noninvasive positive pressure ventilation dependent. General anesthesia with tracheal intubation was administered in 8 patients, and intravenous sedation in 4 patients; 1 received sedation supplemented with regional anesthesia and 3 received deep sedation. One patient had a difficult intubation that resulted in trauma and prolonged tracheal intubation. Three patients developed postoperative respiratory complications. Two patients' procedures were postponed due to inadequate preoperative evaluation and 1 because of disagreement between anesthesia and procedural services as to the optimal

Clinical-dosimetric analysis of measures of dysphagia including gastrostomy-tube dependence among head and neck cancer patients treated definitively by intensity-modulated radiotherapy with concurrent chemotherapy

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Li, Baoqing; Chen, Allen M; Li, Dan; Lau, Derick H; Farwell, D Gregory; Luu, Quang; Rocke, David M; Newman, Kathleen; Courquin, Jean; Purdy, James A

2009-01-01

To investigate the association between dose to various anatomical structures and dysphagia among patients with head and neck cancer treated by definitive intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy. Thirty-nine patients with squamous cancer of the head and neck were treated by definitive concurrent chemotherapy and IMRT to a median dose of 70 Gy (range, 68 to 72). In each patient, a gastrostomy tube (GT) was prophylacticly placed prior to starting treatment. Prolonged GT dependence was defined as exceeding the median GT duration of 192 days. Dysphagia was scored using standardized quality-of-life instruments. Dose-volume histogram (DVH) data incorporating the superior/middle pharyngeal constrictors (SMPC), inferior pharyngeal constrictor (IPC), cricoid pharyngeal inlet (CPI), and cervical esophagus (CE) were analyzed in relation to prolonged GT dependence, dysphagia, and weight loss. At 3 months and 6 months after treatment, 87% and 44% of patients, respectively, were GT dependent. Spearman's ρ analysis identified statistical correlations (p < 0.05) between prolonged GT dependence or high grade dysphagia with IPC V65, IPC V60, IPC Dmean, and CPI Dmax. Logistic regression model showed that IPC V65 > 30%, IPC V60 > 60%, IPC Dmean > 60 Gy, and CPI Dmax > 62 Gy predicted for greater than 50% probability of prolonged GT dependence. Our analysis suggests that adhering to the following parameters may decrease the risk of prolonged GT dependence and dysphagia: IPC V65 < 15%, IPC V60 < 40%, IPC Dmean < 55 Gy, and CPI Dmax < 60 Gy

Gastrostomy Tube (G-Tube)

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... any of these problems: a dislodged tube a blocked or clogged tube any signs of infection (including redness, swelling, or warmth at the tube site; discharge that's yellow, green, or foul-smelling; fever) excessive bleeding or drainage from the tube site severe abdominal pain lasting ...

Acceptability and outcomes of the Percutaneous Endoscopic Gastrostomy (PEG tube placement- patients' and care givers' perspectives

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Shah Hasnain A

2006-11-01

Full Text Available Abstract Background Percutaneous endoscopic gastrostomy tube has now become a preferred option for the long-term nutritional support device for patients with dysphagia. There is a considerable debate about the health issues related to the quality of life of these patients. Our aim of the study was to assess the outcome and perspectives of patients/care givers, about the acceptability of percutaneous endoscopic gastrostomy tube placement. Methods This descriptive analytic study conducted in patients, who have undergone percutaneous endoscopic gastrostomy tube placement during January 1998 till December 2004. Medical records of these patients were evaluated for their demographic characteristics, underlying diagnosis, indications and complications. Telephonic interviews were conducted till March 2005, on a pre-tested questionnaire to address psychological, social and physical performance status, of the health related quality of life issues. Results A total of 191 patients' medical records were reviewed, 120 (63% were males, and mean age was 63 years. Early complication was infection at PEG tube site in 6 (3% patients. In follow up over 365 ± 149 days, late complications (occurring 72 hours later were infection at PEG tube site in 29 (15 % patient and dislodgment/blockage of the tube in 26 (13.6%. Interviews were possible with 126 patients/caretakers. Karnofsky Performance Score of 0, 1, 2, 3 and 4 was found in 13(10%, 18(14%, 21(17%, 29(23% and 45(36% with p-value Conclusion PEG-tube placement was found to be relatively free from serious immediate and long- term complications. Majority of caregivers and patient felt that PEG-tube helped in feeding and prolonging the survival. Studies are needed to assess the real benefit in terms of actual nutritional gain and quality of life in such patients.

Abdominal Plain Film Before Gastrostomy Tube Placement to Predict Success of Percutaneous Endoscopic Procedure

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Pruijsen, J. M.; de Bruin, A.; Sekema, G.; Koetse, H. A.; van Rheenen, P. F.

Objectives: Percutaneous endoscopic gastrostomy (PEG) tube feeding is a convenient method for children requiring long-term enteral nutrition. Preoperative fitness of the majority of pediatric PEG candidates is graded as American Society of Anesthesiologists physical status >= III, indicating

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

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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)

Clinical application of percutaneous gastrostomy and gastrojejunostomy under fluoroscopic guidance

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Zhou Jianping; Wang Zhongmin; Liu Tao; Chen Kemin; Gong Ju; Zheng Yunfeng; Chen Zhijin; Shen Jieyun

2011-01-01

Objective: To evaluate the safety and effectiveness of percutaneous gastrostomy (PRG) and gastrojejunostomy (PRGJ) under fluoroscopic guidance, and to discuss its technical manipulation, the indications and contraindications as well as the complications. Methods: During the period from May 2002 to June 2010 in authors' hospital fluoroscopically-guided PRG or PRGJ was carried out in 40 patients. The clinical data were retrospectively analyzed. With Seldinger technique and under fluoroscopic guidance, a 14 F radiopaque gastrostomy or gastrojejunostomy feeding catheter was successfully placed. The indications, operation procedures, clinical success rate, procedure-related complications, and tube indwelling time, etc. were discussed and analyzed. Results: PRG was conducted in 30 patients. The reasons for performing PRG included neurologic disease (n=13), recurrent aspiration pneumonia (n=6), gastroesophageal reflux due to disfunction of gastrointestinal tract (n=3), subtotal gastrectomy (n=2), esophagomediastinal fistula (n=1) and esophageal carcinoma (n=5). PRGJ was carried out in 10 patients. The disorders included bulbar paralysis (n=3), malignant duodenal obstruction (n=4) and previous gastrostomy-related complications (n=3). Two anchors were used in all patients receiving PRG or PRGJ. Clinical success was achieved in all study patients. No procedure-related or severe complications occurred. Minor complications were observed in four patients (10%), which included local soft tissue infection (n=1), severe puncture site pain (n=1), gastrostomy tube dislodgement (n=1) and obstruction of gastrojejunostomy tube (n=1). During the follow-up period, no aggravation of gastroesophageal reflux or aspiration pneumonia was observed in all patients. The tube indwelling time was 115 to 585 days (mean of 150 days) after tube placement. Conclusion: Fluoroscopically-guided percutaneous gastrostomy or gastrojejunostomy is a safe, simple and minimally-invasive technique. This

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

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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.

Percutaneous gastrostomy -a report of twenty-seven cases-

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Kim, Tae Ho; Lee, Ho Suk; Kim, Yong Joo; Kim, Tae Hun; Suh, Kyung Jin; Kang, Duk Sik

1991-01-01

Nutritional support by gastrostomy feeding is an important treatment adjunct when major swallowing difficulty or debilitating diseases is present. This technique for percutaneous placement of a gastric feeding tube now provides many patients with a simple, safe, and well-tolerated alternative to surgical feeding gastrostomy. We experienced 27 cases of percutaneous gastrostomy from January 1989 to February 1991 at Kyungpook National University Hospital. The underlying diseases of the patients were esophageal cancer (11), pyriform sinus cancer (4), laryngeal cancer (3), tongue cancer (2), lye stricture (1), lung cancer (1), chordoma (1), lethal midline granuloma (1), malignant lymphoma (1), maxillary cancer (1), and tonsil cancer (1). Selding method was used in all cases. In five patients it was difficult to insert the nasogastric tube for air insufflation, and one patient had subtotal gastrectomy with gastrojejunostomy, but gastrostomy was performed in all cases. The general condition improved in all patients. We experienced one case of mild peritonitis, but no other significant complications were observed. Gastrostomy tubes were patient in all patients during their survival period, except two patients who experienced obstruction 2 and 6 months after the procedure. Percutaneous gastrostomy can be used safely and effectively in such patients who have pharyngoesophageal or CNS lesions precluding oral intake

Percutaneous gastrostomy and jejunostomy: Technique, results, and complications in 55 cases

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Mueller, P.R.; Brown, A.; Saini, S.; Hahn, P.F.; Steiner, E.; Ferrucci, J.T.; Forman, B.H.; Silverman, S.G.

1987-01-01

Percutaneous radiologic gastrostomy is a well-described method that has not been widely adopted by radiologists. The authors reviewed their experience to highlight technical points and clinical results. Direct percutaneous gastrostomy was performed in 51 patients and percutaneous jejunostomy in four. Indications for gastrostomy procedures were the need for general nutrition (n = 31), complications of use of a nasogastric feeding tube (n = 7), gastric or small bowel decompression (n = 4) and endoscopic failure (n = 5). The major indication for percutaneous jejunostomy was decompression of small bowel obstruction. Key technical aspects include the use of a novel needle device that tacks the abdominal wall to the stomach, thus assuring a seal between the two structures. In the percutaneous gastrostomies, 18-F Foley catheters were introduced through the tacked portion of the stomach with a Seldinger technique and dilators. For percutaneous jejunostomy, 18-F feeding tubes were placed. All procedures were performed under local anesthesia. The authors conclude that a radiologic percutaneous gastrostomy is a safe and effective procedure and should be pursued aggressively by interventional radiologists

Nasogastric tube versus gastrostomy tube for gastric decompression in abdominal surgery: a prospective, randomized trial comparing patients' tube-related inconvenience.

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Hoffmann, S; Koller, M; Plaul, U; Stinner, B; Gerdes, B; Lorenz, W; Rothmund, M

2001-11-01

Perioperative decompression of the stomach is still a common procedure and can be achieved using either nasogastric tubes (NTs) or gastrostomy tubes (GTs). While both procedures appear to be equally effective, some authors believe that NTs are less convenient for patients than GTs. However, to date, no reliable prospective data are available on this issue. We conducted a prospective, randomized trial comparing NTs versus GTs with a total of 110 patients undergoing elective colon surgery. The primary outcome measure was the patient's tube-related inconvenience and pain, assessed in a standardized interview on day 2 after surgery and quantified by means of a visual-analog scale (VAS). A questionnaire including the EORTC QLQ-C30 and additional items regarding retrospective tube-related judgements was administered on the day of discharge and 4 weeks after discharge. Secondary endpoints were the therapy-related morbidity and general complications. When patients were asked which of their drainage tubes (all patients had three or four drainage tubes, such as decompression drains, urinary drains, central venous line) was most inconvenient, 43% (CI 33-53%) in the NT group reported that the NT was most inconvenient, while only 4% (CI 1-10%) of the GT patients judged the GT most inconvenient ( Ptube system (day 2 p.o.: 71%, CI 61-80%; 4 weeks p.o.: 66%, CI 56-75%) than did GT patients (day 2 p.o.: 94%, CI 88-98%; 4 weeks p.o.: 91% CI 84-96%); again, these differences were statistically significant ( Ptube system have to weigh up the possibilities of different averse clinical as well as subjective outcomes. It is then preferable to include patients' preferences in the individual decision making process (shared-decision making).

Factors Associated with the Risk of Persistent Gastrostomy Site Infection Following Laparoscopic or Open Nissen Fundoplication

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Hisayuki Miyagi

2017-01-01

Full Text Available Background: Gastrostomy for feeding disorders or swallowing dysfunctions can be complicated by persistent gastrostomy site infection (PGSI. PGSI causes nutrient leakage, with dilated PGSI requiring gastrostomy reconstruction. The purpose of this study was to evaluate the causes, patient characteristics, and perioperative management of PGSI after Nissen fundoplication and gastrostomy for patients with gastro-oesophageal reflux. Patients and Methods: The records of all patients who underwent Nissen fundoplication and gastrostomy for gastro-oesophageal reflux over the past 12 years were retrieved. Risk factors were analysed, including age at surgery, gender, operative procedure, use of postoperative ventilator management, gastrostomy tube migration towards the pylorus, bacterial culture results, and length of hospital stay. PGSI as a cause of inflammation was analysed statistically. Results: Forty patients were identified, ranging in age from 1 to 49 years (median, 11 years surgically. Twenty each underwent laparoscopic and open surgery, with all undergoing gastrostomy using the Stamm technique. Four patients developed PGSI. Gastrostomy tubes had migrated postoperatively to the pyloric side in three of these four patients (P < 0.005, increasing intragastric pressure. Three of these four patients also required positive pressure ventilation during the perioperative period (P < 0.001. Conclusion: PGSI correlates with the perioperative management of positive pressure and with increased intragastric pressure resulting from pyloric obstruction, which is caused by aberrant distribution of the gastrostomy tube to the pyloric side. Statistical Analysis Used: Factors in the two groups were compared statistically by Mann–Whitney U-test to determine whether PGSI caused inflammation. Statistical significance was defined as P < 0.05.

[Severe diarrhea after the original well-functioning percutaneous endoscopic gastrostomy tube was replaced by a Mic-Key button].

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Jensen, Susanne Wigh; Eriksen, Jan; Kristensen, Kurt

2006-03-06

We report two cases of colocutaneous fistula as a complication of percutaneous endoscopic gastrostomy (PEG) in small children. Both children developed severe osmotic diarrhoea immediately after the original PEG tube was replaced by a Mic-Key button which subsequently migrated to the colon.

A simple technique for laparoscopic gastrostomy.

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Murphy, C; Rosemurgy, A S; Albrink, M H; Carey, L C

1992-05-01

While endoscopically placed gastrostomy tubes are routinely simple, they are not always feasible. Endoscopic technique also does not uniformly secure the tube to the abdominal wall, which presents possible complications, including leakage, accidental early tube removal, intraperitoneal catheter migration and necrosis of the stomach or abdominal wall because of excessive traction. Presented herein is a technique that is rapid, simple and eliminates some of these potential complications. The technique is easily combined with other operative procedures, such as tracheostomy, is done under direct vision, can be performed quickly with intravenous sedation and local anesthetic and is a safe method of tube placement for enteral feeding or gastric decompression.

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

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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.

Comprehensive approach to the child with gastrostomy

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Erika Šmid

2013-10-01

Full Text Available Endoscopic gastrostomy tube placement is the method of choice for enteral feeding of adults and children. It is most commonly needed in children with neurological impairment, and in those with swallowing difficulties. Complications are relatively common but in most cases not severe. Among the most common complications are bacterial and fungal infections of the skin around the tube.In adults, it is usually performed with local anesthesia, whereas in children general anesthesia is recommended.During the child’s hospitalization, parents are usually present in order to learn how to take care of the child at home. We offer them theoretical and practical knowledge about the life of a child with gastrostomy. We provide them information on feeding, skin care, possible complications, and actively include them in all steps of the process of gastrostomy nursing care as soon as possible.Likewise adults, children also have to be treated as equals, andfor this reason we have to know how to communicate with them, with special attention on child’s non-verbal communication. Nursing care to the child often presents an unfamiliar and even undesirable situation. It is therefore the role of the nurse to mitigate it by appropriate communication.It takes four to five days for parents to obtain sufficient information to be able to take care of their child at home. Upon discharge, they receive written information on percutaneous gastrostomy care.

MAPLE Fabricated Fe3O4@Cinnamomum verum Antimicrobial Surfaces for Improved Gastrostomy Tubes

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Alina Georgiana Anghel

2014-06-01

Full Text Available Cinnamomum verum-functionalized Fe3O4 nanoparticles of 9.4 nm in size were laser transferred by matrix assisted pulsed laser evaporation (MAPLE technique onto gastrostomy tubes (G-tubes for antibacterial activity evaluation toward Gram positive and Gram negative microbial colonization. X-ray diffraction analysis of the nanoparticle powder showed a polycrystalline magnetite structure, whereas infrared mapping confirmed the integrity of C. verum (CV functional groups after the laser transfer. The specific topography of the deposited films involved a uniform thin coating together with several aggregates of bio-functionalized magnetite particles covering the G-tubes. Cytotoxicity assays showed an increase of the G-tube surface biocompatibility after Fe3O4@CV treatment, allowing a normal development of endothelial cells up to five days of incubation. Microbiological assays on nanoparticle-modified G-tube surfaces have proved an improvement of anti-adherent properties, significantly reducing both Gram negative and Gram positive bacteria colonization.

Growth outcomes and complications after radiologic gastrostomy in 120 children

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Lewis, Evan Cole [Children' s Hospital of Eastern Ontario, Department of Pediatrics, Division of Pediatric Neurology, Ottawa (Canada); Connolly, Bairbre; Temple, Michael; John, Philip; Chait, Peter G.; Vaughan, Jennifer; Amaral, Joao G. [The Hospital for Sick Children, Department of Diagnostic Imaging, Division of Image Guided Therapy, Toronto (Canada)

2008-09-15

Enteral feeding is ideal for children with low caloric intake. It can be provided through different methods, including nasogastric, nasojejunal, gastrostomy, or gastrojejunostomy tubes. To assess growth outcomes of pediatric patients following retrograde percutaneous gastrostomy (RPG) and compare complications with those following other gastrostomy methods. We retrospectively reviewed 120 random RPG patients from 2002 to 2003 (mean follow-up, 2.7 years). Patient weights and growth percentiles were recorded at insertion, and at 0-5 months, 6-12 months, and 18-24 months after insertion, and then compared using a Student's t-test. Complications and tube maintenance issues (TMIs) were recorded. Gastrostomy tube insertion was successful in all 120 patients (59 boys, 61 girls; mean age 4.3 years). The most common underlying diagnosis was neurologic disease (29%, 35/120) and the main indication was inadequate caloric intake (24%, 29/120). Significant increases in growth percentile for the entire population were demonstrated between insertion and 0-5 months (18.7-25.3; P<0.001) and between insertion and 18-24 months (18.7-25.8; P<0.001). In boys and girls significant growth increases occurred between insertion and 0-5 months (boys P=0.004; girls P=0.01). There were 11 major postprocedural complications, 100 minor complications and 169 TMIs. RPG provides long-term enteral nutrition in the pediatric population and increases growth significantly 6 and 24 months after insertion. Minor complications and TMIs are frequent. (orig.)

Growth outcomes and complications after radiologic gastrostomy in 120 children

International Nuclear Information System (INIS)

Lewis, Evan Cole; Connolly, Bairbre; Temple, Michael; John, Philip; Chait, Peter G.; Vaughan, Jennifer; Amaral, Joao G.

2008-01-01

Enteral feeding is ideal for children with low caloric intake. It can be provided through different methods, including nasogastric, nasojejunal, gastrostomy, or gastrojejunostomy tubes. To assess growth outcomes of pediatric patients following retrograde percutaneous gastrostomy (RPG) and compare complications with those following other gastrostomy methods. We retrospectively reviewed 120 random RPG patients from 2002 to 2003 (mean follow-up, 2.7 years). Patient weights and growth percentiles were recorded at insertion, and at 0-5 months, 6-12 months, and 18-24 months after insertion, and then compared using a Student's t-test. Complications and tube maintenance issues (TMIs) were recorded. Gastrostomy tube insertion was successful in all 120 patients (59 boys, 61 girls; mean age 4.3 years). The most common underlying diagnosis was neurologic disease (29%, 35/120) and the main indication was inadequate caloric intake (24%, 29/120). Significant increases in growth percentile for the entire population were demonstrated between insertion and 0-5 months (18.7-25.3; P<0.001) and between insertion and 18-24 months (18.7-25.8; P<0.001). In boys and girls significant growth increases occurred between insertion and 0-5 months (boys P=0.004; girls P=0.01). There were 11 major postprocedural complications, 100 minor complications and 169 TMIs. RPG provides long-term enteral nutrition in the pediatric population and increases growth significantly 6 and 24 months after insertion. Minor complications and TMIs are frequent. (orig.)

Malnutrition in healthcare settings and the role of gastrostomy feeding.

Science.gov (United States)

Kurien, Matthew; Williams, Jake; Sanders, David S

2017-08-01

Malnutrition can adversely affect physical and psychological function, influencing both morbidity and mortality. Despite the prevalence of malnutrition and its associated health and economic costs, malnutrition remains under-detected and under-treated in differing healthcare settings. For a subgroup of malnourished individuals, a gastrostomy (a feeding tube placed directly into the stomach) may be required to provide long-term nutritional support. In this review we explore the spectrum and consequences of malnutrition in differing healthcare settings. We then specifically review gastrostomies as a method of providing nutritional support. The review highlights the origins of gastrostomies, and discusses how endoscopic and radiological advances have culminated in an increased demand and placement of gastrostomy feeding tubes. Several studies have raised concerns about the benefits derived following this intervention and also about the patients selected to undergo this procedure. These studies are discussed in detail in this review, alongside suggestions for future research to help better delineate those who will benefit most from this intervention, and improve understanding about how gastrostomies influence nutritional outcomes.

Long-term outcomes of children undergoing video-assisted gastrostomy

OpenAIRE

Sal?, Martin; Santimano, Ana; Helmroth, Sofia; Stenstr?m, Pernilla; Arnbjornsson, Einar ?lafur

2016-01-01

Purpose The aims of this study were to assess the short- and long-term complication rates after video-assisted gastrostomy (VAG), the effects of age and gender on long-term complications and the effect of duration of gastrostomy tube retention on the need for gastroraphy when the gastrostomy device was removed. Methods This was a retrospective study of children undergoing VAG at a single institution. Children who died or moved from the area were excluded. The rates of short- and long-term com...

CT-guided percutaneous gastrostomy: success rate, early and late complications; CT-gesteuerte perkutane Gastrostomie: Technischer Erfolg, Frueh- und Spaetkomplikationen

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Gottschalk, A.; Voelk, M. [Radiologie, Bundeswehrkrankenhaus Ulm (Germany); Strotzer, M. [Radiologie, Klinikum Hohe Warte (Germany); Feuerbach, S.; Rogler, G. [Radiologie, Klinikum der Universitaet Regensburg (Germany); Seitz, J. [Radiologie, MVZ Dr. Neumaier und Kollegen (Germany)

2007-04-15

Purpose: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are the standard methods of ensuring long-term enteral food intake in patients with dysphagia caused by neoplasia or neurological disorders. High-grade obstructions of the upper digestive tract or inadequate transillumination can prevent PEG. CT-guided percutaneous gastrostomy (PG) represents a special technique for enabling gastrostomy in patients for whom the endoscopic method is impossible. The aim of this study was to evaluate the results and complications of CT-guided percutaneous gastrostomy. Materials and Methods: CT-guided PG was performed in 83 patients, mostly with malignancy of the upper respiratory or digestive tract. Medical records for these patients were reviewed, and the results and complications of the CT-guided PG were analyzed retrospectively. Complications were grouped into four categories: Major and minor complications as well as early and late complications. Results: In 95.2 % of all cases (79/83), CT-guided PG was successful in the first attempt. Within the first 3 days, 5 major complications including 4 tube dislocations and one case of peritonitis were found in 4/79 patients (5.1 %). One of these patients experienced two early major complications. Early minor complications, mainly local skin irritations and temporary stomachache, were observed in 31 patients (39.2 %). Three days after CT-guided PG, 4 cases of major complications were documented, yielding a total rate of major complications was 8.7 % (7/79). Hemorrhage requiring blood transfusion or perforation after gastrostomy was not observed. 29.1 % of the patients (23/79) experienced late minor complications. (orig.)

[Nursing Experience With a Patient With Gastrostomy Leakage Resulting in Moisture-Associated Skin Damage].

Science.gov (United States)

Hsu, Mei-Yu; Hsu, Hsiao-Hui; Lyu, Ji-Yan

2016-10-01

Leakage is a common complication of gastrostomy. Exposure of the skin surrounding the gastrostomy tube to moisture or chemical irritants may cause moisture-associated skin damage (MASD) and seriously affect the patient's quality of life. This case study describes a nursing experience with gastrostomy leakage that resulted in MASD. An assessment conducted from July 29, 2015 to August 20, 2015 revealed that heavy gastronomy leakage had caused extensive skin erosion, ulceration, hyperplasia, and superficial infection. Simultaneously, the patient was required to conduct complex stoma care, which resulted in physical and psychological exhaustion. Changes in traditional tube and wound care were discussed on multiple occasions with an interdisciplinary healthcare team. Based on the evidence-based literature, we provide gastrostomy and MASD management strategies. Through team collaboration, we prevented gastric contents from contacting the patient's skin directly, improved patient comfort, controlled effluent and skin infections, maintained fluid and electrolyte balances, and acce-lerated the healing of the damaged skin. We recommend that healthcare professionals caring for patients with gastrostomy leakage be provided with early skin protection programs to learn the standard methods for identifying and correcting leakage factors, containing effluent, and adequately stabilizing the gastrostomy tube in order to reduce the impact on the patient's quality of life. In addition, patient education on tube and skin care should be provided to prevent the reoccurrence of complications.

An evaluation of the fluoroscopy-guided percutaneous gastrostomy with the pull technique

International Nuclear Information System (INIS)

Uhm, Chang Wook; Won, Jong Yun; Yu, Jeong Sik; Ko, Heung Kyu; Lee, Kwang Hun; Lee, Do Yun; Lee, Jong Tae

2008-01-01

To evaluate the safety and usefulness of the fluoroscopy-guided percutaneous gastrostomy (FPG) using a large profile gastrostomy tube accompanied with the pull technique, and without the use of an endoscopy or a gastropexy. From March 2005 to February 2007, 25 patients underwent an FPG using a large profile gastrostomy tube accompanied by the pull technique, in which a 24F pull-type tube was inserted into a patient's mouth and was pulled to the upper abdominal puncture site using a snare, under fluoroscopy. The 18 patients with difficulty swallowing due to muscular atrophic lateral sclerosis or transitional myodystrophy included 5 cases of quadriplegia, 1 case of Parkinson's disease, and 1 metastatic mediastinal tumor. The technical success rate, occurrence of complications, and clinical outcomes were examined. The technical success rate was found to be 100%. In addition, the retention periods for the indwelling tube ranged from 1 to 24 months (mean: 6.5 months), with all tubes retained at a normal position with normal function. No procedure-related mortality occurred. One patient (4%) did however develop a complication in the form of ascites and ascitic fluid leakage around the tube, which was of hepatic origin and was ultimately resolved after the drainage of ascites. As a result of this study the FPG, accompanied with the pull technique using a 24F tube, should be considered as a safe and effective method for examining patients. It was found to have a high success rate and a low complication rate

An evaluation of the fluoroscopy-guided percutaneous gastrostomy with the pull technique

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Uhm, Chang Wook; Won, Jong Yun; Yu, Jeong Sik; Ko, Heung Kyu; Lee, Kwang Hun; Lee, Do Yun; Lee, Jong Tae [Yonsei University College of Medicine, Seoul (Korea, Republic of)

2008-04-15

To evaluate the safety and usefulness of the fluoroscopy-guided percutaneous gastrostomy (FPG) using a large profile gastrostomy tube accompanied with the pull technique, and without the use of an endoscopy or a gastropexy. From March 2005 to February 2007, 25 patients underwent an FPG using a large profile gastrostomy tube accompanied by the pull technique, in which a 24F pull-type tube was inserted into a patient's mouth and was pulled to the upper abdominal puncture site using a snare, under fluoroscopy. The 18 patients with difficulty swallowing due to muscular atrophic lateral sclerosis or transitional myodystrophy included 5 cases of quadriplegia, 1 case of Parkinson's disease, and 1 metastatic mediastinal tumor. The technical success rate, occurrence of complications, and clinical outcomes were examined. The technical success rate was found to be 100%. In addition, the retention periods for the indwelling tube ranged from 1 to 24 months (mean: 6.5 months), with all tubes retained at a normal position with normal function. No procedure-related mortality occurred. One patient (4%) did however develop a complication in the form of ascites and ascitic fluid leakage around the tube, which was of hepatic origin and was ultimately resolved after the drainage of ascites. As a result of this study the FPG, accompanied with the pull technique using a 24F tube, should be considered as a safe and effective method for examining patients. It was found to have a high success rate and a low complication rate.

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.

Practice and problems with gastrostomies.

Science.gov (United States)

McHattie, Gill

2005-08-01

The development of gastrostomy placement has been an important technological advance in the enteral-access field. However, its rapid growth in popularity could be viewed as problematic. The endoscopist or intervention radiologist can no longer act as a technician but requires to follow-up this group of patients in order to determine outcomes that will inform future practice. There has been emphasis on the importance of the multidisciplinary team in informing and assessing patients referred for gastrostomy insertion. Communication between all the professionals caring for a patient and between the carers and the patient allows information to be collated that will determine the benefits and burdens of long-term gastrostomy feeding. At present much of the published experience is limited to the acute care setting. The incidence of complications varies, depending on the investigator's definition of complication and the diagnosis of the patient group. Many reported studies are retrospective, which puts limitations on documentation. Increasing numbers of patients with diverse needs are now being discharged into the community with gastrostomy tubes in place. Whilst the hospital should ensure that written protocols are provided and that all carers involved should have adequate training, it is not unusual for patients to receive mixed messages from the different care teams responsible for their care. In South Glasgow NHS Hospital Division key members of all teams caring for these patients (acute care, community district nurses, learning disabilities team, physical disabilities team and commercial homecare companies) meet regularly to discuss equipment and protocols. The members of this group feel that this approach has improved communication, standardised practice and reduced complications by providing a service that delivers artificial nutrition support but is primarily suited to the patient's disease process.

ORIGINAL ARTICLES Percutaneous endoscopic gastrostomy in ...

African Journals Online (AJOL)

2003-07-14

Jul 14, 2003 ... Surgery, Red Cross War Memorial Children's Hospital and School of Child and. Adolescent ... gastrostomy (viz. no need for a laparotomy, short anaesthetic time or ... long-term nasogastric tube feeding with all its inherent ...

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

events were recorded in relation to the trial. The qualitative substudy identified several factors that had an impact on recruitment, many of which are amenable to change. These included organisational factors, changing cancer treatments and patient and clinician preferences. A key reason for the differential recruitment between sites was the degree to which the multidisciplinary team gave a consistent demonstration of equipoise at all patient interactions at which supplementary feeding was discussed. An exploratory economic model generated from published evidence and expert opinion suggests that, over the 6-month model time horizon, pre-treatment gastrostomy tube feeding is not a cost-effective option, although this should be interpreted with caution and we recommend that this should not form the basis for policy. The economic value-of-information analysis indicates that additional research to eliminate uncertainty around model parameters is highly likely to be cost-effective. The recruitment issues identified for this cohort may not be applicable to other populations undergoing CRT. There remains substantial uncertainty in the economic evaluation. The trial did not meet one of the three criteria for progression, as the recruitment rate was lower than hypothesised. Once patients were recruited to the trial, compliance and retention in the trial were both high. The implementation of organisational and operational measures can increase the numbers recruited. The economic analysis suggests that further research in this area is likely to be cost-effective. The implementation of organisational and operational measures can increase recruitment. The appropriate research question and design of a future study needs to be identified. More work is needed to understand the experiences of nasogastric tube feeding in patients undergoing CRT. Current Controlled Trials ISRCTN48569216. This project was funded by the National Institute for Health Research (NIHR) Health Technology

Multicentre survey of radiologically inserted gastrostomy feeding tube (RIG) in the UK

International Nuclear Information System (INIS)

Lowe, A.S.; Laasch, H.U.; Stephenson, S.; Butterfield, C.; Goodwin, M.; Kay, C.L.; Glancy, S.; Jackson, S.; Brown, D.; McLean, P.; Keanie, J.; Thrower, A.; Briggs, R.; Punekar, S.; Krishnan, S.; Thomas, B.; Yap, K.; Mullan, D.; Maskell, G.; Hancock, J.

2012-01-01

Aims: To evaluate the variance in current UK clinical practice and clinical outcomes for direct percutaneous radiologically inserted gastrostomy (RIG). Materials and methods: A prospective UK multicentre survey of RIG performed between October 2008 and August 2010 was performed through the British Society of Gastrointestinal and Abdominal Radiology (BSGAR). Results: Data from 684 patients were provided by 45 radiologists working at 17 UK centres. Two hundred and sixty-three cases (40%) were performed with loop-retained catheters, and 346 (53%) with balloon-retained devices. Sixty percent of all patients experienced pain in the first 24 h, but settled in the majority thereafter. Early complications, defined as occurring in the first 24 h, included minor bleeding (1%), wound infection (3%), peritonism (2%), and tube misplacement (1%). Late complications, defined as occurring between day 2 and day 30 post-procedure, included mild pain (30%), persisting peritonism (2%), and 30 day mortality of 1% (5/665). Pre-procedural antibiotics or anti-methicillin-resistant Staphylococcus aureus (MRSA) prophylaxis did not affect the rate of wound infection, peritonitis, post-procedural pain, or mortality. Ninety-three percent of cases were performed using gastropexy. Gastropexy decreased post-procedural pain (p < 0.001), but gastropexy-related complications occurred in 5% of patients. However, post-procedure pain increased with the number of gastropexy sutures used (p < 0.001). The use of gastropexy did not affect the overall complication rate or mortality. Post-procedure pain increased significantly as tube size increased (p < 0.001). The use of balloon-retention feeding tubes was associated with more pain than the deployment of loop-retention devices (p < 0.001). Conclusion: RIG is a relatively safe procedure with a mortality of 1%, with or without gastropexy. Pain is the commonest complication. The use of gastropexy, fixation dressing or skin sutures, smaller tube sizes, and

Cone-Beam Computed Tomography-Guided Percutaneous Radiologic Gastrostomy

International Nuclear Information System (INIS)

Moehlenbruch, Markus; Nelles, Michael; Thomas, Daniel; Willinek, Winfried; Gerstner, Andreas; Schild, Hans H.; Wilhelm, Kai

2010-01-01

The purpose of this study was to investigate the feasibility of a flat-detector C-arm-guided radiographic technique (cone-beam computed tomography [CBCT]) for percutaneous radiologic gastrostomy (PRG) insertion. Eighteen patients (13 men and 5 women; mean age 62 years) in whom percutaneous endoscopic gastrostomy (PEG) had failed underwent CBCT-guided PRG insertion. PEG failure or unsuitability was caused by upper gastrointestinal tract obstruction in all cases. Indications for gastrostomy were esophageal and head and neck malignancies, respectively. Before the PRG procedure, initial C-arm CBCT scans were acquired. Three- and 2-dimensional soft-tissue reconstructions of the epigastrium region were generated on a dedicated workstation. Subsequently, gastropexy was performed with T-fasteners after CBCT-guided puncture of the stomach bubble, followed by insertion of an 14F balloon-retained catheter through a peel-away introducer. Puncture of the stomach bubble and PRG insertion was technically successful in all patients without alteration of the epigastric region. There was no malpositioning of the tube or other major periprocedural complications. In 2 patients, minor complications occurred during the first 30 days of follow-up (PRG malfunction: n = 1; slight infection: n = 1). Late complications, which were mainly tube disturbances, were observed in 2 patients. The mean follow-up time was 212 days. CBCT-guided PRG is a safe, well-tolerated, and successful method of gastrostomy insertion in patients in whom endoscopic gastrostomy is not feasible. CBCT provides detailed imaging of the soft tissue and surrounding structures of the epigastric region in one diagnostic tour and thus significantly improves the planning of PRG procedures.

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

International Nuclear Information System (INIS)

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

2012-01-01

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

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

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

2012-03-15

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

CT findings in gastrocolic fistula following percutaneous endoscopic gastrostomy

International Nuclear Information System (INIS)

Brown, Suki; McHugh, Kieran; Ledermann, Sarah; Pierro, Agostino

2007-01-01

We describe the CT findings in an initially asymptomatic boy aged 2 years 9 months with a gastrocolic fistula following percutaneous endoscopic gastrostomy (PEG) placement. The findings consisted of an unusual configuration of the gastrostomy tubing on an abdominal radiograph and upper gastrointestinal study indicating the possibility of transcolic PEG placement, which was confirmed with limited section CT. This well-known and major complication following a common procedure may be recognized on plain abdominal radiography, but it has not to our knowledge been documented previously on CT in a child. (orig.)

CT findings in gastrocolic fistula following percutaneous endoscopic gastrostomy

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Brown, Suki [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); St. George' s Hospital, Radiology Department, London (United Kingdom); McHugh, Kieran [Great Ormond Street Hospital for Children, Department of Radiology, London (United Kingdom); Ledermann, Sarah [Great Ormond Street Hospital for Children, Department of Nephrology, London (United Kingdom); Pierro, Agostino [Great Ormond Street Hospital for Children, Department of Surgery, London (United Kingdom)

2007-02-15

We describe the CT findings in an initially asymptomatic boy aged 2 years 9 months with a gastrocolic fistula following percutaneous endoscopic gastrostomy (PEG) placement. The findings consisted of an unusual configuration of the gastrostomy tubing on an abdominal radiograph and upper gastrointestinal study indicating the possibility of transcolic PEG placement, which was confirmed with limited section CT. This well-known and major complication following a common procedure may be recognized on plain abdominal radiography, but it has not to our knowledge been documented previously on CT in a child. (orig.)

Unsuccessful Practice of Percutaneous Endoscopic Gastrostomy in an Infant with Gastric Volvulus: a Case Report

Directory of Open Access Journals (Sweden)

Levent Duman

2011-09-01

Full Text Available Percutaneous endoscopic gastrostomy (PEG is an easy and safe procedure for long-term enteral feeding in children with inadequate oral intake. Although PEG has been used for treatment of gastric volvulus in adults, there is a little relevant data for its use in children. Here, we report a 17-month-old male infant who was admitted to our hospital with a 1-month history of vomiting. Upper gastrointestinal contrast study revealed an organoaxial gastric volvulus. Then PEG was inserted for the purpose of nutritional support. Because the patient continued to vomit after feeding via gastrostomy, surgery was planned. Laparotomy revealed that the entry of the PEG tube was at the posterior wall of the stomach. The gastrostomy tube was removed, and the opening was repaired. Then the stomach was repositioned, and Nissen fundoplication and a Stamm gastrostomy at the anterior wall of the stomach were performed. The patient had no further episodes of vomiting after surgery and was discharged following an uneventful recovery period.

The sky blue method as a screening test to detect misplacement of percutaneous endoscopic gastrostomy tube at exchange.

Science.gov (United States)

Suzuki, Yutaka; Urashima, Mitsuyoshi; Yoshida, Hideki; Iwase, Tsuyoshi; Kura, Toshiroh; Imazato, Shin; Kudo, Michiaki; Ohta, Tomoyuki; Mizuhara, Akihiro; Tamamori, Yutaka; Muramatsu, Hirohito; Nishiguchi, Yukio; Nishiyama, Yorihiro; Takahashi, Mikako; Nishiwaki, Shinji; Matsumoto, Masami; Goshi, Satoshi; Sakamoto, Shigeo; Uchida, Nobuyuki; Ijima, Masashi; Ogawa, Tetsushi; Shimazaki, Makoto; Takei, Shinichi; Kimura, Chikou; Yamashita, Satoyoshi; Endo, Takao; Nakahori, Masato; Itoh, Akihiko; Kusakabe, Toshiro; Ishizuka, Izumi; Iiri, Takao; Fukasawa, Shingo; Arimoto, Yukitsugu; Kajitani, Nobuaki; Ishida, Kazuhiko; Onishi, Koji; Taira, Akihiko; Kobayashi, Makoto; Itano, Yasuto; Kobuke, Toshiya

2009-01-01

During tube exchange for percutaneous endoscopic gastrostomy (PEG), a misplaced tube can cause peritonitis and death. Thus, endoscopic or radiologic observation is required at tube exchange to make sure the tube is placed correctly. However, these procedures cost extensive time and money to perform in all patients at the time of tube exchange. Therefore, we developed the "sky blue method" as a screening test to detect misplacement of the PEG tube during tube exchange. First, sky blue solution consisting of indigocarmine diluted with saline was injected into the gastric space via the old PEG tube just before the tube exchange. Next, the tube was exchanged using a standard method. Then, we checked whether the sky blue solution could be collected through the new tube or not. Finally, we confirmed correct placement of the tube by endoscopic or radiologic observation for all patients. A total of 961 patients were enrolled. Each tube exchange took 1 to 3 minutes, and there were no adverse effects. Four patients experienced a misplaced tube, all of which were detectable with the sky blue method. Diagnostic parameters of the sky blue method were as follows: sensitivity, 94% (95%CI: 92-95%); specificity, 100% (95%CI: 40-100%); positive predictive value, 100% (95%CI: 100-100%); negative predictive value, 6% (95%CI: 2-16%). These results suggest that the number of endoscopic or radiologic observations to confirm correct replacement of the PEG tube may be reduced to one fifteenth using the sky blue method.

Percutaneous Endoscopic Gastrostomy in the Enteral Feeding of the Elderly

Directory of Open Access Journals (Sweden)

Huan-Lin Chen

2011-09-01

Full Text Available Today we are faced with an aging society that may develop malnutrition because of dysphagia related to dementia, stroke, and malignancy seen often in the elderly. The preferred form of nutritional supplementation for this group is enteral nutrition, and the most appropriate long-term method is by use of a gastrostomy. Percutaneous endoscopic gastrostomy (PEG was first introduced in 1980 as an alternative to the traditional operative procedure and rapidly became the preferred procedure. In geriatric patients, the principal indications are neurological dysphagia and malnutrition, related to an underlying disease or anorexia-cachexia in very elderly. PEG is contraindicated in the presence of respiratory distress, previous gastric resection, total esophageal obstruction, coagulation disorders and sepsis in the elderly. Common complications include wound infection, leakage, hemorrhage, and fistula in the general population, but aspiration pneumonia is the major case of death in this group. Risks and complications of PEG must be discussed with patients and their families; and the decision for percutaneous endoscopic gastrostomy insertion should only be made after careful consideration and discussion between managing physicians, allied health professionals, and the patient and/or family. Four ethical principles may help make feeding decisions: beneficence, non-maleficence, autonomy and justice. Attentive long-term care after tube replacement is mandatory. Acceptance of percutaneous endoscopic gastrostomy placement by patients and their families tends to increase once favorable outcomes are offered.

CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

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De Bucourt, Maximilian; Collettini, Federico; Althoff, Christian; Streitparth, Florian; Greupner, Johannes; Hamm, Bernd (Dept. of Radiology, Charite - Univ. Medicine, Berlin (Germany)), Email: mdb@charite.de; Teichgraeber, U.K. (Dept. of Radiology, Jena Univ. (Germany))

2012-04-15

Background: In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. Purpose: To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. Material and Methods: A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. Results: The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Conclusion: Initial results suggest that the described

CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

International Nuclear Information System (INIS)

De Bucourt, Maximilian; Collettini, Federico; Althoff, Christian; Streitparth, Florian; Greupner, Johannes; Hamm, Bernd; Teichgraeber, U.K.

2012-01-01

Background: In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. Purpose: To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. Material and Methods: A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. Results: The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Conclusion: Initial results suggest that the described

Pain and Swelling after Percutaneous Endoscopic Gastrostomy Removal: An Unexpected Evolution

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Patrícia Queirós

2018-03-01

Full Text Available Gastrostomy site metastization is considered an uncommon complication of percutaneous endoscopic gastrostomy (PEG placement in patients with head and neck tumours, but it is important to consider this possibility when evaluating gastrostomy-related symptoms. The authors present the case of a 40-year-old male with excessive alcohol consumption and active smoking, diagnosed with a stage IV oropharyngeal squamous cell carcinoma. The patient developed a paraneoplastic demyelinating motor polyneuropathy that, associated with tumour mass effect, caused dysphagia with need for nasogastric tube feeding. Treatment with radiotherapy and then chemoradiotherapy was administered and a PEG was placed with the pull method. Cancer remission and resolution of polyneuropathy was achieved, so PEG was removed. Two weeks later, the patient presented with pain and swelling at the gastrostomy site suggesting a local abscess, with improvement after drainage and antibiotic therapy. After 1 month, there was a tumour mass at the gastrostomy site and an oropharyngeal cancer metastasis was diagnosed. The patient underwent surgical excision of abdominal wall metastasis and abdominal disease was controlled. Nevertheless, there was subsequent oropharyngeal neoplasia recurrence and the patient died 6 months later. This case raises the discussion about gastrostomy placement methods that could avoid gastrostomy site metastization, the possible differential diagnosis, and diagnostic workout. Surgical resection may allow metastatic disease control, but by primary disease evolution greatly affects prognosis.

Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation

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Corry, J.; Poon, W.; McPhee, N.; Milner, A. D.; Cruickshank, D.; Rischin, D.; Peters, L. J.

2008-01-01

Full text: Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients' reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients' assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group

Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis

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Pelckmans Paul A

2011-03-01

Full Text Available Abstract Background Percutaneous endoscopic gastrostomy (PEG allows long-term tube feeding. Safety of pull-type and introducer PEG placement in oncology patients with head/neck or oesophageal malignancies is unknown. Methods Retrospective analysis of 299 patients undergoing PEG tube placement between January 2006 and December 2008 revealed 57 oncology patients. All patients with head/neck or oesophageal malignancy were treated with chemo- and radiotherapy. In case of high-grade stenosis introducer Freka® Pexact PEG tube was placed (n = 24 and in all other patients (n = 33 conventional pull-type PEG tube. Short-term complications and mortality rates were compared. Results Patients' characteristics and clinical status were comparable in both groups. Short-term complications were encountered in 11/24 (48% introducer PEG patients as compared to only 4/33 (12% pull-type PEG patients (P vs. 0/33 (0%, P vs. 3/33 (9%, NS. Finally, 3/24 gastrointestinal perforations (12% resulted from a difficult placement procedure vs. 1/33 (3%, leading to urgent surgical intervention and admission to ICU. Two introducer PEG patients died at ICU, resulting in an overall mortality rate of 8% vs. 0% (P = 0.091. Conclusion The introducer Freka® Pexact PEG procedure for long-term tube feeding may lead to significantly higher complication and mortality rates in patients with head/neck or oesophageal malignancies treated with chemo- and radiotherapy. It is suggested to use the conventional pull-type PEG tube placement in this group of patients, if possible.

Initial experience with percutaneous endoscopic gastrostomy with T-fastener fixation in pediatric patients

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Kvello, Morten; Knatten, Charlotte Kristensen; Perminow, Gøri; Skari, Hans; Engebretsen, Anders; Schistad, Ole; Emblem, Ragnhild; Bjørnland, Kristin

2018-01-01

Background and study aims  Insertion of a percutaneous endoscopic gastrostomy (PEG) with push-through technique and T-fastener fixation (PEG-T) has recently been introduced in pediatric patients. The T-fasteners allow a primary insertion of a balloon gastrostomy. Due to limited data on the results of this technique in children, we have investigated peri- and postoperative outcomes after implementation of PEG-T in our department. Patients and methods  This retrospective chart review included all patients below 18 years who underwent PEG-T placement from 2010 to 2014. Main outcomes were 30-day postoperative complications and late gastrostomy-related complications. Results  In total, 87 patients were included, and median follow-up time was 2.4 years (1 month – 4.9 years). Median age and weight at PEG-T insertion were 1.9 years (9.4 months – 16.4 years) and 10.4 kg (5.4 – 33.0 kg), respectively. Median operation time was 28 minutes (10 – 65 minutes), and 6 surgeons and 3 endoscopists performed the procedures. During the first 30 days, 54 complications occurred in 41 patients (47 %). Most common were peristomal infections treated with either local antibiotics in 11 patients (13 %) or systemic antibiotics in 11 other patients (13 %). 9 patients (10 %) experienced tube dislodgment. Late gastrostomy-related complications occurred in 33 patients (38 %). The T-fasteners caused early and late complications in 9 (10 %) and 11 patients (13 %), respectively. Of these, 4 patients (5 %) had subcutaneously migrated T-fasteners which were removed under general anesthesia. Conclusion  We found a high rate of complications after PEG-T. In particular, problems with the T-fasteners and tube dislodgment occurred frequently after PEG-T insertion. PMID:29399615

[Button gastrostomy in children].

