Retroesophageal right subclavian artery: A case report and review ...

African Journals Online (AJOL)

Background: Variations of vessels arising from the aortic arch are numerous. One of the common anatomical variations is the right subclavian artery originating as the last branch of the aortic arch. This is a report of a case of an adult male cadaver with a retroesophageal right subclavian artery. Objective: To highlight the ...

Prediction of subclavian vein location using plain chest radiography.

Science.gov (United States)

Fukutome, T; Shigematsu, A

1986-12-01

The relationship between the right subclavian vein and the thoracic inlet below the clavicle was studied by Venography in 72 patients. The area of the thoracic inlet below the clavicle was defined as a radiolucent area surrounded superiorly by the lower border of the clavicle, inferiorly by the inner margin of the first rib and medially by the lateral margin of the manubrium (CRM area). In 10 patients, the subclavian vein was situated below the axis of the clavicle, and the CRM area was large enough to extend near the top of the first rib arch. In 62 patients, the subclavian vein extended above the axis of the clavicle and the CRM area was small or invisible. The existence of a large thoracic inlet below the clavicle (large CRM area which extends near the top of the first rib arch) may be a useful indicator for predicting the low location of the subclavian vein, and may be used to predict or explain venipuncture failure using the standard infraclavicular approach.

Refractory Hypotension as an Initial Presentation of Bilateral Subclavian Artery Stenosis

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Maxwell Eyram Afari

2016-01-01

Full Text Available Bilateral subclavian stenosis is a rare clinical condition. An interbrachial pressure difference of 15 mm Hg can raise suspicion for unilateral subclavian artery stenosis, but the diagnosis of bilateral subclavian artery stenosis can be challenging. We present a case of a 75-year-old woman who presented with refractory hypotension after surgery. Initial vitals revealed blood pressure in the 60s/50s mm Hg in both arms. Cardiopulmonary examination was remarkable for diminished pulses in all 4 extremities and audible carotid bruits. She continued to be hypotensive despite aggressive fluid resuscitation. Troponin T peaked at 0.24 ng/mL (reference < 0.04, and an echocardiogram revealed a reduction in ejection fraction (37% from 50%. Left and right heart catheterization demonstrated normal filling pressures and cardiac output. During the procedure, however, it was noted that the patient’s central blood pressure was 70–80 mm Hg higher than cuff pressures obtained in either arm. Selective angiography revealed 90% left subclavian ostial stenosis as well as 70% stenosis of the right subclavian artery.

Subclavian Artery Pseudoaneurysm Formation 3 Months after a Game of Rugby Union

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T. Evans

2015-01-01

Full Text Available Pseudoaneurysms of the subclavian artery remain a rare complication after fracture of the clavicle. We report a case of delayed diagnosis of a subclavian artery pseudoaneurysm after a closed fracture of the clavicle in a 15-year-old patient, 3 months after the original injury while playing rugby union. Despite several attendances to the Emergency Department with vague symptoms, the final diagnosis was confirmed by duplex ultrasound and Computed Tomography of the thorax. Surgical repair was indicated due to acute limb ischaemia from distal embolisation from a large pseudoaneurysm, with the patient making a full recovery. This case highlights the need for clinical vigilance when assessing patients, particularly on repeated occasions when their recovery appears to be impaired. A thorough history and clinical examination can raise suspicion of even rare occurrences and aid prompt management.

[Coronary subclavian steal syndrome: two cases after coronary artery bypass grafting

DEFF Research Database (Denmark)

Penninga, L.; Damgaard, S.

2008-01-01

Reverse flow in the internal mammary artery (IMA) graft due to stenosis or occlusion of the proximal ipsilateral subclavian artery causes coronary subclavian steal syndrome (CSSS). We describe two patients who were diagnosed with CSSS following CABG. Patient A presented with angina pectoris...

Right cervical aortic arch with aberrant left subclavian artery.

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Tjang, Yanto S; Aramendi, José I; Crespo, Alejandro; Hamzeh, Gadah; Voces, Roberto; Rodríguez, Miguel A

2008-08-01

The combination of right cervical aortic arch, aberrant retroesophageal left subclavian artery originating from a Kommerell's diverticulum, and a ligamentum arteriosum, constitutes a rare form of vascular ring. Two patients aged 21 days and 54 years, who were diagnosed by multislice 3-dimensional computed tomography and magnetic resonance imaging, underwent surgical division of a vascular ring. The adult required resection of a Kommerell's aneurysm and subclavian artery reimplantation.

Combined jugular and subclavian vein thrombosis following assisted reproductive technology--new observation.

Science.gov (United States)

Salomon, Ophira; Schiby, Ginette; Heiman, Zehava; Avivi, Kamila; Sigal, Carol; Levran, David; Dor, Jeushua; Itzchak, Yacov

2009-08-01

To study the predilection of jugular and subclavian vein thrombosis in patients going through assisted reproductive technology (ART). This technology puts women at high risk of developing the ovarian hyperstimulation syndrome (OHSS) and thrombotic events. Study cases. Large Academic Medical Center. Five women who developed jugular and subclavian vein thrombosis following ART were included in the study. The deep vein thrombosis was demonstrated by ultrasound Doppler or computerized tomography angiography. All women were interviewed and data obtained from outpatient and hospital medical charts. Magnetic resonance imaging and complete thrombophilic profile workup was performed in each woman. Open biopsy from the lesions was taken from one of the women. Correlation between mechanical branchial cysts filled with fluid during OHSS and jugular and subclavian vein thrombosis. Five women developed jugular and subclavian vein thrombosis following ART. They were found to harbor clusters of rudimentary branchial cysts filled with fluid at the time of OHSS, which compressed the jugular and subclavian veins at their junction at the base of the neck. Four patients (80%) were found to be carriers of factor V Leiden. Predilection of jugular and subclavian vein thrombosis early in pregnancy is the result of mechanical compression mediated by rudimentary branchial cysts filled with fluid during OHSS, particularly in subjects who are carriers of factor V Leiden.