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Kozlov, Iu A; Novozhilov, V A; Rasputin, A A; Us, G P; Kuznetsova, N N

2015-01-01

For the period January 2002 to December 2013 it was performed 84 interventions for introduction of gastrostomy tube. The first group included 24 open operations and the second group had 60 laparoscopic operations by using of button devices MIC-KEY (Kimberly-Clark, Roswell, USA) in neonates and infants. Statistically significant difference was not observed during comparison of demographic data of patients. Differences in groups were found in statistical analysis of intra- and postoperative parameters (p<0.05). Mean duration of surgery in the first group was 37.29 min, in the second group - 23.97 min. Time to start of feeding and transition to complete enteral nutrition was less in patients who underwent laparoscopic surgery than after open intervention (10.5 and 19.13 hours, 23.79 and 35.88 hours respectively; p<0.05). It was revealed augmentation of hospital stay in the 1st group in comparison with the 2(nd) group (11.71 and 7.09 days respectively; p<0.05). Frequency of postoperative complications was 18.33% in the 2(nd) group and 24% - in the 1st group (p<0.05). The authors consider that button devices are simply and effective technique of gastrostomy establishment in children. It is associated with minimal surgery duration and allows to start early enteral nutrition in comparison with open techniques.

Fluoroscopic-guided primary single-step percutaneous gastrostomy. Initial results using the Freka {sup registered} GastroTube; Primaere einzeitige durchleuchtungsgesteuerte perkutane Gastrostomie (PG). Erste Ergebnisse mit dem Freka {sup registered} GastroTube

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Hahne, J.D.; Schoennagel, B.P.; Arndt, C.; Bannas, P.; Koops, A.; Adam, G.; Habermann, C.R. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Herrmann, J. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Universitaetsklinikum Hamburg-Eppendorf (Germany). Abt. Paediatrische Radiologie

2011-07-15

Purpose: To determine the practicability and outcome of fluoroscopic-guided primary one-step treatment of percutaneous gastrostomy (PG) with the system Freka {sup registered} Gastro Tube (Fresenius Kabi, Germany). Materials and Methods: In 39 patients (mean age 62.7 {+-} 12.0 years), primary PG was performed based on clinical indication from August 2009 to April 2010. The intervention was performed by an experienced radiologist under aseptic conditions by direct puncture with Freka {sup registered} Gastro Tube under fluoroscopic guidance. The clinical data and outcome as well as any complications originated from the electronic archive of the University Medical Center Hamburg-Eppendorf. Results: The intervention was technically successful in all 39 patients. Within the mean follow-up time of 155.3 {+-} 73.6 days, 29 patients (74.4 %) did not experience complications. 10 patients (25.6 %) had to be revised. Complications manifested after a mean of 135.6 {+-} 61.2 days and mainly corresponded to accidental dislocation (50 %). One patient had to be surgically revised under suspicion of a malpositioned tube and suspected intestinal perforation. Clinically relevant wound infections were not detected. The total costs per patient were 553.17 Euro for our single-step treatment (OPS 5 - 431.x) vs. 963.69 Euro (OPS 5 - 431.x and OPS 8 - 123.0) for the recommended two-step treatment. Conclusion: Fluoroscopic-guided primary single-step treatment with Freka {sup registered} Gastro Tube system is feasible and not associated with an increased complication rate when compared to published literature applying a two-step treatment approach. Material costs as well as human and time resources could be significantly reduced using the single-step treatment. (orig.)

Gastrostomy and gastroesophageal reflux in neurologically impaired children

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Giovanni Cappellano

2003-06-01

Full Text Available Gastrostomy has been increasingly indicated for daily feeding ofneurologically impaired children with swallowing abnormalitiesthat hinder the use of the mouth. Therefore, the enteral route hasstill been used by means of oral, nasogastric or nasojejunal tube.However it is no longer the preferential method, mainly in cases ofprolonged use. Today gastrostomy is the most often utilizedprocedure, particularly Stamm gastrostomy. Many of thesepatients present pulmonary abnormalities due to a possiblegastroesophageal reflux (GER. After the study by Jolley et al.(1, in1985, fundoplication has become a systematic and routinecomplement to gastrostomy. The neurologically impaired patientshave been submitted to two surgeries, leading to possible andpredictable increase in morbidity and mortality rates. Althougheffective when properly indicated, this simple management hasrecently been very much debated and rejected. Thus, an updatingbased on recent studies is necessary to make pediatric surgeonsand pediatricians aware of other manners to solve this problem,which aim at correctly feeding these children with impairedswallowing and GER and helping them have a better quality of life.The literature reviewed was searched in PubMed/Medline, fromJanuary 1994 to May 2003. Other articles read and mentioned inthis review and published before 1994 were collected based onarticles cited in the references. Thus, we could assess thechronological progression in management of neurologicallyimpaired children who need gastrostomy for their feeding, andcarry out an analysis of current fundoplication and the questionwhether the use of a prophylactic antireflux valve is compulsoryor not.

Stability of Balloon-Retention Gastrostomy Tubes with Different Concentrations of Contrast Material: In Vitro Study

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Lopera, Jorge E.; Alvarez, Alex; Trimmer, Clayton; Josephs, Shellie; Anderson, Matthew; Dolmatch, Bart

2009-01-01

The purpose of this study was to determine the performance of two balloon-retention-type gastrostomy tubes when the balloons are inflated with two types of contrast materials at different concentrations. Two commonly used balloon-retention-type tubes (MIC and Tri-Funnel) were inflated to the manufacturer's recommended volumes (4 and 20 cm 3 , respectively) with normal saline or normal saline plus different concentrations of contrast material. Five tubes of each brand were inflated with normal saline and 0%, 25%, 50%, 75%, and 100% contrast material dilutions, using either nonionic hyperosmolar contrast, or nonionic iso-osmolar contrast. The tubes were submerged in a glass basin containing a solution with a pH of 4. Every week the tubes were visually inspected to determine the integrity of the balloons, and the diameter of the balloons was measured with a caliper. The tests were repeated every week for a total of 12 weeks. The MIC balloons deflated slightly faster over time than the Tri-Funnel balloons. The Tri-Funnel balloons remained relatively stable over the study period for the different concentrations of contrast materials. The deflation rates of the MIC balloons were proportionally related to the concentration of saline and inversely related to the concentration of the contrast material. At high contrast material concentrations, solidification of the balloons was observed. In conclusion, this in vitro study confirms that the use of diluted amounts of nonionic contrast materials is safe for inflating the balloons of two types of balloon-retention feeding tubes. High concentrations of contrast could result in solidification of the balloons and should be avoided.

Percutaneous endoscopic gastrostomy.

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Gay, F; el Nawar, A; Van Gossum, A

1992-01-01

From March 87 to March 92, fifty eight patients were referred to our department for percutaneous endoscopic gastrostomy (PEG). The modality of the feeding tube insertion is described. The most common indications for placement were neurologic disorders in 62% of the cases (n = 36) and malignant diseases in 32% (n = 19). The success rate of the technique was 98.3% (n = 57). No procedure-related mortality was observed. A low rate of major complication (1.7%) and minor complication (10.5%) was noted. Feeding tubes were removed in 21% of patients (n = 12); none of them with malignant disease. Survival curve analysis demonstrated that 50% of patients died within 3 months of PEG placement. Such results raise questions about the selection of patients undergoing PEG. Our experience of patients undergoing PEG. Our experience suggests that PEG is easy and safe, even in debilitated patients, having an acceptable life expectancy.

Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

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Ana Grilo

2012-09-01

Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

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

Gastroenteric tube feeding: Techniques, problems and solutions

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Blumenstein, Irina; Shastri, Yogesh M; Stein, Jürgen

2014-01-01

Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision. PMID:25024606

Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: A comparison of indications, complications and outcomes in 370 patients

International Nuclear Information System (INIS)

Silas, Anne M.; Pearce, Lindsay F.; Lestina, Lisa S.; Grove, Margaret R.; Tosteson, Anna; Manganiello, Wendy D.; Bettmann, Michael A.; Gordon, Stuart R.

2005-01-01

Objective: Percutaneous access to the stomach can be achieved by endoscopic or fluoroscopic methods. Our objective was to compare indications, complications, efficacy and outcomes of these two techniques. Methods: Records of 370 patients with feeding tubes placed either endoscopically by gastroenterology, or fluoroscopically by radiology, at our university-based tertiary care center over a 54-month period were reviewed. Results: 177 gastrostomies were placed endoscopically and 193 fluoroscopically. Nutrition was the most common indication in each group (94 and 92%), but the most common underlying diagnosis was neurologic impairment in the endoscopic group (n = 89, 50%) and malignancy in the fluoroscopic group (n = 134, 69%) (p < 0.001). Complications in the first 30 days were more common with fluoroscopic placement (23% versus 11%, p = 0.002), with infection most frequent. Correlates of late complications were inpatient status (OR 0.26, 95%CI: 0.13-0.51) and a diagnosis of malignancy (OR 2.2, 95%CI: 1.03-4.84). Average follow-up time was 108 days in the fluoroscopic group and 174 days in the endoscopic group. Conclusions: Both endoscopic and fluoroscopic gastrostomy tube placement are safe and effective. Outpatient status was associated with greater early and late complication rates; minor complications such as infection were greater in the fluoroscopic group, while malignancy was associated with late complications

Use of a novel laparoscopic gastrostomy technique in children with severe epidermolysis bullosa.

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Patel, Kamlesh; Wells, Jonathan; Jones, Rosie; Browne, Fiona; Moss, Celia; Parikh, Dakshesh

2014-05-01

Supplementing nutrition in children with severe epidermolysis bullosa (EB) is challenging because of skin and mucosal fragility. Percutaneous endoscopic gastrostomy is contraindicated in EB, whereas more invasive open surgical gastrostomy placement can be complicated by chronic leakage. The aim of the study was to review the efficacy and acceptability, in children with severe EB, of our modified 2-port laparoscopic approach using the Seldinger technique with serial dilatation and tube insertion through a peel-away sheath. Retrospective review of children with EB who underwent laparoscopic feeding gastrostomy at our centre since 2009. Seven children (6 severe generalised recessive dystrophic EB, 1 non-Herlitz junctional EB; 2 girls, 5 boys) underwent modified laparoscopic gastrostomy placement at median age 4.85 years (range 1.0-8.8), with fundoplication for gastro-oesophageal reflux in 1 case, with follow-up for 0.3 to 3.9 years. The procedure was well tolerated with oral feeds usually given after 4 hours and whole protein gastrostomy feeds within 24 hours in 6 patients. Improved growth was reflected in mean weight and height z scores: -1.36 (range -2.6 to 0.5) to -0.61 (range -2.34 to 2.0) and -1.09 (range -2.42 to 1.0) to 0.71 (range -1.86 to 1.0), respectively. Postoperatively, 5 patients experienced minor local complications: minimal leakage without skin damage in 3 and transient peristomal granulation rapidly responsive to topical treatment in 2; this followed acute gastrostomy site infection in 1. There was no leakage after the immediate postoperative period. We conclude that our less-invasive laparoscopic gastrostomy technique is effective and better tolerated in children with severe EB, at least in the medium term, than open gastrostomy placement. Longer follow-up is required.

Minority race and male sex as risk factors for non-beneficial gastrostomy tube placements after stroke.

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Faigle, Roland; Carrese, Joseph A; Cooper, Lisa A; Urrutia, Victor C; Gottesman, Rebecca F

2018-01-01

Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding after stroke; however, PEG tubes placed in patients in whom death is imminent are considered non-beneficial. We sought to determine whether placement of non-beneficial PEG tubes differs by race and sex. In this retrospective cohort study, inpatient admissions for stroke patients who underwent palliative/withdrawal of care, were discharged to hospice, or died during the hospitalization, were identified from the Nationwide Inpatient Sample between 2007 and 2011. Logistic regression was used to evaluate the association between race and sex with PEG placement. Of 36,109 stroke admissions who underwent palliative/withdrawal of care, were discharge to hospice, or experienced in-hospital death, a PEG was placed in 2,258 (6.3%). Among PEG recipients 41.1% were of a race other than white, while only 22.0% of patients without PEG were of a minority race (prace was associated with PEG placement compared to whites (OR 1.75, 95% CI 1.57-1.96), and men had 1.27 times higher odds of PEG compared to women (95% CI 1.16-1.40). Racial differences were most pronounced among women: ethnic/racial minority women had over 2-fold higher odds of a PEG compared to their white counterparts (OR 2.09, 95% CI 1.81-2.41), while male ethnic/racial minority patients had 1.44 increased odds of a PEG when compared to white men (95% CI 1.24-1.67, p-value for interaction race and male sex are risk factors for non-beneficial PEG tube placements after stroke.

PEG Tube Placement

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Saptarshi Biswas

2014-01-01

Full Text Available Percutaneous endoscopic gastrostomy (PEG has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

Modified tube gastropexy using a mushroom-tipped silicone catheter for management of gastric dilatation-volvulus in dogs.

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Belch, A; Rubinos, C; Barnes, D C; Nelissen, P

2017-02-01

To report the short- and long-term complications and clinical outcomes of a cohort of dogs managed for gastric dilatation-volvulus using a modified right-sided tube gastropexy technique. Retrospective case series. Of 31 dogs treated, 29 (93·5%) had an excellent short-term outcome, and gastric dilatation-volvulus did not recur in any dog. Twenty-six dogs (84%) were initially fed via the gastrostomy tube postoperatively; three (9·7%) suffered a major complication including septic peritonitis (n=1), and premature tube removal (n=2). Fourteen dogs (45·1%) had minor complications including mild, self-limiting discharge from the stoma site in 13. Modified tube gastropexy using a mushroom-tipped silicone catheter is an effective and safe surgical method for the management of gastric dilatation-volvulus. The gastrostomy tube allowed early enteral feeding and easy administration of medications, including gastroprotectants. © 2017 British Small Animal Veterinary Association.

A PROSPECTIVE STUDY OF COMPLICATIONS RELATED TO PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN ICU PATIENTS

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Lokanath S

2017-11-01

Full Text Available BACKGROUND The first percutaneous endoscopic gastrostomy performed on a child was on June 12, 1979, at the Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Dr. Michael W.L. Gauderer, paediatric surgeon; Dr. Jeffrey Ponsky, endoscopist; and Dr. James Bekeny, surgical resident, performed the procedure on a 4 1 ⁄2-month-old child with inadequate oral intake. The authors of the technique, Dr. Michael W.L. Gauderer and Dr. Jeffrey Ponsky, first published the technique in 1980. In 2001, the details of the development of the procedure were published. Gastrostomy maybe indicated in numerous situations usually those in which normal or nutrition (or nasogastric feeding is impossible. The causes for these situations maybe neurological (e.g. stroke, anatomical (e.g. cleft lip and palate during the process of correction or other (e.g. radiation therapy for tumours in head and neck region. In certain situations where normal or nasogastric feeding is not possible, percutaneous endoscopic gastrostomy maybe of clinical benefit. This provides enteral nutrition (making use of the natural digestion process of the gastrointestinal tract despite bypassing the mouth; enteral nutrition is generally preferable to parenteral nutrition (which is only used when the GI tract must be avoided. The PEG procedure is an alternative to open surgical gastrostomy insertion and does not require a general anaesthetic; mild sedation is typically used. PEG tubes may also be extended into the small intestine by passing a jejunal extension tube (PEG-J tube through the PEG tube and into the jejunum via the pylorus. MATERIALS AND METHODS The present study was carried out in the Department of General Medicine on 32 patients who underwent PEG placement by gastroenterologist at Gayatri Vidya Parishad Hospital, Visakhapatnam, from January 2016 to December 2016. Patients were aged 18 years and above. All patients had placement of Ponsky pull PEs either in the

Paediatric gastrostomy stoma complications and treatments: A rapid scoping review.

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Townley, Ashleigh; Wincentak, Joanne; Krog, Kim; Schippke, Julia; Kingsnorth, Shauna

2018-04-01

To provide a scoping review of the types of treatments used to address paediatric skin-related stoma complications specific to infection, hypergranulation and gastric leakage, and explore their effectiveness and indications for use. Stoma-related complications can be a common occurrence for children with gastrostomy (G) and gastrojejunostomy (GJ) tubes. Nurses require guidance to inform decision-making of the broad spectrum of treatments used in clinical practice. A scoping review using a rapid review approach. Working with a multidisciplinary health professional team, search terms were generated. A systematic search of CINAHL, MEDLINE and EMBASE databases was completed, coupled with an Internet search to identify relevant clinical practice guidelines and hand searching of citation lists. Eligible articles were peer-reviewed English publications, focused on paediatric populations aged 18 years and under, dating from 2002-2016 and described complications and treatment approaches related to G- and GJ-tube stomas. Pertinent information was extracted using a standardised template, and a narrative synthesis approach was used to analyse the data. Twenty-five articles were included in this review. Study designs varied, and complication management was often a secondary focus. A broad spectrum of treatments was used to manage each complication type. There was a lack of consensus on lines of therapy; however, a stepwise approach was often used for complication management, particularly for infections. The evidence on the comparative effectiveness of different treatment strategies of skin-related gastrostomy stoma complications in paediatric practice is sparse. Current evidence is generally limited to expert opinions. Future studies examining efficacy of treatments and their indications for use with children are warranted. Effective management of skin-related stoma complications is important to maintain health and wellness among children who rely on G- and GJ-tubes for

Video assisted gastrostomy in children

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Backman, Torbjörn

2014-01-01

Children with severe diseases can be provided nutritional support through a gastrostomy if needed. At the Department of Paediatric Surgery in Lund we have used the Video Assisted Gastrostomy (VAG) procedure since 1994 when establishing gastrostomies. In this thesis, children with different diseases, who all had undergone the VAG procedure, were studied in five different clinical studies. Postoperative complications were collected and validated. We have not seen any major complications associa...

Mothers' process of decision making for gastrostomy placement.

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Brotherton, Ailsa; Abbott, Janice

2012-05-01

In this article we present the findings of an exploration of mothers' discourses on decision making for gastrostomy placement for their child. Exploring in-depth interviews of a purposive sample, we analyzed the mothers' discourses of the decision-making process to understand how their experiences of the process influenced their subsequent constructions of decision making. Mothers negotiated decision making by reflecting on their personal experiences of feeding their child, either orally or via a tube, and interwove their background experiences with the communications from members of the health care team until a decision was reached. Decision making was often fraught with difficulty, resulting in anxiety and guilt. Experiences of decision making ranged from perceived coercion to true choice, which encompasses a truly child-centered decision. The resulting impact of the decision-making process on the mothers was profound. We conclude with an exploration of the implications for clinical practice and describe how health care professionals can support mothers to ensure that decision-making processes for gastrostomy placement in children are significantly improved.

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

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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.

Ostomy metastasis after pull endoscopic gastrostomy: a unique favorable outcome.

Science.gov (United States)

Fonseca, Jorge; Adriana, Carla; Fróis-Borges, Miguel; Meira, Tânia; Oliveira, Gabriel; Santos, José Carlos

2015-04-01

Head and neck cancer (HNC) patients tend to develop dysphagia. In order to preserve the nutritional support, many undergo endoscopic gastrostomy (PEG). In HNC patients, ostomy metastasis is considered a rare complication of PEG, but there are no reports of successful treatment of these metastatic cancers. We report the case of a 65 years old pharyngeal/laryngeal cancer patient who underwent a PEG before the neck surgery. He was considered to be cured, resumed oral intake and the PEG tube was removed. Ten months after, he returned with a metastasis at the ostomy site. A block resection of the stomach and abdominal wall was performed. Two years after the abdominal surgery, he is free of disease. Although usually considered a rare complication of the endoscopic gastrostomy, ostomy metastasis may be more frequent than usually considered and the present case report demonstrates that these patients may have a favourable outcome. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Assessment of percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients

International Nuclear Information System (INIS)

Kakuta, Risako; Matsuura, Kazuto; Noguchi, Tetsuya; Katagiri, Katsunori; Imai, Takayuki; Ishida, Eichi; Saijyo, Shigeru; Kato, Kengo

2011-01-01

As nutrition support for head and neck cancer patients who receive chemoradiotherapy (CRT) and whose oral cavity or pharynx is exposed to radiation, we perform percutaneous endoscopic gastrostomy (PEG) tube placement. We examined 235 patients who underwent PEG in our division between January 2003 and December 2009. For 64% of them, the purpose of performing PEG was nutrition support for CRT, of whom 74% actually used the tube. However, the situation varied according to the primary sites of patients. Forty-four percent of laryngeal cancer patients who underwent PEG actually used the tube, which was a significantly lower rate than others. Also, 81% of them removed the PEG tube within one year. These findings suggest that PEG-tube placement for nutrition support is not indispensable for all CRT cases. Therefore, we recommend performing PEG for oral, oropharyngeal, and hypopharyngeal cancer patients. (author)

The role of gastrostomy tube placement in advanced dementia with dysphagia: a critical review

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Goldberg LS

2014-10-01

Full Text Available Leanne S Goldberg,1 Kenneth W Altman2 1Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY, USA; 2Baylor College of Medicine, Houston, TX, USAPurpose: Over 4.5 million people in North America had a diagnosis of dementia in the year 2000, and more than half had advanced disease with potential aspiration risk. There is much controversy regarding the use and timing of enteral feeding support in these patients with dysphagia. The management of dysphagia is far more complex when considering quality of life, “comfort care” hand feeding, the use of percutaneous endoscopic gastrostomy tube (PEG, and associated mortality rates. This study seeks to critically review the literature that evaluates PEG placement in this population. Methods: A systematic literature review of PubMed, from 1995–2012, was conducted to identify studies relating to PEG placement in dementia patients with dysphagia. The principal outcomes and related survival rates for this population were compared. Results: In total, 100 articles were identified in the search. Of these, ten met the search criteria and were analyzed. There was one study with a 2b level of evidence, one with 3b, and the remainder had level 4. All studies discussed long-term survival in the PEG versus non-PEG populations. No studies showed definitive evidence to suggest long-term survival rates improved in patients who underwent PEG placement as compared to those who did not. Two studies documented median survival worse in patients over age 80 with dementia and PEG placement.Conclusion: There is presently no evidence to suggest long-term survival rates improved in patients with advanced dementia who underwent PEG placement for dysphagia. Relevance to quality of life, need for nutrition and hydration, and ethical considerations in the decision process are discussed.Keywords: PEG, aspiration, elderly, feeding tube, swallow

Evaluating the Role of Prophylactic Gastrostomy Tube Placement Prior to Definitive Chemoradiotherapy for Head and Neck Cancer

International Nuclear Information System (INIS)

Chen, Allen M.; Li Baoqing; Lau, Derick H.; Farwell, D. Gregory; Luu, Quang; Stuart, Kerri; Newman, Kathleen; Purdy, James A.; Vijayakumar, Srinivasan M.D.

2010-01-01

Purpose: To determine the effect of prophylactic gastrostomy tube (GT) placement on acute and long-term outcome for patients treated with definitive chemoradiotherapy for locally advanced head and neck cancer. Methods and Materials: One hundred twenty consecutive patients were treated with chemoradiotherapy for Stage III/IV head and neck cancer to a median dose of 70 Gy (range, 64-74 Gy). The most common primary site was the oropharynx (66 patients). Sixty-seven patients (56%) were treated using intensity-modulated radiotherapy (IMRT). Seventy patients (58%) received prophylactic GT placement at the discretion of the physician before initiation of chemoradiotherapy. Results: Prophylactic GT placement significantly reduced weight loss during radiation therapy from 43 pounds (range, 0 to 76 pounds) to 19 pounds (range, 0 to 51 pounds), which corresponded to a net change of -14% (range, 0% to -30%) and -8% (range, +1% to -22%) from baseline, respectively (p < 0.001). However, the proportion of patients who were GT-dependent at 6- and 12-months after treatment was 41% and 21%, respectively, compared with 8% and 0%, respectively, for those with and without prophylactic GT (p < 0.001). Additionally, prophylactic GT was associated with a significantly higher incidence of late esophageal stricture compared with those who did not have prophylactic GT (30% vs. 6%, p < 0.001). Conclusions: Although prophylactic GT placement was effective at preventing acute weight loss and the need for intravenous hydration, it was also associated with significantly higher rates of late esophageal toxicity. The benefits of this strategy must be balanced with the risks.

Removal of T-fasteners 2 days after gastrostomy is feasible.

LENUS (Irish Health Repository)

Foster, A

2009-03-01

T-fastener gastropexy is widely performed as part of gastrostomy insertion. The current literature recommends removal of T-fasteners at 2 weeks. We present a series of patients in whom T-fasteners were removed at 2 days with no major complications. We removed T-fasteners in 109 patients (male-to-female ratio 59:50, age range 18 to 88 years, mean age 62 years) at 2 days after gastrostomy insertion. Indications for gastrostomy included amytrophic lateral sclerosis, cerebrovascular accidents, head and neck carcinoma, multiple sclerosis, and others, including brain tumours and chronic inflammatory demyelinating polyneuropathy. No peritubal leaks or other major complications were seen in the study population. In the study group, 15 minor complications were recorded (14%), including localised infection and pain, both of which resolved on removal of T-fasteners. We conclude that it is feasible and safe to remove T-fasteners at 2 days.

Tips and Tricks of Percutaneous Gastrostomy Under Image Guidance in Patients with Limited Access

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Marcy, Pierre-Yves; Figl, Andrea; Thariat, Juliette [Sophia Antipolis University, Nice cedex (France); Lacout, Alexis [Centre Me' dico-Chirurgical, Aurillac (France)

2011-10-15

We read with great interest the article by Chan et al. (1) in the March issue of Korean Journal of Radiology on their experience of modified radiology-guided percutaneous gastrostomy (MRPG). The authors proposed a technique to access the stomach in patients with upper digestive tract obstruction (UDTO). Following marking a patient's left liver inferior margin and room air-colonography, the authors punctured the gastric area using a 21G fine needle under X-ray guidance and withdrew their syringe gradually while injecting contrast medium. We noted that the gastrostomy may be performed using a 0.0035-inch hydrophilic guide wire and a 6.5-Fr angled catheter in almost 100% of patients contraindicated for endoscopy gastrostomy, including those with tortuous or tight cervical stenosis (2). In patients with a collapsed stomach, orally administered effervescent sodium bicarbonate powder can produce sufficient gas in the stomach to allow for a percutaneous needle puncture. In UDTO patients, diatrizoate meglumine can be directly injected into the gastric lumen under ultrasound (US) guidance, as reported by Pugash et al. (3) in 1995. Since the stomach appears collapsed with apposed multi-layer walls and virtual lumen on US, the needle tip is hardly seen. In such circumstances, after having transfixed the stomach with a 21G Chiba needle, further gradual needle withdrawing is performed under fluoroscopic guidance while injecting small amounts of diatrizoate meglumine until a ruga pattern is seen. Moreover, a cancer patient's subcutaneous fat is often absent and the anterior gastric wall is close to the abdominal wall. High frequency US monitoring does improve needle visualization in such a circumstance. Conversely, in obese patients, back- and forth motions of the needle stylet under Doppler color US guidance clearly improves needle visualization. We noted that by using this technique we successfully performed percutaneous fluoroscopy gastrostomy (PFG) in two partially

Tips and Tricks of Percutaneous Gastrostomy Under Image Guidance in Patients with Limited Access

International Nuclear Information System (INIS)

Marcy, Pierre-Yves; Figl, Andrea; Thariat, Juliette; Lacout, Alexis

2011-01-01

We read with great interest the article by Chan et al. (1) in the March issue of Korean Journal of Radiology on their experience of modified radiology-guided percutaneous gastrostomy (MRPG). The authors proposed a technique to access the stomach in patients with upper digestive tract obstruction (UDTO). Following marking a patient's left liver inferior margin and room air-colonography, the authors punctured the gastric area using a 21G fine needle under X-ray guidance and withdrew their syringe gradually while injecting contrast medium. We noted that the gastrostomy may be performed using a 0.0035-inch hydrophilic guide wire and a 6.5-Fr angled catheter in almost 100% of patients contraindicated for endoscopy gastrostomy, including those with tortuous or tight cervical stenosis (2). In patients with a collapsed stomach, orally administered effervescent sodium bicarbonate powder can produce sufficient gas in the stomach to allow for a percutaneous needle puncture. In UDTO patients, diatrizoate meglumine can be directly injected into the gastric lumen under ultrasound (US) guidance, as reported by Pugash et al. (3) in 1995. Since the stomach appears collapsed with apposed multi-layer walls and virtual lumen on US, the needle tip is hardly seen. In such circumstances, after having transfixed the stomach with a 21G Chiba needle, further gradual needle withdrawing is performed under fluoroscopic guidance while injecting small amounts of diatrizoate meglumine until a ruga pattern is seen. Moreover, a cancer patient's subcutaneous fat is often absent and the anterior gastric wall is close to the abdominal wall. High frequency US monitoring does improve needle visualization in such a circumstance. Conversely, in obese patients, back- and forth motions of the needle stylet under Doppler color US guidance clearly improves needle visualization. We noted that by using this technique we successfully performed percutaneous fluoroscopy gastrostomy (PFG) in two partially

Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

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Helena Duarte

2012-12-01

Full Text Available CONTEXT: Healthcare-associated infection represents the most frequent adverse event during care delivery. Medical advances like percutaneous endoscopic gastrostomy have brought improvement on quality of life to patients but an increased risk of healthcare-associated infection. Predictive risk factors for peristomal wound infection are largely unknown but evidence suggests that antibiotic prophylaxis and preventive strategies related to infection control may reduce infection rates. OBJECTIVES: The primary aim was to evaluate the global prevalence rate of peristomal infection. Secondary objectives were to characterise the positive culture results, to evaluate the prophylactic antibiotic protocol and to identify potential risk factors for peristomal infection. METHODS: Retrospective study of 297 patients with percutaneous endoscopic gastrostomy performed at a general hospital between January 2004 and September 2010. Patients received prophylactic cefazolin before the endoscopic gastrostomy procedure. Medical records were reviewed for demographic data, underling disease conditions to percutaneous endoscopic gastrostomy and patient potential intrinsic risk factors. Statistical analysis was made with the statistical program SPSS 17.0. RESULTS: A total of 297 percutaneous endoscopic gastrostomy tubes were inserted. Wound infection occurred in 36 patients (12.1%. Staphylococcus aureus methicillin resistant was the most frequently isolated microorganism (33.3% followed by Pseudomonas aeruginosa (30.6%. The incidence rate had been rising each year and differ from 4.65% in 2004/2007 to 17.9% in 2008/2010. This finding was consistent with the increasing of prevalence global infection rates of the hospital. Most of the infections (55.6% were detected in the first 10 days post procedure. There was no significant difference in age, body mass index values, mean survival time and duration of percutaneous endoscopic gastrostomy feeding between patients with and

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 tube-related complications and problems in patients receiving long-term home enteral nutrition

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Vasileios Alivizatos

2015-04-01

Full Text Available Aim: The aim of this study was to evaluate the long-term complications and problems related to gastrostomy and jejunostomy feeding tubes used for home enteral nutrition support and the effect these have on health care use. Materials and Methods: The medical records of 31 patients having gastrostomy (27 patients and jejunostomy (4 feeding tubes inserted in our Department were retrospectively studied. All were discharged on long-term (>3 months enteral nutrition and followed up at regular intervals by a dedicated nurse. Any problem or complication associated with tube feeding as well as the intervention, if any, that occurred, was recorded. Data were collected and analyzed. Results: All the patients were followed up for a mean of 17.5 months (4-78. The most frequent tube-related complications included inadvertent removal of the tube (broken tube, plugged tube; 45.1%, tube leakage (6.4%, dermatitis of the stoma (6.4%, and diarrhea (6.4%. There were 92 unscheduled health care contacts, with an average rate of such 2.9 contacts over the mean follow-up time of 17.5 months. Conclusion: In patients receiving long-term home enteral nutrition, feeding tube-related complications and problems are frequent and result in significant health care use. Further studies are needed to address their optimal prevention modalities and management.

Pre- and Postoperative Vomiting in Children Undergoing Video-Assisted Gastrostomy Tube Placement

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Torbjörn Backman

2014-01-01

Full Text Available Background. The aim of this study was to determine the incidence of pre- and postoperative vomiting in children undergoing a Video-Assisted Gastrostomy (VAG operation. Patients and Methods. 180 children underwent a VAG operation and were subdivided into groups based on their underlying diagnosis. An anamnesis with respect to vomiting was taken from each of the children’s parents before the operation. After the VAG operation, all patients were followed prospectively at one and six months after surgery. All complications including vomiting were documented according to a standardized protocol. Results. Vomiting occurred preoperatively in 51 children (28%. One month after surgery the incidence was 43 (24% in the same group of children and six months after it was found in 40 (22%. There was a difference in vomiting frequency both pre- and postoperatively between the children in the groups with different diagnoses included in the study. No difference was noted in pre- and postoperative vomiting frequency within each specific diagnosis group. Conclusion. The preoperative vomiting symptoms persisted after the VAG operation. Neurologically impaired children had a higher incidence of vomiting than patients with other diagnoses, a well-known fact, probably due to their underlying diagnosis and not the VAG operation. This information is useful in preoperative counselling.

Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

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Nutnicha Suksamanapun

2017-01-01

Full Text Available Background: Percutaneous endoscopic gastrostomy (PEG and laparoscopic-assisted gastrostomy (LAG are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method. Methods: This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications. Results: Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047, early tube dislodgements (P = 0.02 and complications that require reintervention under general anaesthesia (P < 0.001. Minor complications were equally frequent after both procedures. Conclusions: Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.

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.

Indications, medical conditions and services related to gastrostomy ...

African Journals Online (AJOL)

gastrostomy, is used in paediatric patients when long-term enteral feeding is required.1 This form of ... Gastrostomy feeding may also be indicated in paediatric patients with structural abnormalities, or those who ... with cardiac defects may have difficulty with feeding endurance, resulting in poor weight gain and the need for.

Maternal psychological distress and parenting stress after gastrostomy placement in children.

Science.gov (United States)

Avitsland, Tone Lise; Faugli, Anne; Pripp, Are Hugo; Malt, Ulrik Fredrik; Bjørnland, Kristin; Emblem, Ragnhild

2012-11-01

The aim of the study was to evaluate stress in mothers of children with feeding problems before and after gastrostomy placement, and to identify changes in child health and variables affecting maternal stress. Psychological distress and parenting stress in 34 mothers of children referred for gastrostomy were assessed using general health questionnaire (GHQ) (overall psychological distress), impact of event scale (IES) (intrusive stress related to child's feeding problems), and parenting stress index (PSI) (stress related to parenting) before, 6, and 18 months after placement of a gastrostomy. Information of child health and long-term gastrostomy complications were recorded. A semistructured interview constructed for the present study explored maternal preoperative expectations and child's quality of life. Insertion of a gastrostomy did not significantly influence vomiting or the number of children with a low weight-for-height percentile. All of the children experienced peristomal complications. Despite this, mothers' overall psychological distress was significantly reduced after 6 and 18 months, and the majority of mothers (85%) reported that their preoperative expectations were fulfilled and that the child's quality of life was improved after gastrostomy placement. Maternal concerns for the child's feeding problems, measured as intrusive stress, had effect on maternal overall psychological distress. Despite frequent stomal complications the gastrostomy significantly reduced the mothers' psychological distress and improved the child's quality of life as reported by the mother.

Radiologic percutaneous gastrostomy and gastroenterostomy: Indications, results, and difficulties

International Nuclear Information System (INIS)

Casola, G.; Van Sonnenberg, E.; Sukthankar, R.; Varney, R.A.; Stavas, J.; Cohen, M.; Christensen, R.A.; Wittich, G.R.

1987-01-01

This paper summarizes the authors' experience with 130 radiologic percutaneous gastrostomies (PG) and percutaneous gastroenterostomies (PGE). Procedures were accomplished successfully in 127 of 130 candidates. One case was unsuccessful and two were unfeasible. Indications were for feeding, decompression, or both. Underlying diseases included neurologic disorders, head and neck and esophageal tumors, pelvic and abdominal malignancies, trauma, and a variety of other diseases. Various guidance systems, techniques, and catheters were used. Complications occurred in 8%, most being minor. Three patients were operated on after PG/PGE-two had peritonitis, one due to tube dislodgment. Difficulties were encountered at different portions of the procedure. During catheter insertion the following problems were most common: (1) the access route was difficult because of overlying colon, (2) inability to insert a nasogastric tube in patients with esophageal carcinoma or large head and neck tumors, (3) inability to keep the stomach distended in patients with increased motility and those with surgical gastroenterostomies (Billroth I or II), (4) high position of the residual stomach in patients with hemigastrectomy, (5) the presence of ascites or peritoneal tumor anterior to the stomach in patients with ovarian carcinoma, and (6) tenting or herniation of the anterior wall of the stomach during dilatation. Difficulties that were encountered following catheter insertion included (1) chemical peritonitis from leakage of gastric juices, (2) peritonities from leakage of gastric feedings, (3) leakage around the skin entry site in patients with ascites, (4) catheters backing out and forming an intraperitorial loop, (5) catheters kinking and becoming occluded, and (6) catheters being pulled out

Comparison of fluoroscopy-guided pull-type percutaneous radiological gastrostomy (pull-type-PRG) with conventional percutaneous radiological gastrostomy (push-type-PRG): clinical results in 253 patients

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Yang, Yang; Schneider, J.; Dueber, C.; Pitton, M.B. [University Medical Center of the Johannes Gutenberg University Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany)

2011-11-15

To analyze the clinical results and complications of fluoroscopy guided internal-external pull-type percutaneous radiological gastrostomy (pull-type-PRG) and conventional external-internal percutaneous radiological gastrostomy (push-type-PRG). A total of 253 patients underwent radiological gastrostomy between January 2002 and January 2010. Data were collected retrospectively from radiology reports, Chart review of clinical notes, procedure reports, discharge summaries and subsequent hospital visits. Statistical analysis was performed to compare the two methods for gastrostomy with respect to peri-interventional aspects and clinical results. 128 patients received the Pull-type-PRG whereas the other 125 patients were served with the Push-type-PRG. Indications for gastrostomy were similar in these two groups. The most frequent indications for the both methods were stenotic oesophageal tumors or head/neck tumors (54.7% in pull-type-PRG, 68% in push-type-PRG). Gastrostomy procedures were successful in 98.3% in pull-type-PRG compared to 92% in push-type-PRG. There was no procedure-related mortality. Compared to Push-type-PRG, the peri-interventional complication rate was significantly reduced in pull-type-PRG (14.8% versus 34.4%, P = 0.002). Compared to the external-internal push-type-PRG, the internal-external Pull-type-PRG showed a high primary success rate and a decreased incidence of peri-interventional complications. (orig.)

Comparison of fluoroscopy-guided pull-type percutaneous radiological gastrostomy (pull-type-PRG) with conventional percutaneous radiological gastrostomy (push-type-PRG): clinical results in 253 patients

International Nuclear Information System (INIS)

Yang, Yang; Schneider, J.; Dueber, C.; Pitton, M.B.

2011-01-01

To analyze the clinical results and complications of fluoroscopy guided internal-external pull-type percutaneous radiological gastrostomy (pull-type-PRG) and conventional external-internal percutaneous radiological gastrostomy (push-type-PRG). A total of 253 patients underwent radiological gastrostomy between January 2002 and January 2010. Data were collected retrospectively from radiology reports, Chart review of clinical notes, procedure reports, discharge summaries and subsequent hospital visits. Statistical analysis was performed to compare the two methods for gastrostomy with respect to peri-interventional aspects and clinical results. 128 patients received the Pull-type-PRG whereas the other 125 patients were served with the Push-type-PRG. Indications for gastrostomy were similar in these two groups. The most frequent indications for the both methods were stenotic oesophageal tumors or head/neck tumors (54.7% in pull-type-PRG, 68% in push-type-PRG). Gastrostomy procedures were successful in 98.3% in pull-type-PRG compared to 92% in push-type-PRG. There was no procedure-related mortality. Compared to Push-type-PRG, the peri-interventional complication rate was significantly reduced in pull-type-PRG (14.8% versus 34.4%, P = 0.002). Compared to the external-internal push-type-PRG, the internal-external Pull-type-PRG showed a high primary success rate and a decreased incidence of peri-interventional complications. (orig.)

Buried bumber syndrome (internal button buried of the gastrostomy): Unearthing the solution

International Nuclear Information System (INIS)

Moreno, Nelson; Otero, William; Gomez, Martin; Bula, Rodrigo; Otero, Elder

2006-01-01

The Buried bumper syndrome is a major complication of percutaneous endoscopic gastrostomy and the literature of in of having described of rarely. The physiopathology is the gastric isquemy of the mucous one for an excessive pressure for the ends that fix the gastrostomy. Their clinical manifestations that depend on the depth of migration of the end go from the absence of symptoms, spill of the nutrition enteral being the most frequent, until peritonitis. The diverse described treatment modalities are based on the depth of migration of the end valued endoscopically. The successful use of the ecoendosonography is described for the estimate of the depth of the migration, when you cannot visualize the end internal endoscopically and we propose a handling .algorithm based on this technique

Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

International Nuclear Information System (INIS)

Tyng, Chiang Jeng; Santos, Erich Frank Vater; Guerra, Luiz Felipe Alves; Bitencourt, Almir Galvao Vieira; Barbosa, Paula Nicole Vieira Pinto; Chojniak, Rubens; Universidade Federal do Espirito Santo

2017-01-01

Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications. (author)

Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

Energy Technology Data Exchange (ETDEWEB)

Tyng, Chiang Jeng; Santos, Erich Frank Vater; Guerra, Luiz Felipe Alves; Bitencourt, Almir Galvao Vieira; Barbosa, Paula Nicole Vieira Pinto; Chojniak, Rubens [A. C. Camargo Cancer Center, Sao Paulo, SP (Brazil); Universidade Federal do Espirito Santo (HUCAM/UFES), Vitoria, ES (Brazil). Hospital Universitario Cassiano Antonio de Morais. Radiologia e Diagnostico por Imagem

2017-03-15

Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications. (author)

Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs.

Science.gov (United States)

Moriwaki, Yoshihiro; Otani, Jun; Okuda, Junzo; Zotani, Hitomi; Kasuga, So

2018-03-27

The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach. Copyright © 2018 Elsevier Inc. All rights reserved.

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

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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.

Buried bumper syndrome revisited: a rare but potentially fatal complication of PEG tube placement.

Science.gov (United States)

Biswas, Saptarshi; Dontukurthy, Sujana; Rosenzweig, Mathew G; Kothuru, Ravi; Abrol, Sunil

2014-01-01

Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

Colojejunal Fistula Resulting from a D-PEJ Feeding Tube

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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.

Use of Noninvasive Ventilation During Feeding Tube Placement.

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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.

CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

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Tamura, Akio, E-mail: a.akahane@gmail.com; Kato, Kenichi, E-mail: kkato@iwate-med.ac.jp; Suzuki, Michiko, E-mail: mamimichiko@me.com [Iwate Medical University School of Medicine, Department of Radiology (Japan); Sone, Miyuki, E-mail: msone@me.com [National Cancer Center Hospital, Department of Diagnostic Radiology (Japan); Tanaka, Ryoichi, E-mail: rtanaka@iwate-med.ac.jp; Nakasato, Tatsuhiko, E-mail: nakasato@iwate-med.ac.jp; Ehara, Shigeru, E-mail: ehara@iwate-med.ac.jp [Iwate Medical University School of Medicine, Department of Radiology (Japan)

2016-02-15

PurposeThe purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC).Materials and MethodsThis retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients’ backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device.ResultsDuring the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1–1106 days).ConclusionOur study suggests that CT-guided gastrostomy may be suitable in patients with HNC.

CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

International Nuclear Information System (INIS)

Tamura, Akio; Kato, Kenichi; Suzuki, Michiko; Sone, Miyuki; Tanaka, Ryoichi; Nakasato, Tatsuhiko; Ehara, Shigeru

2016-01-01

PurposeThe purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC).Materials and MethodsThis retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients’ backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device.ResultsDuring the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1–1106 days).ConclusionOur study suggests that CT-guided gastrostomy may be suitable in patients with HNC

Percutaneous endoscopic gastrostomy in children

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Jye Hae Park

2011-01-01

Full Text Available Purpose: Percutaneous endoscopic gastrostomy (PEG can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. Methods: We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6 months. Results: Mean patient age was 9.4 (4.5 years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD. The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87% had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. Conclusion: PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.

Gastric Emptying of Elemental Liquid Diets Versus Semisolid Diets in Bedridden Gastrostomy-fed Patients.

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Horiuchi, Akira; Sakai, Ryosei; Tamaki, Michio; Kajiyama, Masashi; Tanaka, Naoki; Morikawa, Akio

2018-03-21

Aspiration is a common problem in bedridden gastrostomy-fed patients. We compared gastric emptying of an elemental liquid diet and a commercial semisolid diet in bedridden gastrostomy-fed patients. Study 1: from January 2013 to December 2016, consecutive bedridden patients receiving percutaneous endoscopic gastrostomy (PEG) semisolid feeding hospitalized due to aspiration pneumonia were switched to elemental liquid diet feedings. The frequency of defecation, tube feed contents aspirated from the trachea, and aspiration pneumonia during hospitalization were retrospectively reviewed. Study 2 was a randomized, crossover trial comparing C sodium acetate gastric emptying of a commercial elemental liquid or a commercial semisolid diet in bedridden PEG patients and controls. Study 1: 18 patients were enrolled. Elemental liquid diet was aspirated from the trachea in 1 (5.6%) (once in 24 observations); neither aspiration pneumonia nor diarrhea developed during elemental liquid diet feeding over 2 weeks observation. Study 2: 8 PEG patients and 8 healthy subjects were separately randomized to assess gastric emptying of the commercial elemental and semisolid diets. The elemental liquid diet was associated with a significant decrease of the 10%, 30%, or 50% emptying (excretion) time (Pbedridden PEG patients. They may prevent or reduce aspiration pneumonia compared with semisolid diets.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

Accepting or declining non-invasive ventilation or gastrostomy in amyotrophic lateral sclerosis: patients' perspectives.

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Greenaway, L P; Martin, N H; Lawrence, V; Janssen, A; Al-Chalabi, A; Leigh, P N; Goldstein, L H

2015-01-01

The objective was to identify factors associated with decisions made by patients with amyotrophic lateral sclerosis (ALS) to accept or decline non-invasive ventilation (NIV) and/or gastrostomy in a prospective population-based study. Twenty-one people with ALS, recruited from the South-East ALS Register who made an intervention decision during the study timeframe underwent a face-to-face in-depth interview, with or without their informal caregiver present. Sixteen had accepted an intervention (11 accepted gastrostomy, four accepted NIV and one accepted both interventions). Five patients had declined gastrostomy. Thematic analysis revealed three main themes: (1) patient-centric factors (including perceptions of control, acceptance and need, and aspects of fear); (2) external factors (including roles played by healthcare professionals, family, and information provision); and (3) the concept of time (including living in the moment and the notion of 'right thing, right time'). Many aspects of these factors were inter-related. Decision-making processes for the patients were found to be complex and multifaceted and reinforce arguments for individualised (rather than 'algorithm-based') approaches to facilitating decision-making by people with ALS who require palliative interventions.

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.

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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.

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.

[Indication and effectiveness of endoscopic percutaneous gastrostomy as a route of parenteral alimentation for the home care patient].

Science.gov (United States)

Ueda, T; Hida, S; Higasa, K; Shinomiya, S; Matsumoto, T; Fukuoka, K; Yamanaka, E; Ozaki, S; Takayama, E

2000-12-01

We are managing 8 home care patients who have a gastrostomy made using an endoscopic percutaneous technique as a route of parenteral alimentation. Based on our experience, the preconditions for an endoscopic percutaneous gastrostomy as a route of parenteral alimentation are 1. normal gastrointestinal function, 2. difficulty in swallowing, 3. possibility that the caregiver can manage the gastrostomy. When we performed an endoscopic percutaneous gastrostomy as a route of parenteral alimentation for 8 home care patients, we obtained the several advantages mentioned below. 1. Swallowing pneumonia was prevented. 2. Adequate amount of alimental liquid could be infused. 3. Patient could take a bath or shower with the gastrostomy, and good QOL was realized. 4. The home care patient with the gastrostomy could have a satisfactorily long life.

Effects of percutaneous endoscopic gastrostomy on survival of patients in a persistent vegetative state after stroke.

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Wu, Kunpeng; Chen, Ying; Yan, Caihong; Huang, Zhijia; Wang, Deming; Gui, Peigen; Bao, Juan

2017-10-01

To assess the effect of percutaneous endoscopic gastrostomy on short- and long-term survival of patients in a persistent vegetative state after stroke and determine the relevant prognostic factors. Stroke may lead to a persistent vegetative state, and the effect of percutaneous endoscopic gastrostomy on survival of stroke patients in a persistent vegetative state remains unclear. Prospective study. A total of 97 stroke patients in a persistent vegetative state hospitalised from January 2009 to December 2011 at the Second Hospital, University of South China, were assessed in this study. Percutaneous endoscopic gastrostomy was performed in 55 patients, and mean follow-up time was 18 months. Survival rate and risk factors were analysed. Median survival in the 55 percutaneous endoscopic gastrostomy-treated patients was 17·6 months, higher compared with 8·2 months obtained for the remaining 42 patients without percutaneous endoscopic gastrostomy treatment. Univariate analyses revealed that age, hospitalisation time, percutaneous endoscopic gastrostomy treatment status, family financial situation, family care, pulmonary infection and nutrition were significantly associated with survival. Multivariate analysis indicated that older age, no gastrostomy, poor family care, pulmonary infection and poor nutritional status were independent risk factors affecting survival. Indeed, percutaneous endoscopic gastrostomy significantly improved the nutritional status and decreased pulmonary infection rate in patients with persistent vegetative state after stroke. Interestingly, median survival time was 20·3 months in patients with no or one independent risk factors of poor prognosis (n = 38), longer compared with 8·7 months found for patients with two or more independent risk factors (n = 59). Percutaneous endoscopic gastrostomy significantly improves long-term survival of stroke patients in a persistent vegetative state and is associated with improved nutritional status

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

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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.

Serum Zn levels in dysphagic patients who underwent endoscopic gastrostomy for long term enteral nutrition

OpenAIRE

Adriana Santos, Carla; Fonseca, Jorge; Brito, José; Fernandes, Tânia; Gonçalves, Luísa; Sousa Guerreiro, António

2014-01-01

Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedur...

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.

Insertion of balloon retained gastrostomy buttons: a 5-year retrospective review of 260 patients.

LENUS (Irish Health Repository)

Power, Sarah

2013-04-01

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.

Percutaneous endoscopic gastrostomy in neurological rehabilitation: a report of six cases.

Science.gov (United States)

Annoni, J M; Vuagnat, H; Frischknecht, R; Uebelhart, D

1998-08-01

This study reports the cases of six patients with severe chronic neurological disability and swallowing difficulties due to traumatic brain injury (TBI), anoxia and multiple sclerosis (MS). The patients required nutritional supplement through percutaneous endoscopic gastrostomy (PEG). Their clinical follow-up showed a decrease of intercurrent medical complications, especially pressure sores. In addition, an improvement of oropharyngeal function was observed in some patients, also accompanied by slightly better basic psychomotor functions such as vigilance, sustained attention and tone or motor control. However, not every patient did improve with this procedure. The two MS patients benefited most, while the improvement was less homogenous in the three TBI patients. The advantages of PEG over nasogastric tube on oropharyngeal function can be related to the absence of pharyngeal irritation and its role in overall recovery could be due to an increase in social activities, a control of infections, a better rehabilitation schedule and a long-term effect on brain function due to better nutritional support.

Effectiveness of prophylactic percutaneous endoscopic gastrostomy for oropharyngeal cancer patients undergoing concurrent chemoradiotherapy

International Nuclear Information System (INIS)

Teshima, Masanori; Tanimoto, Hitoshi; Saito, Miki; Otsuki, Naoki; Sasaki, Ryohei; Kiyota, Naomi; Okuno, Shinya; Nibu, Ken-ichi

2009-01-01

Patients with head and neck carcinoma are often provided concurrent chemoradiotherapy (CCRT), but they experience severe mucositis and dysphagia. These side effects can lead to decreased oral intake, resulting in interruption of treatment. In our hospital, from September 2007, all patients with oropharyngeal cancer who were to receive CCRT, were principally offered percutaneous endoscopic gastrostomy (PEG) before the start of treatment, and tube feeding was started when swallowing became impaired, to accomplish the treatment as planned. To evaluate the effect of prophylactic PEG, outcome measures in this study included the frequency of unplanned break from CCRT, nutritional deterioration and required analgesic during CCRT, complication of PEG, and patient satisfaction between 15 patients with PEG and 11 patients without PEG as a control group. Although no significant weight loss occurred in either group, there were fewer patients with a Body Mass Index <18.5 in the PEG group after CCRT than in the control group. Regarding the treatment, most patients were satisfied with their PEG and considered that prophylactic PEG was necessary and helpful in completing the CCRT. This study suggests that prophylactic PEG helps patients to complete CCRT both mentally and nutritionally. (author)

Radiologically assisted percutaneous gastrostomy or enterostomy. A retrospective analysis of 90 procedures

International Nuclear Information System (INIS)

Mildenberger, P.; Oberholzer, K.; Kauczor, H.U.; Dueber, C.; Kurz, S.; Schild, H.; Thelen, M.

1996-01-01

To analyse retrospectively the indications, technique and results of radiologically induced gastrostomies or enterostomies. Radiologically assisted gastrostomies or enterostomies were induced in 90 patients, mostly with high grade obstructions due to head and neck tumours or oesophageal tumours. 19/90 patients had had previous resection of the oesophagus or gastric operations. A catheter was successfully introduced in all patients. In 11/90 patients this was followed by a two-stage procedure. In 16/90 patients puncture was performed under CT control because of some anatomical peculiarity. Serious complication occurred in 9/90 patients but in only one was surgery necessary. There were no deaths resulting from the procedure but mortality after 30 days was 6.7%. Radiologically assisted gastrostomies or enterostomies are a reliable and effective form of treatment even amongst difficult patients. The results and complications are comparable to those from endoscopic procedures. (orig.) [de

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.

3D integrated HYDRA simulations of hohlraums including fill tubes

Science.gov (United States)

Marinak, M. M.; Milovich, J.; Hammel, B. A.; Macphee, A. G.; Smalyuk, V. A.; Kerbel, G. D.; Sepke, S.; Patel, M. V.

2017-10-01

Measurements of fill tube perturbations from hydro growth radiography (HGR) experiments on the National Ignition Facility show spoke perturbations in the ablator radiating from the base of the tube. These correspond to the shadow of the 10 μm diameter glass fill tube cast by hot spots at early time. We present 3D integrated HYDRA simulations of these experiments which include the fill tube. Meshing techniques are described which were employed to resolve the fill tube structure and associated perturbations in the simulations. We examine the extent to which the specific illumination geometry necessary to accommodate a backlighter in the HGR experiment contributes to the spoke pattern. Simulations presented include high resolution calculations run on the Trinity machine operated by the Alliance for Computing at Extreme Scale (ACES) partnership. This work was performed under the auspices of the Lawrence Livermore National Security, LLC, (LLNS) under Contract No. DE-AC52-07NA27344.

Percutaneous endoscopic gastrostomy: an update on its indications, management, complications, and care

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Alfredo J. Lucendo

Full Text Available Background: Numerous disorders impairing or diminishing a patient's ability to swallow may benefit from a PEG tube placement. This is considered the elective feeding technique if a functional digestive system is present. Methods: A PubMed-based search restricted to the English literature from the last 20 years was conducted. References in the results were also reviewed to identify potential sources of information. Results: PEG feeding has consistently demonstrated to be more effective and safe than nasogastric tube feeding, having also replaced surgical and radiological gastrostomy techniques for long term feeding. PEG is considered a minimally invasive procedure to ensure an adequate source for enteral nutrition in institutionalized and at home patients. Acute and chronic conditions associated with risk of malnutrition and dysphagia benefit from PEG placement: Beyond degenerative neuro-muscular disorders, an increasing body of evidence supports the advantages of PEG tubes in patients with head and neck cancer and in a wide range of situations in pediatric settings. The safety of PEG placement under antithrombotic medication is discussed. While antibiotic prophylaxis reduces peristomal wound infection rates, co-trimoxazole solutions administered through a newly inserted catheter constitutes an alternative to intravenous antibiotics. Early feeding (3-6 hours after PEG placement firmly supports on safety evidences, additionally resulting in reduced costs and hospital stays. Complications of PEG are rare and the majority prevented with appropriated nursing cares. Conclusions: PEG feeding provides the most valuable access for nutrition in patients with a functional gastrointestinal system. Its high effectiveness, safety and reduced cost underlie increasing worldwide popularity.

Feasibility study of EUS-NOTES as a novel approach for peroral cholecysto-gastrostomy

DEFF Research Database (Denmark)

Saftoiu, Adrian; Vilmann, P; Bhutani, M S

2013-01-01

EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery.......EUS-guided cholecysto-gastrostomy might be a useful minimally invasive procedure used for salvage drainage in advanced pancreaticobiliary cancers, but also for drainage of the gallbladder in acute cholecystitis in patients deemed unfit for laparoscopic surgery....

Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial

International Nuclear Information System (INIS)

Salas, Sebastien; Baumstarck-Barrau, Karine; Alfonsi, Marc; Digue, Laurence; Bagarry, Danielle; Feham, Nasreddine; Bensadoun, Rene Jean; Pignon, Thierry; Loundon, Anderson; Deville, Jean-Laurent; Zanaret, Michel; Favre, Roger; Duffaud, Florence; Auquier, Pascal

2009-01-01

Background and purpose: Concomitant radio-chemotherapy is the gold standard treatment for unresectable head and neck carcinomas. Placement of prophylactic gastrostomy has been proposed to provide adequate nutrition during the therapeutic sequence. The objectives of this study were to assess the impact of prophylactic gastrostomy on the 6-month quality of life, and to determine the factors related to this quality of life. Materials and methods: Design. randomized, controlled, open study ('systematic percutaneous gastrostomy' versus 'no systematic gastrostomy'). Patients. squamous cell head and neck carcinoma (stages III and IV, UICC 1997). Setting. oncological departments of French university teaching hospitals. Treatment. optimal concomitant radio-chemotherapy. Evaluations. T0 baseline evaluation, T1 during the treatment, T2 end of the treatment, and T3 6-month post-inclusion. Primary endpoint. 6-month quality of life (Qol) assessed using SF36, EORTC QLQ-C30, EORTC QLQ H and N35 questionnaires. Results: The Qol changes from baseline included a decline (T1 and T2) followed by an improvement (T3). Qol at 6 months was significantly higher in the group receiving systematic prophylactic gastrostomy (p = 10 -3 ). Higher initial BMI and lower initial Karnofsky index were significant factors related to a higher 6-month Qol. Conclusions: The study results suggest that prophylactic gastrostomy improves post-treatment quality of life for unresectable head and neck cancer patients, after adjusting for other potential predictive quality of life factors.

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...

Healthcare professionals' views on the provision of gastrostomy and noninvasive ventilation to amyotrophic lateral sclerosis patients in England, Wales, and Northern Ireland.

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Ruffell, Tamatha O; Martin, Naomi H; Janssen, Anna; Wijesekera, Lokesh; Knights, Catherine; Burman, Rachel; Oliver, David J; Al-Chalabi, Ammar; Goldstein, Laura H

2013-01-01

Gastrostomy and noninvasive ventilation (NIV) are recommended interventions for the management of symptoms associated with amyotrophic lateral sclerosis (ALS). This study aimed to quantify the views of a range of healthcare professionals (HCPs) on the provision of these interventions in the United Kingdom. A total of 177 HCPs participated in an online survey. Significant differences were found between medical and allied HCPs' views on: whether HCPs adhere to policy and accept legal constraints when it comes to making gastrostomy available to people with ALS; the impressions that HCPs receive of the way patients and caregivers understand the effects of gastrostomy and NIV on symptoms and quality of life; and the challenges HCPs face when caring for patients who have refused gastrostomy. More widely available guidelines for the provision of gastrostomy and advice on the best way to impart information to patients and caregivers about gastrostomy and NIV appear to be needed.

Indications for percutaneous endoscopic gastrostomy and survival in old adults

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Gerd Faxén-Irving

2011-07-01

Full Text Available Background : Many diseases striking old adults result in eating difficulties. Indications for selecting individuals for percutaneous endoscopic gastrostomy (PEG are unclear and everybody may not benefit from the procedure. Objective : The aim of this study was to evaluate indications for and survival after PEG insertion in patients older than 65 years. Design and Methods : A retrospective analysis including age, gender, diagnosis, indication, and date of death was made in 201 consecutive individuals, 94 male, mean age 79±7 years, who received a nutritional gastrostomy. Results: Dysphagia was present in 86% of the patients and stroke was the most common diagnosis (49%. Overall median survival was 123 days and 30-day mortality was 22%. Patients with dementia and Mb Parkinson had the longest survival (i.e. 244 and 233 days, while those with other neurological diseases, and head and neck malignancy had the shortest (i.e. 75 and 106 days. There was no difference in mortality in patients older or younger than 80 years, except in patients with dementia. Conclusions: Old age should not be a contraindication for PEG. A high 30-day mortality indicates that there is a need of better criteria for selection and timing of PEG insertion in the elderly.

SERUM ELECTROLYTES AND OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC GASTROSTOMY

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Joana VIEIRA

Full Text Available ABSTRACT BACKGROUND: Percutaneous endoscopic gastrostomy (PEG is a gold standard for long term enteral feeding. Neurologic dysphagia and head/neck cancer are the most common indications for PEG as they can lead to protein-energy malnutrition and serum electrolyte abnormalities, with potential negative impact on metabolic balance. Refeeding syndrome may also be related with severe electrolyte changes in PEG-fed patients and contribute to poor prognosis. OBJECTIVE: This study aims to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. METHODS: Retrospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016, having head/neck cancer or neurologic dysphagia, who died under PEG feeding. Serum electrolytes (sodium, potassium, chlorine, magnesium, calcium and phosphorus were evaluated immediately before the gastrostomy procedure. Survival after PEG until death was recorded in months. RESULTS: We evaluated 101 patients, 59 with electrolyte alterations at the moment of the gastrostomy. Sodium was altered in 32 (31.7%, magnesium in 21 (20.8%, chlorine in 21 (20.8%, potassium in 14 (13.8%, calcium in 11 (10.9 % and phosphorus in 11 (10.9%. The survival of patients with low sodium (<135 mmol/L was significantly lower when compared to patients with normal/high values, 2.76 months vs 7.80 months, respectively (P=0.007. CONCLUSION: Changes in serum electrolytes of patients undergoing PEG were very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent was hyponatremia, which was associated with significantly shorter survival, probably reflecting severe systemic metabolic distress.

A Retrospective Study of G-Tube Use in Japanese Patients Treated with Concurrent Chemoradiotherapy for Hypopharyngeal Cancer.

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Akihiro Homma

Full Text Available Late toxicity after concurrent chemoradiotherapy (CCRT, such as dysphagia, in patients with squamous cell carcinoma of the head and neck has received a good deal of attention recently. The gastrostomy tube (G-tube dependence rate 1 year after CCRT was reported to be 16.7-42.9% in Western countries. We evaluated swallowing outcomes after CCRT in patients with hypopharyngeal cancer (HPC treated in our hospital and compared them with previous reports.We reviewed 96 consecutive patients with a HPC treated by radiotherapy with intravenous or intra-arterial chemotherapy between 2006 and 2013 at Hokkaido University Hospital, Sapporo, Japan.At 1 month after CCRT, 13 patients (13.7% used a G-tube, whereas 5/91 (5.5% and 4/81 (4.9% used a G-tube at 3 and 6 months, respectively. Two patients used a G-tube at 12 and 24 months after CCRT (G-tube use rate: 2.8% at 12 months, and 3.2% at 24 months. The variables female, posterior wall primary, stage IV, ECOG performance status of 2, and smoking status were significantly associated with G-tube use at 12 months after CCRT, whereas the route of cisplatin administration was not related to G-tube use (p = 0.303.The G-tube use rate up to 1year could be lower in Japanese patients than in Western patients according to previous reports. In particular, Japanese patients resume oral intake sooner than Western patients. Further study of the incidence of dysphagia after CCRT by ethnicity is required to clarify the differences in dysphagia after CCRT.

Pneumoperitoneum with Subcutaneous Emphysema after Percutaneous Endoscopic Gastrostomy

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Yalin Iscan

2014-01-01

Full Text Available Percutaneous endoscopic gastrostomy is a safe way for enteral nutrition in selected patients. Generally, complications of this procedure are very rare but due to patients general health condition, delayed diagnosis and treatment of complications can be life threatening. In this study, we present a PEG-related massive pneumoperitoneum and subcutaneous emphysema in a patient with neuro-Behçet.

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

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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.

Risks of PEG tube placement in patients with cirrhosis-associated ascites

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Al-Abboodi Y

2017-09-01

Full Text Available Yasir Al-Abboodi,1 Ali Ridha,2 Matthew Fasullo,3 Tarek H Naguib4 1Internal Medicine Department, Saint Davis Round Rock Medical Centre, Round Rock, TX, USA, 2Internal Medicine Department, University of Arkansas for Medical Science, Little Rock, AR, USA, 3Internal Medicine Department, Umass Memorial Medical Center, Worcester, MA, USA, 4Internal Medicine Department, Texas Tech University Health and Sciences Center, Amarillo, TX, USA Abstract: This study examined the safety of placing percutaneous endoscopic gastrostomy (PEG tube in people with liver cirrhosis. The target population was further subdivided into people with ascites (case group and people without ascites (control. We compare the morbidity and the mortality difference of PEG placement in cirrhotic patients with ascites vs cirrhotic patients without ascites. We then examined multiple factors including sex, race, chronic illness including hypertension, congestive heart failure, and others and their influence on the inpatient mortality of all cirrhotic patients who had PEG placement. A total of 38,175 inpatient PEG tube placements were identified. Only 583 patients out of 38,175 had a history of cirrhosis. One hundred seven had ascites and the rest did not. Mean age of the patients was 61.14 years. Patient demography included (65.2% male and the rest were female, 359 were white (64.4%, 90 black (14.8%, 84 Hispanic (13.7%, 23 Asians (3.3%, 7 Native Americans (0.4%, and 20 others (3.5%. Complications from PEG procedure in cirrhosis with ascites vs non-ascites included bleeding of 4 (0.8% vs 2 (1.9% (P=0.35, surgical site infection 2 (0.4% vs 1 (0.9% (P=0.51, and urinary tract infection 105 (22.1% vs 34 (23.8% (P=0.34, respectively. There was no colonic injury in either group. The total inpatient mortality was 75 out of the 583. Fifty-six (11.8% were in the ascites group and 19 (17.8% in the non-ascites group (P=0.097. Factors including ascites, postsurgical bleeding, and surgical site

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

Transgastrostomy jejunal intubation for enteric alimentation.

Science.gov (United States)

McLean, G K; Rombeau, J L; Caldwell, M D; Ring, E J; Freiman, D B

1982-12-01

Malnourished patients who cannot maintain an adequate oral intake but have normal intestinal absorption and motility are candidates for enteric alimentation. When impaired gastric peristalsis or an increased risk for aspiration makes gastrostomy feeding unsafe, direct jejunal infusion is the preferred route of alimentation. Angiographic techniques were used to convert previously placed, simple gastrostomies to combined gastrostomy-jejunostomies in 14 patients. In 17 additional patients, a combined gastrostomy-jejunal tube was placed under local anesthesia; angiographic techniques assisted in the placement of 11 of these tubes.

Effect of percutaneous endoscopic gastrostomy on gastro-esophageal reflux in mechanically-ventilated patients.

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Douzinas, Emmanuel E; Tsapalos, Andreas; Dimitrakopoulos, Antonios; Diamanti-Kandarakis, Evanthia; Rapidis, Alexandros D; Roussos, Charis

2006-01-07

To investigate the effect of percutaneous endoscopic gastrostomy (PEG) on gastroesophageal reflux (GER) in mechanically-ventilated patients. In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilator-associated pneumonia (VAP) and GER > 6% were divided into PEG group (n = 16) or non-PEG group (n = 20). Another 11 ventilated patients without reflux (GER Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue. A significant decrease of median (range) reflux was observed in PEG group from 7.8 (6.2 - 15.6) at baseline to 2.7 (0 - 10.4) on d 7 post-gastrostomy (P position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

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

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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.

Therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding.

Science.gov (United States)

Takatori, Kento; Yoshida, Rihito; Horai, Aya; Satake, Shinya; Ose, Takayuki; Kitajima, Naoto; Yoneda, Shushi; Adachi, Kyoichi; Amano, Yuji; Kinoshita, Yoshikazu

2013-10-01

Aspiration pneumonia is an emerging problem in patients receiving gastrostomy feeding. This study is designed to clarify the therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding. The study subjects were 119 patients with dysphasia who required gastrostomy feeding. They were randomly assigned to the control (without medication), lansoprazole (15 mg, 1/day), and mosapride (5 mg, 3/day) groups. The number of days with fever (≥37.8 °C), vomiting, and antibiotics administration, as well as the occurrence of pneumonia were investigated during the 6-month observation period. The incidence of pneumonia during the observation period was significantly lower in the mosapride group as compared to the control (7/38 vs. 16/40, p = 0.038) and lansoprazole (vs. 20/41, p = 0.005) groups. The mosapride group also showed a significant decrease in days with fever and antibiotics administration as compared to the other groups. Multivariate analysis revealed that the presence of hiatal hernia was a significant risk factor and administration of mosapride was a significant preventive factor for pneumonia. Mosapride has a preventive effect on occurrence of pneumonia in patients receiving gastrostomy feeding.

Laparoscopy-assisted percutaneous endoscopic gastrostomy using a "Funada-kit II" device.

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Takahashi, Toshiaki; Miyano, Go; Shiyanagi, Satoko; Lane, Geoffrey J; Yamataka, Atsuyuki

2012-09-01

We aimed at assessing the effect of using a "Funada-kit II" device during laparoscopy-assisted percutaneous endoscopic gastrostomy (Lap-PEG), by reviewing 29 cases of Lap-PEG we performed from 2001 to 2011. We started using the "Funada-kit II" (CREATE MEDIC CO., Kanagawa, Japan) device with two parallel needles to puncture the stomach and assist suturing the anterior gastric wall to the anterior abdominal wall during Lap-PEG in 2011 (F-PEG). By introducing a loop through the lumen of one needle which allows placement of a suture introduced through the lumen of the other needle. Once repeated, the stomach can be pexied at two points, approximately 2 cm apart. We compared Lap-PEG (n = 23) with F-PEG (n = 6) where the mean ages and weights at surgery and sex ratios were similar. All cases were uneventful without intraoperative complications, although one postoperative wound infection occurred in a Lap-PEG case. There were no differences in the duration of analgesia, time taken to commence tube feeding, and return to full feeding. However, mean operating time was significantly shorter in F-PEG (28.1 min) versus Lap-PEG (46.1 min) p < 0.05. As per results F-PEG would appear to be as safe as Lap-PEG, but much quicker.

Outcome of Rehabilitation and Swallowing Therapy after Percutaneous Endoscopic Gastrostomy in Dysphagia Patients.

Science.gov (United States)

Toh Yoon, Ezekiel Wong; Hirao, Jun; Minoda, Naoko

2016-12-01

The objective of this study was to investigate the outcomes of rehabilitation (with swallowing therapy) after percutaneous endoscopic gastrostomy (PEG) in patients with neurogenic dysphagia. Forty-seven patients (29 males and 18 females) who were transferred to the rehabilitation ward of our hospital after receiving PEG tube placements during a 5-year period were enrolled in this study. Patients' demographic data, comorbidities, nutritional statuses, and laboratory biomarkers before the PEG procedure were collected. Rehabilitation (with swallowing therapy) outcomes such as changes in Functional Independence Measure (FIM) and dysphagia grade (using Fujishima's classification) were evaluated. Significant improvements in FIM scores and dysphagia grades after rehabilitation therapy were observed. Twenty-seven patients (57.4 %) were discharged with some oral intake and 10 patients (21.3%) were discharged PEG-free (defined as the PEG tube not being used or removed). Factors associated with being discharged with some oral intake were increase in FIM score (adjusted OR 1.10, 95 % CI 1.02-1.19) and higher baseline dysphagia grade (adjusted OR 1.88, 95 % CI 1.04-3.39). Factors associated with being discharged PEG-free were longer rehabilitation period (OR 1.03, 95 % CI 1.01-1.04), absence of respiratory disorders (OR 0.12, 95 % CI 0.03-0.35), and increase in FIM score (OR 1.17, 95 % CI 1.08-1.28). Changes in dysphagia grade were significantly correlated with changes in FIM score (r 2  = 0.46, p dysphagia.

Decision Making About Gastrostomy and Noninvasive Ventilation in Amyotrophic Lateral Sclerosis.

Science.gov (United States)

Martin, Naomi H; Lawrence, Vanessa; Murray, Joanna; Janssen, Anna; Higginson, Irene; Lyall, Rebecca; Burman, Rachel; Leigh, P Nigel; Al-Chalabi, Ammar; Goldstein, Laura H

2016-08-01

We used thematic analysis to investigate factors affecting decision making about gastrostomy and noninvasive ventilation (NIV) by people with Amyotrophic Lateral Sclerosis (ALS) from the viewpoint of the health care professionals (HCPs) supporting them. We conducted 20 in-depth interviews with 19 HCPs nominated by people with ALS who had made a decision to accept or decline NIV or gastrostomy. We found the main themes influencing decision making were patient-centric, caregiver-related or related to HCPs' own beliefs, perspectives, and actions. HCPs felt patients should be, and were, in control of decision making, although caregivers and HCPs played a role. The patient's evaluation of quality of life, the desirability of prolonging life, and acceptance of the disease and its progression by both patient and caregiver were the most important factors identified by HCPs. HCPs should be aware of the importance of multiprofessional discussions, and the potential influences (identified above) that might require discussion with patients and caregivers. © The Author(s) 2015.

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.

Subcooled Pool Boiling from Two Tubes of 6 Degree Included Angle in Vertical Alignment

Energy Technology Data Exchange (ETDEWEB)

Kang, Myeong-Gie [Andong National University, Andong (Korea, Republic of)

2015-05-15

One of the major issues in the design of a heat exchanger is the heat transfer in a tube bundle. The passive condensation heat exchanger (PCHX) adopted in APR+ has U-type tube. The PCHX is submerged in the passive condensation cooling tank (PCCT). The heat exchanging tubes are in vertical alignment and inclined at 3 degrees to prevent water hammer as shown in Fig. 1. For the cases, the upper tube is affected by the lower tube. Therefore, the results for a single tube are not applicable to the design of the PCHX. However, the passive heat exchangers are submerged in the subcooled water under atmospheric pressure. The water temperature in the PCCT rises according to the PAFS actuation and reaches the saturation temperature after more than 2.5 hours. Since this period is very important to maintain reactor integrity, the exact evaluation of heat transfer on the tube bundle is indispensable. Although an experimental study on both subcooled and saturated pool boiling of water was performed to obtain local heat transfer coefficients on a 3 degree inclined tube at atmospheric pressure by Kang, no previous results were treating the bundle effect in the subcooled liquid. The heat transfer on the upper tube is enhanced compared with the single tube. The enhancement of the heat transfer on the upper tube is estimated by the bundle effect ( h{sub r} ). It is defined as the ratio of the heat transfer coefficient ( h{sub b} ) for an upper tube in a bundle with lower tubes activated to that for the same tube activated alone in the bundle. The upper tube within a tube bundle can significantly increase nucleated boiling heat transfer compared to the lower tubes at moderate heat fluxes. Summarizing the published results, it is still necessary to identify effects of liquid subcooling on inclined tubes for application to the PCHX design. Therefore, the present study is aimed to study the variations of pool boiling heat transfer on a tube bundle having a 6 degree included angle in

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

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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.

Sound propagation in narrow tubes including effects of viscothermal and turbulent damping with application to charge air coolers

Science.gov (United States)

Knutsson, Magnus; Åbom, Mats

2009-02-01

Charge air coolers (CACs) are used on turbocharged internal combustion engines to enhance the overall gas-exchange performance. The cooling of the charged air results in higher density and thus volumetric efficiency. It is also important for petrol engines that the knock margin increases with reduced charge air temperature. A property that is still not very well investigated is the sound transmission through a CAC. The losses, due to viscous and thermal boundary layers as well as turbulence, in the narrow cooling tubes result in frequency dependent attenuation of the transmitted sound that is significant and dependent on the flow conditions. Normally, the cross-sections of the cooling tubes are neither circular nor rectangular, which is why no analytical solution accounting for a superimposed mean flow exists. The cross-dimensions of the connecting tanks, located on each side of the cooling tubes, are large compared to the diameters of the inlet and outlet ducts. Three-dimensional effects will therefore be important at frequencies significantly lower than the cut-on frequencies of the inlet/outlet ducts. In this study the two-dimensional finite element solution scheme for sound propagation in narrow tubes, including the effect of viscous and thermal boundary layers, originally derived by Astley and Cummings [Wave propagation in catalytic converters: Formulation of the problem and finite element scheme, Journal of Sound and Vibration 188 (5) (1995) 635-657] is used to extract two-ports to represent the cooling tubes. The approximate solutions for sound propagation, accounting for viscothermal and turbulent boundary layers derived by Dokumaci [Sound transmission in narrow pipes with superimposed uniform mean flow and acoustic modelling of automobile catalytic converters, Journal of Sound and Vibration 182 (5) (1995) 799-808] and Howe [The damping of sound by wall turbulent shear layers, Journal of the Acoustical Society of America 98 (3) (1995) 1723-1730], are

Usage of prophylactic radiologically inserted gastrostomy in head and neck cancer patients

International Nuclear Information System (INIS)

Mallinson, P.I.; Tun, J. Kyaw; Byass, O.R.; Cast, J.E.I.

2012-01-01

Aim: To assess outcomes and usage rate of prophylactic radiologically inserted gastrostomy (RIG) in head and neck cancer (HNC) patients. Materials and methods: Outcome data of all HNC patients who underwent prophylactic RIG over a 22-month period (November 2007 to September 2009) in a tertiary referral centre were collected retrospectively. Thirty-day mortality, major and minor complication rates, and subsequent usage of the RIG were analysed. Results: Fifty-one HNC patients underwent prophylactic RIG. Three minor and no major immediate complications were identified. Sixteen minor and three major complications at 30-days were identified. Three (5.9%) major complications were identified. There was one death due to disease progression and not RIG insertion. The RIG was not used in 17.7% of patients post-procedure. Conclusion: Prophylactic RIG in HNC patients has a comparable mortality rate to RIG insertion in HNC patients with mixed indications. However, the number of cases where the gastrostomy is not used raises important concerns and warrants further investigation.

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.

Vitamin D status of gastrostomy-fed children with special needs: a cross-sectional pilot study.

Science.gov (United States)

Kuter, Hayley; Das, Geeta; Mughal, M Zulf

2017-12-01

To assess the vitamin D status of gastrostomy-fed children. Vitamin D status was measured in 32 children aged five to 16 years recruited from special schools in Manchester, UK (53° 48 ' N). All children were receiving a nutritionally complete, commercially prepared enteral feed via gastrostomy, and had been established on this regimen for over 12 months. Serum concentrations of 25-hydroxyvitamin D (25OHD) were measured at the end of winter. Children with serum concentrations of 25OHD >50 nmol/L were considered to be sufficient, and those with concentrations 50 nmol/L). One subject was vitamin D deficient (serum 25OHD vitamin D insufficient (serum 25OHD >25 nmol/L - vitamin D derived from enteral feeds was 9.45 μg/day; range 3.5-30; 13 children (41%) received less than 10 μg of vitamin D per day from their enteral feed. Nutritionally complete gastrostomy feeds may be protective against vitamin D deficiency in the majority of children with special needs. We recommend that all children over 1 year of age receive 10 μg (400 IU) of vitamin D, as recommended by the Scientific Advisory Committee on Nutrition (SACN). ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

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

Difficulties with percutaneous endoscopic gastrostomy (PEG): a practical guide for the endoscopist.

LENUS (Irish Health Repository)

O'Mahony, S

2013-03-01

Percutaneous endoscopic gastrostomy (PEG) is a widely used and effective means of providing long-term nutrition in patients with inadequate oral intake. The demand for this intervention has risen steadily since the early 1990s. Endoscopists who perform PEG insertion have become increasingly concerned about inappropriate use of this intervention.

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.

Achieving consistent image quality and overall radiation dose reduction for coronary CT angiography with body mass index-dependent tube voltage and tube current selection

International Nuclear Information System (INIS)

Wang, G.; Gao, J.; Zhao, S.; Sun, X.; Chen, X.; Cui, X.

2014-01-01

Aim: To develop a quantitative body mass index (BMI)-dependent tube voltage and tube current selection method for obtaining consistent image quality and overall dose reduction in computed tomography coronary angiography (CTCA). Methods and materials: The images of 190 consecutive patients (group A) who underwent CTCA with fixed protocols (100 kV/193 mAs for 100 patients with a BMI of <27 and 120 kV/175 mAs for 90 patients with a BMI of >27) were retrospectively analysed and reconstructed with an adaptive statistical iterative reconstruction (ASIR) algorithm at 50% blending. Image noise was measured and the relationship to BMI was studied to establish BMI-dependent tube current for obtaining CTCA images with user-specified image noise. One hundred additional cardiac patients (group B) were examined using prospective triggering with the BMI-dependent tube voltage/current. CTCA image-quality score, image noise, and effective dose from groups B and C (subgroup of A of 100 patients examined with prospective triggering only) were obtained and compared. Results: There was a linear relationship between image noise and BMI in group A. Using a BMI-dependent tube current in group B, an average CTCA image noise of 27.7 HU (target 28 HU) and 31.7 HU (target 33 HU) was obtained for the subgroups of patients with BMIs of >27 and of <27, respectively, and was independent of patient BMI. There was no difference between image-quality scores between groups B and C (4.52 versus 4.60, p > 0.05). The average effective dose for group B (2.56 mSv) was 42% lower than group C (4.38 mSv; p < 0.01). Conclusion: BMI-dependent tube voltage/current selection in CTCA provides an individualized protocol that generates consistent image quality and helps to reduce overall patient radiation dose. - Highlights: • BMI-dependent kVp and mA selection method may be established in CCTA. • BMI-dependent kVp and mA enables consistent CCTA image quality. • Overall dose reduction of 40% can

Metal diffusion from furnace tubes depends on location

International Nuclear Information System (INIS)

Albright, L.F.

1988-01-01

Studies of metal samples from an ethylene furnace on the Texas Gulf Coast, using a scanning electron microscope (SEM) and an energy dispersive X-ray analyzer (EDAX), reveal preferential diffusion of chromium, titanium, and aluminum in the coil wall to the surfaces of the tube where they form metal oxides. These elements are gradually depleted from the tube wall. Complicated surface reactions that include the formation of several metal oxides, metal sulfides, and metal-catalyzed coke also occur. Several mechanisms can be postulated as to how metal fines or compounds are formed and transferred in the coil and transfer lines exchanger (TLX) of ethylene units. These surface reactions directly or indirectly affect coke formation in the tube. Finally, creep in the coils is likely a factor in promoting corrosion. Such creep is promoted by variable temperature-time patterns to which a coil is exposed during pyrolysis, and then decoking. Periods of stress and compression occur in the coil walls. Knowledge of the diffusion and reactions that take place can result in better furnace operations and decoking procedures to extend the life of the furnace tubes. In this second installment of a four-part series, photomicrographs of four pyrolysis tube samples from the ethylene furnace indicate that significant differences existed between the outer surfaces, inner surfaces, and cross-sectional areas of the samples. The first installment of the series dealt with coke

The establishment of enteral nutrition with minimally-invasive interventional procedure under endoscopic or imaging guidance

International Nuclear Information System (INIS)

Li Feng; Cheng Yingsheng

2010-01-01

For patients unable to get the necessary nutrition orally, a variety of techniques,including surgical way, to make gastrostomy with tube placement have been employed. For recent years, gastrostomy and tube placement with the help of endoscopic guidance or percutaneous interventional management has been developed, which is superior to surgical procedure in minimizing injuries, decreasing cost and reducing complications. In certain clinical situations, both endoscopic method and interventional method can be employed. This paper aims to make a comprehensive review of the indications, techniques and skills, advantages and disadvantages of both the endoscopy-guided and the imaging-guided percutaneous gastrojejunostomy for the establishment of enteral nutrition. (authors)

Percutaneous endoscopic gastrostomy feeding of locally advanced oro-pharygo-laryngeal cancer patients: Blenderized or commercial food?

Science.gov (United States)

Papakostas, Pyrros; Tsaousi, Georgia; Stavrou, George; Rachovitsas, Dimitrios; Tsiropoulos, Gavriil; Rova, Constantina; Konstantinidis, Ioannis; Michalopoulos, Antonios; Grosomanidis, Vasilios; Kotzampassi, Katerina

2017-11-01

Head and neck cancer patients commonly suffer from severe malnutrition at the time of tentative diagnosis. Percutaneous Endoscopic Gastrostomy [PEG] feeding is now considered as an efficient tool to reduce nutritional deterioration alongside concurrent treatment. We undertook the challenge to retrospectively evaluate the impact of a commercial, disease-specific, feeding formula [Supportan, Fresenius Kabi, Hellas] versus blenderized family food on nutritional outcome. This is a retrospective analysis of prospectively collected nutritional and anthropometric data at the time of PEG placement, at the 8th week [after treatment termination] and at 8 months [6mo of recovery from treatment]. All patients were prescribed a commercial feeding formula. The final dataset included 212 patients: 112 received the commercial formula, 69 voluntarily decided to switch into blenderized-tube-feeding, and 31 were prescribed to receive a home-made formula of standard ingredients. The commercial formula seemed to help patients to fight the catabolism of concurrent treatment, since, at the 8mo assessment, both Body Mass index and Fat Free Mass had almost recovered to the values at the time of first diagnosis. Neither group on blenderized or home-made formulas exhibited nutritional improvement, but experienced a significant deterioration throughout the study period, with the home-made formula group being the worst. These findings clearly indicate that home-made and blenderized foods do not adequately support the nutritional requirements of patients with HNC scheduled to receive concurrent CRT treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Functional Outcomes After De-escalated Chemoradiation Therapy for Human Papillomavirus-Positive Oropharyngeal Cancer: Secondary Analysis of a Phase 2 Trial.

Science.gov (United States)

Hegde, John V; Shaverdian, Narek; Felix, Carol; Wang, Pin-Chieh; Veruttipong, Darlene; Hsu, Sophia; Riess, Jonathan W; Rao, Shyam D; Daly, Megan E; Chen, Allen M

2018-03-01

To analyze functional outcomes for patients treated on a phase 2 trial of de-escalated chemoradiation therapy for human papillomavirus-positive oropharyngeal cancer. Patient eligibility included p16-positive, stage III or IV oropharyngeal squamous cell carcinoma and a Zubrod performance status of 0 to 1. Treatment was induction chemotherapy with paclitaxel, 175 mg/m 2 , and carboplatin, area under the curve (AUC) of 6 mg/ml/min, for 2 cycles every 21 days, followed by concurrent paclitaxel, 30 mg/m 2 , every 7 days with dose-reduced radiation therapy of 54 or 60 Gy. Trends in body weight and body mass index (BMI) were analyzed with gastrostomy tube and narcotic use rates. Functional outcomes were assessed using the University of Washington Quality of Life Scale and the Functional Assessment of Cancer Therapy-Head and Neck Scale. Forty-five patients were registered, of whom 40 were evaluable. Only 1 patient had a BMI deemed unhealthy at the completion of treatment. For the 15 patients (38%) with a normal BMI (18-25 kg/m 2 ) before treatment, recovery back to baseline occurred at approximately 18 months (average BMI, 23.2 kg/m 2 vs 22.3 kg/m 2 ; P=.09). In 2 patients (5%), gastrostomy tubes were placed during treatment. No patient was enteral feeding tube-dependent at 6 months after treatment. Ninety-five percent of patients tolerated a normal regular diet at last follow-up. De-escalated chemoradiation therapy may improve functional outcomes as indicated by the relatively low incidence of gastrostomy tube placement and long-term dysphagia. In patients with a normal BMI prior to chemoradiation therapy, BMI recovered to baseline levels. Copyright © 2017 Elsevier Inc. All rights reserved.

Gastrostomy feeding tube - pump

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Gastrostomy tube placement - slideshow

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Psychological as well as illness factors influence acceptance of non-invasive ventilation (NIV) and gastrostomy in amyotrophic lateral sclerosis (ALS): a prospective population study.

Science.gov (United States)

Martin, Naomi H; Landau, Sabine; Janssen, Anna; Lyall, Rebecca; Higginson, Irene; Burman, Rachel; McCrone, Paul; Sakel, Mohammed; Ellis, Catherine M; Shaw, Christopher E; Al-Chalabi, Ammar; Leigh, P Nigel; Goldstein, Laura H

2014-09-01

Our objective was to identify factors associated with acceptance of non-invasive ventilation (NIV) and gastrostomy in an exploratory population-based study. Seventy-eight people with ALS at least six months post-diagnosis, and 50 caregivers, were recruited from the South-East ALS Register. Baseline physical, cognitive and psychological measures were obtained. Three-monthly follow-ups monitored whether patients had accepted or refused NIV or gastrostomy. Following an intervention decision, post-decision interviews repeated baseline measures and included further intervention-specific questionnaires. Results showed that 32 people with ALS made at least one intervention decision and of these 10 decided about both NIV and gastrostomy. While illness factors predicted those needing to make an intervention decision, cognitive and education status, and level of executive dysfunction were associated with decision-making and acceptance or refusal of interventions. Patients' understanding of their illness, their early approach to considering interventions and carer-related factors were also associated with treatment decisions. In conclusion, our findings highlight the complexity of decision-making and provide a platform for designing further studies. Cognitive and psychosocial factors may assume a greater role in palliative care decisions for people with ALS than has been explicitly recognized. Future work must clarify how to ensure patients are not inadvertently being denied suitable interventions.

Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy

International Nuclear Information System (INIS)

McDonald, Mark W.; Liu, Yuan; Moore, Michael G.; Johnstone, Peter A. S.

2016-01-01

To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT). Forty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation. In a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus. Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life

Time-dependent crack growth in steam generator tube leakage

International Nuclear Information System (INIS)

Chung, H.D.; Lee, J.H.; Park, Y.W.; Choi, Y.H.

2006-01-01

In general, cracks found in steam generator tubes have semi-elliptical shapes and it is assumed to be rectangular shape for conservatism after crack penetration. Hence, the leak and crack growth behavior has not been clearly understood after the elliptical crack penetrates the tube wall. Several experimental results performed by Argonne Nation Laboratory exhibited time-dependent crack growth behavior of rectangular flaws as well as trapezoidal flaws under constant pressure. The crack growth faster than expected was observed in both cases, which is likely attributed to time-dependent crack growth accompanied by fatigue sources such as the interaction between active jet and crack. The stress intensity factor, K 1 , is necessary for the prediction of the observed fatigue crack growth behavior. However, no K 1 solution is available for a trapezoidal flaw. The objective of this study is to develop the stress intensity factor which can be used for the fatigue analysis of a trapezoidal crack. To simplify the analysis, the crack is assumed to be a symmetric trapezoidal shape. A new K 1 formula for axial trapezoidal through-wall cracks was proposed based on the FEM results. (author)

Treatment of idiopathic hepatic lipidosis in cats: 11 cases (1986-1987).

Science.gov (United States)

Jacobs, G; Cornelius, L; Allen, S; Greene, C

1989-09-01

Idiopathic hepatic lipidosis was diagnosed in 11 cats. Cats were treated by delivery of balanced nutrients supplemented with L-carnitine via a surgically placed gastrostomy tube. Feeding through the gastrostomy tube was initiated in the hospital and was continued at home in all cats. The mean duration of gastrostomy tube feeding was 48 days (range, 22 to 98 days). Vomiting associated with feeding (3 cats) and localized cellulitis at the gastrostomy site (2 cats) were the most frequent complications. Vomiting was controlled by reducing the volume of food administered at each feeding or by administration of metoclopramide. Cellulitis was treated successfully by parenteral administration of antibiotics and local wound cleansing. Seven of 11 cats (65%) survived and have remained clinically healthy for 15 to 29 months (mean, 20 months) since diagnosis. The other 4 cats died of peritonitis (n = 1), pneumonia (n = 1), hepatic encephalopathy (n = 1), or cardiopulmonary arrest (n = 1) between 0 and 10 days after surgery.

Swallowing function in pediatric patients with bilateral vocal fold immobility.

Science.gov (United States)

Hsu, Jeffrey; Tibbetts, Kathleen M; Wu, Derek; Nassar, Michel; Tan, Melin

2017-02-01

Infants with bilateral vocal fold immobility (BVFI) often have poor swallow function in addition to potential airway compromise. While there are several reports on BVFI and its effect on patients' airway status, little is known about long term swallow function. We aim to characterize the swallowing function over time in pediatric patients with bilateral vocal fold immobility. A retrospective review of medical records of infants diagnosed with BVFI at a tertiary care children's hospital between 2005 and 2014 was conducted. Patient demographics, nature and etiology of immobility, laryngoscopy findings, comorbidities, and swallow outcomes at diagnosis and follow-up were recorded. Swallowing outcomes as measured by presence or absence of a gastrostomy tube were compared by etiology, vocal fold status, and normal or developmentally delay using the Fisher's exact test. 110 patients with a diagnosis of vocal fold immobility were identified. Twenty-nine (26%) had BVFI and twenty-three had complete medical records. Etiologies of vocal fold immobility include cardiac related in 13% (3/23), idiopathic in 30% (7/23) prolonged intubation in 26% (6/23) central neurologic in 22% (5/23), trauma in 4% (1/23), and infection in 4% (1/23). Average follow-up time was 44 months (range 5-94 months). Ten patients (56.5%) required a gastrostomy tube at time of diagnosis. Of this cohort who received gastrostomy tubes, three (30%) ultimately transitioned to complete oral feeds. Return of vocal fold mobility did not correlate with swallow function. In those with non-neurologic etiologies, the need for gastrostomy tube at end of follow up was unlikely. There was a statistically significant difference in the percentage of gastrostomy tube-free children at most recent follow up in patients who were normally developed (86%) versus those who were developmentally delayed (33%) (p = 0.02). We characterized the swallowing function of 23 pediatric patients with BVFI. Comorbidities are significant

Acute gastric volvulus treated with laparoscopic reduction and percutaneous endoscopic gastrostomy.

Science.gov (United States)

Jeong, Sang-Ho; Ha, Chang-Youn; Lee, Young-Joon; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Ha, Woo-Song

2013-07-01

Acute gastric volvulus requires emergency surgery, and a laparoscopic approach for both acute and chronic gastric volvulus was reported recently to give good results. The case of a 50-year-old patient with acute primary gastric volvulus who was treated by laparoscopic reduction and percutaneous endoscopic gastrostomy is described here. This approach seems to be feasible and safe for not only chronic gastric volvulus, but also acute gastric volvulus.

The results of the percutaneous endoscopic gastrostomy insertion: Analysis of 113 cases

Directory of Open Access Journals (Sweden)

Nazım Ekin

2015-09-01

Full Text Available Objective: In this study, we aimed to evaluate the results and experiences of the patients who received percutaneous endoscopic gastrostomy (PEG. Methods: A total of 113 patients who admitted to the Dicle University Medical Faculty , Department of Gastroenterology between January 2012 and December 2014 and in whom received PEG was performed. The patients were assessed in terms of indications, complications and results. Results: Among these patients, 70 (61.9% were male and 40 (38.1% were female. Though 8 (7% patients had head, neck and esophageal cancer; 105 (93% patients had primer or seconder neurological disorders. After the PEG, any serious complication was seen in patients. Wound infections were encountered in five patients (4.4% and the rate of minor complications was found to be 9.7%. The risk of complications was higher in patients over sixty years and men (p values of 0.049 and 0.022. Conclusion: Percutaneous endoscopic gastrostomy, a simple and safe method of enteral nutrition with a low complication rate, should be the first choice when extended period enteral nutrition is required. There is increased risk of complications in elderly males.

Clinical significance of percutaneous endoscopic gastrostomy for patients with severe craniocerebral injury

Directory of Open Access Journals (Sweden)

Du Hanggen

2014-12-01

Full Text Available Objective: To investigate the application of percutaneous endoscopic gastrostomy (PEG to patients with severe craniocerebral injury for the purpose of nutritional support therapy and pulmonary infection prevention. Methods: A total of 43 patients with severe craniocerebral injury admitted to our department from January 2008 to December 2012 received PEG followed by nutritional therapy. There were other 82 patients who were prescribed nasal-feeding nutrition. Nutrition status was evaluated by comparing serum albumin levels, and the incidence of pulmonary infection 1 week before and 2 weeks after operation was identifi ed and compared. Results: Both PEG and nasal-feeding nutrition therapies have significantly levated serum albumin levels (P<0.05. Serum albumin levels before and after nutritional therapies showed no significant difference between the two groups (P>0.05. The incidence of pulmonary infection in PEG group was significantly decreased compared with that in nasal-feeding nutrition group (P<0.05. Conclusion: PEG is an effective method for severe craniocerebral injury patients. It can not only provide enteral nutrition but also prevent pulmonary infection induced by esophageal refl ux. Key words: Gastrostomy; Craniocerebral trauma; Enteral nutrition

Gastrostomia endoscópica em pacientes com cardiopatia complicada Percutaneous endoscopic gastrostomy in cardiologic complicated patients

Directory of Open Access Journals (Sweden)

Celso CUKIER

2000-10-01

Full Text Available Pacientes cardiopatas complicados com isquemia cerebral e insuficiência cardíaca necessitam terapia nutricional enteral prolongada por se apresentarem em situação de risco nutricional. Complicações advindas do uso prolongado da sonda nasoenteral poderiam ser evitadas com a execução da gastrostomia endoscópica. Esta é alternativa técnica para acesso ao tubo digestivo em nutrição enteral. O objetivo deste estudo foi avaliar o tempo de indicação para gastrostomia endoscópica em pacientes com nutrição enteral com uso de sonda nasoenteral e as principais complicações do procedimento. Doze pacientes foram submetidos a gastrostomia endoscópica, sendo oito do sexo masculino. A idade média foi de 62,42 + 22,10 anos. A indicação principal foi síndrome isquêmica cerebral após parada cardiorespiratória por patologia clínica (sete pacientes ou cirurgia cardiovascular complicada (cinco. O tempo médio para indicação da gastrostomia endoscópica foi de 35,58 + 26,79 dias após introdução da nutrição enteral. Não houve intercorrências com o procedimento e, no período pós-operatório tardio, ocorreu infecção do orifício de inserção da gastrostomia endoscópica em um caso, resolvida com cuidados locais. Em conclusão, a gastrostomia endoscópica é técnica segura, com baixa incidência de complicações. Pode ser realizada em ambulatório, no leito do paciente, ou em centro de terapia intensiva e sua indicação deveria ser mais precoce.Complicated cardiologic patients with brain ischemia and heart failure need long term enteral nutrition. Long term nasoenteral tuibe feeding may cause complications that could be avoided with percutaneous endoscopic gastrostomy. The aim of this study was to evaluate the indications for percutaneous endoscopic gastrostomy and its main complications. Twelve patients were submitted to percutaneous endoscopic gastrostomy (eight male with main age of 62,42 ± 22,10 years old. Brain ischemia

Psychological as well as illness factors influence acceptance of non-invasive ventilation (NIV) and gastrostomy in amyotrophic lateral sclerosis (ALS):A prospective population study

OpenAIRE

Martin, Naomi H; Landau, Sabine; Janssen, Anna; Lyall, Rebecca; Higginson, Irene; Burman, Rachel; McCrone, Paul; Sakel, Mohammed; Ellis, Catherine M; Shaw, Christopher E; Al-Chalabi, Ammar; Leigh, P Nigel; Goldstein, Laura H

2014-01-01

Our objective was to identify factors associated with acceptance of non-invasive ventilation (NIV) and gastrostomy in an exploratory population-based study. Seventy-eight people with ALS at least six months post-diagnosis, and 50 caregivers, were recruited from the South-East ALS Register. Baseline physical, cognitive and psychological measures were obtained. Three-monthly follow-ups monitored whether patients had accepted or refused NIV or gastrostomy. Following an intervention decision, pos...

Esophageal rupture caused by explosion of an automobile tire tube: a case report.

Science.gov (United States)

Yu, Yongkang; Ding, Sheng; Zheng, Yifeng; Li, Wei; Yang, Lie; Zheng, Xiushan; Liu, Xiaoyan; Jiang, Jianqing

2013-08-23

There have been no reports in the literature of esophageal rupture in adults resulting from an explosion of an automobile tire. We report the first case of just such an occurrence after an individual bit into a tire, causing it to explode in his mouth. A 47-year-old Han Chinese man presented with massive hemorrhage in his left eye after he accidentally bit an automobile tire tube which burst into his mouth. He was diagnosed with esophageal rupture based on a chest computed tomography scan and barium swallow examination. Drainage of empyema (right chest), removal of thoracic esophagus, exposure of cervical esophagus, cardiac ligation and gastrostomy were performed respectively. After that, esophagogastrostomy was performed. Successful anastomosis was obtained at the neck with no postoperative complications 3 months after the surgery. The patient was discharged with satisfactory outcomes. We present this case report to bring attention to esophageal rupture in adults during the explosion of an automobile tire tube in the mouth.

Experimental comparison of rate-dependent hysteresis models in characterizing and compensating hysteresis of piezoelectric tube actuators

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Aljanaideh, Omar, E-mail: omaryanni@gmail.com [Department of Mechanical Engineering, The University of Jordan, Amman 11942 (Jordan); Habineza, Didace; Rakotondrabe, Micky [AS2M department, FEMTO-ST Institute, Univ. Bourgogne Franche-Comté, Univ. de Franche-Comté/CNRS/ENSMM, 25000 Besançon (France); Al Janaideh, Mohammad [Department of Mechanical and Industrial Engineering, The Mechatronics and Microsystems Design Laboratory, University of Toronto (Canada); Department of Mechatronics Engineering, The University of Jordan, Amman 11942 (Jordan)

2016-04-01

An experimental study has been carried out to characterize rate-dependent hysteresis of a piezoelectric tube actuator at different excitation frequencies. The experimental measurements were followed by modeling and compensation of the hysteresis nonlinearities of the piezoelectric tube actuator using both the inverse rate-dependent Prandtl–Ishlinskii model (RDPI) and inverse rate-independent Prandtl–Ishlinskii model (RIPI) coupled with a controller. The comparison of hysteresis modeling and compensation of the actuator with both models is presented.

Experimental comparison of rate-dependent hysteresis models in characterizing and compensating hysteresis of piezoelectric tube actuators

International Nuclear Information System (INIS)

Aljanaideh, Omar; Habineza, Didace; Rakotondrabe, Micky; Al Janaideh, Mohammad

2016-01-01

An experimental study has been carried out to characterize rate-dependent hysteresis of a piezoelectric tube actuator at different excitation frequencies. The experimental measurements were followed by modeling and compensation of the hysteresis nonlinearities of the piezoelectric tube actuator using both the inverse rate-dependent Prandtl–Ishlinskii model (RDPI) and inverse rate-independent Prandtl–Ishlinskii model (RIPI) coupled with a controller. The comparison of hysteresis modeling and compensation of the actuator with both models is presented.

Utility of esophageal gastroduodenoscopy at the time of percutaneous endoscopic gastrostomy in trauma patients

Directory of Open Access Journals (Sweden)

Scalea Thomas M

2007-07-01

Full Text Available Abstract Background The utility of esophagogastroduodenoscopy (EGD performed at the time of percutaneous endoscopic gastrostomy (PEG is unclear. We examined whether EGD at time of PEG yielded clinically useful information important in patient care. We also reviewed the outcome and complication rates of EGD-PEG performed by trauma surgeons. Methods Retrospective review of all trauma patients undergoing EGD with PEG at a level I trauma center from 1/01–6/03. Results 210 patients underwent combined EGD with PEG by the trauma team. A total of 37% of patients had unsuspected upper gastrointestinal lesions seen on EGD. Of these, 35% had traumatic brain injury, 10% suffered multisystem injury, and 47% had spinal cord injury. These included 15 esophageal, 61 gastric, and six duodenal lesions, mucosal or hemorrhagic findings on EGD. This finding led to a change in therapy in 90% of patients; either resumption/continuation of H2 -blockers or conversion to proton-pump inhibitors. One patient suffered an upper gastrointestinal bleed while on H2-blocker. It was treated endoscopically. Complication rates were low. There were no iatrogenic visceral perforations seen. Three PEGs were inadvertently removed by the patient (1.5%; one was replaced with a Foley, one replaced endoscopically, and one patient underwent gastric repair and open jejunostomy tube. One PEG leak was repaired during exploration for unrelated hemorrhage. Six patients had significant site infections (3%; four treated with local drainage and antibiotics, one requiring operative debridement and later closure, and one with antibiotics alone. Conclusion EGD at the time of PEG may add clinically useful data in the management of trauma patients. Only one patient treated with acid suppression therapy for EGD diagnosed lesions suffered delayed gastrointestinal bleeding. Trauma surgeons can perform EGD and PEG with acceptable outcomes and complication rates.

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

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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.

[Percutaneous endoscopic gastrostomy in a myotrophic lateral sclerosis. Experience in a district general hospital].

Science.gov (United States)

Prior-Sánchez, Inmaculada; Herrera-Martínez, Aura Dulcinea; Tenorio Jiménez, Carmen; Molina Puerta, María José; Calañas Continente, Alfonso Jesús; Manzano García, Gregorio; Gálvez Moreno, María Ángeles

2014-12-01

Amyotrophic Lateral Sclerosis (ALS) is a degenerative disorder that affects the pyramidal tract, producing progressive motor dysfunctions leading to paralysis. These patients can present with dysphagia, requiring nutritional support with a nasogastric tube or Percutaneous Endoscopic Gastrostomy (PEG). PEG is associated with increased survival rates. However, the timing of PEG placement remains a significant issue for clinicians. To analyse the characteristics of ALS patients at the moment of PEG placement and their progression. Descriptive retrospective study including patients diagnosed with ALS and PEG who were assessed during the 2005-2014 period in our hospital. Nutritional parameters and respiratory function were assessed for all patients, as well as their progression. The data was analysed using SPSS15. 37 patients were included (56.8% men, 43.2% women) with an average age of 60 at diagnosis, and an average age of 63.1 at PEG placement. 48.6% started with spinal affection and 51.4%, with bulbar affection. 43.2% of the patients received oral nutritional supplements prior to PEG placement for a mean period of 11.3 months. The mean forced vital capacity at diagnosis was 65.45±13.67%, with a negative progression up to 39.47±14.69% at the moment of PEG placement. 86.5% of patients required non-invasive positive-pressure ventilation. 86.5% presented with dysphagia, 64.9% with weight loss > 5-10% from their usual weight, 8.1% with low Body Mass Index, 27% with malnutrition and 73% with aworsened breathing function; therefore, 100% met the criteria for PEG placement according to our protocol. The period on enteral feeding was extended for 10.1 months with a mortality of 50% during the first 6 months from PEG placement. There is evidence of a 3-year delay between diagnosis and PEG placement, with a survival rate of 50% at 6 months from PEG insertion. Further studies are required to establish whether an earlier placement might increase survival rates. Copyright AULA

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...

A case report of percutaneous endoscopic gastrostomy left-side gastropexy to resolve a recurrent gastric dilatation in a dog previously treated with right-side gastropexy for gastric dilatation volvulus.

Science.gov (United States)

Spinella, Giuseppe; Cinti, Filippo; Pietra, Marco; Capitani, Ombretta; Valentini, Simona

2014-12-01

A 6-year-old, large-breed, female dog was evaluated for gastric dilatation (GD). The dog was affected by GD volvulus, which had been surgically treated with gastric derotation and right incisional gastropexy. Recurrence of GD appeared 36 hours after surgery. The dilatation was immediately treated with an orogastric probe but still recurred 4 times. Therefore, a left-side gastropexy by percutaneous endoscopic gastrostomy (PEG) was performed to prevent intermittent GD. After PEG tube placement, the patient recovered rapidly without side effects. Several techniques of gastropexy have been described as a prophylactic method for gastric dilatation volvulus, but to the authors' knowledge, this is the first report of left-sided PEG gastropexy performed in a case of canine GD recurrence after an incisional right gastropexy. Copyright © 2015 Elsevier Inc. All rights reserved.

Heat exchanger for cooling a liquid metal with air, including panels of identical tubes

International Nuclear Information System (INIS)

Malaval, C.

1985-01-01

The heat exchanger includes panels of identical tubes, each one comprising two horizontal collectors situated at the vertical of each other and a group of vertical tubes for cooling arranged in a horizontal parallelepiped casing opened on two of its opposite sides. The air flows from the inlet to the outlet face of the casing. The panels of tubes are arranged side by side so that their outlet faces form a prismatic surface of which the height is vertical and the inner space communicates with a vertical axis chimney. Each one of the panels is hanging from a fixed structure by means of articulated fasteners, by means of its upper collector only. The invention applies, more particularly, for cooling the primary sodium of fast neutron reactors after they are stopped [fr

[Pull percutaneous endoscopic gastrostomy: personal experience].

Science.gov (United States)

Geraci, G; Sciumè, C; Pisello, F; Li Volsi, F; Facella, T; Tinaglia, D; Modica, G

2007-04-01

To review the indications, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG), that are placed routinely in patients unable to obtain adequate nutrition from oral feeding for swallowing disorders (neurological diseases, head and neck cancer, oesophageal cancer, psychological disorders). Retrospective review of patients referred for PEG placement from 2003 to 2005. Endoscopic Surgery in Section of General and Thoracic Surgery, Faculty of Medicine and Surgery, Palermo, Italy. A total of 50 patients, 11 women and 39 men, referred our Section for PEG placement. Indications for PEG placement included various neurologic impairment (82%), oesophageal non-operable cancer (6%), cardia non-operable cancer (4%), cerebrovascular accident (2%), anorexia (2%), pharyngeal esophageal obstruction (2%), head and neck cancer (2%). All patients received preoperative antibiotics as short-term profilaxis. 51 PEGs were positioned in 50 patients. No major complications were registered; 45 patients (90%) were alive at 1 year follow-up and no mortality procedure-related was registered. Percutaneous endoscopic gastrotomy removal had been performed on 2 patients as end-point of treatment, and 43 patients continued to have PEGs in use at 2006. Outpatients PEG placement using conscious sedation is a safe and effective method for providing enteral nutrition. This technique constitutes the gold standard treatment for enteral nutrition in patients with neurologic impairment or as prophylactic in patients affected by head and neck cancer who needs demolitive surgery. Patients should be carefully assessed, and discussion with the patient and their families should be held to determine that the patient is an appropriate candidate. The Authors feel prophylactic antibiotics lessened the incidence of cutaneous perigastrostomy infection.

De novo radiologic placement of button gastrostomy: a feasibility study in children with cancer

International Nuclear Information System (INIS)

Richioud, Bertrand; Beji, Hedi; Kalenderian, Anne-Charlotte; Cuinet, Marie; Pilleul, Frank; Louazon, Typhaine; Bertrand, Amandine; Roux, Pascale; Marec-Berard, Perrine

2015-01-01

Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. To assess the safety and effectiveness of such treatment at a single center. We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects - local leakage and granulation tissue formation - both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. The procedure and devices were well tolerated and mostly effective in our cohort. (orig.)

De novo radiologic placement of button gastrostomy: a feasibility study in children with cancer

Energy Technology Data Exchange (ETDEWEB)

Richioud, Bertrand; Beji, Hedi; Kalenderian, Anne-Charlotte; Cuinet, Marie; Pilleul, Frank [Centre Leon Berard, Department of Radiology, Lyon (France); Louazon, Typhaine; Bertrand, Amandine; Roux, Pascale; Marec-Berard, Perrine [Institut d' Hematologie et d' Oncologie Pediatrique, Pediatric Oncology, Lyon (France)

2015-12-15

Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. To assess the safety and effectiveness of such treatment at a single center. We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects - local leakage and granulation tissue formation - both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. The procedure and devices were well tolerated and mostly effective in our cohort. (orig.)

Time-dependent leak behavior of flawed Alloy 600 tube specimens at constant pressure

Energy Technology Data Exchange (ETDEWEB)

Bahn, Chi Bum, E-mail: bahn@anl.gov [Argonne National Laboratory, Argonne, IL 60439 (United States); Majumdar, Saurin [Argonne National Laboratory, Argonne, IL 60439 (United States); Harris, Charles [United States Nuclear Regulatory Commission, Rockville, MD 20852 (United States)

2011-10-15

Leak rate testing has been performed using Alloy 600 tube specimens with throughwall flaws. Some specimens have shown time-dependent leak behavior at constant pressure conditions. Fractographic characterization was performed to identify the time-dependent crack growth mechanism. The fracture surface of the specimens showed the typical features of ductile fracture, as well as the distinct crystallographic facets, typical of fatigue crack growth at low {Delta}K level. Structural vibration appears to have been caused by the oscillation of pressure, induced by a high-pressure pump used in a test facility, and by the water jet/tube structure interaction. Analyses of the leak behaviors and crack growth indicated that both the high-pressure pump and the water jet could significantly contribute to fatigue crack growth. To determine whether the fatigue crack growth during the leak testing can occur solely by the water jet effect, leak rate tests at constant pressure without the high-pressure pump need to be performed. - Highlights: > Leak rate of flawed Alloy 600 tubing increased at constant pressure condition. > Fractography revealed two cases: ductile tearing and crystallographic facets. > Crystallographic facets are typical features of fatigue crack growth at low {Delta}K. > Fatigue source could be water jet-induced vibration and/or high-pressure pump pulsation.

Long-term results of percutaneous endoscopic gastrostomies

Directory of Open Access Journals (Sweden)

Faruk Aksoy

2012-06-01

Full Text Available Objectives: In order to provide enteral nutrition for patientsin intensive-care units who cannot be fed orally, weaimed to present our percutaneous endoscopic gastrostomy(PEG experience, which is a minimally invasivemethod.Materials and methods: In this study, 700 patients whoapplied to our clinic between January 2000 and June2011 and who had a PEG because they could not be fedorally were retrospectively assessed in terms of indications,complications, and results.Results: Among these patients, 400 (57% were maleand 300 (43% were female. Most of the patients withfeeding problems had also neurologically caused pathologies.After the PEG, 50 (7.1% patients had under-skininfections, 18 (2.5% patients had leakage from the edgeof the PEG, and 16 (2.0% patients had bleeding from theedge of the PEG.Conclusion: PEG is a secure and effective nutritionmethod as it can be performed with a minimally invasiveprocedure and it has low mortality and morbidity.

Endoscopic gastrostomy, nasojejunal and oral feeding comparison in aspiration pneumonia patients

Directory of Open Access Journals (Sweden)

Ozge E Onur

2013-01-01

Full Text Available Background: Aspiration pneumonia is a potentially preventable illness requiring attention to small details of patient care. The type, management, and care of feeding should be carried out properly. Materials andMethods: This is a prospective clinical study of enteral feeding on patients admitted to hospital with aspiration pneumonia. The known enteral nutritional methods, advantages, and disadvantages were told to the patient or proxy. If they didn′t accept Percutaneous endoscopic gastrostomy (PEG, nasojejunal tube (NJT was advised. If they denied all of the procedures, oral feeding education was given. A total of 94 patients were enrolled to the study, 29 of them accepted PEG, 42 preferred NJT, and 23 preferred oral route. Results: A total of 94 patients with a mean age of 77.84, standard deviation 10.784; 95% confidence interval (CI 75.63-80.03 were enrolled to the study of which 27 (28.7% patients had a history of aspiration pneumonia. Oral feeding was prominently preferred for patients nursed by a relative (15; 65.2% of Oral feeding group and 16% of total or a caregiver (7; 30.4% of Oral feeding group and 7.4% of total while only 1 (4.3% of Oral feeding group and 1.1% of total with a health-care worker (P = 0.001. Overall re-aspiration rates at the 6 th month were 58%, 78%, 91% in EG, NJT, oral groups, respectively. Sixth months′ survival rates of the different feeding groups were not significantly divergent from each other. History of aspiration was also found to be a significant contributor of mortality. Conclusion: In aspiration pneumonia patients′ long-term survival rates of the different feeding groups were not significantly divergent from each other.

Development of a canine model to enable the preclinical assessment of pH-dependent absorption of test compounds.

Science.gov (United States)

Fancher, R Marcus; Zhang, Hongjian; Sleczka, Bogdan; Derbin, George; Rockar, Richard; Marathe, Punit

2011-07-01

A preclinical canine model capable of predicting a compound's potential for pH-dependent absorption in humans was developed. This involved the surgical insertion of a gastrostomy feeding tube into the stomach of a beagle dog. The tube was sutured in position to allow frequent withdrawal of gastric fluid for pH measurement. Therefore, it was possible to measure pH in the stomach and assess the effect of gastric pH-modifying agents on the absorption of various test compounds. Fasted gastric pH in the dog showed considerable inter- and intra-animal variability. Pretreatment of pentagastrin (6 µg/kg intramuscularly) 20 min prior to test compound administration was determined to be adequate for simulating fasting stomach pH in humans. Pretreatment with famotidine [40 mg orally] 1 h prior to test compound administration was determined to be adequate for simulating human gastric pH when acid-reducing agents are coadministered. Pentagastrin and famotidine pretreatments were used to test two discovery compounds and distinct differences in their potential for pH-dependent absorption were observed. The model described herein can be used preclinically to screen out compounds, differentiate compounds, and support the assessment of various formulation- and prodrug-based strategies to mitigate the pH effect. Copyright © 2011 Wiley-Liss, Inc. and the American Pharmacists Association

Current status of percutaneous endoscopic gastrostomy (PEG) in a general hospital in Japan: a cross-sectional study

Science.gov (United States)

Kusano, Chika; Yamada, Nobuo; Kikuchi, Kenji; Hashimoto, Masaji; Gotoda, Takuji

2016-01-01

Background: There has been debate over the indications for percutaneous endoscopic gastrostomy (PEG) in recent years in Japan. In addition, the level of satisfaction of patients and patient’s family after PEG remains unclear. The aim of this study was to investigate the current status of PEG and the level of satisfaction of patients and patients’ families after PEG in Japan. Methods: We reviewed the existing data of all patients who underwent PEG tube insertion at Yuri Kumiai General Hospital (Akita, Japan) between February 2000 and December 2010. We examined the following points: underlying diseases requiring PEG, levels of consciousness, and performance status. We also sent a questionnaire to the patients and patient’s families to ask about their satisfaction with and thoughts about PEG. Results: The data of 545 patients who underwent PEG were reviewed. There were 295 men and 250 women, with a mean age of 77.2 ± 11.4 years. PEG was indicated most frequently for cerebrovascular disorders (48.2%, 239/545). There were 515 (94.4%, 515/545) patients showing consciousness disturbance and 444 (81.5%, 444/545) bedridden patients. The questionnaire was answered by one patient himself and 316 patients’ families. When asked, “Was performing PEG a good decision?”, 57.5% (182/316) of the patients’ families answered yes. Meanwhile, when patients’ family members were asked if they would wish to undergo PEG if they were in the same condition as the patient, 28.4% (90/316) answered yes, whereas 55.3% (175/316) answered no. Conclusions: Few patients were able to make their own decision about PEG tube placement because of consciousness disturbance. As a result, many family members of the patients did not want to experience PEG for themselves. Future studies should be performed to clarify the quality of life and ethical aspects associated with PEG. PMID:27313796

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

Science.gov (United States)

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 inserted, and humidified oxygen was introduced via the suction line. Using these tubes, the patient could produce speech sounds, but use was limited to 10 min due to discomfort. Second, a mouthstick stylus, fixed on a mouthpiece that fits over the maxillary teeth, was used. The patient used both a communication board and a touch screen device with this mouthstick stylus. The speaking tracheostomy tube and mouthstick stylus greatly improved his ability to communicate.

Weekly Dose-Volume Parameters of Mucosa and Constrictor Muscles Predict the Use of Percutaneous Endoscopic Gastrostomy During Exclusive Intensity-Modulated Radiotherapy for Oropharyngeal Cancer

International Nuclear Information System (INIS)

Sanguineti, Giuseppe; Gunn, G. Brandon; Parker, Brent C.; Endres, Eugene J.; Zeng Jing; Fiorino, Claudio

2011-01-01

Purpose: To define predictors of percutaneous endoscopic gastrostomy (PEG) use during intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer. Methods and Materials: Data for 59 consecutive patients treated with exclusive IMRT at a single institution were recovered. Of 59 patients, 25 were treated with hyperfractionation (78 Gy, 1.3 Gy per fraction, twice daily; 'HYPER'); and 34 of 59 were treated with a once-daily fractionation schedule (66 Gy, 2.2 Gy per fraction, or 70 Gy, 2 Gy per fraction; 'no-HYPER'). On the basis of symptoms during treatment, a PEG tube could have been placed as appropriate. A number of clinical/dosimetric factors, including the weekly dose-volume histogram of oral mucosa (OM DVHw) and weekly mean dose to constrictors and larynx, were considered. The OM DVHw of patients with and without PEG were compared to assess the most predictive dose-volume combinations. Results: Of 59 patients, 22 needed a PEG tube during treatment (for 15 of 22, ≥3 months). The best cutoff values for OM DVHw were V9.5 Gy/week 3 and V10 Gy/week 3 . At univariate analysis, fractionation, mean weekly dose to OM and superior and middle constrictors, and OM DVHw were strongly correlated with the risk of PEG use. In a stepwise multivariate logistic analysis, OM V9.5 Gy/week (≥64 vs. 3 ) was the most predictive parameter (odds ratio 30.8, 95% confidence interval 3.7-254.2, p = 0.0015), confirmed even in the no-HYPER subgroup (odds ratio 21, 95% CI 2.1 confidence interval 210.1, p = 0.01). Conclusions: The risk of PEG use is drastically reduced when OM V9.5-V10 Gy/week is 3 . These data warrant prospective validation.

Design of shell-and-tube heat exchangers when the fouling depends on local temperature and velocity

Energy Technology Data Exchange (ETDEWEB)

Butterworth, D. [HTFS, Hyprotech, Didcot (United Kingdom)

2002-07-01

Shell-and-tube heat exchangers are normally designed on the basis of a uniform and constant fouling resistance that is specified in advance by the exchanger user. The design process is then one of determining the best exchanger that will achieve the thermal duty within the specified pressure drop constraints. It has been shown in previous papers [Designing shell-and-tube heat exchangers with velocity-dependant fouling, 34th US national Heat Transfer Conference, 20-22 August 2000, Pittsburg, PA; Designing shell-and-tube heat exchangers with velocity-dependant fouling, 2nd Int. Conf. on Petroleum and Gas Phase Behavior and Fouling, 27-31 August 2000, Copenhagen] that this approach can be extended to the design of exchangers where the design fouling resistance depends on velocity. The current paper briefly reviews the main findings of the previous papers and goes on to treat the case where the fouling depends also on the local temperatures. The Ebert-Panchal [Analysis of Exxon crude-oil, slip-stream coking data, Engineering Foundation Conference on Fouling Mitigation of Heat Exchangers, 18-23 June 1995, California] form of fouling rate equation is used to evaluate this fouling dependence. When allowing for temperature effects, it becomes difficult to divorce the design from the way the exchanger will be operated up to the point when the design fouling is achieved. However, rational ways of separating the design from the operation are proposed. (author)

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.

Esophageal stents, percutaneous gastrostomy, gastrojejunostomy and celiac ganglion block

International Nuclear Information System (INIS)

Koroglu, M.

2012-01-01

Full text: Indications, contraindications, procedure and complications will be discussed along with the technical aspects. Interesting cases will be demonstrated. Fluoroscopic guided placement of a metallic (bare or covered) stent is increasingly being used for the treatment of malignant and benign esophageal strictures. Percutaneously placed feeding catheters (e.g. gastrostomy) offer the best option for the patients who require long term nutrition. These procedures are generally simpler, have higher technical success rates and considered to be safer than endoscopic or surgical placement techniques. Celiac ganglia block is effective in relieving chronic abdominal pain, especially originating from the malignancies of the pancreas, liver, gallbladder and alimentary tract from the stomach to the transverse portion of the large colon. The relevant anatomy, indications, contraindications, different application techniques and results of celiac blockade will be reviewed.

Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

Directory of Open Access Journals (Sweden)

Mahalu William

2011-09-01

Full Text Available Abstract Background Oesophageal perforation is a condition associated with a high mortality. Its management is still controversial with operative treatment being favoured but a shift to conservative management is occurring. Very little exists in medical literature about its management in Sub-Saharan Africa, where the paucity of thoracic surgeons is compounded by limited diagnostic and therapeutic facilities. Case Presentation We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy, nil by mouth with feeding gastrostomy, intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia. Conclusion In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations.

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

Directory of Open Access Journals (Sweden)

Eiji Mitate

2015-01-01

Full Text Available 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 inserted, and humidified oxygen was introduced via the suction line. Using these tubes, the patient could produce speech sounds, but use was limited to 10 min due to discomfort. Second, a mouthstick stylus, fixed on a mouthpiece that fits over the maxillary teeth, was used. The patient used both a communication board and a touch screen device with this mouthstick stylus. The speaking tracheostomy tube and mouthstick stylus greatly improved his ability to communicate.

Dependence of CuO particle size and diameter of reaction tubing on tritium recovery for tritium safety operation

Energy Technology Data Exchange (ETDEWEB)

Hu, Cui, E-mail: cdxohc10000@163.com [Shizuoka University, 836 Ohya, Suruga-ku Shizuoka 422-8529 (Japan); Uemura, Yuki; Yuyama, Kenta; Fujita, Hiroe; Sakurada, Shodai; Azuma, Keisuke [Shizuoka University, 836 Ohya, Suruga-ku Shizuoka 422-8529 (Japan); Taguchi, Akira; Hara, Masanori; Hatano, Yuji [University of Toyama, 3190 Gofuku, Toyama 939-8555 (Japan); Chikada, Takumi; Oya, Yasuhisa [Shizuoka University, 836 Ohya, Suruga-ku Shizuoka 422-8529 (Japan)

2016-12-15

Highlights: • Influence of CuO particle size and diameter of reaction tubing on the tritium recovery was evaluated. • Reaction rate constant of tritium with CuO particle has been calculated by the combination of experimental results and a simulation code. • Dependence of reaction tubing length on tritium conversion ratio has been explored. - Abstract: Usage of CuO and water bubbler is one of the conventional and convenient methods for tritium recovery. In present work, influence of CuO particle size and diameter of reaction tubing on the tritium recovery was evaluated. Reaction rate constant of tritium with CuO particle has been calculated by the combination of experimental results and a simulation code. Then, these results were applied for exploring the dependence of reaction tubing length on tritium conversion ratio. The results showed that the surface area of CuO has a great influence on the oxidation rate constant. The frequency factor of the reaction would be approximately doubled by reducing the CuO particle size from 1.0 mm to 0.2 mm. Cross section of reaction tubing mainly affected on the duration of tritium at the temperature below 600 K. Reaction tubing with length of 1 m at temperature of 600 K would be suitable for keeping the tritium conversion ratio above 99.9%. The length of reaction tubing can be reduced by using the smaller CuO particle or increasing the CuO temperature.

Nonlinear time-dependent simulation of helix traveling wave tubes

International Nuclear Information System (INIS)

Peng Wei-Feng; Yang Zhong-Hai; Hu Yu-Lu; Li Jian-Qing; Lu Qi-Ru; Li Bin

2011-01-01

A one-dimensional nonlinear time-dependent theory for helix traveling wave tubes is studied. A generalized electromagnetic field is applied to the expression of the radio frequency field. To simulate the variations of the high frequency structure, such as the pitch taper and the effect of harmonics, the spatial average over a wavelength is substituted by a time average over a wave period in the equation of the radio frequency field. Under this assumption, the space charge field of the electron beam can be treated by a space charge wave model along with the space charge coefficient. The effects of the radio frequency and the space charge fields on the electrons are presented by the equations of the electron energy and the electron phase. The time-dependent simulation is compared with the frequency-domain simulation for a helix TWT, which validates the availability of this theory. (interdisciplinary physics and related areas of science and technology)

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.

Tube to tube excursive instability - sensitivities and transients

International Nuclear Information System (INIS)

Brown, M.; Layland, M.W.

1980-01-01

A simple basic analysis of excursive instability in a boiler tube shows how it depends upon operating conditions and physical properties. A detailed mathematical model of an AGR boiler is used to conduct a steady state parameter sensitivity survey. It is possible from this basis to anticipate the effects of changes in operating conditions and changes in design parameters upon tube to tube stability. Dynamic responses of tubes operating near the stability threshold are examined using a mathematical model. Simulated excursions are triggered by imparting small abrupt pressure changes on the boiler inlet pressure. The influences of the magnitude of the pressure change, waterside friction factor and gas side coupling between tubes are examined. (author)

Laparoscopic gastropexy relieves symptoms of obstructed gastric volvulus in highoperative risk patients.

Science.gov (United States)

Yates, Robert B; Hinojosa, Marcelo W; Wright, Andrew S; Pellegrini, Carlos A; Oelschlager, Brant K

2015-05-01

Operative repair of obstructive gastric volvulus is challenging. In high-operative risk patients with obstructive gastric volvulus, we perform laparoscopic reduction of gastric volvulus and anterior abdominal wall sutured gastropexy. This case series reports our experience with this operation. We reviewed the charts of all patients who presented with obstructive gastric volvulus and underwent laparoscopic gastropexy between 2007 and 2013. Eleven patients underwent laparoscopic gastropexy. Median age was 83 years (50 to 92). Six patients presented with chronic obstruction; 5 presented with acute obstruction. Median postoperative hospitalization was 2 days (1 to 39). Two patients required reoperation for displaced gastrostomy tubes. At median follow-up of 3 months (2 weeks to 57 months), all patients remained free of gastric obstructive symptoms and recurrent episodes of volvulus. Only 1 patient received nutrition via gastrostomy tube. Laparoscopic gastropexy can treat obstructed gastric volvulus in highoperative risk patients. Because of associated morbidity, gastrostomy tubes should be placed selectively. Copyright © 2015 Elsevier Inc. All rights reserved.

Locking device of a guiding ring on a plate including an aperture; application to guide tube of nuclear reactor

International Nuclear Information System (INIS)

Cauquelin, C.; Poitrenaud, P.

1987-01-01

To make easy to take to pieces a guide tube, by a simple tool, this device includes a guide ring. This guide ring aligned with an aperture in a plate has a tubular support fixed to the plate and coaxial with the aperture and lock the guide tube by rotation [fr

[Non-invasive mechanical ventilation with a facial interface during sedation for a percutaneous endoscopic gastrostomy in a patient with amyotrophic lateral sclerosis].

Science.gov (United States)

González-Frasquet, M C; García-Covisa, N; Vidagany-Espert, L; Herranz-Gordo, A; Llopis-Calatayud, J E

2015-11-01

Amyotrophic lateral sclerosis is a chronic neurodegenerative disease of the central nervous system which affects the motor neurons and produces a progressive muscle weakness, leading to atrophy and muscle paralysis, and ultimately death. Performing a percutaneous endoscopic gastrostomy with sedation in patients with amyotrophic lateral sclerosis can be a challenge for the anesthesiologist. The case is presented of a 76-year-old patient who suffered from advanced stage amyotrophic lateral sclerosis, ASA III, in which a percutaneous endoscopic gastrostomy was performed with deep sedation, for which non-invasive ventilation was used as a respiratory support to prevent hypoventilation and postoperative respiratory complications. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Analysis of Patients' X-ray Exposure in 146 Percutaneous Radiologic Gastrostomies.

Science.gov (United States)

Petersen, Tim-Ole; Reinhardt, Martin; Fuchs, Jochen; Gosch, Dieter; Surov, Alexey; Stumpp, Patrick; Kahn, Thomas; Moche, Michael

2017-09-01

Purpose  Analysis of patient´s X-ray exposure during percutaneous radiologic gastrostomies (PRG) in a larger population. Materials and Methods  Data of primary successful PRG-procedures, performed between 2004 and 2015 in 146 patients, were analyzed regarding the exposition to X-ray. Dose-area-product (DAP), dose-length-product (DLP) respectively, and fluoroscopy time (FT) were correlated with the used x-ray systems (Flatpanel Detector (FD) vs. Image Itensifier (BV)) and the necessity for periprocedural placement of a nasogastric tube. Additionally, the effective X-ray dose for PRG placement using fluoroscopy (DL), computed tomography (CT), and cone beam CT (CBCT) was estimated using a conversion factor. Results  The median DFP of PRG-placements under fluoroscopy was 163 cGy*cm 2 (flat panel detector systems: 155 cGy*cm 2 ; X-ray image intensifier: 175 cGy*cm 2 ). The median DLZ was 2.2 min. Intraprocedural placement of a naso- or orogastric probe (n = 68) resulted in a significant prolongation of the median DLZ to 2.5 min versus 2 min in patients with an already existing probe. In addition, dose values were analyzed in smaller samples of patients in which the PRG was placed under CBCT (n = 7, median DFP = 2635 cGy*cm 2 ), or using CT (n = 4, median DLP = 657 mGy*cm). Estimates of the median DFP and DLP showed effective doses of 0.3 mSv for DL-assisted placements (flat panel detector 0.3 mSv, X-ray image converter 0.4 mSv), 7.9 mSv using a CBCT - flat detector, and 9.9 mSv using CT. This corresponds to a factor 26 of DL versus CBCT, or a factor 33 of DL versus CT. Conclusion  In order to minimize X-ray exposure during PRG-procedures for patients and staff, fluoroscopically-guided interventions should employ flat detector systems with short transmittance sequences in low dose mode and with slow image frequency. Series recordings can be dispensed with. The intraprocedural placement of a naso- or orogastric probe

Comparative effects of different enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy: a network meta-analysis

Directory of Open Access Journals (Sweden)

Zhang ZH

2016-05-01

Full Text Available Zhihong Zhang,1,2 Yu Zhu,1 Yun Ling,3 Lijuan Zhang,1 Hongwei Wan1 1Department of Nursing, Shanghai Proton and Heavy Ion Center, 2Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 3Department of Human Resource, Shanghai Proton and Heavy Ion Center, Shanghai, People’s Republic of China Abstract: Nasogastric tube (NGT and percutaneous endoscopic gastrostomy were frequently used in the head and neck cancer patients when malnutrition was present. Nevertheless, the evidence was inclusive in terms of the choice and the time of tube placement. The aim of this network meta-analysis was to evaluate the comparative effects of prophylactic percutaneous endoscopic gastrostomy (pPEG, reactive percutaneous endoscopic gastrostomy (rPEG, and NGT in the head and neck cancer patients receiving radiotherapy or chemoradiotherapy. Databases of PubMed, Web of Science, and Elsevier were searched from inception to October 2015. Thirteen studies enrolling 1,631 participants were included in this network meta-analysis. The results indicated that both pPEG and NGT were superior to rPEG in the management of weight loss. pPEG was associated with the least rate of treatment interruption and nutrition-related hospital admission among pPEG, rPEG, and NGT. Meanwhile, there was no difference in tube-related complications. Our study suggested that pPEG might be a better choice in malnutrition management in the head and neck cancer patients undergoing radiotherapy or chemoradiotherapy. However, its effects need to be further investigated in more randomized controlled trials. Keywords: malnutrition, tube feeding, weight loss, treatment interruption, readmission, complication

Vibration and wear prediction for steam generator tubes: Final report

International Nuclear Information System (INIS)

Rao, M.S.M.; Gupta, G.D.; Eisinger, F.L.

1988-06-01

As part of the overall EPRI program to develop a mechanistic model for tube fretting and wear prediction, Foster Wheeler Development Corporation undertook the responsibility of developing analytical models to predict structural response and wear in a multispan tube. The project objective was to develop the analytical capability to simulate the time-dependent motion of a multispan steam generator tube in the presence of the clearance gaps at each tube baffle or support. The models developed were to simulate nonlinear tube-to-tube support interaction by determining the impact force, the sliding distance, and the resultant tube wear. Other objectives of the project included: validate the models by comparing the analytical results with the EPRI tests done at Combustion Engineering (C-E) on single multispan tubes; test the models for simulating the U-bend region of the steam generator tube, including the antivibration bars; and develop simplified methods to treat the nonlinear dynamic problem of a multispan tube so that computing costs could be minimized. 15 refs., 53 figs., 27 tabs

Transarterial embolization of massive gastric ulcer bleeding in gastrostomy patients caused by a balloon replacement tube: a case report

Energy Technology Data Exchange (ETDEWEB)

Youn, Byong Jong; Hur, Jin; Lee, Kwang Hun; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

2007-02-15

We present the case of a 77-year-old woman with massive gastric ulcer bleeding caused by a balloon replacement tube that required emergent transcatheter left gastric arterial embolization in stop the ulcer bleeding.

Damping in heat exchanger tube bundles. A review

International Nuclear Information System (INIS)

Iqbal, Qamar; Khushnood, Shahab; Ghalban, Ali Roheim El; Sheikh, Nadeem Ahmed; Malik, Muhammad Afzaal; Arastu, Asif

2007-01-01

Damping is a major concern in the design and operation of tube bundles with loosely supported tubes in baffles for process shell and tube heat exchangers and steam generators which are used in nuclear, process and power generation industries. System damping has a strong influence on the amplitude of vibration. Damping depends upon the mechanical properties of the tube material, geometry of intermediate supports and the physical properties of shell-side fluid. Type of tube motion, number of supports, tube frequency, vibration amplitude, tube mass or diameter, side loads, support thickness, higher modes, shell-side temperature etc., affect damping in tube bundles. The importance of damping is further highlighted due to current trend of larger exchangers with increased shell-side velocities in modern units. Various damping mechanisms have been identified (Friction damping, Viscous damping, Squeeze film damping, Support damping. Two-Phase damping, and very recent-Thermal damping), which affect the performance of process exchangers and steam generators with respect to flow induced vibration design, including standard design guidelines. Damping in two-phase flow is very complex and highly void fraction, and flow-regime dependent. The current paper focuses on the various known damping mechanisms subjected to both single and two-phase cross-flow in process heat exchangers and steam generators and formulates the design guidelines for safer design. (author)

Modeling and Simulation of U-tube Steam Generator

Science.gov (United States)

Zhang, Mingming; Fu, Zhongguang; Li, Jinyao; Wang, Mingfei

2018-03-01

The U-tube natural circulation steam generator was mainly researched with modeling and simulation in this article. The research is based on simuworks system simulation software platform. By analyzing the structural characteristics and the operating principle of U-tube steam generator, there are 14 control volumes in the model, including primary side, secondary side, down channel and steam plenum, etc. The model depends completely on conservation laws, and it is applied to make some simulation tests. The results show that the model is capable of simulating properly the dynamic response of U-tube steam generator.

O uso da gastrostomia percutânea endoscópica The use of percutaneous endoscopic gastrostomy

Directory of Open Access Journals (Sweden)

Marcos Ferreira Minicucci

2005-08-01

Full Text Available A gastrostomia percutânea endoscópica foi introduzida na prática clínica como via alternativa de alimentação enteral. É procedimento que não necessita de anestesia ou laparotomia, como a gastrostomia cirúrgica. A gastrostomia percutânea endoscópica tem como objetivos a manutenção do aporte nutricional e a melhoria da qualidade de vida e sobrevida dos pacientes. É indicada quando o paciente necessita de dieta enteral por período superior a um mês. A freqüência de complicações varia de 1,0% a 10,0% e a mortalidade de 0,3% a 1,0%. É propósito deste trabalho abordar aspectos relevantes desse método de alimentação enteral, aprimorar seu manejo, bem como facilitar o manejo pelos pacientes que dele se utilizam. Para isso, vamos comentar as indicações e contra-indicações da gastrostomia percutânea endoscópica, técnica de colocação, material das sondas, antibiótico profilático, início de utilização, custo do procedimento, além de suas complicações, aspectos legais e éticos.Percutaneous endoscopic gastrostomy is an alternative way to administer enteral diets. It is a procedure requiring no anesthetic or abdominal incision as required in open surgical gastrostomy. The main objective of percutaneous endoscopic gastrostomy is to prevent deterioration of the nutritional status and improve the quality of life and it is now the method of choice when the patient requires an enteral diet for more than a month. Complications occur in 1.0% to10.0% of the cases and mortality in 0.3% to 1.0%. This paper deals with aspects relevant to this method of enteral feeding, how to improve handling procedures and deal with the patients who use it, commenting on the indications and contraindications for its use, placement techniques, materials used for the probes, prophylactic antibiotics, start-up of its use and costs, in addition to discussing some of its complications and legal and ethical aspects.

Cytokines levels, Severity of acute mucositis and the need of PEG tube installation during chemo-radiation for head and neck cancer - a prospective pilot study

International Nuclear Information System (INIS)

Meirovitz, Amichay; Kuten, Michal; Billan, Salem; Abdah-Bortnyak, Roxolyana; Sharon, Anat; Peretz, Tamar; Sela, Mordechai; Schaffer, Moshe; Barak, Vivian

2010-01-01

The purpose of this pilot study was to detect a correlation between serum cytokine levels and severity of mucositis, necessitating installation of a percutaneous endoscopic gastrostomy tube (PEG) in head and neck (H&N) cancer patients receiving combined chemo-radiation therapy. Fifteen patients with H&N epithelial cancer were recruited to this study. All patients received radiotherapy to the H&N region, with doses ranging from 50-70 Gy. Chemotherapy with cisplatin, carboplatin, 5-fluorouracil and taxanes was given to high-risk patients, using standard chemotherapy protocols. Patients were evaluated for mucositis according to WHO common toxicity criteria, and blood samples were drawn for inflammatory (IL-1, IL-6, IL-8, TNF-α) and anti-inflammatory (IL-10) cytokine levels before and during treatment. A positive correlation was found between IL-6 serum levels and severity of mucositis and dysphagia; specifically, high IL-6 levels at week 2 were correlated with a need for PEG tube installation. A seemingly contradictory correlation was found between low IL-8 serum levels and a need for a PEG tube. These preliminary results, indicating a correlation between IL-6 and IL-8 serum levels and severity of mucositis and a need for a PEG tube installation, justify a large scale study

Cross-talk in straw tube chambers

Energy Technology Data Exchange (ETDEWEB)

Marzec, J. E-mail: janusz.marzec@ire.pw.edu.pl

2003-05-11

An analytical model of the signal transmission between neighboring straw tubes with resistive cathodes (cross-talk) is presented. The dependence of the cross-talk level on the cathode resistance, tube length, particle detection point, the distance of the tube from the shielding planes, and termination of the tube ends is analyzed.

Cross-talk in straw tube chambers

International Nuclear Information System (INIS)

Marzec, J.

2003-01-01

An analytical model of the signal transmission between neighboring straw tubes with resistive cathodes (cross-talk) is presented. The dependence of the cross-talk level on the cathode resistance, tube length, particle detection point, the distance of the tube from the shielding planes, and termination of the tube ends is analyzed

Tube holding system

International Nuclear Information System (INIS)

Cunningham, R.C.

1978-01-01

A tube holding rig is described for the lateral support of tubes arranged in tight parcels in a heat exchanger. This tube holding rig includes not less than two tube supporting assemblies, with a space between them, located crosswise with respect to the tubes, each supporting assembly comprising a first set of parallel components in contact with the tubes, whilst a second set of components is also in contact with the tubes. These two sets of parts together define apertures through which the tubes pass [fr

Flame oscillations in tubes with nonslip at the walls

Energy Technology Data Exchange (ETDEWEB)

Akkerman, V' yacheslav; Bychkov, Vitaly; Petchenko, Arkady [Institute of Physics, Umeaa University, SE-901 87 Umeaa (Sweden); Eriksson, Lars-Erik [Department of Applied Mechanics, Chalmers University of Technology, 412 96 Goeteborg (Sweden)

2006-06-15

A laminar premixed flame front propagating in a two-dimensional tube is considered with nonslip at the walls and with both ends open. The problem of flame propagation is solved using direct numerical simulations of the complete set of hydrodynamic equations including thermal conduction, diffusion, viscosity, and chemical kinetics. As a result, it is shown that flame interaction with the walls leads to the oscillating regime of burning. The oscillations involve variations of the curved flame shape and the velocity of flame propagation. The oscillation parameters depend on the characteristic tube width, which controls the Reynolds number of the flow. In narrow tubes the oscillations are rather weak, while in wider tubes they become stronger with well-pronounced nonlinear effects. The period of oscillations increases for wider tubes, while the average flame length scaled by the tube diameter decreases only slightly with increasing tube width. The average flame length calculated in the present work is in agreement with that obtained in the experiments. Numerical results reduce the gap between the theory of turbulent flames and the experiments on turbulent combustion in tubes. (author)

TIME-DEPENDENT TURBULENT HEATING OF OPEN FLUX TUBES IN THE CHROMOSPHERE, CORONA, AND SOLAR WIND

Energy Technology Data Exchange (ETDEWEB)

Woolsey, L. N.; Cranmer, S. R., E-mail: lwoolsey@cfa.harvard.edu [Harvard-Smithsonian Center for Astrophysics, 60 Garden St., Cambridge, MA 02138 (United States)

2015-10-01

We investigate several key questions of plasma heating in open-field regions of the corona that connect to the solar wind. We present results for a model of Alfvén-wave-driven turbulence for three typical open magnetic field structures: a polar coronal hole, an open flux tube neighboring an equatorial streamer, and an open flux tube near a strong-field active region. We compare time-steady, one-dimensional turbulent heating models against fully time-dependent three-dimensional reduced-magnetohydrodynamic modeling of BRAID. We find that the time-steady results agree well with time-averaged results from BRAID. The time dependence allows us to investigate the variability of the magnetic fluctuations and of the heating in the corona. The high-frequency tail of the power spectrum of fluctuations forms a power law whose exponent varies with height, and we discuss the possible physical explanation for this behavior. The variability in the heating rate is bursty and nanoflare-like in nature, and we analyze the amount of energy lost via dissipative heating in transient events throughout the simulation. The average energy in these events is 10{sup 21.91} erg, within the “picoflare” range, and many events reach classical “nanoflare” energies. We also estimated the multithermal distribution of temperatures that would result from the heating-rate variability, and found good agreement with observed widths of coronal differential emission measure distributions. The results of the modeling presented in this paper provide compelling evidence that turbulent heating in the solar atmosphere by Alfvén waves accelerates the solar wind in open flux tubes.

A thermal conductivity model for nanofluids including effect of the temperature-dependent interfacial layer

International Nuclear Information System (INIS)

Sitprasert, Chatcharin; Dechaumphai, Pramote; Juntasaro, Varangrat

2009-01-01

The interfacial layer of nanoparticles has been recently shown to have an effect on the thermal conductivity of nanofluids. There is, however, still no thermal conductivity model that includes the effects of temperature and nanoparticle size variations on the thickness and consequently on the thermal conductivity of the interfacial layer. In the present work, the stationary model developed by Leong et al. (J Nanopart Res 8:245-254, 2006) is initially modified to include the thermal dispersion effect due to the Brownian motion of nanoparticles. This model is called the 'Leong et al.'s dynamic model'. However, the Leong et al.'s dynamic model over-predicts the thermal conductivity of nanofluids in the case of the flowing fluid. This suggests that the enhancement in the thermal conductivity of the flowing nanofluids due to the increase in temperature does not come from the thermal dispersion effect. It is more likely that the enhancement in heat transfer of the flowing nanofluids comes from the temperature-dependent interfacial layer effect. Therefore, the Leong et al.'s stationary model is again modified to include the effect of temperature variation on the thermal conductivity of the interfacial layer for different sizes of nanoparticles. This present model is then evaluated and compared with the other thermal conductivity models for the turbulent convective heat transfer in nanofluids along a uniformly heated tube. The results show that the present model is more general than the other models in the sense that it can predict both the temperature and the volume fraction dependence of the thermal conductivity of nanofluids for both non-flowing and flowing fluids. Also, it is found to be more accurate than the other models due to the inclusion of the effect of the temperature-dependent interfacial layer. In conclusion, the present model can accurately predict the changes in thermal conductivity of nanofluids due to the changes in volume fraction and temperature for

Population-based comparison of two feeding tube approaches for head and neck cancer patients receiving concurrent systemic-radiation therapy: is a prophylactic feeding tube approach harmful or helpful?

Science.gov (United States)

Olson, Robert; Karam, Irene; Wilson, Gavin; Bowman, Angela; Lee, Christopher; Wong, Frances

2013-12-01

The purpose of this study is to compare patient outcomes between a therapeutic versus a prophylactic gastrostomy tube (GT) placement approach in patients treated with concurrent systemic and radiation (SRT) therapy for head and neck cancer (HNC). Outcomes were compared between all HNC patients treated with concurrent SRT from January 2001 to June 2009 from a center that only places GTs therapeutically when clinically necessary (center A) versus a center that generally places them prophylactically (center B). A total of 445 patients with HNC were identified, with 63 % from center A. As anticipated, GTs were placed less commonly in center A compared to B (31 versus 88 %; p approach results in exposing higher number of patients to GT complications. The higher rate of hospitalizations using a therapeutic approach suggests that patients are sicker when GTs are required. Given the similar weight loss and survival, a therapeutic approach at an earlier stage of need may be a preferable approach, when access to prompt GT placement is available.

Modelling of pressure tube Quench using PDETWO

International Nuclear Information System (INIS)

Parlatan, Y.; Lei, Q.M.; Kwee, M.

2004-01-01

Transient two-dimensional heat conduction calculations have been carried out to determine the time-dependent temperature distribution in an overheated pressure tube during quenching with water. The purpose of the calculations is to provide input for evaluation of thermal (secondary) stresses in the pressure tube due to quench. The quench phenomenon in pressure tubes could occur in several hypothetical accident scenarios, including incidents involving intermittent buoyancy-induced flow during outages. In these scenarios, there will be two (radial and axial) or three dimensional temperature gradients, resulting in thermal stresses in the pressure tube, as the water front reaches and starts to cool down the hot pressure tube. The transient, two-dimensional heat conduction equation in the pressure tube during quench is solved using a FORTRAN package called PDETWO, available in the open literature for solving time-dependent coupled systems of non-linear partial differential equations over a two-dimensional rectangular region. This routine is based on finite difference solution of coupled, non-linear partial differential equations. Temperature gradient in the circumferential gradient is neglected for conservatism and convenience. The advancing water front is not modelled explicitly, and assumed to be at a uniform temperature and moving at a constant velocity inferred from experimental data. For outer surface and both ends of the pressure tube in the axial direction, a zero-heat flux boundary condition is assumed, while for the inner surface a moving water-quench front is assumed by appropriately varying the fluid temperature and the heat transfer coefficient. The pressure tube is assumed to be at a uniform temperature of 400 o C initially, to represent conditions expected during an intermittent buoyancy-influenced flow scenario. The results confirm the expectations that axial temperature gradients and associated heat fluxes are small in comparison with those in the

Microdischarges in DC accelerator tubes

International Nuclear Information System (INIS)

Eastham, D.A.; Thorn, R.

1978-07-01

Voltage tests on the Daresbury ceramic/titanium accelerator tube have shown that microdischarges play an important role in the conditioning process. It has been found that the voltage onset for microdischarges in a tube is dependent on the surface contamination of the electrodes and the tube geometry (in particular the tube length). This geometrical effect can be related to the trajectories of secondary ions emitted from the electrode surfaces. Sensitive diagnostic techniques have been developed to study the mass and energy distribution of ions emitted along the axis of the tube during these predischarges. The energy distribution of protons (and H - ions) can be related to the origins of the discharges in the tube. Detailed results are presented for a particular tube geometry. (author)

Development and Evaluation of a Home Enteral Nutrition Team

Directory of Open Access Journals (Sweden)

Sarah Dinenage

2015-03-01

Full Text Available The organisation of services to support the increasing number of people receiving enteral tube feeding (ETF at home varies across regions. There is evidence that multi-disciplinary primary care teams focussed on home enteral nutrition (HEN can provide cost-effective care. This paper describes the development and evaluation of a HEN Team in one UK city. A HEN Team comprising dietetians, nurses and a speech and language therapist was developed with the aim of delivering a quality service for people with gastrostomy tubes living at home. Team objectives were set and an underpinning framework of organisation developed including a care pathway and a schedule of training. Impact on patient outcomes was assessed in a pre-post test evaluation design. Patients and carers reported improved support in managing their ETF. Cost savings were realised through: (1 prevention of hospital admission and related transport for ETF related issues; (2 effective management and reduction of waste of feed and thickener; (3 balloon gastrostomy tube replacement by the HEN Team in the patient’s home, and optimisation of nutritional status. This service evaluation demonstrated that the establishment of a dedicated multi-professional HEN Team focussed on achievement of key objectives improved patient experience and, although calculation of cost savings were estimates, provided evidence of cost-effectiveness.

Experimental study of tube/support impact forces in multi-span PWR steam generator tubes

International Nuclear Information System (INIS)

Axisa, F.; Desseaux, A.; Gibert, R.J.

1984-12-01

The vibro-impact response of a straight part of a steam generator tube is investigated experimentally and using numerical simulation with the aim to relate tube overall dynamics with excitation and tube-support clearance. Configuration studied here corresponds to the tube being excited in only one direction at its first resonance presenting an antinode of vibration at the impacted support. Tests show namely that midspan displacement of tube is almost proportional to excitation level and clearance. Impact forces averaged over a cycle of vibration are almost proportional to excitation and poorly dependent on clearance. Results of numerical simulation are in fairly good agreement with test results

X-ray tube current control

International Nuclear Information System (INIS)

Dupuis, W.A.; Resnick, T.A.

1982-01-01

A closed loop feedback system for controlling the current output of an x-ray tube. The system has circuitry for improving the transient response and stability of the x-ray tube current over a substantial nonlinear portion of the tube current production characteristic. The system includes a reference generator for applying adjustable step function reference signals representing desired tube currents. The system also includes means for instantaneous sensing of actual tube current. An error detector compares the value of actual and reference tube current and produces an error signal as a function of their difference. The system feedback loop includes amplification circuitry for controlling x-ray tube filament dc voltage to regulate tube current as a function of the error signal value. The system also includes compensation circuitry, between the reference generator and the amplification circuitry, to vary the loop gain of the feedback control system as a function of the reference magnitude

Resonant oscillations in open axisymmetric tubes

Science.gov (United States)

Amundsen, D. E.; Mortell, M. P.; Seymour, B. R.

2017-12-01

We study the behaviour of the isentropic flow of a gas in both a straight tube of constant cross section and a cone, open at one end and forced at or near resonance at the other. A continuous transition between these configurations is provided through the introduction of a geometric parameter k associated with the opening angle of the cone where the tube corresponds to k=0. The primary objective is to find long-time resonant and near-resonant approximate solutions for the open tube, i.e. k→ 0. Detailed analysis for both the tube and cone in the limit of small forcing (O(ɛ 3)) is carried out, where ɛ 3 is the Mach number of the forcing function and the resulting flow has Mach number O(ɛ ). The resulting approximate solutions are compared with full numerical simulations. Interesting distinctions between the cone and the tube emerge. Depending on the damping and detuning, the responses for the tube are continuous and of O(ɛ ). In the case of the cone, the resonant response involves an amplification of the fundamental resonant mode, usually called the dominant first-mode approximation. However, higher modes must be included for the tube to account for the nonlinear generation of higher-order resonances. Bridging these distinct solution behaviours is a transition layer of O(ɛ 2) in k. It is found that an appropriately truncated set of modes provides the requisite modal approximation, again comparing well to numerical simulations.

Percutaneous endoscopic gastrostomy in patients with amyotrophic lateral sclerosis: Mortality and complications.

Science.gov (United States)

Carbó Perseguer, J; Madejón Seiz, A; Romero Portales, M; Martínez Hernández, J; Mora Pardina, J S; García-Samaniego, J

2018-03-26

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that causes severe dysphagia and weight loss. Percutaneous endoscopic gastrostomy (PEG) is currently the technique of choice for the enteral nutrition of these patients. To analyse mortality and complications in a series of patients diagnosed with ALS who underwent PEG, and to evaluate factors related to patient survival after the procedure. We performed a prospective, observational study including all patients diagnosed with ALS and treated by our hospital's Gastroenterology Department in the period 1997-2013. We studied mortality, complications, and clinical and biochemical parameters, and correlated these with the survival rate. The study included a total of 57 patients, of whom 49 were ultimately treated with PEG. ALS onset was bulbar in 30 patients and spinal in 19. Mortality during the procedure and at 30 days was 2% (n = 1). Six patients (12.2%) experienced major complications; 17 (34.7%) experienced less serious complications which were easily resolved with conservative treatment. No significant differences were observed in forced vital capacity, albumin level, or age between patients with (n = 6) and without (n = 43) major complications. PEG is an effective, relatively safe procedure for the enteral nutrition of patients with ALS, although not without morbidity and mortality. Neither forced vital capacity nor the form of presentation of ALS were associated with morbidity in PEG. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Automated Determination of Oxygen-Dependent Enzyme Kinetics in a Tube-in-Tube Flow Reactor.

Science.gov (United States)

Ringborg, Rolf H; Toftgaard Pedersen, Asbjørn; Woodley, John M

2017-09-08

Enzyme-mediated oxidation is of particular interest to synthetic organic chemists. However, the implementation of such systems demands knowledge of enzyme kinetics. Conventionally collecting kinetic data for biocatalytic oxidations is fraught with difficulties such as low oxygen solubility in water and limited oxygen supply. Here, we present a novel method for the collection of such kinetic data using a pressurized tube-in-tube reactor, operated in the low-dispersed flow regime to generate time-series data, with minimal material consumption. Experimental development and validation of the instrument revealed not only the high degree of accuracy of the kinetic data obtained, but also the necessity of making measurements in this way to enable the accurate evaluation of high K MO enzyme systems. For the first time, this paves the way to integrate kinetic data into the protein engineering cycle.

New process for the relief of mechanically induced stresses in steam generator tubes

International Nuclear Information System (INIS)

Joyeux, J.P.

1980-01-01

Heat exchangers include very generally a set of tubes assembled in 'U-type' exchangers or in 'pass-through' exchangers. The tubes are introduced in holes drilled in the tube sheet plate, welded at their extremity and expanded to insure the necessary tightness. The steam generators built by FRAMATOME belong to the U-type and include, depending upon the nominal power of the plant, about three or five thousand inconel tubes. This material has been selected for its resistance to corrosion action at high temperatures. But one drawback of inconel is that residual stress lowers considerably this resistance to corrosion; so it is very important to apply manufacturing processes involving a residual stress level as low as possible. A new process, which involves 'kiss' rolling, is described. (author)

Motion-dependent excitation mechanisms in a square in-line tube bundle subject to water cross flow: an experimental modal analysis; Mecanismes d`excitation dependant du mouvement de la structure dans un faisceau de tube soumis a un ecoulement: une analyse modale experimentale

Energy Technology Data Exchange (ETDEWEB)

Grangers, S.; Campistron, R.; Lebret, J.

1994-09-01

This paper deals with the physical mechanisms inducing motion-development dynamic fluid forces in a tube array subject to water cross-flow. Three configurations have been tested. In the first one, a single flexible tube was positioned in the middle of an array of rigid cylinders; in the second one, a single flexible tube was positioned in the first row of an array of rigid cylinders; in the third one, the first three rows of the array were flexible, the other cylinders being rigid. Tube response measurements were analyzed by the inverse methodology developed at EDF/R and D D/HTA and implemented into the IMENE and MEIDEE softwares. This methodology allows for studying the variation of the fluid-structure system eigenvalues with flow velocity. From the information, motion-dependent fluid forces can also be estimated. The results of these analyses are compared to previously published data and to the theoretical results obtained with a slightly extended version of the Lever and Weaver analytical model. The main conclusions which can be drawn are as follows: -for each configuration tested, dynamic instabilities occur which induce sudden large amplitude motions for certain flow velocities; -these instabilities seem to result from the interaction of various physical mechanisms; two of them have been clearly identified: they are (i) a single mode flutter phenomenon and (ii) a complex interaction between tube motion and a symmetric vortex shedding; in the last case, tube oscillations regenerate a flow periodicity which had been damped out by flow turbulence when the tube was motionless, then the shed vortices act in turn on tube motion and precipitate the dynamic instability; -in the configurations tested, the location of the flexible tube within the array has a major influence on the development of low-structure interaction; -the Lever and Weaver model gives interesting qualitative trends but the quantitative results are not good. (authors). 22 refs., 20 figs., 1 appendix.

Oral og verbal dyspraksi hos en i øvrigt rask pige

DEFF Research Database (Denmark)

Nikoghosyan-Bossen, Gohar

2018-01-01

In the absence of any known neurological condition, dyspraxia is the inability to plan and execute movement. This case report describes a girl with swallowing difficulties, who was diagnosed with oral dyspraxia, as all other possible explanations had been ruled out. A percutaneous endoscopic...... gastrostomy was performed at the age of 6.5 months, and as a five-year-old she was still dependent on supplementary nutrition through the tube, even though she had gradually learned to swallow. Her difficulties to correctly pronounce syllables and words were later diagnosed as childhood apraxia of speech...

PROBLEMS IN THE TUBING/PACKER SYSTEM

OpenAIRE

Davorin Matanović; Mario Livaja

1993-01-01

When gas and oil wells are completed and produced or treated through the tubing connected to packer, there is a great number of problems to be solved. Changes in temperatures and pressures that occure during various operations ussually result in changes in tubing lengths or tubing to packer forces, depending on tubing to packer connections. This paper summarises some earlier papers and explains partly elaborated details. It also gives a complete approach to solve problems in uniform strings r...

Including Children Dependent on Ventilators in School.

Science.gov (United States)

Levine, Jack M.

1996-01-01

Guidelines for including ventilator-dependent children in school are offered, based on experience with six such students at a New York State school. Guidelines stress adherence to the medical management plan, the school-family partnership, roles of the social worker and psychologist, orientation, transportation, classroom issues, and steps toward…

Effect of Tube Pitch on Pool Boiling Heat Transfer of Vertical Tube Bundle

International Nuclear Information System (INIS)

Kang, Myeong Gie

2016-01-01

Summarizing the previous results it can be stated that heat transfer coefficients are highly dependent on the tube pitch and the heat flux of the relevant tube. The published results are mostly about the horizontal tubes. However, there are many heat exchangers consisting of vertical tubes like AP600. Therefore, the focus of the present study is an identification of the effects of a tube pitch as well as the heat flux of a relevant tube on the heat transfer of a tube bundle installed vertically. When the heat flux is increased many bubbles are generating due to the increase of the nucleation sites. The bubbles become coalescing with the nearby bubbles and generates big bunches of bubbles on the tube surface. This prevents the access of the liquid to the surface and deteriorates heat transfer. The bubble coalescence is competing with the mechanisms enhancing heat transfer. The pitch was varied from 28.5 mm to 95 mm and the heat flux of the nearby tube was changed from 0 to 90kW/m"2. The enhancement of the heat transfer is clearly observed when the heat flux of the nearby tube becomes larger and the heat flux of the upper tube is less than 40kW/m"2. The effect of the tube pitch on heat transfer is negligible as the value of DP/ is increased more than 4.

XFEL OSCILLATOR SIMULATION INCLUDING ANGLE-DEPENDENT CRYSTAL REFLECTIVITY

International Nuclear Information System (INIS)

Fawley, William; Lindberg, Ryan; Kim, K.-J.; Shvyd'ko, Yuri

2010-01-01

The oscillator package within the GINGER FEL simulation code has now been extended to include angle-dependent reflectivity properties of Bragg crystals. Previously, the package was modified to include frequencydependent reflectivity in order to model x-ray FEL oscillators from start-up from shot noise through to saturation. We present a summary of the algorithms used for modeling the crystal reflectivity and radiation propagation outside the undulator, discussing various numerical issues relevant to the domain of high Fresnel number and efficient Hankel transforms. We give some sample XFEL-O simulation results obtained with the angle-dependent reflectivity model, with particular attention directed to the longitudinal and transverse coherence of the radiation output.

The temperature dependence of the tensile properties of thermally treated Alloy 690 tubing

International Nuclear Information System (INIS)

Harrod, D.L.; Gold, R.E.; Larsson, B.; Bjoerkman, G.

1992-01-01

Tensile tests were run in air on full tube cross-sections of 22.23 mm OD by 1.27 mm wall thickness Alloy 690 steam generator production tubes from ten (10) heats of material at eight (8) temperatures between room temperature and 760 degrees C. The tubing was manufactured to specification requirements consistent with the EPRI guidelines for Alloy 690 tubing. The room temperature stress-strain curves are described quite well by the Voce equation. Ductile fracture by dimpled rupture was observed at all test temperatures. The elevated temperature tensile properties are compared with design data given in the ASME Code

Enhanced methods for operating refueling station tube-trailers to reduce refueling cost

Science.gov (United States)

Elgowainy, Amgad; Reddi, Krishna

2017-08-22

A method and apparatus are provided for operating a refueling station including source tube-trailers and at least one compressor to reduce refueling cost. The refueling station includes a gaseous fuel supply source including a plurality of tanks on a tube trailer coupled to a first control unit, and high pressure buffer storage having predefined capacity coupled to a second control unit and the first tanks by a pressure control valve and the first control unit, and at least one compressor. The refueling station is operated at different modes depending on a state of the refueling station at the beginning of each operational mode. The refueling system is assessed at the end of each operational mode to identify the state of the system and select a next mode of operation. The operational modes include consolidating hydrogen, or any gaseous fuel, within the tubes mounted on the trailer.

Gallbladder mucocoele and concurrent hepatic lipidosis in a cat.

Science.gov (United States)

Bennett, S L; Milne, M; Slocombe, R F; Landon, B P

2007-10-01

A 3-year-old Domestic Shorthair cat was presented with weight loss, anorexia and icterus. Feline hepatic lipidosis and gallbladder mucocoele were diagnosed; this is the first report of gallbladder mucocoele in the cat. The case was managed successfully with cholecystojejunostomy, gastrostomy tube placement and tube feeding for 3 months. The cat has survived over the long term with minimal complications.

Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia

Directory of Open Access Journals (Sweden)

Lisa M Poole

2017-01-01

Full Text Available Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5% had a sensory deficit alone, 4 (2.9% had a motor deficit alone, and 4 (2.9% had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6% underwent formal swallow evaluation, and 4 (2.9% had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9% had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%, or to home or home with home health (n = 48, 35.3%. Seven patients (5.1% died in the hospital, and eight more (5.9% were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.

Anharmonic properties of Raman modes in double wall carbon nano tubes

Energy Technology Data Exchange (ETDEWEB)

Marquina, J. [Universidad de los Andes, Facultad de Ciencias, Centro de Estudios Avanzados en Optica, 5101 Merida (Venezuela, Bolivarian Republic of); Power, Ch.; Gonzalez, J. [Universidad de los Andes, Facultad de Ciencias, Centro de Estudios en Semiconductores, 5101 Merida (Venezuela, Bolivarian Republic of); Broto, J. M. [Universite de Toulouse, Laboratoire National des Champs Magnetiques Intenses, CNRS UPR 3228, 31400 Toulouse (France); Flahaut, E., E-mail: castella@ula.v [Universite Paul Sabatier, Laboratoire de Chimie des Materiaux Inorganiques, UMR CNRS 5085, 31062 Toulouse (France)

2011-07-01

The temperature dependence of the radial breathing modes (RB Ms) and the zone-center tangential optical phonons (G-bands) of double-walled carbon nano tubes has been investigated between 300 and 700 K using Raman scattering. As expected, with increasing temperature, the frequencies of the Raman peaks, including the RB Ms and G-bands downshift simultaneously. We show here that the temperature dependence of the RB Ms can be fitted by a simple linear dependence and different RB Ms have different frequency shifts. We observe a noticeable nonlinearity in the temperature dependence of the G-band associated with the outer semiconducting tube G+ext (s). The deviation from the linear trend is due to the contribution of the third-order anharmonic term in the lattice potential energy with a pure temperature effect. An estimated value of 1.5 for the Grueneisen parameter of the G+ext (s) band was found. (Author)

Total laryngectomy and permanent tracheostomy for treatment of laryngeal rhabdomyosarcoma in a dog

International Nuclear Information System (INIS)

Block, G.; Clarke, K.; Salisbury, S.K.; DeNicola, D.B.

1995-01-01

An extensive, laryngeal tumor was identified in a nine-year-old, spayed female, mixed-breed dog. Clinical staging of the tumor included computed tomography. Six days prior to surgery, a percutaneous gastrostomy tube was placed under endoscopic guidance. Surgical treatment included total laryngectomy and permanent tracheostomy. The histologic diagnosis of the tumor was rhabdomyosarcoma. There were no major postoperative complications, and there have been no signs of local recurrence, metastatic disease, or long-term complications associated with the surgical procedure during an 18-month follow-up period

Percutaneous transgastric irrigation drainage in combination with endoscopic necrosectomy in necrotizing pancreatitis (with videos).

Science.gov (United States)

Raczynski, Susanne; Teich, Niels; Borte, Gudrun; Wittenburg, Henning; Mössner, Joachim; Caca, Karel

2006-09-01

Endoscopic drainage of pancreatic acute and chronic pseudocysts and pancreatic necrosectomy have been shown to be beneficial for critically ill patients, with complete endoscopic resolution rates of around 80%. Our purpose was to describe an improved endoscopic technique used to treat pancreatic necrosis. Case report. University hospital. Two patients with large retroperitoneal necroses were treated with percutaneous transgastric retroperitoneal flushing tubes and a percutaneous transgastric jejunal feeding tube by standard percutaneous endoscopic gastrostomy access in addition to endoscopic necrosectomy. Intensive percutaneous transgastric flushing in combination with percutaneous normocaloric enteral nutrition and repeated endoscopic necrosectomy led to excellent outcomes in both patients. Small number of patients. The "double percutaneous endoscopic gastrostomy" approach for simultaneous transgastric drainage and normocaloric enteral nutrition in severe cases of pancreatic necroses is safe and effective. It could be a promising improvement to endoscopic transgastric treatment options in necrotizing pancreatitis.

Healthcare Professionals’ Views on the Provision of Gastrostomy and Noninvasive Ventilation to Amyotrophic Lateral Sclerosis Patients in England, Wales, and Northern Ireland

OpenAIRE

Ruffell, Tamatha; Martin, Naomi; Janssen, Anna; Wijesekera, Lokesh; Knights, Catherine; Burman, Rachel; Oliver, David J.; Al-Chalabi, Ammar; Goldstein, Laura

2013-01-01

Gastrostomy and noninvasive ventilation (NIV) are recommended interventions for the management of symptoms associated with amyotrophic lateral sclerosis (ALS). This study aimed to quantify the views of a range of healthcare professionals (HCPs) on the provision of these interventions in the United Kingdom. A total of 177 HCPs participated in an online survey. Significant differences were found between medical and allied HCPs’ views on: whether HCPs adhere to policy and accept legal constraint...

Friction modelling of preloaded tube contact dynamics

International Nuclear Information System (INIS)

Hassan, M.A.; Rogers, R.J.

2004-01-01

Many loosely supported components are subjected to flow-induced vibration leading to localized wear. Life prediction depends on robust and accurate modelling of the nonlinear dynamics as the components interact with their supports. The output of such analysis is the component dynamic response and impact forces, including friction forces during stick-slip motions. Such results are used to determine the normal work rates, which are utilized to predict fretting wear damage. Accurate estimates of these parameters are essential. This paper presents simulations of a loosely supported fuel-channel tube subject to turbulence excitation. The effects of tube/support clearance and preload are investigated. Several friction models, including velocity-limited, spring-damper, and force-balance are utilized. A comparison of these models is carried out to investigate their accuracy. The results show good agreement with experimental work rates when a simple iterative procedure to update the friction forces is used. (authors)

Friction modelling of preloaded tube contact dynamics

International Nuclear Information System (INIS)

Hassan, M.A.; Rogers, R.J.

2005-01-01

Many loosely supported components are subjected to flow-induced vibration leading to localized wear. Life prediction depends on robust and accurate modelling of the nonlinear dynamics as the components interact with their supports. The output of such analysis is the component dynamic response and impact forces, including friction forces during stick-slip motions. Such results are used to determine the normal work rates, which are utilized to predict fretting wear damage. Accurate estimates of these parameters are essential. This paper presents simulations of a loosely supported fuel-channel tube subject to turbulence excitation. The effects of tube/support clearance and preload are investigated. Several friction models, including velocity-limited, spring-damper and force-balance are utilized. A comparison of these models is carried out to investigate their accuracy. The results show good agreement with experimental work rates when a simple iterative procedure to update the friction forces is used

A simple suture-retrieval device for the placement of u-stitches during laparoscopic gastrostomy.

Science.gov (United States)

Mattei, Peter

2009-02-01

During minimally invasive operations, it is sometimes necessary to retrieve the end of a suture or a suture needle and bring it out through the abdominal wall. Using a standard needle and a length of suture, we have developed a simple device that allows the retrieval of a suture end during minimally invasive operations that require the placement of U-or stay stitches. The author has used the device described during more than 100 laparoscopic gastrostomy placement procedures and other operations involving the placement of U- or stay stitches with excellent results and no complications. Using a beveled hollow-bore needle and a loop of polypropylene suture, one can construct a simple device that allows the retrieval of a suture from within a body cavity during minimally invasive surgery, making the placement of U- and stay stitches easier and more precise.

Manipulation and functionalization of nano-tubes: application to boron nitride nano-tubes

International Nuclear Information System (INIS)

Maguer, A.

2007-01-01

This PhD work is divided into two parts dealing with boron nitride (BNNT) and carbon nano-tubes. The first part is about synthesis, purification and chemical functionalization of BNNT. Single-walled BNNT are synthesized by LASER ablation of a hBN target. Improving the synthesis parameters first allowed us to limit the byproducts (hBN, boric acid). A specific purification process was then developed in order to enrich the samples in nano-tubes. Purified samples were then used to develop two new chemical functionalization methods. They both involve chemical molecules that present a high affinity towards the BN network. The use of long chain-substituted quinuclidines and borazines actually allowed the solubilization of BNNT in organic media. Purification and functionalization were developed for single-walled BNNT and were successfully applied to multi-walled BNNT. Sensibility of boron to thermic neutrons finally gave birth to a study about covalent functionalization possibilities of the network. The second part of the PhD work deals with separation of carbon nano-tubes depending on their properties. Microwave irradiation of carbon nano-tubes first allowed the enrichment of initially polydisperse samples in large diameter nano-tubes. A second strategy involving selective interaction between one type of tubes and fullerene micelles was finally envisaged to selectively solubilize carbon nano-tubes with specific electronic properties. (author) [fr

Bilio-entero-gastrostomy: prospective assessment of a modified biliary reconstruction with facilitated future endoscopic access

Directory of Open Access Journals (Sweden)

Hamad Mostafa A

2012-06-01

Full Text Available Abstract Background Hepaticojejunostomy (HJ is the classical reconstruction for benign biliary stricture. Endoscopic management of anastomotic complications after hepaticojejunostomy is extremely difficult. In this work we assess a modified biliary reconstruction in the form of bilio-entero-gastrostomy (BEG regarding the feasibility of endoscopic access to HJ and management of its stenosis if encountered. Methods From October 2008 till February 2011 all patients presented to the authors with benign biliary stricture who needed bilio-enteric shunt were considered. For each patient bilio-entero-gastrostomy (BEG of either type I, II or III was constructed. In the fourth week postoperatively, endoscopy was performed to explore the possibility to access the biliary anastomosis and perform cholangiography. Results BEG shunt was performed for seventeen patients, one of whom, with BEG type I, died due to myocardial infarction leaving sixteen patients with a diagnosis of postcholecystectomy biliary injury (9, inflammatory stricture with or without choledocholithiasis (5 and strictured biliary shunt (2. BEG shunts were either type I (3, type II (3 or type III (10. Endoscopic follow up revealed successful access to the anastomosis in 14 patients (87.5%, while the access failed in one type I and one type II BEG (12.5%. Mean time needed to access the anastomosis was 12.6 min (2-55 min. On a scale from 1–5, mean endoscopic difficulty score was 1.7. One patient (6.25%, with BEG type I, developed anastomotic stricture after 18 months that was successfully treated endoscopically by stenting. These preliminary results showed that, in relation to the other types, type III BEG demonstrated the tendency to be surgically simpler to perform, endoscopicall faster to access, easier and with no failure. Conclusions BEG, which is a modified biliary reconstruction, facilitates endoscopic access of the biliary anastomosis, offers management option for its

Suppression of acoustic streaming in tapered pulse tubes

International Nuclear Information System (INIS)

Olson, J.R.; Swift, G.W.

1998-01-01

In a pulse tube cryocooler, the gas in the pulse tube can be thought of as an insulating piston, transmitting pressure and velocity from the cold heat exchanger to the hot end of the pulse tube. Unfortunately, convective heat transfer can carry heat from the hot end to the cold end and reduce the net cooling power. Here, the authors discuss one driver of such convection: steady acoustic streaming as generated by interactions between the boundary and the oscillating pressure, velocity, and temperature. Using a perturbation method, they have derived an analytical expression for the streaming in a tapered pulse tube with axially varying mean temperature in the acoustic boundary layer limit. The calculations showed that the streaming depends strongly on the taper angle, the ratio of velocity and pressure amplitudes, and the phase between the velocity and pressure, but it depends only weakly on the mean temperature profile and is independent of the overall oscillatory amplitude. With the appropriate tapering of the tube, streaming can be eliminated for a particular operating condition. Experimentally, the authors have demonstrated that an orifice pulse tube cryocooler with the calculated zero-streaming taper has more cooling power than one with either a cylindrical tube or a tapered pulse tube with twice the optimum taper angle

Liquid-Nitrogen Test for Blocked Tubes

Science.gov (United States)

Wagner, W. R.

1984-01-01

Nondestructive test identifies obstructed tube in array of parallel tubes. Trickle of liquid nitrogen allowed to flow through tube array until array accumulates substantial formation of frost from moisture in air. Flow stopped and warm air introduced into inlet manifold to heat tubes in array. Tubes still frosted after others defrosted identified as obstructed tubes. Applications include inspection of flow systems having parallel legs.

Optimizing Tube Precurvature to Enhance Elastic Stability of Concentric Tube Robots.

Science.gov (United States)

Ha, Junhyoung; Park, Frank C; Dupont, Pierre E

2017-02-01

Robotic instruments based on concentric tube technology are well suited to minimally invasive surgery since they are slender, can navigate inside small cavities and can reach around sensitive tissues by taking on shapes of varying curvature. Elastic instabilities can arise, however, when rotating one precurved tube inside another. In contrast to prior work that considered only tubes of piecewise constant precurvature, we allow precurvature to vary along the tube's arc length. Stability conditions for a planar tube pair are derived and used to formulate an optimal design problem. An analytic formulation of the optimal precurvature function is derived that achieves a desired tip orientation range while maximizing stability and respecting bending strain limits. This formulation also includes straight transmission segments at the proximal ends of the tubes. The result, confirmed by both numerical and physical experiment, enables designs with enhanced stability in comparison to designs of constant precurvature.

Exergo-economic analysis of finned tube for waste heat recovery including phase change heat transfer

International Nuclear Information System (INIS)

Wu, Shuang Ying; Jiu, Jing Rui; Xiao, Lan; Li, You Rong; Liu, Chao; Xu, Jin Liang

2013-01-01

In this paper, an exergo-economic criterion, i.e. the net profit per unit transferred heat load, is established from the perspective of exergy recovery to evaluate the performance of finned tube used in waste heat recovery. Also, the dimensionless exergy change number is introduced to investigate the effect of the flow (mechanical) exergy loss rate on the recovered thermal exergy. Selecting R245fa as a working fluid and exhaust flue gas as a heat source, the effects of the internal Reynolds number Re_i, the external Reynolds number Re_o , the unit cost of thermal exergy ε_q , the geometric parameter of finned tube η_oβ and the phase change temperature T_v etc. on the performance of finned tube are discussed in detail. The results show that the higher T_v and η_oβ, and lower Re_i may lead to the negligible flow(mechanical) exergy loss rate. There exists an optimal value of Re_i where the net profit per unit transferred heat load peaks, while the variations of Re_o, ε_q and T_v cause monotonic change of the net profit per unit transferred heat load. The phase change temperature exerts relatively greater influence on the exergo-economic performance of finned tube in comparison with other parameters. And there exists a critical phase change temperature, where the net profit per unit transferred heat load is equal to zero.

Behavioural treatment of severe food refusal in five toddlers with developmental disabilities

NARCIS (Netherlands)

Moor, J.M.H. de; Didden, H.C.M.; Korzilius, H.P.L.M.

2007-01-01

BACKGROUND: Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. METHODS: A behavioural treatment package was

Behavioral treatment of severe food refusal in five toddlers with developmental disabilities

NARCIS (Netherlands)

Moor, J.M.H. de; Didden, H.C.M.; Korzilius, H.P.L.M.

2007-01-01

Background Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. Methods A behavioural treatment package was

Behavioural treatment of severe food refusal in five toddlers with developmental disabilities.

NARCIS (Netherlands)

Moor, J.M.H. de; Didden, R.; Korzilius, H.P.L.M.

2007-01-01

BACKGROUND: Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. METHODS: A behavioural treatment package was

[Gastric aspiration therapy is a possible alternative to treatment of obesity

DEFF Research Database (Denmark)

Christensen, Marie Møller; Jorsal, Tina; Naver, Lars Peter Skat

2017-01-01

Aspiration therapy with AspireAssist is a novel endoscopic obesity treatment. Patients aspirate approximately 30% of an ingested meal through a draining system connected to a percutanous endoscopic gastrostomy tube. AspireAssist was recently approved by the US Food and Drug Administration...

Gastrisk aspirationsbehandling er et muligt alternativ til behandling af fedme

DEFF Research Database (Denmark)

Christensen, Marie Møller; Jorsal, Tina; Naver, Lars Peter Skat

2017-01-01

Aspiration therapy with AspireAssist is a novel endoscopic obesity treatment. Patients aspirate approximately 30% of an ingested meal through a draining system connected to a percutanous endoscopic gastrostomy tube. AspireAssist was recently approved by the US Food and Drug Administration...

Thermal stresses in composite tubes using complementary virtual work

Science.gov (United States)

Hyer, M. W.; Cooper, D. E.

1988-01-01

This paper addresses the computation of thermally induced stresses in layered, fiber-reinforced composite tubes subjected to a circumferential gradient. The paper focuses on using the principle of complementary virtual work, in conjunction with a Ritz approximation to the stress field, to study the influence on the predicted stresses of including temperature-dependent material properties. Results indicate that the computed values of stress are sensitive to the temperature dependence of the matrix-direction compliance and matrix-direction thermal expansion in the plane of the lamina. There is less sensitivity to the temperature dependence of the other material properties.

Methicillin-Resistant Staphylococcus Aureus (MRSA Carriage Certainly Poses a Risk in Pregnant Women

Directory of Open Access Journals (Sweden)

Azadeh Bagheri

2015-03-01

Conclusion: Patients with a history of hospitalization, surgery, dialysis, or residence in a long-term care facility within 1 year of enrollment, a permanent indwelling catheter or percutaneous medical device (eg, tracheostomy tube, gastrostomy tube, or Foley catheter as well as pregnancy are known positive culture for MRSA and require an extensive check up to role out this problem. [Cukurova Med J 2015; 40(1.000: 28-35

Sunspots and the physics of magnetic flux tubes. II. Aerodynamic drag

International Nuclear Information System (INIS)

Parker, E.N.

1979-01-01

The aerodynamic drag on a slender flux tube stretched vertically across a convective cell may push the flux tube into the updrafts or into the downdrafts, depending on the density stratification of the convecting fluid and the asymmetry of the fluid motions. The drag is approximately proportional to the local kinetic energy density, so the density stratification weights the drag in favor of the upper layers where the density is low, tending to push the vertical tube into the downdrafts. If, however, the horizontal motions in the convective cell are concentrated toward the bottom of the cell, they may dominate over the upper layers, pushing the tube into the updrafts. In the simple, idealized circumstance of a vertical tube extending across a fluid of uniform density in a convective cell that is symmetric about its midplane, the net aerodynamic drag vanishes in lowest order. The higher order contributions, including the deflection of the tube, then provide a nonvanishing force pushing the tube into a stable equilibrium midway between the updraft and the downdraft.It is pointed out that in the strongly stratified convective zone of the Sun, a downdraft herds flux tubes together into a cluster, while an updraft disperses them. To account for the observed strong cohesion of the cluster of flux tubes that make up a sunspot, we propose a downdraft of the order 2 km s - 1 through the cluster of seprate tubes beneath the sunspot

Ballooning of CANDU pressure tube in local thermal transients

International Nuclear Information System (INIS)

Mihalache, Maria; Ionescu, Viorel

2008-01-01

In certain LOCA scenarios for the CANDU fuel channel, the ballooning of the pressure tube and contact with the calandria tube can occur. After the contact moment, a radial heat transfer from cooling fluid to moderator takes place through the contact area. If the temperature of channel walls increases, the contact area is drying and the heat transfer becomes inefficiently. In INR-Pitesti the DELOCA code was developed to simulate the mechanical behaviour of pressure tube during pre-contact transition, and mechanical and thermal behaviour of pressure tube and calandria tube after occurrence of the contact between the two tubes. The code contains few models: thermal creep of Zr-2.5%Nb alloy, the heat transfer by conduction through the cylindrical walls, channel failure criteria and calculus of heat transfer at the calandria tube - moderator interface. This code evaluates the contact and channel failure moments. This paper gives a DELOCA code description and the fuel channel behaviour analysis, in transient temperature conditions of the pressure tube, using the materials properties, time and temperature dependencies of these properties as obtained in the different laboratories of the world and in the INR - Pitesti in the last years. DELOCA computer code simulated the fuel channel response to the constant heating rates of inside pressure tube surface. The paper presents contact temperature and time dependencies on the heating rate, and the appropriate fitting functions. (authors)

Practical Guidance on How to Handle Levodopa/Carbidopa Intestinal Gel Therapy of Advanced PD in a Movement Disorder Clinic

DEFF Research Database (Denmark)

Pedersen, Stephen Wørlich; Clausen, Jesper Bøje; Gregerslund, Mie Manon

2012-01-01

, (Duodopa®, Abbott Laboratories) is delivered continuously through a percutaneous endoscopic gastrostomy with the inner tube placed in the duodenum by means of a device (CADD legacy Duodopa pump (CE 0473)). The therapy implies continuous dopaminergic delivery directly to the duodenum and is therefore...

Irradiation creep and growth of zircaloy-4 tubes

International Nuclear Information System (INIS)

Lansiart, S.; Darchis, L.; Pelchat, J.

1990-01-01

The influence of temperature and fast neutron flux on irradiation creep and growth of stress relieved zircaloy-4 pressurized tubes has been derived from experimental irradiations in NaK, performed up to 2.5 10 25 n.m -2 in the temperature range [280, 350] 0 C. A significant influence of temperature on axial growth has been observed: at 280 0 C the elongation can no longer be expressed as a linear function of fluence as for the 350 0 C irradiation temperature; diametral growth, on the other hand, always appears negligible. Irradiation creep obviously depends on temperature too; the diametral strain (including thermal part) has been modelled as a sum of primary and secondary terms, the former being independent of fluence. For the tubing considered it is observed that the ranking of the different batches, with respect to diametral creep resistance, is the same before and under irradiation. Concerning axial creep strain the stress relieved material behaves as does an isotropic tube. This is not the case of recrystallized zircaloy-4 F, which shows a non negligible axial deformation, related to the diametral creep one, even though this diametral irradiation creep strain is strongly reduced comparatively to that of the stress relieved material. The comparison of the two materials growth rates is more complex since their dependence on temperature and flux differs

Bottom nozzle to guide tube connection

International Nuclear Information System (INIS)

Bryan, W.J.

1991-01-01

This patent describes a nuclear fuel assembly which includes an upper end fitting and a lower end fitting spaced therefrom and connected thereto by elongated guide tubes of one alloy having an open upper end and a closed lower end with spaced fuel element retaining grids mounted on the guide tubes therebetween, the closed lower ends of the guide tubes including a threaded central passageway and the attachment of the guide tubes to the lower end fitting of another alloy. It comprises: an externally threaded bolt with a first end threadably received in the threaded central passageway of the lower end of the guide tube and a head at the other end of the side of the lower end fitting opposite the guide tube; an interruption in the external threads of the bolt which forms a groove which communicates the interior of the guide tube with the side of the lower end fitting opposite the guide tube and enhances its frictional engagement with the threaded central passageway, thereby to hold and attach the guide tube and lower end fitting firmly together, even through a series of temperature cycles

Peritonitis related to percutaneous endoscopic gastrostomy using the direct method for cancer patients.

Science.gov (United States)

Osera, Shozo; Yano, Tomonori; Odagaki, Tomoyuki; Oono, Yasuhiro; Ikematsu, Hiroaki; Ohtsu, Atsushi; Kaneko, Kazuhiro

2015-10-01

Percutaneous endoscopic gastrostomy (PEG) using the direct method is generally indicated for cancer patients. However, there are little available data about peritonitis related to this method. The aim of this retrospective analysis was to assess peritonitis related to PEG using the direct method in patients with cancer. We assessed the prevalence of peritonitis and the relationship between peritonitis and patients' backgrounds, as well as the clinical course after peritonitis. Between December 2008 and December 2011, peritonitis was found in 9 (2.1 %) of 421 patients. Of the 9 patients with peritonitis, 4 had received PEG prior to chemoradiotherapy. Emergency surgical drainage was required in 1 patient, and the remaining 8 recovered with conservative treatment. Peritonitis occurred within 8 days of PEG for 8 of the 9 patients and occurred within 2 days of suture removal for 4 of the 9 patients. Peritonitis related to PEG using the direct method was less frequent for cancer patients. Peritonitis tended to occur within a few days after removal of securing suture and in patients with palliative stage.

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.

Vibration characteristics of tubes in a heat exchanger

International Nuclear Information System (INIS)

Simonis; Steininger, D.

1985-01-01

Circumferential tube cracking has occurred in the once-through steam generators used in nuclear power plants. Analyses of failed tubes indicate that a fatigue process induced by tube vibration could cause the leaks. To investigate the vibration amplitude of tube spans during reactor operation, twenty-three tube spans were instrumented with accelerometers and strain gages at Three Mile Island Unit 2. To aid in the interpretation of the operational vibration measurements, tests were performed, in air, to determine the predominant resonant frequencies and mode shapes of selected tubes. By adapting modal analysis techniques, the two predominant response frequencies were determined for 100 randomly selected tube spans and the 23 instrumented tube spans; plus, the predominant mode shape was determined for five tube spans bounded by the tube sheet and the fifteenth support plate and one tube span bounded by the ninth and tenth support plate. The average value for the first and second predominant response frequency was 65 Hz and 170 Hz, respectively. The predominant frequencies for the individual tube spans are distributed randomly with no spatial orientation. The first predominant mode shape for the six tube spans tested corresponded to a classical beam with elastic supports. The equivalent stiffness of the elastic supports depend upon the tube span tested

The Functionality of Paratexts on YouTube

DEFF Research Database (Denmark)

Simonsen, Thomas Mosebo

2014-01-01

This chapter investigates paratexts and their functionality on YouTube. It is argued that YouTube content is in fact characterized by its dependence and usage of paratexts as part of YouTube's infrastructure. Paratexts are presented as being either auto-generated by YouTube or created by its users....... They are furthermore identified through a distinction between spatial and temporal relationships. Based on these distinctions, a small survey of some of the most popular videos on YouTube is conducted in order to examine the appearance and functionality of paratexts. A principal argument of the chapter...... is that the functionality of the paratexts can be explained by what Genette characterizes as the paratext's illocutionary force, which is examined in relationship to YouTube's paratexts and, more specifically, the site's implementation of links. The chapter also argues that paratexts may be characterized as a necessary...

Revisiting resolution in hydrodynamic countercurrent chromatography: tubing bore effect.

Science.gov (United States)

Berthod, A; Faure, K

2015-04-17

A major challenge in countercurrent chromatography (CCC), the technique that works with a support-free biphasic liquid system, is to retain the liquid stationary phase inside the CCC column (Sf parameter). Two solutions are commercially available: the hydrostatic CCC columns, also called centrifugal partition chromatographs (CPC), with disks of interconnected channels and rotary seals, and the hydrodynamic CCC columns with bobbins of coiled open tube and no rotary seals. It was demonstrated that the amount of liquid stationary phase retained by a coiled tube was higher with larger bore tubing than with small bore tubes. At constant column volume, small bore tubing will be longer producing more efficiency than larger bore tube that will better retain the liquid stationary phase. Since the resolution equation in CCC is depending on both column efficiency and stationary phase retention ratio, the influence of the tubing bore should be studied. This theoretical work showed that there is an optimum tubing bore size depending on solute partition coefficient and mobile phase flow rate. The interesting result of the theoretical study is that larger tubing bores allow for dramatically reduced experiment durations for all solutes: in reversed phase CCC (polar mobile phase), hydrophobic solutes are usually highly retained. These apolar solutes can be separated by the same coil at high flow rates and reduced Sf with similar retention times as polar solutes separated at smaller flow rates and much higher Sf. Copyright © 2015 Elsevier B.V. All rights reserved.

Airway Management in a Patient with Wolf-Hirschhorn Syndrome.

Science.gov (United States)

Gamble, John F; Kurian, Dinesh J; Udani, Andrea G; Greene, Nathaniel H

2016-01-01

We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation.

Fiber-optic Michelson interferometer fixed in a tilted tube for direction-dependent ultrasonic detection

Science.gov (United States)

Gang, Tingting; Hu, Manli; Qiao, Xueguang; Li, JiaCheng; Shao, Zhihua; Tong, Rongxin; Rong, Qiangzhou

2017-01-01

A fiber-optic interferometer is proposed and demonstrated experimentally for ultrasonic detection. The sensor consists of a compact Michelson interferometer (MI), which is fixed in a tilted-tube end-face (45°). Thin gold films are used for the reflective coatings of two arms and one of the interference arms is etched serving as the sensing arm. The spectral sideband filter technique is used to interrogate the continuous and pulse ultrasonic signals (with frequency of 300 KHz). Furthermore, because of the asymmetrical structure of the sensor, it presents strong direction-dependent ultrasonic sensitivity, such that the sensor can be considered a vector detector. The experimental results show that the sensor is highly sensitive to ultrasonic signals, and thus it can be a candidate for ultrasonic imaging of seismic physical models.

Recovery of normal esophageal function in a kitten with diffuse megaesophagus and an occult lower esophageal stricture.

Science.gov (United States)

Schneider, Jaycie; Ames, Marisa; DiCicco, Michael; Savage, Mason; Atkins, Clarke; Wood, Michael; Gookin, Jody L

2015-06-01

An 8-week-old male domestic shorthair was presented to the Internal Medicine Service at North Carolina State University for regurgitation. Radiographic diagnosis of generalized esophageal dilation and failure of esophageal peristalsis were compatible with diagnosis of congenital megaesophagus. Endoscopic examination of the esophagus revealed a fibrous stricture just orad to the lower esophageal sphincter. Conservative management to increase the body condition and size of the kitten consisted of feeding through a gastrostomy tube, during which time the esophagus regained normal peristaltic function, the stricture orifice widened in size and successful balloon dilatation of the stricture was performed. Esophageal endoscopy should be considered to rule out a stricture near the lower esophageal sphincter in kittens with radiographic findings suggestive of congenital megaesophagus. Management of such kittens by means of gastrostomy tube feeding may be associated with a return of normal esophageal motility and widening of the esophageal stricture, and facilitate subsequent success of interventional dilation of the esophageal stricture. © ISFM and AAFP 2014.

Electron tube

Science.gov (United States)

Suyama, Motohiro [Hamamatsu, JP; Fukasawa, Atsuhito [Hamamatsu, JP; Arisaka, Katsushi [Los Angeles, CA; Wang, Hanguo [North Hills, CA

2011-12-20

An electron tube of the present invention includes: a vacuum vessel including a face plate portion made of synthetic silica and having a surface on which a photoelectric surface is provided, a stem portion arranged facing the photoelectric surface and made of synthetic silica, and a side tube portion having one end connected to the face plate portion and the other end connected to the stem portion and made of synthetic silica; a projection portion arranged in the vacuum vessel, extending from the stem portion toward the photoelectric surface, and made of synthetic silica; and an electron detector arranged on the projection portion, for detecting electrons from the photoelectric surface, and made of silicon.

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.)

System and method having multi-tube fuel nozzle with differential flow

Science.gov (United States)

Hughes, Michael John; Johnson, Thomas Edward; Berry, Jonathan Dwight; York, William David

2017-01-03

A system includes a multi-tube fuel nozzle with a fuel nozzle body and a plurality of tubes. The fuel nozzle body includes a nozzle wall surrounding a chamber. The plurality of tubes extend through the chamber, wherein each tube of the plurality of tubes includes an air intake portion, a fuel intake portion, and an air-fuel mixture outlet portion. The multi-tube fuel nozzle also includes a differential configuration of the air intake portions among the plurality of tubes.

Guided waves in magnetospheric tubes of enhanced density

International Nuclear Information System (INIS)

Maltsev, Yu.P.; Lyatsky, W.B.

1981-01-01

Properties of a guided MHD-wave propagating in a magnetic field tube with the plasma density differing from the ambient density are studied. Like the Alven wave this wave propagates along the magnetic field and is connected with the field-aligned currents flowing at the periphery of the oscillating tube. The guided wave is accompanied by the magnetic field compression, nevertheless the wave moves without attenuation. The guided wave velocity is between the Alven velocities inside and outside the oscillating tube. In a tube of elliptical cross-section the propagation velocity depends on the polarization of the wave. (author)

Apparatus for forming an explosively expanded tube-tube sheet joint

International Nuclear Information System (INIS)

Schroeder, J.W.

1984-01-01

The invention relates to apparatus for expanding a tube into a bore formed in a tube sheet. According to the invention, a primary explosive containing a relatively high number of grains of explosive per unit length extends within the tube coextensive with that portion of the tube to be expanded. An energy transfer cord extends between a detonator and the primary explosive and includes a relatively low number of grains of explosive per unit length which are insufficient to detonate the primary explosive. The transfer cord is covered by a sheath to contain the debris and gases associated with the explosion of the explosive therein. A booster extends between the energy transfer cord and the primary explosive and contains an explosive which can be detonated by the explosive in the energy transfer cord and can, upon exploding, in turn detonate the primary explosive. (author)

Salvage of a failed open gastrocutaneous fistula repair with an endoscopic over-the-scope clip

Directory of Open Access Journals (Sweden)

Joshua Jaramillo

2016-05-01

Full Text Available Once enteral access via gastrostomy tube (G-tube is no longer indicated, the tube is typically removed in clinic with a high probability of spontaneous closure. When spontaneous closure is not achieved, the formation of a gastrocutaneous fistula (GCF is possible. The incidence of GCF is directly related with the length of time the tube has been placed. When conservative management fails, surgical intervention is the standard treatment. Endoscopic techniques have been described for primary closure of GCF in adults including banding and cauterizing of the fistula tract with placement of a standard endoscopic clip. Over-the-scope clips (OTSC have recently been reported in primary GCF closure in children (Wright et al., 2015. In patients with skin irritation surrounding a GCF making surgical repair difficult, endoscopic OTSC closure provides particular benefit. It is our belief that this is the first case report of endoscopically salvaging a leak from a failed open GCF repair.

Gas tube-switched high voltage DC power converter

Science.gov (United States)

She, Xu; Bray, James William; Sommerer, Timothy John; Chokhawala, Rahul

2018-05-15

A direct current (DC)-DC converter includes a transformer and a gas tube-switched inverter circuit. The transformer includes a primary winding and a secondary winding. The gas tube-switched inverter circuit includes first and second inverter load terminals and first and second inverter input terminals. The first and second inverter load terminals are coupled to the primary winding. The first and second inverter input terminals are couplable to a DC node. The gas tube-switched inverter circuit further includes a plurality of gas tube switches respectively coupled between the first and second inverter load terminals and the first and second inverter input terminals. The plurality of gas tube switches is configured to operate to generate an alternating current (AC) voltage at the primary winding.

Preparation of metallic uranium tubes; Elaboration des tubes d'uranium metallique

Energy Technology Data Exchange (ETDEWEB)

Lerouge, G; Decours, J [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1964-07-01

The production furnace is an induction heated vacuum furnace having a capacity at the moment of 250 kg. Previously the crucible was heated by the inductor, the mould being outside the inductor. The tubes thus produced contained cavities, the alloy structure was fine; this was cold-mould casting, At the moment the top of the moulds are pre-heated, this is the so called hot-mould casting. This method has the advantage of eliminating the cavities but leads to a less fine microstructure. The alloy used for the 18 x 40 mm and 23 x 43 mm tubes is U-Mo (1.1 per cent). Since the moulds are now heated at the top, the solidification of the metal is very slow in this zone leading to a pronounced {gamma} grain, whereas towards the base the faster cooling leads to a smaller {gamma} grain. The {gamma} structure depends essentially on the solidification rate and on the time spent in this zone. In order to obtain a fine and homogeneous grain along the whole length of the tube, a controlled cooling treatment is effected. It consists in heating the uranium tubes in the {gamma} place and then in cooling them at a rate of between 20 and 50 deg C/mm down to 400 deg C. The 77 x 95 mm and 54 x 70 mm annular elements are at the moment being produced for research purposes. Their preparation is similar to that of 18 x 40 mm and 23 x 43 mm elements. The 77 x 95 mm tubes are at the moment made from U-Cr alloy (0.1 per cent); because of their size, their preparation is carried out in 600 mm diameter furnaces. (authors) [French] Le four d'elaboration est un four sous vide chaufffe par induction, dont la capacite actuelle est de 250 kg. Anterieurement le creuset seul etait chauffe par l'inducteur, les moules etaient hors de l'inducteur. Les tubes obtenus presentaient des cavites, la structure de l'alliage etait fine, c'etait la coulee en moules froids. Actuellement on prechauffe le haut des moules, c'est la coulee dite en moules chauds. Cette facon de faire a l'avantage de supprimer les cavites

X-ray tube

International Nuclear Information System (INIS)

Webley, R.S.

1975-01-01

The object of the invention described is to provide an X-ray tube providing a scanned X-ray output which does not require a scanned electron beam. This is obtained by an X-ray tube including an anode which is rotatable about an axis, and a source of a beam of energy, for example an electron beam, arranged to impinge on a surface of the anode to generate X-radiation substantially at the region of incidence on the anode surface. The anode is rotatable about the axis to move the region of incidence over the surface. The anode is so shaped that the rotation causes the region of incidence to move in a predetermined manner relative to fixed parts of the tube so that the generated X-radiation is scanned in a predetermined manner relative to the tube. (UK)

[Gastric aspiration therapy is a possible alternative to treatment of obesity

DEFF Research Database (Denmark)

Christensen, Marie Møller; Jorsal, Tina; Naver, Lars Peter Skat

2017-01-01

Aspiration therapy with AspireAssist is a novel endoscopic obesity treatment. Patients aspirate approximately 30% of an ingested meal through a draining system connected to a percutanous endoscopic gastrostomy tube. AspireAssist was recently approved by the US Food and Drug Administration, and it......-term effects are warranted....

Stricture location predicts swallowing outcomes following endoscopic rendezvous procedures.

Science.gov (United States)

Adams, Katherine N; Shah, Rupali N; Buckmire, Robert A

2017-06-01

Complete pharyngoesophageal strictures may be encountered by the otolaryngologist as a consequence of radiation/chemoradiotherapy therapies for head and neck cancer. A combined anterograde and retrograde dilation procedure (rendezvous procedure) has proven to be a useful surgical intervention in these cases. We assess the long-term swallowing outcomes of this patient cohort including gastrostomy tube (G-tube) reliance, swallowing quality of life, and variables that contribute to improved swallowing outcomes. Retrospective chart review. A retrospective chart review of 18 consecutive patients treated with rendezvous procedures between April 2007 and May 2015 was carried out. Data were collected from chart review and follow-up telephone calls including demographics, surgical/postoperative course details, and Eating Assessment Tool (EAT-10) (swallowing quality of life) scores. The completion rate of the procedure was 83% (15 completed/3 procedures aborted). Average follow-up was 22 months. Thirteen of 15 (86.7%) achieved an oral diet, and 7/15 (46.7%) had their G-tube removed. G-tube-independent (GTI) patients had an average stricture length of 2.33 cm and an average distance from the incisors of 17.4 cm compared to G-tube dependent-(GTD) patients who had an average stricture length of 2.63 cm and 14.6 cm mean distance from the incisors (P = .66 and .0343, respectively). Final EAT-10 scores averaged 20.1 in GTI patients and 33.8 in GTD patients (P = .022). Stricture/incisor distance and EAT-10 scores demonstrated a moderate to strong negative correlation (r = -0.67). Following the endoscopic rendezvous procedure, swallowing outcomes and G-tube status is related to the distance of the stricture from the incisors. 2b Laryngoscope, 127:1388-1391, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Characteristics of U-tube assembly design for CANDU 6 type steam generators

International Nuclear Information System (INIS)

Park, Jun Su; Jeong, Seung Ha

1996-06-01

Since the first operation of nuclear steam generator early 1960s, its performance requirements have been met but the steam generator problems have been met but the steam generator problems have been major cause of reducing the operational reliability, plant safety and availability. U-tube assembly of steam generator forms the primary system pressure boundary of the plant and have experienced several types of tube degradation problems. Tube failure and leakage resulting from the degradation will cause radioactive contamination of secondary system by the primary coolant, and this may lead to unplanned plant outages and costly repair operations such as tube plugging or steam generator replacement. For the case of steam generators for heavy water reactors, e.g. Wolsong 2, 3, and 4 NPP, a high cost of heavy water will be imposed additionally. During the plant operation, steam generator tubes can potentially be subject to adverse environmental conditions which will cause damages to U-tube assembly. Types of the damage depend upon the combined effects of design factors, materials and chemical environment of steam generator, and they are the pure water stress corrosion cracking, intergranular attack, pitting, wastage, denting, fretting and fatigue, etc. In this report, a comprehensive review of major design factors of recirculating steam generators has been performed against the potential tube damages. Then the design characteristics of CANDU-type Wolsong steam generator were investigated in detail, including tube material, thermalhydraulic aspects, tube-to-tubesheet joint, tube supports, water chemistry and sludge management. 9 tabs., 18 figs., 38 refs. (Author) .new

Numerical study on turbulent heat transfer and pressure drop of nanofluid in coiled tube-in-tube heat exchangers

International Nuclear Information System (INIS)

Aly, Wael I.A.

2014-01-01

Highlights: • The performance of helically coiled tube heat exchanger using nanofluid is modeled. • The 3D turbulent flow and conjugate heat transfer of CTITHE are solved using FVM. • The effects of nanoparticle concentration and curvature ratio are investigated. • The Gnielinski correlation for Nu for turbulent flow in helical tubes can be used for water-based Al 2 O 3 nanofluid. - Abstract: A computational fluid dynamics (CFD) study has been carried out to study the heat transfer and pressure drop characteristics of water-based Al 2 O 3 nanofluid flowing inside coiled tube-in-tube heat exchangers. The 3D realizable k–ε turbulent model with enhanced wall treatment was used. Temperature dependent thermophysical properties of nanofluid and water were used and heat exchangers were analyzed considering conjugate heat transfer from hot fluid in the inner-coiled tube to cold fluid in the annulus region. The overall performance of the tested heat exchangers was assessed based on the thermo-hydrodynamic performance index. Design parameters were in the range of; nanoparticles volume concentrations 0.5%, 1.0% and 2.0%, coil diameters 0.18, 0.24 and 0.30 m, inner tube and annulus sides flow rates from 2 to 5 LPM and 10 to 25 LPM, respectively. Nanofluid flows inside inner tube side or annular side. The results obtained showed a different behavior depending on the parameter selected for the comparison with the base fluid. Moreover, when compared at the same Re or Dn, the heat transfer coefficient increases by increasing the coil diameter and nanoparticles volume concentration. Also, the friction factor increases with the increase in curvature ratio and pressure drop penalty is negligible with increasing the nanoparticles volume concentration. Conventional correlations for predicting average heat transfer and friction factor in turbulent flow regime such as Gnielinski correlation and Mishra and Gupta correlation, respectively, for helical tubes are also valid for

Slit Tubes for Semisoft Pneumatic Actuators.

Science.gov (United States)

Belding, Lee; Baytekin, Bilge; Baytekin, Hasan Tarik; Rothemund, Philipp; Verma, Mohit S; Nemiroski, Alex; Sameoto, Dan; Grzybowski, Bartosz A; Whitesides, George M

2018-03-01

This article describes a new principle for designing soft or 'semisoft' pneumatic actuators: SLiT (for SLit-in-Tube) actuators. Inflating an elastomeric balloon, when enclosed by an external shell (a material with higher Young's modulus) containing slits of different directions and lengths, produces a variety of motions, including bending, twisting, contraction, and elongation. The requisite pressure for actuation depends on the length of the slits, and this dependence allows sequential actuation by controlling the applied pressure. Different actuators can also be controlled using external "sliders" that act as reprogrammable "on-off" switches. A pneumatic arm and a walker constructed from SLiT actuators demonstrate their ease of fabrication and the range of motions they can achieve. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Airway Management in a Patient with Wolf-Hirschhorn Syndrome

Directory of Open Access Journals (Sweden)

John F. Gamble

2016-01-01

Full Text Available We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation.

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

Falling film evaporation on a tube bundle with plain and enhanced tubes

International Nuclear Information System (INIS)

Habert, M.

2009-04-01

The complexities of two-phase flow and evaporation on a tube bundle present important problems in the design of heat exchangers and the understanding of the physical phenomena taking place. The development of structured surfaces to enhance boiling heat transfer and thus reduce the size of evaporators adds another level of complexity to the modeling of such heat exchangers. Horizontal falling film evaporators have the potential to be widely used in large refrigeration systems and heat pumps, in the petrochemical industry and for sea water desalination units, but there is a need to improve the understanding of falling film evaporation mechanisms to provide accurate thermal design methods. The characterization of the effect of enhanced surfaces on the boiling phenomena occurring in falling film evaporators is thus expected to increase and optimize the performance of a tube bundle. In this work, the existing LTCM falling film facility was modified and instrumented to perform falling film evaporation measurements on single tube row and a small tube bundle. Four types of tubes were tested including: a plain tube, an enhanced condensing tube (Gewa-C+LW) and two enhanced boiling tubes (Turbo-EDE2 and Gewa-B4) to extend the existing database. The current investigation includes results for two refrigerants, R134a and R236fa, at a saturation temperature of T sat = 5 °C, liquid film Reynolds numbers ranging from 0 to 3000, at heat fluxes between 20 and 60 kW/m² in pool boiling and falling film configurations. Measurements of the local heat transfer coefficient were obtained and utilized to improve the current prediction methods. Finally, the understanding of the physical phenomena governing the falling film evaporation of liquid refrigerants has been improved. Furthermore, a method for predicting the onset of dry patch formation has been developed and a local heat transfer prediction method for falling film evaporation based on a large experimental database has been proposed

Burnout specific features in steam-water mixture annular flow in a tube

International Nuclear Information System (INIS)

Doroshchuk, V.E.

1981-01-01

Some unexplained burnout specific features in a steam-generating tube are analysed on the basis of experimental data. The following problems are considered: 1) the effect of the tube length and the state of the working medium (single-phase, two-phase) on burnout at the tube inlet; 2) the character of the specific thermal flow dependence at the moment of burnout appearance on the mass steam content q=f(x). It is found that the effect of the tube length on the burnout exists only in a relatively narrow range of the operating parameters. The run of the q=f(x) dependence is also explained [ru

Bundled multi-tube nozzle for a turbomachine

Science.gov (United States)

Lacy, Benjamin Paul; Ziminsky, Willy Steve; Johnson, Thomas Edward; Zuo, Baifang; York, William David; Uhm, Jong Ho

2015-09-22

A turbomachine includes a compressor, a combustor operatively connected to the compressor, an end cover mounted to the combustor, and an injection nozzle assembly operatively connected to the combustor. The injection nozzle assembly includes a cap member having a first surface that extends to a second surface. The cap member further includes a plurality of openings. A plurality of bundled mini-tube assemblies are detachably mounted in the plurality of openings in the cap member. Each of the plurality of bundled mini-tube assemblies includes a main body section having a first end section and a second end section. A fluid plenum is arranged within the main body section. A plurality of tubes extend between the first and second end sections. Each of the plurality of tubes is fluidly connected to the fluid plenum.

Rac1 controls epithelial tube length through the apical secretion and polarity pathways

Directory of Open Access Journals (Sweden)

Kévin Sollier

2016-01-01

Full Text Available The morphometric parameters of epithelial tubes are critical to the physiology and homeostasis of most organs. In addition, many human diseases are associated with tube-size defects. Here, we show that Rac1 limits epithelial tube elongation in the developing fly trachea by promoting Rab5-dependent endocytosis of the apical determinant Crumbs. Rac1 is also involved in a positive feedback loop with the septate junction protein Coracle. Thereby, Rac1 precludes paracellular diffusion and contributes to the septate junction-dependent secretion of the chitin-modifying enzymes Vermiform and Serpentine, which restrict epithelial tube length independently of Crumbs. Thus, Rac1 is a critical component of two important pathways controlling epithelial tube morphogenesis.

Experimental results of the consequences of sodium water reactions at the bottom tube plate region of straight tube steam generators

International Nuclear Information System (INIS)

Ruloff, G.

1990-01-01

Experience with sodium water reactions has shown, that the course of such a steam generator accident depends strongly on its place in the steam generator. For the EFR steam generators we have to differentiate between: weld region at the upper tube plate (gas space); bundle region; weld region at the bottom tube plate. This paper describes results of a running tests program simulating the bottom tube plate area. One main part of these tests is the investigation of the influence of wastage protection shrouds between the tubes in the weld region to avoid a fast leak propagation and to give time for leak detection and mastering of the accidents. (author). 10 figs, 2 tabs

[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.

Steam generator tube integrity program

International Nuclear Information System (INIS)

Dierks, D.R.; Shack, W.J.; Muscara, J.

1996-01-01

A new research program on steam generator tubing degradation is being sponsored by the U.S. Nuclear Regulatory Commission (NRC) at Argonne National Laboratory. This program is intended to support a performance-based steam generator tube integrity rule. Critical areas addressed by the program include evaluation of the processes used for the in-service inspection of steam generator tubes and recommendations for improving the reliability and accuracy of inspections; validation and improvement of correlations for evaluating integrity and leakage of degraded steam generator tubes, and validation and improvement of correlations and models for predicting degradation in steam generator tubes as aging occurs. The studies will focus on mill-annealed Alloy 600 tubing, however, tests will also be performed on replacement materials such as thermally-treated Alloy 600 or 690. An overview of the technical work planned for the program is given

Time-dependent shock acceleration of energetic electrons including synchrotron losses

International Nuclear Information System (INIS)

Fritz, K.; Webb, G.M.

1990-01-01

The present investigation of the time-dependent particle acceleration problem in strong shocks, including synchrotron radiation losses, solves the transport equation analytically by means of Laplace transforms. The particle distribution thus obtained is then transformed numerically into real space for the cases of continuous and impulsive injections of particles at the shock. While in the continuous case the steady-state spectrum undergoes evolution, impulsive injection is noted to yield such unpredicted features as a pile-up of high-energy particles or a steep power-law with time-dependent spectral index. The time-dependent calculations reveal varying spectral shapes and more complex features for the higher energies which may be useful in the interpretation of outburst spectra. 33 refs

Light hydrogen isotopes in the single - walled carbon nano tube

International Nuclear Information System (INIS)

Khugaev, A.V.; Sultanov, R.A.; Guster, D.

2007-01-01

Full text: Progress of our understanding of the molecular hydrogen behavior in the nano tube interior open an intriguing possibility for the applications of these knowledge's to the solution of the hydrogen storage problem and light isotopes gas selectivity. That can strongly change the situation at the energy production in the world and completely change our civil life. These investigations underline the influence of the quantum effects on the properties of molecular hydrogen in the nano tube interior and it leads to the pure quantum-mechanical reformulation of the problem for the hydrogen behavior inside carbon nano tube as a problem of molecular quantum system behavior in the external field induced by the regular nano tube surface. In the present paper the molecular hydrogen behavior in the carbon nano tube was considered in the simple quantum mechanical manner. The main attention was paid to the investigation of the quantum sieving selectivity in the dependence of nano tube composition, radius and symmetry properties. For the interaction potential between hydrogen and nano tube surface was taken some phenomenological LJ(12,6) - (Lennard - Jones) potential and the external field induced by the nano tube in its interior is considered as a simple sum over the all nano tube carbon atoms. Influence of the structure of rotation (vibration) spectrum of the energy levels of diatomic molecules, such as H 2 , HD and D 2 on the final results and finite size of the nano tube along the axis of symmetry, its boundary effects is discussed in details. Thermal oscillations of nano tube surface were considered separately in the dependence of the temperature gradient along of the axis of symmetry

Time-Domain Analysis of Coupled Carbon Nano tube Interconnects

International Nuclear Information System (INIS)

Fathi, D.

2014-01-01

This paper describes a new method for the analysis of coupling effects including the crosstalk effects between two driven coupled single-walled carbon nano tubes (SWCNTs) and the intertalk effects between two neighboring shells in a multi walled carbon nano tube (MWCNT), based on transmission line circuit modeling. Using rigorous calculations, a new parametric transfer function has been obtained for the analysis of the impact of aggressor line on the victim line, which depends on the various coupling parameters such as the mutual inductance, the coupling capacitance, and the tunneling resistance. The influences of various parameters such as the contact resistance and the switching factor on the time behavior of coupling effects between the two coupled CNTs and an important effect named “crosstalk-induced delay” are studied and analyzed

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.

Preparation of metallic uranium tubes; Elaboration des tubes d'uranium metallique

Energy Technology Data Exchange (ETDEWEB)

Lerouge, G.; Decours, J. [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1964-07-01

The production furnace is an induction heated vacuum furnace having a capacity at the moment of 250 kg. Previously the crucible was heated by the inductor, the mould being outside the inductor. The tubes thus produced contained cavities, the alloy structure was fine; this was cold-mould casting, At the moment the top of the moulds are pre-heated, this is the so called hot-mould casting. This method has the advantage of eliminating the cavities but leads to a less fine microstructure. The alloy used for the 18 x 40 mm and 23 x 43 mm tubes is U-Mo (1.1 per cent). Since the moulds are now heated at the top, the solidification of the metal is very slow in this zone leading to a pronounced {gamma} grain, whereas towards the base the faster cooling leads to a smaller {gamma} grain. The {gamma} structure depends essentially on the solidification rate and on the time spent in this zone. In order to obtain a fine and homogeneous grain along the whole length of the tube, a controlled cooling treatment is effected. It consists in heating the uranium tubes in the {gamma} place and then in cooling them at a rate of between 20 and 50 deg C/mm down to 400 deg C. The 77 x 95 mm and 54 x 70 mm annular elements are at the moment being produced for research purposes. Their preparation is similar to that of 18 x 40 mm and 23 x 43 mm elements. The 77 x 95 mm tubes are at the moment made from U-Cr alloy (0.1 per cent); because of their size, their preparation is carried out in 600 mm diameter furnaces. (authors) [French] Le four d'elaboration est un four sous vide chaufffe par induction, dont la capacite actuelle est de 250 kg. Anterieurement le creuset seul etait chauffe par l'inducteur, les moules etaient hors de l'inducteur. Les tubes obtenus presentaient des cavites, la structure de l'alliage etait fine, c'etait la coulee en moules froids. Actuellement on prechauffe le haut des moules, c'est la coulee dite en moules chauds. Cette facon de faire a l

High Power Microwave Tubes: Basics and Trends, Volume 2

Science.gov (United States)

Kesari, Vishal; Basu, B. N.

2018-01-01

Volume 2 of the book begins with chapter 6, in which we have taken up conventional MWTs (such as TWTs, klystrons, including multi-cavity and multi-beam klystrons, klystron variants including reflex klystron, IOT, EIK, EIO and twystron, and crossed-field tubes, namely, magnetron, CFA and carcinotron). In chapter 7, we have taken up fast-wave tubes (such as gyrotron, gyro-BWO, gyro-klystron, gyro-TWT, CARM, SWCA, hybrid gyro-tubes and peniotron). In chapter 8, we discuss vacuum microelectronic tubes (such as klystrino module, THz gyrotron and clinotron BWO); plasma-assisted tubes (such as PWT, plasma-filled TWT, BWO, including PASOTRON, and gyrotron); and HPM (high power microwave) tubes (such as relativistic TWT, relativistic BWO, RELTRON (variant of relativistic klystron), relativistic magnetron, high power Cerenkov tubes including SWO, RDG or orotron, MWCG and MWDG, bremsstrahlung radiation type tube, namely, vircator, and M-type tube MILO). In Chapter 9, we provide handy information about the frequency and power ranges of common MWTs, although more such information is provided at relevant places in the rest of the book as and where necessary. Chapter 10 is an epilogue that sums up the authors' attempt to bring out the various aspects of the basics of and trends in high power MWTs.

Mini implant supported molar tubes: A novel method for attaching the molar tubes

Directory of Open Access Journals (Sweden)

Nitin V Muralidhar

2017-01-01

Full Text Available Banding or bonding procedures have been the only means of attaching molar tubes onto the permanent molar teeth till date in the field of orthodontics. This clinical innovation aims to include the use of mini implant for the purpose of attaching the molar tubes thereby eliminating the iatrogenic effects of banding and bonding of the teeth.

Source Terms for HFIR Beam Tube Shielding Analyses, and a Complete Shielding Analysis of the HB-3 Tube

International Nuclear Information System (INIS)

Bucholz, J.A.

2000-01-01

The High Flux Isotope Reactor (HFIR) at the Oak Ridge National Laboratory is in the midst of a massive upgrade program to enhance experimental facilities. The reactor presently has four horizontal experimental beam tubes, all of which will be replaced or redesigned. The HB-2 beam tube will be enlarged to support more guide tubes, while the HB-4 beam tube will soon include a cold neutron source

Source Terms for HFIR Beam Tube Shielding Analyses, and a Complete Shielding Analysis of the HB-3 Tube

Energy Technology Data Exchange (ETDEWEB)

Bucholz, J.A.

2000-07-01

The High Flux Isotope Reactor (HFIR) at the Oak Ridge National Laboratory is in the midst of a massive upgrade program to enhance experimental facilities. The reactor presently has four horizontal experimental beam tubes, all of which will be replaced or redesigned. The HB-2 beam tube will be enlarged to support more guide tubes, while the HB-4 beam tube will soon include a cold neutron source.

Analysis of forming limit in tube hydroforming

International Nuclear Information System (INIS)

Kim, Chan Il; Yang, Seung Hang; Kim, Young Suk

2013-01-01

The automotive industry has shown increasing interest in tube hydroforming. Despite many automobile structural parts being produced from cylindrical tubes, failures frequently occur during tube hydroforming under improper forming conditions. These problems include wrinkling, buckling, folding back, and bursting. We perform analytical studies to determine forming limits in tube hydroforming and demonstrate how these forming limits are influenced by the loading path. Theoretical results for the forming limits of wrinkling and bursting are compared with experimental results for an aluminum tube.

Heat removal capability of divertor coaxial tube assembly

International Nuclear Information System (INIS)

Shibui, Masanao; Nakahira, Masataka; Tada, Eisuke; Takatsu, Hideyuki

1994-05-01

To deal with high power flowing in the divertor region, an advanced divertor concept with gas target has been proposed for use in ITER/EDA. The concept uses a divertor channel to remove the radiated power while allowing neutrals to recirculate. Candidate channel wall designs include a tube array design where many coaxial tubes are arranged in the toroidal direction to make louver. The coaxial tube consists of a Be protection tube encases many supply tubes wound helically around a return tube. V-alloy and hardened Cu-alloy have been proposed for use in the supply and return tubes. Some coolants have also been proposed for the design including pressurized He and liquid metals, because these coolants are consistent with the selection of coolants for the blanket and also meet the requirement of high temperature operation. In the coaxial tube design, the coolant area is restricted and brittle Be material is used under severe thermal cyclings. Thus, to obtain the coaxial tube with sufficient safety margin for the expected fusion power excursion, it is essential to understand its applicability limit. The paper discusses heat removal capability of the coaxial tube and recommends some design modifications. (author)

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.

Boiling and condensation in microfin tubes

Science.gov (United States)

Schlager, Lynn M.

A general overview of microfin tubes and their applications is presented. Manufacturing processes, commercial availability, experimental heat transfer, and pressure drop data for various refrigerants (including alternative refrigerants and refrigerant-oil mixtures), physical mechanisms of enhancement, and the incorporation of microfin tubes in common heat exchanger configurations are discussed. Microfin tubes, also known by various trade names, are characterized by numerous small fins which typically spiral down the inside wall of tubes at angles ranging from 10 to 30 degrees. The number of fins ranges from 48 to 70 with typical fin heights of 0.12 to 0.30 mm (fin height generally less than 3 percent of the inside diameter of the tube). Fin shapes may vary and the inside surface area of microfin tubes is 10 to 70 percent greater than the area of equivalent smooth tubes. Heat transfer can be enhanced by up to a factor of three with microfin tubes.

Wave propagation in spatially modulated tubes

Energy Technology Data Exchange (ETDEWEB)

Ziepke, A., E-mail: ziepke@itp.tu-berlin.de; Martens, S.; Engel, H. [Institut für Theoretische Physik, Hardenbergstraße 36, EW 7-1, Technische Universität Berlin, 10623 Berlin (Germany)

2016-09-07

We investigate wave propagation in rotationally symmetric tubes with a periodic spatial modulation of cross section. Using an asymptotic perturbation analysis, the governing quasi-two-dimensional reaction-diffusion equation can be reduced into a one-dimensional reaction-diffusion-advection equation. Assuming a weak perturbation by the advection term and using projection method, in a second step, an equation of motion for traveling waves within such tubes can be derived. Both methods predict properly the nonlinear dependence of the propagation velocity on the ratio of the modulation period of the geometry to the intrinsic width of the front, or pulse. As a main feature, we observe finite intervals of propagation failure of waves induced by the tube’s modulation and derive an analytically tractable condition for their occurrence. For the highly diffusive limit, using the Fick-Jacobs approach, we show that wave velocities within modulated tubes are governed by an effective diffusion coefficient. Furthermore, we discuss the effects of a single bottleneck on the period of pulse trains. We observe period changes by integer fractions dependent on the bottleneck width and the period of the entering pulse train.

Precision heat forming of tetrafluoroethylene tubing

Science.gov (United States)

Ruiz, W. V.; Thatcher, C. S. (Inventor)

1981-01-01

An invention that provides a method of altering the size of tetrafluoroethylene tubing which is only available in limited combination of wall thicknesses and diameter are discussed. The method includes the steps of sliding the tetrafluoroethylene tubing onto an aluminum mandrel and clamping the ends of the tubing to the mandrel by means of clamps. The tetrafluorethylene tubing and mandrel are then placed in a supporting coil which with the mandrel and tetrafluorethylene tubing are then positioned in a insulated steel pipe which is normally covered with a fiber glass insulator to smooth out temperature distribution therein. The entire structure is then placed in an event which heats the tetrafluorethylene tubing which is then shrunk by the heat to the outer dimension of the aluminum mandrel. After cooling the aluminum mandrel is removed from the newly sized tetrafluorethylene tubing by a conventional chemical milling process.

An experimental study on the impact collapse characteristics of CF/Epoxy circular tubes

International Nuclear Information System (INIS)

Kim, Y.N.; Im, K.H.; Park, J.W.; Yang, I.Y.

2003-01-01

This study is to investigate the energy absorption characteristics of CF/Epoxy (Carbon-Fiber/Epoxy Resin) circular tubes in static and impact tests. The experimental results varied significantly as a function of interlaminar number, orientation angle of outer and trigger. When a CFRP composite tube is crushed, static/impact energy is consumed by friction between the loading plate and the splayed fronds of the tube, by fracture of the fibers, matrix and their interface, and the response is complex and depends on the interaction among the different mechanisms, such as transverse shearing, laminar bending and local buckling. The collapse mode depended upon orientation angle of outer of CFRP tubes and loading status(static/impact). Typical collapse modes of CFRP tubes are wedge collapse mode, splaying collapse mode and fragmentation collapse mode

21 CFR 868.5800 - Tracheostomy tube and tube cuff.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheostomy tube and tube cuff. 868.5800 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5800 Tracheostomy tube and tube cuff. (a) Identification. A tracheostomy tube and tube cuff is a device intended to be placed into a...

Explicit homoclinic tube solutions and chaos for Zakharov system with periodic boundary

International Nuclear Information System (INIS)

Dai Zhengde; Huang Jian; Jiang Murong

2006-01-01

In this Letter, the explicit homoclinic tube solutions for Zakharov system with periodic boundary conditions, and even constraints, are exhibited. The results show that there exist two family homoclinic tube solutions depending on parameters (a,p), which asymptotic to a periodic cycle of one dimension. The structures of homoclinic tubes have been investigated

The Mashups of YouTube

DEFF Research Database (Denmark)

Simonsen, Thomas Mosebo

2013-01-01

This article focuses on YouTube mashups and how we can understand them as a specific subgenre on YouTube. The Mashups are analysed as audiovisual recontextualizations that are given new meaning, e.g., via collaborative social communities or for individual promotional purposes. This is elaborated......, but rather in its social and communicative abilities within the YouTube community. This leads to the article’s overall argument that the main characteristic of the YouTube Mashup can be explained in terms of connectivity. It is argued that Mashups reveal a double articulation of connectivity; one...... that involves the social mechanisms of the Mashups, and another mode, which concerns the explicit embedding of structural connectivity that accentuates the medium-specific infrastructure of YouTube. This double articulation of connectivity is furthermore elaborated on by including Grusin and Bolter’s concept...

Characteristics of rectangular drift tube for muon identifier

International Nuclear Information System (INIS)

Denisov, D.S.; Musienko, Yu.V.

1987-01-01

The results of a study of an aluminum drift tube with a cross section of 50 x 100 mm are presented. Argon-methane and argon-isobutane mixtures were used as fillers. For a 16% methane concentration, the nonlinearity of the time-coordinate dependence does not exceed 2 mm. The tube can operate in the self-quenched streamer mode when filled with a mixture of argon with isobutane

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

Ultrasonic inspection of tube to tube plate welds

International Nuclear Information System (INIS)

Telford, D.W.; Peat, T.S.

1985-01-01

To monitor the deterioration of a weld between a tube and tube plate which has been repaired by a repair sleeve inside the tube and brazed at one end to the tube, ultrasound from a crystal at the end of a rod is launched, in the form of Lamb-type waves, into the tube through the braze and allowed to travel along the tube to the weld and be reflected back along the tube. The technique may also be used for the type of heat exchanger in which, during construction, the tubes are welded to the tube plate via external sleeves in which case the ultrasound is used in a similar manner to inspect the sleeve/tube plate weld. an electromagnetic transducer may be used to generate the ultrasound. The ultrasonic head comprising the crystal and an acoustic baffle is mounted on a Perspex (RTM) rod which may be rotated by a stepping motor. Echo signals from the region of deterioration may be isolated by use of a time gate in the receiver. The device primarily detects circumferentially orientated cracks, and may be used in heat exchangers in nuclear power plants. (author)

Multidisciplinary approach to the management of a case of classical respiratory diphtheria requiring percutaneous endoscopic gastrostomy feeding.

Science.gov (United States)

Haywood, Matthew James; Vijendren, Ananth; Acharya, Vikas; Mulla, Rohinton; Panesar, Miss Jaan

2017-03-06

We present a case of a Caucasian woman aged 67 years referred with a 4-day history of sore throat, dysphagia, fever and nasal blockage. Examination revealed a swollen neck and pharyngeal pseudomembrane. A throat swab was positive on culture for Corynebacterium ulcerans , with toxin expression confirmed on PCR and Elek testing. A diagnosis of classical respiratory diphtheria was made, with subsequent confirmation of the patient's domesticated dog as the source of infection. The dog had recently been attacked by a wild badger and was being treated for an ear infection. The patient made a good recovery with intravenous antimicrobial and supportive therapy; however, she subsequently developed a diphtheritic polyneuropathy in the form of a severe bulbar palsy with frank aspiration necessitating percutaneous endoscopic gastrostomy feeding. A mild sensorimotor peripheral neuropathy was also diagnosed. The patient eventually made an almost complete recovery. 2017 BMJ Publishing Group Ltd.

Giant fibrovascular esophageal polyp misdiagnosed as achalasia.

Science.gov (United States)

Cordoş, I; Istrate, A; Codreşi, M; Bolca, C

2012-01-01

A 59 years old woman was admitted in our unit accusing longtime dysphagia and regurgitation. On admission, the patient was wearing a 3 month old definitive feeding gastrostomy tube. The contrast swallow, endoscopy and esophageal manometry established the diagnostic--achalasia. We removed the gastrostomy tube and we performed an open Heller myotomy. The postoperative period was uneventful and the patient was discharged one week later with affirmatively unimpaired deglutition. One month later, the patient was admitted via emergency with a giant fibrous tumor arising from her mouth after an episode of strong coughing and vomiting. The repeated endoscopy showed a giant esophageal polyp that was missed by the previous investigations, originating from pharingoesophageal junction. The esophageal polyp was resected by cervical approach with good postoperative outcome. The polyp's particular extreme dimensions (27 cm) prevented the acute asphyxia by blockage at the laryngeal level, possibly provoked by smaller tumors. As postoperative one month barium swallow showed a normal esophageal aspect, a final question remains--was achalasia real or an erroneous diagnosis was established the second time too?

Percutaneous gastroenterostomy

Energy Technology Data Exchange (ETDEWEB)

Wittich, G.R.; Van Sonnenberg, E.; Casola, G.; Jantsch, H.; Walter, R.; Lechner, G.

1987-05-01

Percutaneous gastrostomies or gastroenterostomies serve for temporary or permanent enteric feeding in patients with obstruction or functional derangement of the esophagus or hypopharynx. In addition, this radiological procedure may be indicated for small bowel decompression. The authors present their experience in 71 patients. Insufflation of air through a nasogastric tube or catheter is the preferred method for gastric distension. The inferior margin of the left lobe of the liver and the transverse colon are localized sonographically and fluoroscopically prior to puncture. Either Seldinger or Trocartechniques have proven effective in establishing access to the stomach. The feeding tube is advanced into the proximal jejunum to reduce the likelyhood of gastroesophageal reflux and possible aspiration. Complications were encountered in four patients and included catheter dislocation in three and respiratory distress in one patient.

Automatic welding of stainless steel tubing

Science.gov (United States)

Clautice, W. E.

1978-01-01

The use of automatic welding for making girth welds in stainless steel tubing was investigated as well as the reduction in fabrication costs resulting from the elimination of radiographic inspection. Test methodology, materials, and techniques are discussed, and data sheets for individual tests are included. Process variables studied include welding amperes, revolutions per minute, and shielding gas flow. Strip chart recordings, as a definitive method of insuring weld quality, are studied. Test results, determined by both radiographic and visual inspection, are presented and indicate that once optimum welding procedures for specific sizes of tubing are established, and the welding machine operations are certified, then the automatic tube welding process produces good quality welds repeatedly, with a high degree of reliability. Revised specifications for welding tubing using the automatic process and weld visual inspection requirements at the Kennedy Space Center are enumerated.

Dermatology on YouTube.

Science.gov (United States)

Boyers, Lindsay N; Quest, Tyler; Karimkhani, Chante; Connett, Jessica; Dellavalle, Robert P

2014-06-15

YouTube, reaches upwards of six billion users on a monthly basis and is a unique source of information distribution and communication. Although the influence of YouTube on personal health decision-making is well established, this study assessed the type of content and viewership on a broad scope of dermatology related content on YouTube. Select terms (i.e. dermatology, sun protection, skin cancer, skin cancer awareness, and skin conditions) were searched on YouTube. Overall, the results included 100 videos with over 47 million viewers. Advocacy was the most prevalent content type at 24% of the total search results. These 100 videos were "shared" a total of 101,173 times and have driven 6,325 subscriptions to distinct YouTube user pages. Of the total videos, 35% were uploaded by or featured an MD/DO/PhD in dermatology or other specialty/field, 2% FNP/PA, 1% RN, and 62% other. As one of the most trafficked global sites on the Internet, YouTube is a valuable resource for dermatologists, physicians in other specialties, and the general public to share their dermatology-related content and gain subscribers. However, challenges of accessing and determining evidence-based data remain an issue.

Numerical investigation of heat transfer characteristic of fixed planar elastic tube bundles

International Nuclear Information System (INIS)

Duan, Derong; Ge, Peiqi; Bi, Wenbo

2015-01-01

Highlights: • Both tube-side and shell-side of planar elastic tube bundles were investigated. • Heat transfer and fluid flow were studied from the local analysis perspective. • Secondary flow varies depending on the fluid flow state and the geometry of tube. • Curvature plays a role on the external flow field. • The heat transfer of the two intermediate tube bundles is augmented. - Abstract: Planar elastic tube bundles are a novel approach to enhance heat transfer by using flow-induced vibration. This paper studied the heat transfer characteristic and fluid flow in both tube-side and shell-side using numerical simulation. Two temperature difference formulas were used to calculate convective heat transfer coefficient and the results were verified by theoretical analysis and experimental correlations. The effect of Reynolds number on overall convective heat transfer coefficient and pressure drop in tube-side and shell-side were studied. The comparison of the secondary flow in planar elastic tube bundles and conical spiral tube bundles were conducted. The external flow field and local convective heat transfer around the periphery of fixed planar elastic tube bundles subjected to the cross fluid flow were also analyzed. The results show that the energy consumption efficiency should be taken into account in the forced heat transfer process conducted by adjusting the fluid flow. The secondary flow varies depending on the fluid flow state and the geometry of tube. Hence, it is deduced that the heat transfer enhancement is obtained because the thermal boundary layer in the deformed planar elastic tube bundles caused by flow-induced vibration is damaged by the disordered secondary flow. In addition, the convective heat transfer capability of outside the two intermediate tube bundles is enhanced because of the effect of irregular and complex fluid flow affected by the role of curved tubes on both sides

Influence of steam generator tube ruptures during semiscale loss-of-coolant experiments

International Nuclear Information System (INIS)

Cozzuol, J.M.; Larson, T.K.

1978-01-01

Tests which simulated rupture of steam generator tubes during loss-of-coolant experiments in a PWR type system have been conducted in the Semiscale Mod-1 system. Analysis of test data indicates that high rod cladding temperatures occured only for a band of tube ruptures (between 12 and 20 tubes) and that the peak cladding temperatures attained within this band were strongly dependent on the magnitude of the tube rupture flow rates. Maximum cladding temperature of about 1255 K was observed for tests which simulated tube ruptures within this narrow band. (author)

Heat Exchanger Tube to Tube Sheet Joints Corrosion Behavior

Directory of Open Access Journals (Sweden)

M. Iancu

2013-03-01

Full Text Available Paper presents the studies made by the authors above the tube to tube sheet fittings of heat exchanger with fixed covers from hydrofining oil reforming unit. Tube fittings are critical zones for heat exchangers failures. On a device made from material tube and tube sheet at real joints dimensions were establish axial compression force and traction force at which tube is extracted from expanded joint. Were used two shapes joints with two types of fittings surfaces, one with smooth hole of tube sheet and other in which on boring surface we made a groove. From extracted expanded tube zones were made samples for corrosion tests in order to establish the corrosion rate, corrosion potential and corrosion current in working mediums such as hydrofining oil and industrial water at different temperatures. The corrosion rate values and the temperature influence are important to evaluate joints durability and also the results obtained shows that the boring tube sheet shape with a groove on hole tube shape presents a better corrosion behavior then the shape with smooth hole tube sheet.

Formability of Micro-Tubes in Hydroforming

International Nuclear Information System (INIS)

Hartl, Christoph; Anyasodor, Gerald; Lungershausen, Joern

2011-01-01

Micro-hydroforming is a down-scaled metal forming process, based on the expansion of micro-tubes by internal pressurization within a die cavity. The objective of micro-hydroforming is to provide a technology for the economic mass production of complex shaped hollow micro-components. Influence of size effects in metal forming processes increases with scaling down of metal parts. Investigations into the change in formability of micro-tubes due to metal part scaling down constituted an important subject within the conducted fundamental research work. Experimental results are presented, concerning the analysis of the formability of micro-tubes made from stainless steel AISI 304 with an outer diameter of 800 μm and a wall thickness of 40 μm. An average ratio of tube wall thickness to grain size of 1.54 of up to 2.56 was analyzed. Miniaturised mechanical standard methods as well as bulge tests with internal hydrostatic pressurization of the tubular specimens were applied to analyze the influence of size-dependent effects. A test device was developed for the bulge experiments which enabled the pressurization of micro-tubes with internal pressures up to 4000 bar. To determine the attainable maximum achievable expansion ratio the tubes were pressurized in the bulge tests with increasing internal pressure until instability due to necking and subsequent bursting occurred. Comparisons with corresponding tests of macro-tubes, made from the here investigated material, showed a change in formability of micro-tubes which was attributed to the scaling down of the hydroforming process. In addition, a restricted applicability of existing theoretical correlations for the determination of the maximum pressure at bursting was observed for down-scaled micro-hydroforming.

Influence of tube volume on measurement uncertainty of GM counters

Directory of Open Access Journals (Sweden)

Stanković Koviljka Đ.

2010-01-01

Full Text Available GM counters are often used in radiation detection since they generate a strong signal which can be easily detected. The working principal of a GM counter is based on the interaction of ionizing radiation with the atoms and molecules of the gas present in the counter's tube. Free electrons created as a result of this interaction become initial electrons, i. e. start an avalanche process which is detected as a pulse of current. This current pulse is independent of the energy imparted on the gas, that being the main difference between a GM counter and the majority of other radiation detectors. In literature, the dependence on the incidence of radiation energy, tube's orientation and characteristics of the reading system are quoted as the main sources of measurement uncertainty of GM counters. The aim of this paper is to determine the dependence of measurement uncertainty of a GM counter on the volume of its counter's tube. The dependence of the pulse current on the size of the counter's tube has, therefore, been considered here, both in radial and parallel geometry. The initiation and expansion of the current pulse have been examined by means of elementary processes of electrical discharge such as the Markov processes, while the changes in the counter's tube volume were put to test by the space - time enlargement law. The random variable known as the 'current pulse in the counter's tube' (i. e. electrical breakdown of the electrode configuration has also been taken into account and an appropriate theoretical distribution statistically determined. Thus obtained theoretical results were then compared to corresponding experimental results established in controlled laboratory conditions.

Tube spacer grid for a heat-exchanger tube bundle

International Nuclear Information System (INIS)

Scheidl, H.

1976-01-01

A tube spacer grid for a heat-exchanger tube bundle is formed by an annular grid frame having a groove formed in its inner surface in which the interspaced grid bars have their ends positioned and held in interspaced relationship by short sections of tubes passed through holes axially formed in the grid frame so that the tubes are positioned between the ends of the grid bars in the grooves. The tube sections may be cut from the same tubes used to form the tube bundle. 5 claims, 3 drawing figures

Template synthesis of test tube nanoparticles using non-destructive replication.

Science.gov (United States)

Wagner, Jonathan; Yao, Jingyuan; Rodgers, David; Hinds, Bruce

2013-03-01

Nano test tubes are a promising delivery vehicle for a range of therapeutics, including small molecule drugs and biologics. However, current template synthesis methods of producing nano test tubes are prohibitively expensive and time consuming. Here, non-destructive template replication was used to increase nano test tube yield from porous alumina by more than a hundredfold. We demonstrate how to produce nano test tubes of several sizes and compositions, including hybrid tubes with different inner and outer surfaces for targeted surface chemistry. Nano test tubes were readily suspended and stored in aqueous solutions without the need for chemical treatment. These nano test tubes should find application as delivery vehicles for therapeutics, particularly for processive 'bionanoreactors' loaded with enzymes.

Feasibility and Safety of Overtubes for PEG-Tube Placement in Patients with Head and Neck Cancer

Directory of Open Access Journals (Sweden)

Crispin O. Musumba

2015-01-01

Full Text Available Background. Percutaneous endoscopic gastrostomy (PEG placement using the “pull” technique is commonly utilized for providing nutritional support in head and neck cancer (HNC patients, but it may be complicated by peristomal metastasis in up to 3% of patients. Overtube-assisted PEG placement might reduce this risk. However, this technique has not been systemically studied for this purpose to date. Methods. Retrospective analysis of consecutive patients with HNC who underwent overtube-assisted PEG placement at Westmead Hospital, Australia, between June 2011 and December 2013. Data were extracted from patients’ endoscopy reports and case notes. We present our technique for PEG insertion and discuss the feasibility and safety of this method. Results. In all 53 patients studied, the PEG tubes were successfully placed using 25 cm long flexible overtubes, in 89% prophylactically (before commencing curative chemoradiotherapy, and in 11% reactively (for treatment of tumor related dysphagia or weight loss. During a median follow-up period of 16 months, 3 (5.7% patients developed peristomal infection and 3 others developed self-limiting peristomal pain. There were no cases of overtube-related adverse events or overt cutaneous metastases observed. Conclusions. Overtube-assisted PEG placement in patients with HNC is a feasible, simple, and safe technique and might be effective for preventing cutaneous metastasis.

Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis.

Science.gov (United States)

Zhou, Dong; Deng, Xu-Feng; Liu, Quan-Xing; Chen, Qian; Min, Jia-Xin; Dai, Ji-Gang

2016-05-27

In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy. According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software. Five studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] -0.60; 95 % confidence intervals [CIs] -0.68-- 0.52; P tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57-1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42-1.58; P = 0.54]. Our results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates.

YouTube as an information source for pediatric adenotonsillectomy and ear tube surgery.

Science.gov (United States)

Sorensen, Jeffrey A; Pusz, Max D; Brietzke, Scott E

2014-01-01

Assess the overall quality of information on adenotonsillectomy and ear tube surgery presented on YouTube (www.youtube.com) from the perspective of a parent or patient searching for information on surgery. The YouTube website was systematically searched on select dates with a formal search strategy to identify videos pertaining to pediatric adenotonsillectomy and ear tube surgery. Only videos with at least 5 (ear tube surgery) or 10 (adenotonsillectomy) views per day were included. Each video was viewed and scored by two independent scorers. Videos were categorized by goal and scored for video/audio quality, accuracy, comprehensiveness, and procedure-specific content. Cross-sectional study. Public domain website. Fifty-five videos were scored for adenotonsillectomy and forty-seven for ear tube surgery. The most common category was educational (65.3%) followed by testimonial (28.4%), and news program (9.8%). Testimonials were more common for adenotonsillectomy than ear tube surgery (41.8% vs. 12.8%, p=0.001). Testimonials had a significantly lower mean accuracy (2.23 vs. 2.62, p=0.02), comprehensiveness (1.71 vs. 2.22, p=0.007), and TA specific content (0.64 vs. 1.69, p=0.001) score than educational type videos. Only six videos (5.9%) received high scores in both video/audio quality and accuracy/comprehensiveness of content. There was no significant association between the accuracy and comprehensive score and views, posted "likes", posted "dislikes", and likes/dislikes ratio. There was an association between "likes" and mean video quality (Spearman's rho=0.262, p=0.008). Parents/patients searching YouTube for information on pediatric adenotonsillectomy and ear tube surgery will generally encounter low quality information with testimonials being common but of significantly lower quality. Viewer perceived quality ("likes") did not correlate to formally scored content quality. Published by Elsevier Ireland Ltd.

Contribution to the heat transfer analysis of substitute refrigerants in evaporator tubes with smooth or enhanced tube surfaces

Energy Technology Data Exchange (ETDEWEB)

Kattan, N

1997-12-31

The substitution of CFC refrigerants in refrigeration systems, heat pumps and organic Rankine cycles for heat recovery, requests a good knowledge of heat transfer properties of substitute fluids. A new test facility has been built at the Laboratory for Industrial Energy Systems (LENI) to contribute to this international effort. It consists of two sets of concentric tubes allowing either annular or inside tube convective boiling with a counter current water flow heating to be studied. A new data base including heat transfer coefficients and pressure drop measurements for four new refrigerants (R123, R134A, R402A and R404A) and three older refrigerants (R11, R12 and R502) has been collected. Flow boiling measurements covered a broad range of mass velocities, vapor qualities and heat fluxes. Some of the tests included plain tubes and others enhanced surface tubes (microfilms from Wieland) in horizontal and vertical orientations. An improved Wilson plot technique, that covers both the transition and turbulent flow regimes of the water flowing in the annular channel for the inside tube boiling tests, is proposed to overcome the severe limitations of conventional Wilson plots, to improve accuracy and to facilitate data processing. Mean flow boiling heat transfer coefficients were measured for R12 and R134A evaporating inside a horizontal plain tube and for R11 and R123 evaporating inside a horizontal plain tube. Local flow boiling heat transfer coefficients were measured for : R134A, R123, R404A and R502 evaporating inside a horizontal plain tube, for R134A and R123 evaporating inside a horizontal microfin tube and for R134 evaporating inside a vertical microfin tube. In addition microfin heat transfer augmentation relative to plain tube test data was investigated. The measured heat transfer coefficients were compared to different existing inside tube flow boiling correlations. (author) figs., tabs., refs.

Eddy-current inspection of ferromagnetic tubing using pulsed magnetic saturation

Energy Technology Data Exchange (ETDEWEB)

Dodd, C V; Deeds, W E

1986-07-01

A pulsed eddy-current system has been designed and developed for nondestructive evaluation of 2.25Cr-1Mo steam generator tubing from the bore side. Since the tubing is ferromagnetic, a large current pulse is sent through a driver coil to produce magnetic saturation all the way through the tube wall. A pickup coil produces an output pulse that is dependent upon the tube properties as well as the driving pulse. The output pulse heights at selected times are used as data that are computer-correlated with calibration data taken from machined standards. Performance data, circuit diagrams, and computer programs are given for the system, which has been demonstrated to detect small flaws located near the outside of a thick ferromagnetic tube.

Data analysis for steam generator tubing samples

International Nuclear Information System (INIS)

Dodd, C.V.

1996-07-01

The objective of the Improved Eddy-Current ISI for Steam Generators program is to upgrade and validate eddy-current inspections, including probes, instrumentation, and data processing techniques for inservice inspection of new, used, and repaired steam generator tubes; to improve defect detection, classification and characterization as affected by diameter and thickness variations, denting, probe wobble, tube sheet, tube supports, copper and sludge deposits, even when defect types and other variables occur in combination; to transfer this advanced technology to NRC's mobile NDE laboratory and staff. This report provides a description of the application of advanced eddy-current neural network analysis methods for the detection and evaluation of common steam generator tubing flaws including axial and circumferential outer-diameter stress-corrosion cracking and intergranular attack. The report describes the training of the neural networks on tubing samples with known defects and the subsequent evaluation results for unknown samples. Evaluations were done in the presence of artifacts. Computer programs are given in the appendix

Study on Influence of Tube Arrays on Fluid Elastic Instability

Science.gov (United States)

Ishihara, Kunihiko; Kitayama, Gen

The tube bank is used in boilers, heat exchangers in power plants and steam generators in nuclear plants. These tubes sometimes vibrate violently and come to the fatigue failure due to the flow induced vibration which is caused by the cross flow. This phenomenon is that the large vibrations arise at the critical flow velocity and it is called fluid elastic instability. However the relation between the onset velocity of fluid elastic instability and the tube array's geometry has not been clarified sufficiently. There is a few reference related to the relation between the pitch to diameter ratio and the onset velocity even in the lattice arrays. In this paper, the influence of tube arrays on fluid elastic instability is examined by experiments. As a result, it is clarified that the tube vibrations become large as T/D increases and L/D decreases, and the tube vibrations strongly depend on the dynamic characteristics of tubes such as the natural frequency and the damping ability.

Template synthesis of test tube nanoparticles using non-destructive replication

International Nuclear Information System (INIS)

Wagner, Jonathan; Rodgers, David; Yao Jingyuan; Hinds, Bruce

2013-01-01

Nano test tubes are a promising delivery vehicle for a range of therapeutics, including small molecule drugs and biologics. However, current template synthesis methods of producing nano test tubes are prohibitively expensive and time consuming. Here, non-destructive template replication was used to increase nano test tube yield from porous alumina by more than a hundredfold. We demonstrate how to produce nano test tubes of several sizes and compositions, including hybrid tubes with different inner and outer surfaces for targeted surface chemistry. Nano test tubes were readily suspended and stored in aqueous solutions without the need for chemical treatment. These nano test tubes should find application as delivery vehicles for therapeutics, particularly for processive ‘bionanoreactors’ loaded with enzymes. (paper)

Thru-tubing inflatable workover systems

International Nuclear Information System (INIS)

Coronado, M.P.; Mody, R.K.; Craig, G.C.

1991-01-01

Recent technological advances in inflatable packing element design has allowed non-conventional workover techniques to be accomplished through the production tubing. The improved capabilities of these elements, coupled with new tool designs allowing workovers to be completed with coiled tubing or electric wireline, has seen growing applications. These workovers include, selective and zonal chemical treatments, temporary and permanent plugback operations, intermediate zone blankoff, production and injection flow profile modifications and formation fracturing. They are completed without pulling the production tubing from the well, and thus do not require a rig on the well. Since these tools are snubbed in the well with coiled tubing or electric wireline, thus eliminating the need to kill the well, heavy weight kill fluids, which may cause formation damage, are not required. These tools have been designed to operate with hydraulic pressure and workstring tension within the coiled tubing limitations. This paper outlines the development of these Thru-tubing systems and application techniques that have been developed as a result of their field use. It discusses case histories of applications using this technology and the resulting increase in well performance. This paper also describes auxiliary equipment that has been developed to allow these tool systems to be used safely on coiled tubing and electric wireline

Thermal Conductivity of Nanotubes Revisited: Effects of Chirality, Isotope Impurity, Tube Length, and Temperature

OpenAIRE

Zhang, Gang; Li, Baowen

2004-01-01

We study the dependence of thermal conductivity of single walled nanotubes (SWNT) on chirality, isotope impurity, tube length and temperature by nonequilibrium molecular dynamics method with accurate potentials. It is found that, contrary to electronic conductivity, the thermal conductivity is insensitive to the chirality. The isotope impurity, however, can reduce the thermal conductivity up to 60% and change the temperature dependence behavior. We also found that the tube length dependence o...

Flux Tube Dynamics in the Dual Superconductor

International Nuclear Information System (INIS)

Lampert, M.; Svetitsky, B.

1999-01-01

We have studied plasma oscillations in a flux tube created in a dual superconductor. The theory contains an Abelian gauge field coupled magnetically to a Higgs field that confines electric charge via the dual Meissner effect. Starting from a static flux tube configuration, with electric charges at either end, we release a fluid of electric charges in the system that accelerate and screen the electric field. The weakening of the electric field allows the flux tube to collapse, and the inertia of the charges forces it open again. We investigate both Type I and Type II superconductors, with plasma frequencies both above and below the threshold for radiation into the Higgs vacuum. (The parameters appropriate to QCD are in the Type II regime; the plasma frequency depends on the mass taken for the fluid constituents.) The coupling of the plasma oscillations to the Higgs field making up the flux tube is the main new feature in our work

Production and guide tube transmission of very cold neutrons from pulsed cold source

International Nuclear Information System (INIS)

Utsuro, Masahiko; Okumura, Kiyoshi

1982-01-01

The intensity and the energy spectra of Very Cold Neutrons (VCN) transmitted through a curved guide tube were measured by using the time-of-flight method of VCN. In the measurements, the curved guide tube having a characteristic neutron velocity of about 70 m/s is combined to a pulsed cold source of an electron linac in an internal target geometry. A space dependence of the VCN spectra was observed on the radial positions of a detector at the guide tube exit. A simple theoretical analysis on the transmission of VCN in the curved guide tube is also presented with taking into consideration about the effects of a finite size and a finite distance of the VCN-emitting source, and simple analytical formulas for the exit spectra of the guide tube are given. Comparisons between the experimental results and the theoretical calculations show good agreements, and the satisfactory performance of the present VCN guide tube assembly was ascertained. These results present also instructive features for understanding the structures and the space dependence of the exit spectra of a neutron guide tube. The VCN spectra at the guide tube exit can be divided into a few energy regions according to the transmission processes of VCN. Thus, the present study provides useful informations for the preparations of a VCN source with a curved guide tube. (author)

Improved guide tube bulge tool

International Nuclear Information System (INIS)

Vaill, R.E.; Phillips, W.D.

1979-01-01

A guide tube bulge tool for securing control rod guide tubes to a fuel assembly grid, includes a cylinder having several flexible tines each of which is equipped with a semispherical radially outwardly extending projection. A tapered ram fits into the cylinder so as to force the tines outwardly when the ram is pulled into the cylinder while supporting the other tines. (UK)

Working session 3: Tubing integrity

International Nuclear Information System (INIS)

Cueto-Felgueroso, C.; Strosnider, J.

1997-01-01

Twenty-three individuals representing nine countries (Belgium, Canada, the Czech Republic, France, Japan, the Slovak Republic, Spain, the UK, and the US) participated in the session on tube integrity. These individuals represented utilities, vendors, consultants and regulatory authorities. The major subjects discussed by the group included overall objectives of managing steam generator tube degradation, necessary elements of a steam generator degradation management program, the concept of degradation specific management, structural integrity evaluations, leakage evaluations, and specific degradation mechanisms. The group's discussions on these subjects, including conclusions and recommendations, are summarized in this article

Coaxial Tubing Systems Increase Artificial Airway Resistance and Work of Breathing.

Science.gov (United States)

Wenzel, Christin; Schumann, Stefan; Spaeth, Johannes

2017-09-01

Tubing systems are an essential component of the ventilation circuit, connecting the ventilator to the patient's airways. Coaxial tubing systems incorporate the inspiratory tube within the lumen of the expiratory one. We hypothesized that by design, these tubing systems increase resistance to air flow compared with conventional ones. We investigated the flow-dependent pressure gradient across coaxial, conventional disposable, and conventional reusable tubing systems from 3 different manufacturers. Additionally, the additional work of breathing and perception of resistance during breathing through the different devices were determined in 18 healthy volunteers. The pressure gradient across coaxial tubing systems was up to 6 times higher compared with conventional ones (1.90 ± 0.03 cm H 2 O vs 0.34 ± 0.01 cm H 2 O, P tubing systems, accordingly. Our findings suggest that the use of coaxial tubing systems should be carefully considered with respect to their increased resistance. Copyright © 2017 by Daedalus Enterprises.

Screening of nursing home residents for colonization with carbapenem-resistant Enterobacteriaceae admitted to acute care hospitals: Incidence and risk factors.

Science.gov (United States)

Cunha, Cheston B; Kassakian, Steven Z; Chan, Ryan; Tenover, Fred C; Ziakas, Panos; Chapin, Kimberle C; Mermel, Leonard A

2016-02-01

There are increasing reports of multidrug-resistant gram-negative bacilli in nursing homes and acute care hospitals. We performed a point prevalence survey to detect fecal carriage of gram-negative bacteria carrying carbapenem resistance genes or which were otherwise resistant to carbapenem antibiotics among 500 consecutive admissions from local nursing homes to 2 hospitals in Providence, Rhode Island. We performed a case-control study to identify risk factors associated with carriage of carbapenem-resistant Enterobacteriaceae (CRE). There were 404 patients with 500 hospital admissions during which they had rectal swab samples cultured. Fecal carriage of any carbapenem-resistant or carbapenemase- producing gram-negative bacteria was found in 23 (4.6%) of the 500 hospital admissions, including 7 CRE (1.4%), 2 (0.4%) of which were Klebsiella pneumoniae carbapenemase (ie, blaKPC) producing (CPE) Citrobacter freundii, 1 of which was carbapenem susceptible by standard testing methods. Use of a gastrostomy tube was associated with CRE carriage (P = .04). We demonstrated fecal carriage of carbapenem-resistant or carbapenemase-producing gram-negative bacteria in 4.6% of nursing home patients admitted to 2 acute care hospitals, but only 0.4% of such admissions were patients with fecal carriage of CPE. Use of gastrostomy tubes was associated with fecal carriage of gram-negative bacteria with detectable carbapenem resistance. CRE fecal carriage is uncommon in our hospital admissions from nursing homes. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Failure analysis of the boiler water-wall tube

OpenAIRE

S.W. Liu; W.Z. Wang; C.J. Liu

2017-01-01

Failure analysis of the boiler water-wall tube is presented in this work. In order to examine the causes of failure, various techniques including visual inspection, chemical analysis, optical microscopy, scanning electron microscopy and energy dispersive spectroscopy were carried out. Tube wall thickness measurements were performed on the ruptured tube. The fire-facing side of the tube was observed to have experienced significant wall thinning. The composition of the matrix material of the tu...

Polycrystalline models for the calculation of residual stresses in zirconium alloys tubes

International Nuclear Information System (INIS)

Signorelli, J.W.; Turner, P.A.; Lebensohn, R.A.; Pochettino, A.A.

1995-01-01

Tubes made of different Zirconium alloys are used in various types of reactors. The final texture of tubes as well as the distribution of residual stresses depend on the mechanical treatments done during their manufacturing process. The knowledge and prediction of both the final texture and the distribution of residual stresses in a tube for nuclear applications are of outstanding importance in relation with in-reactor performance of the tube, especially in what concerns to its irradiation creep and growth behaviour. The viscoplastic and the elastoplastic self consistent polycrystal models are used to investigate the influence of different mechanical treatments, performed during rolling processes on the final distribution of intergranular residual stresses of zirconium alloys tubes. The residual strains predictions with both formulations show a non linear dependence with the orientation, but they are qualitatively different. This discrepancy could be explain in terms of the relative plastic activity between the -type and -type deformation modes predicted with the viscoplastic and elastoplastic models. (author). 10 refs., 4 figs., 1 tab

Refrigerant charge, pressure drop, and condensation heat transfer in flattened tubes

Energy Technology Data Exchange (ETDEWEB)

Wilson, M J; Newell, T A; Chato, J C [University of Illinois, Urbana, IL (United States). Dept. of Mechanical and Industrial Engineering; Infante Ferreira, C A [Delft University of Technology (Netherlands). Laboratory for Refrigeration and Indoor Climate Control

2003-06-01

Horizontal smooth and microfinned copper tubes with an approximate diameter of 9 mm were successively flattened in order to determine changes in flow field characteristics as a round tube is altered into a flattened tube profile. Refrigerants R134a and R410A were investigated over a mass flux range from 75 to 400 kg m{sup -2} s{sup -}2{sup 1} and a quality range from approximately 10-80%. For a given refrigerant mass flow rate, the results show that a significant reduction in refrigerant charge is possible. Pressure drop results show increases of pressure drop at a given mass flux and quality as a tube profile is flattened. Heat transfer results indicate enhancement of the condensation heat transfer coefficient as a tube is flattened. Flattened tubes with an 18{sup o} helix angle displayed the highest heat transfer coefficients. Smooth tubes and axial microfin tubes displayed similar levels of heat transfer enhancement. Heat transfer enhancement is dependent on the mass flux, quality and tube profile. (author)

A theory for fluidelastic instability of tube-support-plate-inactive modes

International Nuclear Information System (INIS)

Cai, Y.; Chen, S.S.; Chandra, S.

1991-01-01

Fluidelastic instability of loosely supported tubes, vibrating in a tube support plate (TSP)-inactive mode, is suspected to be one of the main causes of the tube failure in some operating steam generators and heat exchangers. This paper presents a mathematical model for fluidelastic instability of loosely supported tubes exposed to nonuniform crossflow. the model incorporates all motion-dependent fluid forces based on the unsteady-flow theory. In the unstable region associated with a TSP-inactive mode, tube motion can be described by two linear models: TSP-inactive mode when tubes do not strike the TSP, and TSP-active mode when tubes do strike the TSP. The bilinear model (consisting of these linear models) presented here simulates the characteristics of fluidelastic instability of loosely supported tubes in stable and unstable regions associated with TSP-inactive modes. Analytical results obtained with the model are compared with published experimental data; they agree reasonably well. The prediction procedure presented for the fluidelastic instability response of loosely supported tubes is applicable to the stable and unstable regions of the TSP-inactive mode

Eddy current inspection of weld defects in tubing

Science.gov (United States)

Katragadda, G.; Lord, W.

1992-01-01

An approach using differential probes for the inspection of weld defects in tubing is studied. Finite element analysis is used to model the weld regions and defects. Impedance plane signals are predicted for different weld defect types and compared wherever possible with signals from actual welds in tubing. Results show that detection and sizing of defects in tubing is possible using differential eddy current techniques. The phase angle of the impedance plane trajectory gives a good indication of the sizing of the crack. Data on the type of defect can be obtained from the shape of the impedance plane trajectory and the phase. Depending on the skin depth, detection of outer wall, inner wall, and subsurface defects is possible.

Pressure loss characteristics of LSTF steam generator heat-transfer tubes. Pressure loss increase due to tube internal instruments

International Nuclear Information System (INIS)

Suzuki, Mitsuhiro

1994-11-01

The steam generator of the Large-Scale Test Facility (LSTF) includes 141 heat-transfer U-tubes with different lengths. Six U-tubes among them are furnished with 15 or 17 probe-type instruments (conduction probe with a thermocouple; CPT) protuberant into the primary side of the U-tubes. Other 135 U-tubes are not instrumented. This results in different hydraulic conditions between the instrumented and non-instrumented U-tubes with the same length. A series of pressure loss characteristics tests was conducted at a test apparatus simulating both types of U-tube. The following pressure loss coefficient (K CPT ) was reduced as a function of Reynolds number (Re) from these tests under single-phase water flow conditions. K CPT =0.16 5600≤Re≤52820, K CPT =60.66xRe -0.688 2420≤Re≤5600, K CPT =2.664x10 6 Re -2.06 1371≤Re≤2420. The maximum uncertainty is 22%. By using these results, the total pressure loss coefficients of full length U-tubes were estimated. It is clarified that the total pressure loss of the shortest instrumented U-tube is equivalent to that of the middle-length non-instrumented U-tube and also that a middle-length instrumented U-tube is equivalent to the longest non-instrumented U-tube. Concludingly. it is important to take account of the CPT pressure loss mentioned above in estimation of fluid behavior at the non-instrumented U-tubes either by using the LSTF experiment data from the CPT-installed U-tubes or by using any analytical codes. (author)

Preventing Silicone Tube Extrusion after Nasolacrimal Duct Intubation in Children

Directory of Open Access Journals (Sweden)

Ali-Akbar Sabermoghaddam

2010-01-01

Full Text Available Herein we report our experience with a simple technique for reducing the rate of silicone tube extrusion after nasolacrimal duct (NLD intubation for congenital NLD obstruction. Medical records of children older than 2 years, with or without history of failed probing, who had undergone NLD intubation with a Crawford silicone tube over a period of 4 years were reviewed. In all subjects, one end of the Crawford tube was passed through a piece of scalp vein tubing followed by applying one or two knots. All Crawford tubes were removed after 3 months. Main outcome measures included complications such as tube extrusion, nasal discharge, crust formation and pyogenic granuloma formation. Fifty-seven patients, including 49 unilateral and 8 bilateral cases with mean age of 3.8΁1.6 (range, 2 to 11.5 years were operated. No complications such as tube dislodgement, significant nasal discharge, crust or pyogenic granuloma formation occurred prior to Crawford tube removal. All silicone tubes were successfully removed from the nasal cavity. In conclusion, passing one end of the Crawford tube through a small piece of scalp vein tubing before knotting it in the nasal cavity seems to decrease the rate of tube extrusion which is the most common complication following NLD intubation in children.

HF electronic tubes. Technologies, grid tubes and klystrons

International Nuclear Information System (INIS)

Lemoine, Th.

2009-01-01

This article gives an overview of the basic technologies of electronic tubes: cathodes, electronic optics, vacuum and high voltage. Then the grid tubes, klystrons and inductive output tubes (IOT) are introduced. Content: 1 - context and classification; 2 - electronic tube technologies: cathodes, electronic optics, magnetic confinement (linear tubes), periodic permanent magnet (PPM) focussing, collectors, depressed collectors; 3 - vacuum technologies: vacuum quality, surface effects and interaction with electrostatic and RF fields, secondary emission, multipactor effect, thermo-electronic emission; 4 - grid tubes: operation of a triode, tetrodes, dynamic operation and classes of use, 'common grid' and 'common cathode' operation, ranges of utilisation and limitations, operation of a tetrode on unadjusted load, lifetime of a tetrode, uses of grid tubes; 5 - klystrons: operation, impact of space charge, multi-cavity klystrons, interaction efficiency, extended interaction klystrons, relation between interaction efficiency, perveance and efficiency, ranges of utilization and power limitations, multi-beam klystrons and sheet beam klystrons, operation on unadjusted load, klystron band pass and lifetime, uses; 6 - IOT: principle of operation, ranges of utilisation and limitations, interaction efficiency and depressed collector IOT, IOT lifetime and uses. (J.S.)

Dosimetric Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Squamous Cell Carcinoma of the Head and Neck

International Nuclear Information System (INIS)

Caudell, Jimmy J.; Schaner, Philip E.; Desmond, Renee A.; Meredith, Ruby F.; Spencer, Sharon A.; Bonner, James A.

2010-01-01

Purpose: Intensification of radiotherapy and chemotherapy for head-and-neck cancer may lead to increased rates of dysphagia. Dosimetric predictors of objective findings of long-term dysphagia were sought. Methods and Materials: From an institutional database, 83 patients were identified who underwent definitive intensity-modulated radiotherapy for squamous cell carcinoma of the head and neck, after exclusion of those who were treated for a second or recurrent head-and-neck primary lesion, had locoregional recurrence at any time, had less than 12 months of follow-up, or had postoperative radiotherapy. Dosimetric parameters were analyzed relative to three objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy (PEG) tube dependence at 12 months, aspiration on modified barium swallow, or pharyngoesophageal stricture requiring dilation. Results: Mean dose greater than 41 Gy and volume receiving 60 Gy (V 60 ) greater than 24% to the larynx were significantly associated with PEG tube dependence and aspiration. V 60 greater than 12% to the inferior pharyngeal constrictor was also significantly associated with increased PEG tube dependence and aspiration. V 65 greater than 33% to the superior pharyngeal constrictor or greater than 75% to the middle pharyngeal constrictor was associated with pharyngoesophageal stricture requiring dilation. Conclusions: Doses to the larynx and pharyngeal constrictors predicted long-term swallowing complications, even when controlled for other clinical factors. The addition of these structures to intensity-modulated radiotherapy optimization may reduce the incidence of dysphagia, although cautious clinical validation is necessary.

Endoscopic dilation of complete oesophageal obstructions with a combined antegrade-retrograde rendezvous technique.

Science.gov (United States)

Bertolini, Reto; Meyenberger, Christa; Putora, Paul Martin; Albrecht, Franziska; Broglie, Martina Anja; Stoeckli, Sandro J; Sulz, Michael Christian

2016-02-21

To investigate the combined antegrade-retrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome. This single-centre case series includes consecutive patients who were unable to swallow due to complete oesophageal obstruction and underwent combined antegrade-retrograde endoscopic dilation (CARD) within the last 10 years. The patients' demographic characteristics, clinical parameters, endoscopic therapy, adverse events, and outcomes were obtained retrospectively. Technical success was defined as effective restoration of oesophageal patency. Swallowing success was defined as either percutaneous endoscopic gastrostomy (PEG)-tube independency and/or relevant improvement of oral food intake, as assessed by the functional oral intake scale (FOIS) (≥ level 3). The cohort consisted of six patients [five males; mean age 71 years (range, 54-74)]. All but one patient had undergone radiotherapy for head and neck or oesophageal cancer. Technical success was achieved in five out of six patients. After discharge, repeated dilations were performed in all five patients. During follow-up (median 27 mo, range, 2-115), three patients remained PEG-tube dependent. Three of four patients achieved relevant improvement of swallowing (two patients: FOIS 6, one patient: FOIS 7). One patient developed mediastinal emphysema following CARD, without a need for surgery. The CARD technique is safe and a viable alternative to high-risk blind antegrade dilation in patients with complete proximal oesophageal obstruction. Although only half of the patients remained PEG-tube independent, the majority improved their ability to swallow.

Failure analysis of the boiler water-wall tube

Directory of Open Access Journals (Sweden)

S.W. Liu

2017-10-01

Full Text Available Failure analysis of the boiler water-wall tube is presented in this work. In order to examine the causes of failure, various techniques including visual inspection, chemical analysis, optical microscopy, scanning electron microscopy and energy dispersive spectroscopy were carried out. Tube wall thickness measurements were performed on the ruptured tube. The fire-facing side of the tube was observed to have experienced significant wall thinning. The composition of the matrix material of the tube meets the requirements of the relevant standards. Microscopic examinations showed that the spheroidization of pearlite is not very obvious. The failure mechanism is identified as a result of the significant localized wall thinning of the boiler water-wall tube due to oxidation.

Severe neurotoxicity following ingestion of tetraethyl lead.

Science.gov (United States)

Wills, Brandon K; Christensen, Jason; Mazzoncini, Joe; Miller, Michael

2010-03-01

Organic lead compounds are potent neurotoxins which can result in death even from small exposures. Traditionally, these compounds are found in fuel stabilizers, anti-knock agents, and leaded gasoline. Cases of acute organic lead intoxication have not been reported for several decades. We report a case of a 13-year-old Iraqi male who unintentionally ingested a fuel stabilizer containing 80-90% tetraethyl lead, managed at our combat support hospital. The patient developed severe neurologic symptoms including agitation, hallucinations, weakness, and tremor. These symptoms were refractory to escalating doses of benzodiazepines and ultimately required endotracheal intubation and a propofol infusion. Adjunctive therapies included chelation, baclofen, and nutrition provided through a gastrostomy tube. The patient slowly recovered and was discharged in a wheelchair 20 days after ingestion, still requiring tube feeding. Follow-up at 62 days post-ingestion revealed near-resolution of symptoms with residual slurred speech and slight limp. This case highlights the profound neurotoxic manifestations of acute organic lead compounds.

Torsion of the normal fallopian tube.

Science.gov (United States)

Provost, M W

1972-01-01

From 1961 to 1970 a number of cases of torsion of the Fallopian tube were seen at the Kaiser Foundation Hospital in San Francisco of which 3 cases are reported. Of the many theories of causation, pelvic congestion seemed the most likely. The only universal symptom is pain, located in the quadrant of the affected tube and sometimes radiating to the thigh or flank. Nausea and vomiting are frequent; temperature and white cell count are only slightly elevated or normal. A mass is often felt, depending on the amount of hemorrhage. Correct diagnosis is almost never made preoperatively. The only treatment is laparotomy and surgical correction.

Measurement of leakage dose distribution from Crookes tube using imaging plate

International Nuclear Information System (INIS)

Fujibuchi, Toshioh; Obara, Satoshi; Inoue, Hajime; Kato, Hideyuki; Kobayashi, Ikuo; Hosoda, Masahiro

2011-01-01

Crookes tube is used on an educational site in the junior high school and the high school, etc. for the purpose to learn the character of cathode rays. When using the tube, X rays are generated, however, there is few example of confirming in which direction to scatter in detail. Understanding how the distribution of the leakage dose is important because of efficient exposure decrease. The distribution of X rays generated from Crookes tube was measured by arranging imaging plates in six surroundings to enclose Crookes tube. The electron collided with a metal target and X rays had extended backward. The dose was greatly different depending on the direction. When experimenting with Crookes tube, it is necessary to consider not only the dose but also distribution. (author)

Evaluation of a steam generator tube repair process using an explosive expansion techniuqe at TMI-1

International Nuclear Information System (INIS)

Rajan, J.; Shook, T.A.; Leonard, L.

1983-01-01

After a planned shutdown of Unit No. 1 at Three Mile Island, cracks were discovered in the primary side of steam generator tubes in the vicinity of the upper surface of the upper tubesheet. The nature of these cracks was later characterized as intergranular stress corrosion. The licensee, General Public Utilities Nuclear (GPUN), proposed to form a new tube-to-tubesheet seal below the cracks using a repair process wherein a detonating cord and polyethylene cartridge assembly inserted into the tube explosively expand the tube against the tubesheet. The explosive expansion process has had numerous applications over the years in the initial fabrication of heat exchanger tube-to-tubesheet assemblies and in repair processes using sleeving. However, this is the first use of this process in a steam generator to expand a previously rolled tube and to form a new seal between it and the tubesheet below a defective region in the tube. The seal obtained between the tube and tubesheet depends on the magnitude of explosive energy released in the detonating process. In this application, it is desired to obtain a mechanical bond rather than a metallurgical welding of the tube and tubesheet. A number of critical variables must be taken into account in order to obtain a successful mechanical seal. These include the explosive power of the detonating cord, the number of expansion shots used, the length of tube which is expanded, cartridge and tube diameters, the diameter of the tubesheet hole, the materials of the tube and tubesheet, and the condition of the surfaces at the time of repair. (orig./GL)

Healthcare information on YouTube: A systematic review.

Science.gov (United States)

Madathil, Kapil Chalil; Rivera-Rodriguez, A Joy; Greenstein, Joel S; Gramopadhye, Anand K

2015-09-01

This article reviews the peer-reviewed literature addressing the healthcare information available on YouTube. Inclusion and exclusion criteria were determined, and the online databases PubMed and Web of Knowledge were searched using the search phrases: (1) YouTube* AND Health* and (2) YouTube* AND Healthcare*. In all, 18 articles were reviewed, with the results suggesting that (1) YouTube is increasingly being used as a platform for disseminating health information; (2) content and frame analysis were the primary techniques employed by researchers to analyze the characteristics of this information; (3) YouTube contains misleading information, primarily anecdotal, that contradicts the reference standards and the probability of a lay user finding such content is relatively high; (4) the retrieval of relevant videos is dependent on the search term used; and (5) videos from government organizations and professional associations contained trustworthy and high-quality information. YouTube is used as a medium for promoting unscientific therapies and drugs that are yet to be approved by the appropriate agencies and has the potential to change the beliefs of patients concerning controversial topics such as vaccinations. This review recognizes the need to design interventions to enable consumers to critically assimilate the information posted on YouTube with more authoritative information sources to make effective healthcare decisions. © The Author(s) 2014.

Carbon nano tubes embedded in polymer nano fibers

International Nuclear Information System (INIS)

Dror, Y.; Kedem, S.; Khalfin, R.L.; Paz, Y.; Cohenl, Y.; Salalha, Y.; Yarin, A.L.; Zussman, A.

2004-01-01

Full Text: The electro spinning process was used successfully to embed Multi-walled carbon nano tubes (MWCNTs) and single-walled carbon nano tubes (SWCNTs) in a matrix of poly(ethylene oxide) (PEO) forming composite nano fibers. Initial dispersion of SWCNTs in water was achieved by the use of an amphphilic alternating copolymer of styrene and sodium maleate. MWNT dispersion was achieved by ionic and nonionic surfactants. The distribution and conformation of the nano tubes in the nano fibers were studied by transmission electron microscopy (TEM). Oxygen plasma etching was used to expose the nano tubes within the nano fibers to facilitate direct observation. Nano tube alignment within the nano fibers was shown to depend strongly on the quality of the initial dispersions. Well-dispersed and separated nano tubes were embedded in a straight and aligned form while entangled non-separated nano tubes were incorporated as dense aggregates. X-ray diffraction demonstrated a high degree of orientation of the PEO crystals in the electro spun nano fibers with embedded SWCNTs, whereas incorporation of MVCNTs had a detrimental effect on the polymer orientation. Composite polymer nano fibers containing dispersed phases of nanometric TiO 2 particles and MWCNTs were also prepared electro spinning. In this case, the polymer matrix was poly(acrylonitrile) (PAN). The morphology and possible applications of these composite nano fibers will be discussed

Experimental Investigation of Reynolds Number Effects on Test Quality in a Hypersonic Expansion Tube

Science.gov (United States)

Rossmann, Tobias; Devin, Alyssa; Shi, Wen; Verhoog, Charles

2017-11-01

Reynolds number effects on test time and the temporal and spatial flow quality in a hypersonic expansion tube are explored using high-speed pressure, infrared optical, and Schlieren imaging measurements. Boundary layer models for shock tube flows are fairly well established to assist in the determination of test time and flow dimensions at typical high enthalpy test conditions. However, the application of these models needs to be more fully explored due to the unsteady expansion of turbulent boundary layers and contact regions separating dissimilar gasses present in expansion tube flows. Additionally, expansion tubes rely on the development of a steady jet with a large enough core-flow region at the exit of the acceleration tube to create a constant velocity region inside of the test section. High-speed measurements of pressure and Mach number at several locations within the expansion tube allow for the determination of an experimental x-t diagram. The comparison of the experimentally determined x-t diagram to theoretical highlights the Reynolds number dependent effects on expansion tube. Additionally, spatially resolved measurements of the Reynolds number dependent, steady core-flow in the expansion tube viewing section are shown. NSF MRI CBET #1531475, Lafayette College, McCutcheon Foundation.

Tube-support response to tube-denting evaluation. Volume 1. Final report

International Nuclear Information System (INIS)

Anderson, P.L.; Hall, J.F.; Shah, P.K.; Wills, R.L.

1983-05-01

The response of the tube supports is one of the important considerations of tube denting in a steam generator. Investigations have indicated that damaged tube supports have the potential to distort and damage tubes. This investigation considers the response to tube denting of the Combustion Engineering type tube supports. Drilled support plates and eggcrate tube supports are tested in a model steam generator in which tube denting is induced. The experimental data is used to verify and refine analytical predictor models developed using finite element techniques. It was found that analytical models underpredicted the deformations of the tube supports and appropriate modifications to enhance the predictive capability are identified. Non-destructive examination methods are evaluated for application to operating steam generators. It was found that the standard eddy current and profilometry techniques are acceptable methods for determining tube deformations, but these techniques are not adequate to assess tube support damage. Radiography is judged to be the best available means of determining the extent and progression of damage in tube supports

Substrate engineering for Ni-assisted growth of carbon nano-tubes

Energy Technology Data Exchange (ETDEWEB)

Kolahdouz, Z.; Kolahdouz, M. [Department of Electrical and Computer Engineering, Nano-electronic Laboratory, University of Tehran, Tehran (Iran, Islamic Republic of); Ghanbari, H. [Tarbiat Modarres University, Tehran (Iran, Islamic Republic of); Mohajerzadeh, S. [Department of Electrical and Computer Engineering, Nano-electronic Laboratory, University of Tehran, Tehran (Iran, Islamic Republic of); Naureen, S. [School of Information and Communication Technology, KTH (Royal Institute of Technology) Kista (Sweden); Radamson, H.H., E-mail: rad@kth.se [School of Information and Communication Technology, KTH (Royal Institute of Technology) Kista (Sweden)

2012-10-01

The growth of carbon multi-walled nano-tubes (MWCNTs) using metal catalyst (e.g. Ni, Co, and Fe) has been extensively investigated during the last decade. In general, the physical properties of CNTs depend on the type, quality and diameter of the tubes. One of the parameters which affects the diameter of a MWCNT is the size of the catalyst metal islands. Considering Ni as the metal catalyst, the formed silicide layer agglomerates (island formation) after a thermal treatment. One way to decrease the size of Ni islands is to apply SiGe as the base for the growth. In this study, different methods based on substrate engineering are proposed to change/control the MWCNT diameters. These include (i) well-controlled oxide openings containing Ni to miniaturize the metal island size, and (ii) growth on strained or partially relaxed SiGe layers for smaller Ni silicide islands.

Condenser tube buckling within tube-tubesheet joints

International Nuclear Information System (INIS)

Willertz, L.E.; Kalnins, A.; Updike, D.P.

1991-01-01

The problem of the appearance of protrusions, or bumps, in the interior of roller-expanded tubes within a tubesheet is addressed. Such bumps have been observed in condensers of power plants. A brief history of the reported occurrences of the bumps is given. The hypothesis is advanced that the mechanics of the formation of the bumps is similar to a buckling problem that has 'bifurcation at infinity'. Following this hypothesis, a two-dimensional physical model is developed, and the application of this model to study a three-dimensional bump is proposed. It is proposed in this paper that an initial deviation from the circular shape of the tube required to produce a bump. It is shown that without such a deviation the tubes cannot buckle. An experiment with short tube segments has been performed that verifies some of the features of the observed condenser tube bumps. Exactly what force produced the initial deviation for the observed bumps is still unknown. Available evidence implicates the hydro-laser jet that is used in the cleaning of tubes and tubesheets. A scenario of how a bump could have been produced by the hydro-laser jet is proposed. (author)

Adhesives for bonded molar tubes during fixed brace treatment.

Science.gov (United States)

Millett, Declan T; Mandall, Nicky A; Mattick, Rye Cr; Hickman, Joy; Glenny, Anne-Marie

2017-02-23

Orthodontic treatment involves using fixed or removable appliances (dental braces) to correct the positions of teeth. The success of a fixed appliance depends partly on the metal attachments (brackets and bands) being glued to the teeth so that they do not become detached during treatment. Brackets (metal squares) are usually attached to teeth other than molars, where bands (metal rings that go round each tooth) are more commonly used. Orthodontic tubes (stainless steel tubes that allow wires to pass through them), are typically welded to bands but they may also be glued directly (bonded) to molars. Failure of brackets, bands and bonded molar tubes slows down the progress of treatment with a fixed appliance. It can also be costly in terms of clinical time, materials and time lost from education/work for the patient. This is an update of the Cochrane review first published in 2011. A new full search was conducted on 15 February 2017 but no new studies were identified. We have only updated the search methods section in this new version. The conclusions of this Cochrane review remain the same. To evaluate the effectiveness of the adhesives used to attach bonded molar tubes, and the relative effectiveness of the adhesives used to attach bonded molar tubes versus adhesives used to attach bands, during fixed appliance treatment, in terms of: (1) how often the tubes (or bands) come off during treatment; and (2) whether they protect the bonded (or banded) teeth against decay. The following electronic databases were searched: Cochrane Oral Health's Trials Register (to 15 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1) in the Cochrane Library (searched 15 February 2017), MEDLINE Ovid (1946 to 15 February 2017), and Embase Ovid (1980 to 15 February 2017). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or

Effectiveness of prophylactic percutaneous endoscopic gastrostomy on nutritional status and mucositis in oropharyngeal cancer patients undergoing concurrent chemoradiotherapy

International Nuclear Information System (INIS)

Takahashi, Miki; Takemoto, Naoko; Sano, Ayaka

2012-01-01

Recently, concurrent chemoradiotherapy (CCRT) is frequently used for the treatment of oropharyngeal cancer. However, CCRT induces mucositis and dysphagia and causes inadequate oral nutrition intake. Thus, percutaneous endoscopic gastrostomy (PEG) in advance is recently recommended. To evaluate the effectiveness of PEG on nutritional intake, nutritional status, blood test, and grade of mucositis of 29 patients who had CCRT with PEG were investigated retrospectively. The results were statistically compared with those of 13 patients who had CCRT without PEG as a control group. Regarding the total energy, no significant change was observed in the PEG group, while the total energy intake significantly decreased in the control group (P=0.026). A significant correlation was observed between the rate of body weight loss during CCRT and total energy intake (R=0.78). The total energy intake of patients who could maintain body weight was 34.1 kcal/kg/day. Taken together, these results suggested that early nutritional administration using PEG can reduce the weight loss during CCRT. (author)

Variable-energy drift-tube linear accelerator

Science.gov (United States)

Swenson, Donald A.; Boyd, Jr., Thomas J.; Potter, James M.; Stovall, James E.

1984-01-01

A linear accelerator system includes a plurality of post-coupled drift-tubes wherein each post coupler is bistably positionable to either of two positions which result in different field distributions. With binary control over a plurality of post couplers, a significant accumlative effect in the resulting field distribution is achieved yielding a variable-energy drift-tube linear accelerator.

21 CFR 101.79 - Health claims: Folate and neural tube defects.

Science.gov (United States)

2010-04-01

... pregnancy had a reduced risk of having a child with a neural tube defect. (Products containing this level of... neural tube defect, those with insulin-dependent diabetes mellitus, and women with seizure disorders who... mcg) when labeled for use by adults and children 4 or more years of age, or 800 mcg when labeled for...

Transduced for determining if steam generator tubes are locked in at support plate

International Nuclear Information System (INIS)

Hayes, J.K.

1984-01-01

A nuclear steam generator is described which includes a vessel, means to introduce vaporizable fluid into the bottom portion of the vessel, an outlet near the top through which vapor is discharged, a horizontal tube sheet extending across the vessel, a plurality of U-shaped tubes, having each end secured to and extending through the tube sheet, means for introducing heating fluid to one end of each of the U-shaped tubes, means for removing heating fluid from the other end of each of the U-shaped tubes, tube support means positioned within the vessel for preventing tube vibration, the tube support means including horizontally positioned means closely surrounding, but slightly spaced from each tube, means through which access can be had to the vessel interior beneath the tube sheet when the steam generator is not in operation, and testing means for determining whether or not a tube is locked into a tube support means including a longitudinal member, with a first end located inside the tube to be tested, and a second end located outside of the tube, means for securing the first end of the member to the inside of the tube, means for heating a length of the longitudinal member, and an equal length of the tube, to an elevated temperature, and means for indicating movement of the second end of the longitudinal member away from the tube end, which would indicate that the tube is locked into the support means

Flow Analysis of Isobutane (R-600A) Inside AN Adiabatic Capillary Tube

Science.gov (United States)

Alok, Praveen; Sahu, Debjyoti

2018-02-01

Capillary tubes are simple narrow tubes but the phase change which occurs inside the capillary tubes is complex to analyze. In the present investigation, an attempt is made to analyze the flow of Isobutane (R-600a) inside the coiled capillary tubes for different load conditions by Homogeneous Equilibrium Model. The Length and diameter of the capillary tube not only depend on the pressure and temperature of the condenser and evaporator but also on the cooling load. The present paper investigates the change in dimensions of the coil capillary tube with respect to the change in cooling load on the system for the constant condenser and evaporator conditions. ANSYS CFX (Central Florida Expressway) software is used to study the flow characteristics of the refrigerant. Appropriate helical coil is selected for this analysis.

Recovery from severe dysphagia in systemic sclerosis - myositis overlap: a case report.

Science.gov (United States)

Chinniah, Keith J; Mody, Girish M

2017-06-01

Dysphagia is common in inflammatory myopathies and usually responds to corticosteroids. Severe dysphagia requiring feeding by percutaneous endoscopic gastrostomy is associated with significant morbidity and high mortality. A 56-year old African Black woman initially presented with systemic sclerosis (SSC) - myositis overlap and interstitial lung disease. She responded to high dose corticosteroids and cyclophosphamide followed by azathioprine, with improvement in her lung function and regression of the skin changes. Six years later she had a myositis flare with severe dysphagia. Her myositis improved after high doses of corticosteroids, azathioprine and two doses of intravenous immunoglobulin (IVIG). As her dysphagia persisted, she was fed via a percutaneous endoscopic gastrostomy (PEG) tube and given a course of rituximab. Her dysphagia gradually resolved and the PEG tube was removed within two months. She received another dose of rituximab six months later and continued low dose prednisone and azathioprine. Her muscle power improved, weight returned to normal and she remained well 20 months after hospital discharge. Our patient with SSC-myositis overlap and severe dysphagia requiring PEG feeding, improved with high dose corticosteroids, azathioprine, two courses of IVIG and rituximab, and remained in remission 20 months after hospital discharge.

Advanced evacuated tube collectors

Science.gov (United States)

Schertz, W. W.; Hull, J. R.; Winston, R.; Ogallagher, J.

1985-04-01

The essence of the design concept for these new collectors is the integration of moderate levels of nonimaging concentration inside the evacuated tube itself. This permanently protects the reflection surfaces and allows the use of highly reflecting front surface mirrors with reflectances greater than 95%. Previous fabrication and long term testing of a proof-of-concept prototype has established the technical success of the concept. Present work is directed toward the development of a manufacturable unit that will be suitable for the widest possible range of applications. Design alternatives include scaling up the original prototype's tube diameter from 5 cm to 10 cm, using an internal shaped metal concentrating reflector, using a variety of profile shapes to minimize so-called gap losses and accommodate both single ended and double-ended flow geometries, and allowing the use of heat pipes for the absorber tube.

Sleeving repair of heat exchanger tubes

International Nuclear Information System (INIS)

Street, Michael D.; Schafer, Bruce W.

2000-01-01

Defective heat exchanger tubes can be repaired using techniques that do not involve the cost and schedule penalties of component replacement. FTI's years of experience repairing steam generator tubes have been successfully applied to heat exchangers. Framatome Technologies heat exchanger sleeves can bridge defective areas of the heat exchanger tubes, sleeves have been designed to repair typical heat exchanger tube defects caused by excessive tube vibration, stress corrosion cracking, pitting or erosion. By installing a sleeve, the majority of the tube's heat transfer and flow capacity is maintained and the need to replace the heat exchanger can be delayed or eliminated. Both performance and reliability are improved. FTI typically installs heat exchanger tube sleeves using either a roll expansion or hydraulic expansion process. While roll expansion of a sleeve can be accomplished very quickly, hydraulic expansion allows sleeves to be installed deep within a tube where a roll expander cannot reach. Benefits of FTI's heat exchanger tube sleeving techniques include: - Sleeves can be positioned any where along the tube length, and for precise positioning of the sleeve eddy current techniques can be employed. - Varying sleeve lengths can be used. - Both the roll and hydraulic expansion processes are rapid and both produce joints that do not require stress relief. - Because of low leak rates and speed of installations, sleeves can be used to preventatively repair likely-to-fail tubes. - Sleeves can be used for tube stiffening and to limit leakage through tube defects. - Because of installation speed, there is minimal impact on outage schedules and budgets. FTI's recently installed heat exchanger sleeving at the Kori-3 Nuclear Power Station in conjunction with Korea Plant Service and Engineering Co., Ltd. The sleeves were installed in the 3A and 3B component cooling water heat exchangers. A total of 859 tubesheet and 68 freespan sleeves were installed in the 3A heat

Recurrent inspection of tubes

International Nuclear Information System (INIS)

Andersson, S.

1984-01-01

Recommendations concerning the selection of areas for the inspection of tubes have been outlined. The aim is to focus the control on the regions which are important for the safety and where damage is supposed to take place. The number of zones will depend on the risk factors as judged by experts. The localizing will be based upon probable damaging mechanisms. A certain number of areas should be chosen at random. (G.B.)

Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward.

Science.gov (United States)

Ikenaga, Yasunori; Nakayama, Sayaka; Taniguchi, Hiroki; Ohori, Isao; Komatsu, Nahoko; Nishimura, Hitoshi; Katsuki, Yasuo

2017-05-01

Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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.

Chest tube insertion

Science.gov (United States)

Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... Be careful there are no kinks in your tube. The drainage system should always sit upright and be placed ...

Vibro-impact responses of a tube with tube--baffle interaction

International Nuclear Information System (INIS)

Shin, Y.S.; Sass, D.E.; Jendrzejczyk, J.A.

1978-01-01

The relatively small, inherent tube-to-baffle hole clearances associated with manufacturing tolerances in heat exchangers affect the vibrational characteristics and the response of the tube. Numerical studies were made to predict the vibro-impact response of a tube with tube-baffle interaction. The finite element method has been employed with a non-linear elastic contact spring-dashpot to model the effect of the relative approach between the tube and the baffle plate. The coupled equations of motion are directly integrated with a proportional system damping represented by a linear combination of mass and stiffness. Lumped mass approach with explicit time integration scheme was found to be a suitable choice for tube-baffle impacting analysis. Fourier analyses indicate that the higher mode contributions to the tube response are significant for strong tube-baffle impacting. The contact damping forces are negligible compared with the contact spring forces. The numerical analysis results are in reasonably good agreement with those of the experiments

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.

Steam generator tubing development for commercial fast breeder reactors

International Nuclear Information System (INIS)

Sessions, C.E.; Uber, C.F.

1981-01-01

The development work to design, manufacture, and evaluate pre-stressed double-wall 2/one quarter/ Cr-1 Mo steel tubing for commercial fast breeder reactor steam generator application is discussed. The Westinghouse plan for qualifying tubing vendors to produce this tubing is described. The results achieved to date show that a long length pre-stressed double-wall tube is both feasible and commercially available. The evaluation included structural analysis and experimental measurement of the pre-stress within tubes, as well as dimensional, metallurgical, and interface wear tests of tube samples produced. This work is summarized and found to meet the steam generator design requirements. 10 refs

Elastic-plastic analysis of tube expansion in tubesheets

International Nuclear Information System (INIS)

Kasraie, B.; O'Donnell, W.J.; Porowski, J.S.; Selz, A.

1983-01-01

Conditions for expansion of tubes in tubesheets are often determined by the test. The tightness of the joint and pull out force are used as criteria for evaluation of the results. For closely spaced tubes, it is also necessary to control development of the plastic regions in the ligaments surrounding the tube being expanded. High local strains may occur and excessive distortion may result if the expansion of the tube is continued beyond the admissible limits. Elastic-plastic finite element analyses are performed herein in order to establish conditions for rolling of the tubes in tubesheets of low ligament efficiency. Such penetration patterns are often required in the design of tubular reactors for catalytic processes. The model considered includes individual tube expansion in tubesheets with triangular penetration patterns. The effect of prior expansion of the neighboring tubes is also evaluated. Gap elements are used to model the initial clearance of the tube in the hole. Development of the plastic zones and distortion of the ligaments is monitored during radial expansion of the tube diameter. The residual stresses between the tube and the hole surface and the history of gap closing after removal of the expansion tool are determined. The effect of axial extension of the tube on the tube thinning is determined. Tube thinning is often used as a measure of tube expansion in manufacturing processes. For the analyzed ligament efficiency, reliable joints are obtained for a thinning range within 2% to 3%

Hybrid friction diffusion bonding of 316L stainless steel tube-to-tube sheet joints for coil-wound heat exchangers

Energy Technology Data Exchange (ETDEWEB)

Haneklaus, Nils; Cionea, Cristian; Reuven, Rony; Frazer, David; Hosemann, Peter; Peterson, Per F. [Dept of Nuclear Engineering, University of California, Berkeley (United States)

2016-11-15

Hybrid friction diffusion bonding (HFDB) is a solid-state bonding process first introduced by Helmholtz-Zentrum Geesthacht to join aluminum tube-to-tube sheet joints of Coil-wound heat exchangers (CWHE). This study describes how HFDB was successfully used to manufacture 316L test samples simulating tube-to-tube sheet joints of stainless steel CWHE for molten salt coolants as foreseen in several advanced nuclear- and thermal solar power plants. Engineering parameters of the test sample fabrication are presented and results from subsequent non-destructive vacuum decay leak testing and destructive tensile pull-out testing are discussed. The bonded areas of successfully fabricated samples as characterized by tube rupture during pull-out tensile testing, were further investigated using optical microscopy and scanning electron microscopy including electron backscatter diffraction.

Effect of Magnetic Twist on Nonlinear Transverse Kink Oscillations of Line-tied Magnetic Flux Tubes

Science.gov (United States)

Terradas, J.; Magyar, N.; Van Doorsselaere, T.

2018-01-01

Magnetic twist is thought to play an important role in many structures of the solar atmosphere. One of the effects of twist is to modify the properties of the eigenmodes of magnetic tubes. In the linear regime standing kink solutions are characterized by a change in polarization of the transverse displacement along the twisted tube. In the nonlinear regime, magnetic twist affects the development of shear instabilities that appear at the tube boundary when it is oscillating laterally. These Kelvin–Helmholtz instabilities (KHI) are produced either by the jump in the azimuthal component of the velocity at the edge of the sharp boundary between the internal and external part of the tube or by the continuous small length scales produced by phase mixing when there is a smooth inhomogeneous layer. In this work the effect of twist is consistently investigated by solving the time-dependent problem including the process of energy transfer to the inhomogeneous layer. It is found that twist always delays the appearance of the shear instability, but for tubes with thin inhomogeneous layers the effect is relatively small for moderate values of twist. On the contrary, for tubes with thick layers, the effect of twist is much stronger. This can have some important implications regarding observations of transverse kink modes and the KHI itself.

Temperature Profile in Fuel and Tie-Tubes for Nuclear Thermal Propulsion Systems

Energy Technology Data Exchange (ETDEWEB)

Vishal Patel

2015-02-01

A finite element method to calculate temperature profiles in heterogeneous geometries of tie-tube moderated LEU nuclear thermal propulsion systems and HEU designs with tie-tubes is developed and implemented in MATLAB. This new method is compared to previous methods to demonstrate shortcomings in those methods. Typical methods to analyze peak fuel centerline temperature in hexagonal geometries rely on spatial homogenization to derive an analytical expression. These methods are not applicable to cores with tie-tube elements because conduction to tie-tubes cannot be accurately modeled with the homogenized models. The fuel centerline temperature directly impacts safety and performance so it must be predicted carefully. The temperature profile in tie-tubes is also important when high temperatures are expected in the fuel because conduction to the tie-tubes may cause melting in tie-tubes, which may set maximum allowable performance. Estimations of maximum tie-tube temperature can be found from equivalent tube methods, however this method tends to be approximate and overly conservative. A finite element model of heat conduction on a unit cell can model spatial dependence and non-linear conductivity for fuel and tie-tube systems allowing for higher design fidelity of Nuclear Thermal Propulsion.

Status of pulse tube development at CEA/SBT

International Nuclear Information System (INIS)

Ravex, A.; Rolland, P.

1994-01-01

Interest in the pulse tube comes from its potential for high reliability and low level of induced vibration. A numerical model has been developed to provide a tool for practical design. It has been successfully validated against the experimental results obtained with a single stage double inlet pulse tube which has achieved a temperature of 28 K at a frequency of a few Hz. Further developments have demonstrated the capability of operating a pulse tube at higher frequencies in association with a Stirling pressure oscillator. Current projects include coaxial geometry for miniature pulse tubes with linear resonant pressure oscillators. A 4 K multistaged pulse tube is also in development. (authors). 5 figs., 12 refs

Experimental study of thermal–hydraulic performance of cam-shaped tube bundle with staggered arrangement

International Nuclear Information System (INIS)

Bayat, Hamidreza; Lavasani, Arash Mirabdolah; Maarefdoost, Taher

2014-01-01

Highlights: • Thermal–hydraulic performance of a non-circular tube bundle has been investigated experimentally. • Tubes were mounted in staggered arrangement with two longitudinal pitch ratios 1.5 and 2. • Drag coefficient and Nusselt number of tubes in second row was measured. • Friction factor of this tube bundle is lower than circular tube bundle. • Thermal–hydraulic performance of this tube bundle is greater than circular tube bundle. - Abstract: Flow and heat transfer from cam-shaped tube bank in staggered arrangement is studied experimentally. Tubes were located in test section of an open loop wind tunnel with two longitudinal pitch ratios 1.5 and 2. Reynolds number varies in range of 27,000 ⩽ Re D ⩽ 42,500 and tubes surface temperature is between 78 and 85 °C. Results show that both drag coefficient and Nusselt number depends on position of tube in tube bank and Reynolds number. Tubes in the first column have maximum value of drag coefficient, while its Nusselt number is minimum compared to other tubes in tube bank. Moreover, pressure drop from this tube bank is about 92–93% lower than circular tube bank and as a result thermal–hydraulic performance of this tube bank is about 6 times greater than circular tube bank

Sheared bioconvection in a horizontal tube

Science.gov (United States)

Croze, O. A.; Ashraf, E. E.; Bees, M. A.

2010-12-01

The recent interest in using microorganisms for biofuels is motivation enough to study bioconvection and cell dispersion in tubes subject to imposed flow. To optimize light and nutrient uptake, many microorganisms swim in directions biased by environmental cues (e.g. phototaxis in algae and chemotaxis in bacteria). Such taxes inevitably lead to accumulations of cells, which, as many microorganisms have a density different to the fluid, can induce hydrodynamic instabilites. The large-scale fluid flow and spectacular patterns that arise are termed bioconvection. However, the extent to which bioconvection is affected or suppressed by an imposed fluid flow and how bioconvection influences the mean flow profile and cell transport are open questions. This experimental study is the first to address these issues by quantifying the patterns due to suspensions of the gravitactic and gyrotactic green biflagellate alga Chlamydomonas in horizontal tubes subject to an imposed flow. With no flow, the dependence of the dominant pattern wavelength at pattern onset on cell concentration is established for three different tube diameters. For small imposed flows, the vertical plumes of cells are observed merely to bow in the direction of flow. For sufficiently high flow rates, the plumes progressively fragment into piecewise linear diagonal plumes, unexpectedly inclined at constant angles and translating at fixed speeds. The pattern wavelength generally grows with flow rate, with transitions at critical rates that depend on concentration. Even at high imposed flow rates, bioconvection is not wholly suppressed and perturbs the flow field.

Pressure tube rupture in a closed tank

International Nuclear Information System (INIS)

Khater, H.A.; Hadaller, G.I.; Stern, F.

1985-06-01

A study has been prepared on the feasibility of conducting pressure tube/calandria tube rupture tests in a closed tank, simulating a scaled-down calandria vessel. The study includes: i) a review of previous work, ii) an analytical investigation of the scaling problem of the calandria vessel and relevant in-core structures, iii) selection of a method for initiating pressure tube/calandria tube rupture, iv) a set of specifications for the test assembly, v) general arrangement drawings, vi) a proposal for a test matrix, vii) a survey and evaluation of existing facilities which could provide the required high pressure, temperature and fluid inventory, and viii) a cost estimate for the detailed design and construction, instrumentation, data acquisition and reduction, testing and reporting. The study concludes that it is both technically and practically feasible to conduct pressure tube rupture tests in a closed tank

Neural tube closure depends on expression of Grainyhead-like 3 in multiple tissues.

Science.gov (United States)

De Castro, Sandra C P; Hirst, Caroline S; Savery, Dawn; Rolo, Ana; Lickert, Heiko; Andersen, Bogi; Copp, Andrew J; Greene, Nicholas D E

2018-03-15

Failure of neural tube closure leads to neural tube defects (NTDs), common congenital abnormalities in humans. Among the genes whose loss of function causes NTDs in mice, Grainyhead-like3 (Grhl3) is essential for spinal neural tube closure, with null mutants exhibiting fully penetrant spina bifida. During spinal neurulation Grhl3 is initially expressed in the surface (non-neural) ectoderm, subsequently in the neuroepithelial component of the neural folds and at the node-streak border, and finally in the hindgut endoderm. Here, we show that endoderm-specific knockout of Grhl3 causes late-arising spinal NTDs, preceded by increased ventral curvature of the caudal region which was shown previously to suppress closure of the spinal neural folds. This finding supports the hypothesis that diminished Grhl3 expression in the hindgut is the cause of spinal NTDs in the curly tail, carrying a hypomorphic Grhl3 allele. Complete loss of Grhl3 function produces a more severe phenotype in which closure fails earlier in neurulation, before the stage of onset of expression in the hindgut of wild-type embryos. This implicates additional tissues and NTD mechanisms in Grhl3 null embryos. Conditional knockout of Grhl3 in the neural plate and node-streak border has minimal effect on closure, suggesting that abnormal function of surface ectoderm, where Grhl3 transcripts are first detected, is primarily responsible for early failure of spinal neurulation in Grhl3 null embryos. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Pressure tube reactor

International Nuclear Information System (INIS)

Susuki, Akira; Murata, Shigeto; Minato, Akihiko.

1993-01-01

In a pressure tube reactor, a reactor core is constituted by arranging more than two units of a minimum unit combination of a moderator sealing pipe containing a calandria tube having moderators there between and a calandria tube and moderators. The upper header and a lower header of the calandria tank containing moderators are communicated by way of the moderator sealing tube. Further, a gravitationally dropping mechanism is disposed for injecting neutron absorbing liquid to a calandria gas injection portion. A ratio between a moderator volume and a fuel volume is defined as a function of the inner diameter of the moderator sealing tube, the outer diameter of the calandria tube and the diameter of fuel pellets, and has no influence to intervals of a pressure tube lattice. The interval of the pressure tube lattice is enlarged without increasing the size of the pressure tube, to improve production efficiency of the reactor and set a coolant void coefficient more negative, thereby enabling to improve self controllability and safety. Further, the reactor scram can be conducted by injecting neutron absorbing liquid. (N.H.)

CFD modeling of a boiler's tubes rupture

International Nuclear Information System (INIS)

Rahimi, Masoud; Khoshhal, Abbas; Shariati, Seyed Mehdi

2006-01-01

This paper reports the results of a study on the reason for tubes damage in the superheater Platen section of the 320 MW Bisotoun power plant, Iran. The boiler has three types of superheater tubes and the damage occurs in a series of elbows belongs to the long tubes. A three-dimensional modeling was performed using an in-house computational fluid dynamics (CFD) code in order to explore the reason. The code has ability of simultaneous solving of the continuity, the Reynolds-Averaged Navier-Stokes (RANS) equations and employing the turbulence, combustion and radiation models. The whole boiler including; walls, burners, air channels, three types of tubes, etc., was modeled in the real scale. The boiler was meshed into almost 2,000,000 tetrahedral control volumes and the standard k-ε turbulence model and the Rosseland radiation model were used in the model. The theoretical results showed that the inlet 18.9 MPa saturated steam becomes superheated inside the tubes and exit at a pressure of 17.8 MPa. The predicted results showed that the temperature of the steam and tube's wall in the long tubes is higher than the short and medium size tubes. In addition, the predicted steam mass flow rate in the long tube was lower than other ones. Therefore, it was concluded that the main reason for the rupture in the long tubes elbow is changing of the tube's metal microstructure due to working in a temperature higher than the design temperature. In addition, the structural fatigue tension makes the last elbow of the long tube more ready for rupture in comparison with the other places. The concluded result was validated by observations from the photomicrograph of the tube's metal samples taken from the damaged and undamaged sections

Impulse generation by detonation tubes

Science.gov (United States)

Cooper, Marcia Ann

Impulse generation with gaseous detonation requires conversion of chemical energy into mechanical energy. This conversion process is well understood in rocket engines where the high pressure combustion products expand through a nozzle generating high velocity exhaust gases. The propulsion community is now focusing on advanced concepts that utilize non-traditional forms of combustion like detonation. Such a device is called a pulse detonation engine in which laboratory tests have proven that thrust can be achieved through continuous cyclic operation. Because of poor performance of straight detonation tubes compared to conventional propulsion systems and the success of using nozzles on rocket engines, the effect of nozzles on detonation tubes is being investigated. Although previous studies of detonation tube nozzles have suggested substantial benefits, up to now there has been no systematic investigations over a range of operating conditions and nozzle configurations. As a result, no models predicting the impulse when nozzles are used exist. This lack of data has severely limited the development and evaluation of models and simulations of nozzles on pulse detonation engines. The first experimental investigation measuring impulse by gaseous detonation in plain tubes and tubes with nozzles operating in varying environment pressures is presented. Converging, diverging, and converging-diverging nozzles were tested to determine the effect of divergence angle, nozzle length, and volumetric fill fraction on impulse. The largest increases in specific impulse, 72% at an environment pressure of 100 kPa and 43% at an environment pressure of 1.4 kPa, were measured with the largest diverging nozzle tested that had a 12° half angle and was 0.6 m long. Two regimes of nozzle operation that depend on the environment pressure are responsible for these increases and were first observed from these data. To augment this experimental investigation, all data in the literature regarding

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.)

Numerical study of chemical reactions in a surface microdischarge tube with mist flow based on experiment

International Nuclear Information System (INIS)

Shibata, T; Nishiyama, H

2014-01-01

Recently, a water treatment method of spraying solution into a discharge region has been developed and shows high energy efficiency. In this study, a simulation model of a water treatment method using a surface microdischarge (SMD) tube with mist flow is proposed for further understanding the detailed chemical reactions. Our model has three phases (plasma, gas and liquid) and three simulation steps. The carrier gas is humid air including 2% or 3% water vapour. The chemical species diffusion characteristics in the SMD tube and the concentrations in a droplet are clarified in a wide pH interval. The simulation results show that the chemical species generated on the SMD tube inner wall are diffused to the central axis and dissolved into fine droplets. Especially, OH radicals dissolve into droplets a few mm away from the SMD tube wall because of acidification of the droplets. Furthermore, the hydrogen peroxide density, which is the most important indicator of a radical reaction in water, is influenced by the initial solution pH. This pH dependence results from ozone self-decomposition in water. (paper)

Numerical study of chemical reactions in a surface microdischarge tube with mist flow based on experiment

Science.gov (United States)

Shibata, T.; Nishiyama, H.

2014-03-01

Recently, a water treatment method of spraying solution into a discharge region has been developed and shows high energy efficiency. In this study, a simulation model of a water treatment method using a surface microdischarge (SMD) tube with mist flow is proposed for further understanding the detailed chemical reactions. Our model has three phases (plasma, gas and liquid) and three simulation steps. The carrier gas is humid air including 2% or 3% water vapour. The chemical species diffusion characteristics in the SMD tube and the concentrations in a droplet are clarified in a wide pH interval. The simulation results show that the chemical species generated on the SMD tube inner wall are diffused to the central axis and dissolved into fine droplets. Especially, OH radicals dissolve into droplets a few mm away from the SMD tube wall because of acidification of the droplets. Furthermore, the hydrogen peroxide density, which is the most important indicator of a radical reaction in water, is influenced by the initial solution pH. This pH dependence results from ozone self-decomposition in water.

THE TOPOLOGY OF CANONICAL FLUX TUBES IN FLARED JET GEOMETRY

Energy Technology Data Exchange (ETDEWEB)

Lavine, Eric Sander; You, Setthivoine, E-mail: Slavine2@uw.edu, E-mail: syou@aa.washington.edu [University of Washington, 4000 15th Street, NE Aeronautics and Astronautics 211 Guggenheim Hall, Box 352400, Seattle, WA 98195 (United States)

2017-01-20

Magnetized plasma jets are generally modeled as magnetic flux tubes filled with flowing plasma governed by magnetohydrodynamics (MHD). We outline here a more fundamental approach based on flux tubes of canonical vorticity, where canonical vorticity is defined as the circulation of the species’ canonical momentum. This approach extends the concept of magnetic flux tube evolution to include the effects of finite particle momentum and enables visualization of the topology of plasma jets in regimes beyond MHD. A flared, current-carrying magnetic flux tube in an ion-electron plasma with finite ion momentum is thus equivalent to either a pair of electron and ion flow flux tubes, a pair of electron and ion canonical momentum flux tubes, or a pair of electron and ion canonical vorticity flux tubes. We examine the morphology of all these flux tubes for increasing electrical currents, different radial current profiles, different electron Mach numbers, and a fixed, flared, axisymmetric magnetic geometry. Calculations of gauge-invariant relative canonical helicities track the evolution of magnetic, cross, and kinetic helicities in the system, and show that ion flow fields can unwind to compensate for an increasing magnetic twist. The results demonstrate that including a species’ finite momentum can result in a very long collimated canonical vorticity flux tube even if the magnetic flux tube is flared. With finite momentum, particle density gradients must be normal to canonical vorticities, not to magnetic fields, so observations of collimated astrophysical jets could be images of canonical vorticity flux tubes instead of magnetic flux tubes.

Use of CATHENA to model calandria-tube/moderator heat transfer after pressure-tube/calandria-tube ballooning contact

International Nuclear Information System (INIS)

Fan, H.Z.; Bilanovic, Z.; Nitheanandan, T.

2004-01-01

A study was performed to assess the effect of the calandria-tube/moderator heat transfer after pressure-tube/calandria tube ballooning contact using CATHENA. Results of this study indicated that the analytical tool, CATHENA, can be applied for pool boiling heat transfer on the external surface of a large diameter tube, such as the calandria tube used in CANDU reactors. The methodology in such CANDU-generic study can be used to simulate the tube surface with multiple boiling regimes and to assess the benefits of closely coupling thermalhydraulics modelling and fuel/fuel channel behaviour modelling. CATHENA (Canadian Algorithm for THErmalhydraulic Network Analysis) is a one-dimensional, two-fluid thermalhydraulic simulation code designed by AECL to analyse two-phase flow and heat transfer in piping networks. The detailed heat transfer package in CATHENA allows a connection to be established from the multiple solid surfaces of tubes to the surrounding large amount of moderator water, which acts as a heat sink during a postulated loss of coolant event. The generalized heat transfer package within CATHENA allows the tube walls to be divided into several layers in the radial direction and several sectors in the circumferential direction, to account for heat transfer conditions in these two directions. The CATHENA code with the generalized heat transfer package is capable of capturing key pool-boiling phenomena such as nucleate, transition and film boiling heat transfer as well as an ability to model the rewet phenomenon to some extent. A CATHENA input model was generated and used in simulations of selected contact boiling experiment test cases. The transient wall temperatures have been calculated in different portions of the calandria tube. By using this model an adequate agreement was achieved between CATHENA calculation and experimental measurement The CATHENA code enables one to investigate the transient and local thermal-mechanical behaviour of the calandria tube

High-intensity focused ultrasound ablation around the tubing.

Science.gov (United States)

Siu, Jun Yang; Liu, Chenhui; Zhou, Yufeng

2017-01-01

High-intensity focused ultrasound (HIFU) has been emerging as an effective and noninvasive modality in cancer treatment with very promising clinical results. However, a small vessel in the focal region could be ruptured, which is an important concern for the safety of HIFU ablation. In this study, lesion formation in the polyacrylamide gel phantom embedded with different tubing (inner diameters of 0.76 mm and 3 mm) at varied flow speeds (17-339 cm/s) by HIFU ablation was photographically recorded. Produced lesions have decreased length (~30%) but slightly increased width (~6%) in comparison to that without the embedded tubing. Meanwhile, bubble activities during the exposures were measured by passive cavitation detection (PCD) at the varied pulse repetition frequency (PRF, 10-30 Hz) and duty cycle (DC, 10%-20%) of the HIFU bursts. High DC and low flow speed were found to produce stronger bubble cavitation whereas no significant influence of the PRF. In addition, high-speed photography illustrated that the rupture of tubing was produced consistently after the first HIFU burst within 20 ms and then multiple bubbles would penetrate into the intraluminal space of tubing through the rupture site by the acoustic radiation force. Alignment of HIFU focus to the anterior surface, middle, and posterior surface of tubing led to different characteristics of vessel rupture and bubble introduction. In summary, HIFU-induced vessel rupture is possible as shown in this phantom study; produced lesion sizes and shapes are dependent on the focus alignment to the tubing, flow speed, and tubing properties; and bubble cavitation and the formation liquid jet may be one of the major mechanisms of tubing rupture as shown in the high-speed photography.

Wear behavior of 2-1/4 Cr-1Mo tubing against alloy 718 tube-support material in sodium-cooled steam generators

International Nuclear Information System (INIS)

Wilson, W.L.

1983-05-01

A series of prototypic steam generator 2-1/4 Cr-1 Mo tube/alloy 718 tube support plate wear tests were conducted in direct support of the Westinghouse Nuclear Components Division -- Breeder Reactor Components Project Large Scale steam Generator design. The initial objective was to verify the acceptable wear behavior of softer, ''over-aged'' alloy 718 support plate material. For all interfaces under all test conditions, resultant wear damage was adhesive in nature with varying amounts of 2-1/4 Cr-1 Mo tube material being adhesively transferred to the alloy 718 tube supports. Maximum tube wear depths exceeded the initially established design allowable limit of 127 μm (.005 in.) at 17 of the 18 interfaces tested. A decrease in contact stresses produced acceptable tube wear depths below a readjusted maximum design allowable value of 381 μm (.015 in.). Additional conservatisms associated with the simulation of a 40-year lifetime of rubbing in a one-week laboratory test provided further confidence that the 381 μm maximum tube wear allowance would not be exceeded in service. Softer, ''over-aged'' alloy 718 material was found to produce slightly less wear damage on 2-1/4 Cr-1 Mo tubing than fully age hardened material. Also, air formed oxide films on the alloy 718 reduced initial tube wear and delayed the onset of adhesive surface damage. However, at high surface stress levels, these films were not sufficiently stable to provide adequate long term protection from adhesive wear. The results of the present work and those of previous test programs suggest that the successful in-sodium tribological performance of 2-1/4 Cr-1 Mo/alloy 718 rubbing couples is dependent upon the presence of lubricative surface films, such as oxides and/or surface reaction or deposition products. 11 refs., 13 figs., 4 tabs

Shape Modeling of a Concentric-tube Continuum Robot

DEFF Research Database (Denmark)

Bai, Shaoping; Xing, Charles Chuhao

2012-01-01

Concentric-tube continuum robots feature with simple and compact structures and have a great potential in medical applications. The paper is concerned with the shape modeling of a type of concentric-tube continuum robot built with a collection of super-elastic NiTiNol tubes. The mechanics...... is modeled on the basis of energy approach for both the in-plane and out-plane cases. The torsional influences on the shape of the concentric-tube robots are considered. An experimental device was build for the model validation. The results of simulation and experiments are included and analyzed....

Improvement of pump tubes for gas guns and shock tube drivers

Science.gov (United States)

Bogdanoff, D. W.

1990-01-01

In a pump tube, a gas is mechanically compressed, producing very high pressures and sound speeds. The intensely heated gas produced in such a tube can be used to drive light gas guns and shock tubes. Three concepts are presented that have the potential to allow substantial reductions in the size and mass of the pump tube to be achieved. The first concept involves the use of one or more diaphragms in the pump tube, thus replacing a single compression process by multiple, successive compressions. The second concept involves a radical reduction in the length-to-diameter ratio of the pump tube and the pump tube piston. The third concept involves shock heating of the working gas by high explosives in a cyclindrical geometry reusable device. Preliminary design analyses are performed on all three concepts and they appear to be quite feasible. Reductions in the length and mass of the pump tube by factors up to about 11 and about 7, respectively, are predicted, relative to a benchmark conventional pump tube.

Noninflammatory fallopian tube pathology in children

International Nuclear Information System (INIS)

Merlini, Laura; Anooshiravani, Mehrak; Hanquinet, Sylviane; Vunda, Aaron; Borzani, Irene; Napolitano, Marcello

2008-01-01

Noninflammatory tubal abnormalities are rare in children and usually not well covered by traditional educational material. The presenting symptoms are nonspecific and are common to many other conditions, so its preoperative diagnosis is rarely made. The purpose of this study was to review the hospital charts and imaging findings in children and sexually inactive adolescents who showed fallopian tube pathology. Understanding of the pertinent findings of previous imaging examinations might assist radiologists in making the correct preoperative diagnosis and increase the likelihood of preserving the fallopian tubes. The clinical entities described in this article include isolated tubal torsion, paratubal cysts, hydrosalpinx, undescended/ectopic fallopian tube, and tubal inguinal hernia. (orig.)

Assembly and method for testing the integrity of stuffing tubes

Energy Technology Data Exchange (ETDEWEB)

Morrison, E.F.

1996-12-31

A stuffing tube integrity checking assembly includes first and second annular seals, with each seal adapted to be positioned about a stuffing tube penetration component. An annular inflation bladder is provided, the bladder having a slot extending longitudinally there along and including a separator for sealing the slot. A first valve is in fluid communication with the bladder for introducing pressurized fluid to the space defined by the bladder when mounted about the tube. First and second releasible clamps are provided. Each clamp assembly is positioned about the bladder for securing the bladder to one of the seals for thereby establishing a fluid-tight chamber about the tube.

WWER steam generator tube structural and leakage integrity

International Nuclear Information System (INIS)

Splichal, K.; Krhounek, Vl.; Otruba, J.; Ruscak, M.

1998-01-01

The integrity of heat exchange tubes may influence the lifetime of WWER steam generators and appears to be an important criterion for the evaluation of their safety and operational reliability. The basic requirements are to assure very low probability of radioactive water leakage, preventing unstable crack growth and sudden tube rupture. These requirements led to development of permissible limits for primary to secondary leak evaluation and heat exchange tubes plugging. The stress corrosion cracking and pitting are the main corrosion damages of WWER heat exchange tubes and are initiated from the outer surface. Both the initiation and crack growth cause thinning of the tube wall and lead to part thickness cracks and through wall cracks, oriented preferentially in the axial direction. The paper presents the leakage and plugging limits for WWER steam generators, which have been determined from leak tests and burst tests. The tubes with axial part-through and through-wall defects have been used. The permissible value of primary to secondary leak rate was evaluated with respect to permissible axial through-wall defect size of WWER 440 and 1000 steam generator tubes. Blocking of the tube cracks by corrosion product particles and other compounds reduces the primary to secondary leak rate. The plugging limits involve the following factors: permissible tube wall thickness which determine further operation of the tubes with defects and assures their integrity under operating conditions and permissible size of a through-wall crack which is sufficiently stable under normal and accident conditions in relation to the critical crack length. For the evaluation of burst test of heat exchange tubes with longitudinal through-wall defects the instability criterion has been used and the dependence of the normalised burst pressure on the normalised length of an axial through-wall defect has been determined. The validity of the criterion of instability for WWER tubes with through

The role of the interventional radiologist in enteral alimentation.

Science.gov (United States)

Given, M F; Lyon, S M; Lee, M J

2004-01-01

The provision of enteral nutrition through the placement of gastrostomy/gastrojejunostomy tubes is a well-established procedure. Traditionally, these catheters have been placed either surgically or endoscopically; however, over the past two decades interventional radiologists have increasingly performed these procedures successfully. The perceived advantages of this route lie in the reported lower morbidity and mortality rates. In addition, percutaneous radiologically guided (PRG) catheters may be placed in certain subgroups of patients in whom it would be technically difficult or impossible by other routes, e.g., patients with head and neck or oesophageal tumours. The aim of this review is to describe the techniques of radiologically placed gastrostomy/gastrojejunostomy, discuss its indications and contraindications, describe any associated potential complications and compare PRG results with the more established techniques of open surgical and endoscopic placement. We also describe some recent procedural and catheter modifications.

The role of the interventional radiologist in enteral alimentation

Energy Technology Data Exchange (ETDEWEB)

Given, M.F.; Lyon, S.M.; Lee, M.J. [Department of Academic Radiology, Beaumont Hospital, Dublin 9 (Ireland); Royal College of Surgeons in Ireland, St. Stephen' s Green, Dublin 2 (Ireland)

2004-01-01

The provision of enteral nutrition through the placement of gastrostomy/gastrojejunostomy tubes is a well-established procedure. Traditionally, these catheters have been placed either surgically or endoscopically; however, over the past two decades interventional radiologists have increasingly performed these procedures successfully. The perceived advantages of this route lie in the reported lower morbidity and mortality rates. In addition, percutaneous radiologically guided (PRG) catheters may be placed in certain subgroups of patients in whom it would be technically difficult or impossible by other routes, e.g., patients with head and neck or oesophageal tumours. The aim of this review is to describe the techniques of radiologically placed gastrostomy/gastrojejunostomy, discuss its indications and contraindications, describe any associated potential complications and compare PRG results with the more established techniques of open surgical and endoscopic placement. We also describe some recent procedural and catheter modifications. (orig.)

Flow-induced decentering and tube support interaction for steam generator tubes: experiment and physical interpretation

International Nuclear Information System (INIS)

Gay, N.; Granger, S.

1992-11-01

Maintaining PWR components under reliable operating conditions requires a complex design to prevent various damaging processes including flow-induced vibration and wear mechanisms. To improve the prediction of tube/support interaction and wear in PWR components, EDF has undertaken a comprehensive program oriented to both experimental and computational studies. The present paper illustrates one aspect of this program, related to the determination of contact forces between steam generator tubes and anti-vibration bars (AVBs). The dynamic, nonlinear behavior of a U-tube excited by an air cross-flow is investigated on the CLAVECIN experiment. Interesting and rather unexpected results have been obtained, by varying clearances and flow velocities. The paper is focused on four main points: (i) the originality of the experiment with a force measurement device located in flow; (ii) the importance of a refined data processing for accurately measuring contact forces; (iii) the presentation of the unexpected phenomena revealed in the CLAVECIN experiment, i.e. a flow-induced decentering of the tube which changed the initial tube/AVB clearance, and the consequences on tube/support interaction; (iv) the influence of the actual tube/support clearance in flow on wear mechanisms. The work, presented in the second part of this paper, concentrates exclusively on the physical interpretation of the flow-induced decentering phenomenon and on the theoretical analysis of its consequences on dynamic tube/support interaction. We show that the flow-induced decentering phenomenon can be generated by an unstable quasi-static coupling between the flexible tube and the confined flow, in the vicinity of the support system. This phenomenon is not specific to the CLAVECIN tests and it can be expected every time that a movable obstacle is subjected to confined flow. Moreover, in single-sided impacting conditions, the theoretical analysis confirms the linear relation, found in the CLAVECIN tests

Steam generator tube rupture simulation using extended finite element method

Energy Technology Data Exchange (ETDEWEB)

Mohanty, Subhasish, E-mail: smohanty@anl.gov; Majumdar, Saurin; Natesan, Ken

2016-08-15

Highlights: • Extended finite element method used for modeling the steam generator tube rupture. • Crack propagation is modeled in an arbitrary solution dependent path. • The FE model is used for estimating the rupture pressure of steam generator tubes. • Crack coalescence modeling is also demonstrated. • The method can be used for crack modeling of tubes under severe accident condition. - Abstract: A steam generator (SG) is an important component of any pressurized water reactor. Steam generator tubes represent a primary pressure boundary whose integrity is vital to the safe operation of the reactor. SG tubes may rupture due to propagation of a crack created by mechanisms such as stress corrosion cracking, fatigue, etc. It is thus important to estimate the rupture pressures of cracked tubes for structural integrity evaluation of SGs. The objective of the present paper is to demonstrate the use of extended finite element method capability of commercially available ABAQUS software, to model SG tubes with preexisting flaws and to estimate their rupture pressures. For the purpose, elastic–plastic finite element models were developed for different SG tubes made from Alloy 600 material. The simulation results were compared with experimental results available from the steam generator tube integrity program (SGTIP) sponsored by the United States Nuclear Regulatory Commission (NRC) and conducted at Argonne National Laboratory (ANL). A reasonable correlation was found between extended finite element model results and experimental results.

Steam generator tube rupture simulation using extended finite element method

International Nuclear Information System (INIS)

Mohanty, Subhasish; Majumdar, Saurin; Natesan, Ken

2016-01-01

Highlights: • Extended finite element method used for modeling the steam generator tube rupture. • Crack propagation is modeled in an arbitrary solution dependent path. • The FE model is used for estimating the rupture pressure of steam generator tubes. • Crack coalescence modeling is also demonstrated. • The method can be used for crack modeling of tubes under severe accident condition. - Abstract: A steam generator (SG) is an important component of any pressurized water reactor. Steam generator tubes represent a primary pressure boundary whose integrity is vital to the safe operation of the reactor. SG tubes may rupture due to propagation of a crack created by mechanisms such as stress corrosion cracking, fatigue, etc. It is thus important to estimate the rupture pressures of cracked tubes for structural integrity evaluation of SGs. The objective of the present paper is to demonstrate the use of extended finite element method capability of commercially available ABAQUS software, to model SG tubes with preexisting flaws and to estimate their rupture pressures. For the purpose, elastic–plastic finite element models were developed for different SG tubes made from Alloy 600 material. The simulation results were compared with experimental results available from the steam generator tube integrity program (SGTIP) sponsored by the United States Nuclear Regulatory Commission (NRC) and conducted at Argonne National Laboratory (ANL). A reasonable correlation was found between extended finite element model results and experimental results.

Vibro-impact responses of a tube with tube--baffle interaction. [LMFBR

Energy Technology Data Exchange (ETDEWEB)

Shin, Y S; Sass, D E; Jendrzejczyk, J A

1978-01-01

The relatively small, inherent tube-to-baffle hole clearances associated with manufacturing tolerances in heat exchangers affect the vibrational characteristics and the response of the tube. Numerical studies were made to predict the vibro-impact response of a tube with tube-baffle interaction. The finite element method has been employed with a non-linear elastic contact spring-dashpot to model the effect of the relative approach between the tube and the baffle plate. The coupled equations of motion are directly integrated with a proportional system damping represented by a linear combination of mass and stiffness. Lumped mass approach with explicit time integration scheme was found to be a suitable choice for tube-baffle impacting analysis. Fourier analyses indicate that the higher mode contributions to the tube response are significant for strong tube-baffle impacting. The contact damping forces are negligible compared with the contact spring forces. The numerical analysis results are in reasonably good agreement with those of the experiments.

Experiment and analysis of instability of tube rows subject to liquid crossflow

International Nuclear Information System (INIS)

Chen, S.S.; Jendrzejczyk, J.A.

1981-09-01

A tube array subjected to crossflow may become unstable by either one or both of the two basic mechanisms: velocity mechanism and displacement mechanism. The significance of these two mechanisms depends on the mass-damping parameter. The velocity mechanism is dominant for tube arrays with a low mass-damping parameter, and the displacement mechanism is dominant for tube arrays with a high mass-damping parameter. This report presents an experimental and analytical investigation of tube rows in liquid crossflow. The main objective is to verify a mathematical model and the transition between the two mechanisms at the intermediate values of mass-damping parameter. Tests of two tube rows are conducted to determine the critical flow velocity as a function of system damping. Experimental and analytical results are found to be in good agreement

Bender/Coiler for Tubing

Science.gov (United States)

Stoltzfus, J. M.

1983-01-01

Easy-to-use tool makes coils of tubing. Tubing to be bend clamped with stop post. Die positioned snugly against tubing. Operator turns handle to slide die along tubing, pushing tubing into spiral groove on mandrel.

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...

Nursing administration of medication via enteral tubes in adults: a systematic review.

Science.gov (United States)

Phillips, Nicole M; Nay, Rhonda

2007-09-01

Background  Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives  The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy  The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included

Notes on the voltage performance of accelerator tube sub-modules for the NSF tandem

International Nuclear Information System (INIS)

Eastham, D.A.; Groome, A.E.; Powell, P.

1978-01-01

Measurements are reported of the d.c. voltage performance of vacuum accelerator tube sub-modules for the Nuclear Structure Facility 30 MV Tandem at Daresbury. Using diagnostic techniques it has been possible to separate out the different processes in the tube which can lead to breakdown. As a result, improved sub-modules have been produced. Tests, have simulated the ion exchange processes which occur in longer tube lengths, and a better understanding has been obtained of the way in which these processes depend on the tube geometry and cleanliness. (U.K.)

Light Production in the Double Chooz Photomultiplier Tubes

Energy Technology Data Exchange (ETDEWEB)

Calvo, E.; Cerrada, M.; Crespo, J. I.; Gil-Botella, I.; Jimenez, S.; Lopez, M.; Novella, P.; Palomares, C.; Santorelli, R.; Verdugo, A.

2012-09-13

In this document we present a study of the phenomenon of light emission (called glowing) in the bases of the Hamamatsu R7081MOD-ASSY photomultiplier tubes (PMTs) used in the Double Chooz experiment. The tests have been carried out at the CIEMAT laboratories over a photomultiplier tube of the same model. We have studied the phenomenon making first a characterization of it, and then focusing on the dependence of the rate and the amount of emitted light versus voltage and temperature. In addition, we have looked for the possible existence of an ultraviolet component in the light which would be harmful for the experiment because it could be able to excite the scintillator liquid. Finally, we propose and test a method to reduce the light emission using a cover on the base of the photomultiplier tube.. (Author)

The development and application of overheating failure model of FBR steam generator tubes. 2

International Nuclear Information System (INIS)

Miyake, Osamu; Hamada, Hirotsugu; Tanabe, Hiromi

2001-11-01

The JNC technical report 'The Development and Application of Overheating Failure Model of FBR Steam Generator Tubes' summarized the assessment method and its application for the overheating tube failure in an event of sodium-water reaction accident of fast breeder reactor's steam generators (SGs). This report describes the following items studied after the publication of the above technical report. 1. On the basis of the SWAT-3 experimental data, realistic local heating conditions (reaction zone temperature and related heat transfer conditions) for the sodium-water reaction were proposed. New correlations are cosine-shaped temperature profiles with 1,170 C maximum for the 100% and 40% Monju operating conditions, and those with 1,110 C maximum for the 10% condition. 2. For the cooling effects inside of target tubes, LWR's studies of critical heat flux (CHF) and post-CHF heat transfer correlations have been examined and considered in the assessment. The revised assessment adopts the Katto's correlation for CHF, and the Condie-Bengston IV correlation for post-CHF. 3. Other additional examination for the assessment includes treatments of the whole heating effect (other than the local reaction zone) due to the sodium-water reaction, and the temperature-dependent thermal properties of the heat transfer tube material (2.25Cr-1Mo steel). The revised overheating tube failure assessment method has been applied to the Monju SG studies. It is revealed consequently that no tube failure occurs in 100%, 40%, and 10% operating conditions when an initial leak is detected by the cover gas pressure detection system. The assessment for the SG system improved for the detection and blowdown systems shows even better safety margins against the overheating tube failure. (author)

Steam generator tube extraction

International Nuclear Information System (INIS)

Delorme, H.

1985-05-01

To enable tube examination on steam generators in service, Framatome has now developed a process for removing sections of steam generator tubes. Tube sections can be removed without being damaged for treating the tube section expanded in the tube sheet

A thermal mixing model of crossflow in tube bundles for use with the porous body approximation

International Nuclear Information System (INIS)

Ashcroft, J.; Kaminski, D.A.

1996-06-01

Diffusive thermal mixing in a heated tube bundle with a cooling fluid in crossflow was analyzed numerically. From the results of detailed two-dimensional models, which calculated the diffusion of heat downstream of one heated tube in an otherwise adiabatic flow field, a diffusion model appropriate for use with the porous body method was developed. The model accounts for both molecular and turbulent diffusion of heat by determining the effective thermal conductivity in the porous region. The model was developed for triangular shaped staggered tube bundles with pitch to diameter ratios between 1.10 and 2.00 and for Reynolds numbers between 1,000 and 20,000. The tubes are treated as nonconducting. Air and water were considered as working fluids. The effective thermal conductivity was found to be linearly dependent on the tube Reynolds number and fluid Prandtl number, and dependent on the bundle geometry. The porous body thermal mixing model was then compared against numerical models for flows with multiple heated tubes with very good agreement

Steam generator tube integrity requirements and operating experience in the United States

International Nuclear Information System (INIS)