Balloon catheter dilatation in the treatment of the subclavian steal syndrome

International Nuclear Information System (INIS)

Arlart, I.P.

1988-01-01

The present paper reports on the results of PTA in the treatment of subclavian steal syndrome and significant proximal subclavian artery stenosis in thirteen patients. In all cases, it was possible to dilate the stenoses successfully and without complications. Cerebral symptoms caused by the steal phenomenon (seven patients) were relieved in all cases and ischaemic symptoms in the arms produced by exercise were cured in ten out of eleven patients. Balloon catheter dilatation of proximal subclavian stenosis in symptomatic patients is the treatment of choice, as judged by our own experience and the data in the literature. (orig.) [de

Stenting-plasty with brachial puncture in the treatment of subclavian steal syndrome

International Nuclear Information System (INIS)

Chen Quan; Jing Zaiping; Zhao Zhiqing; Feng Xiang; Lu Qingsheng; Mei Zhijun

2007-01-01

Objective: To study the clinical effect of stenting-plasty with retrograde brachial puncture for subclavian steal syndrome patients. Methods: To analyze the clinical results of stenting-plasty with retrograde brachial puncture in 15 patients with subclavian steal syndrome. Results: MRA or DSA showed the subclavian arteries with different degrees of stenosis (80%-100%) in all patients. Stenting-plasty with retrograde brachia] puncture was used in all patients. After placement of wall or polmaz stent, the pulse recovered and the syndrome disappeared. Postoperative angiography showed patency of the artery and stent. The patients were followed up for 3-30 months without recurrence of symptoms. Conclusions: Stenting-plasty with retrograde brachial puncture is a rather proper method to treat subclavian steal syndrome with more coincidence to the vascular anatomy, decrease the maneuver trouble and increase the successful rate. (authors)

An isolated left subclavian artery supplied by a collateral artery from the abdominal aorta

International Nuclear Information System (INIS)

Ming, Zhu; Qian, Wang

2009-01-01

An isolated left subclavian artery is a rare anomaly. We report a 9-month-old boy with an isolated left subclavian artery associated with tetralogy of Fallot and the right aortic arch. MRI and angiography show that the blood supply through the left subclavian artery was maintained by a large tortuous collateral artery from the abdominal aorta. This type of collateral artery structure is unique. (orig.)

An isolated left subclavian artery supplied by a collateral artery from the abdominal aorta

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Ming, Zhu; Qian, Wang [Shanghai Jiaotong University School of Medicine, Department of Radiology, Shanghai Children' s Medical Center, Shanghai (China)

2009-08-15

An isolated left subclavian artery is a rare anomaly. We report a 9-month-old boy with an isolated left subclavian artery associated with tetralogy of Fallot and the right aortic arch. MRI and angiography show that the blood supply through the left subclavian artery was maintained by a large tortuous collateral artery from the abdominal aorta. This type of collateral artery structure is unique. (orig.)

Two-phase summation imaging using transvenous DSA in subclavian steal syndrome

International Nuclear Information System (INIS)

Arlart, I.P.

1984-01-01

A simple method is reported to obtain a two-phase summation image in subclavian steal syndrome using digital subtraction angiography (DSA) via selection of a mask during the early arterial phase and the contrast image during delayed retrograde filling of the ipsilateral vertebral artery and the postocclusive subclavian artery. The summation image results by employing replay of the stored image information. (orig.) [de

INTERNAL BALLOON TAMPONADE - A NONSURGICAL METHOD FOR REMOVAL OF ACCIDENTALLY PLACED SHEATHS FROM THE SUBCLAVIAN ARTERY

NARCIS (Netherlands)

VANDIJK, RB; DENHEIJER, P; DEMUINCK, E; LIE, KI

One of the possible complications of subclavian vein puncture is accidental puncture of the subclavian artery. If this is not noted immediately after the puncture, insertion of a large bore sheath in the subclavian artery is likely to follow. We describe our experience with a new method that enables

Thoracic aortic stent-graft placement combined with left subclavian artery 'chimney operation': therapeutic analysis of 15 cases with insufficient proximal anchor area

International Nuclear Information System (INIS)

Liu Jiayi; Huang Lianjun; Fan Zhanming; Zhang Zhaoqi

2012-01-01

Objective: To discuss the strategies for the management of insufficient proximal anchoring area during the performance of transluminal stent-graft placement (TSGP), and to evaluate the feasibility of intentional coverage of the left subclavian artery (LSA) together with left subclavian artery stent-graft placement by using 'chimney operation' technique. Methods: A total of 15 patients with thoracic aortic diseases complicated by insufficient proximal anchoring area, who were encountered in authors' hospital during the period from Dec. 2009 to April 2011, were enrolled in this study. The clinical data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection (n=6), aortic pseudoaneurysm (n=1), aortic aneurysm (n=4) and penetrating ulcer (n=4). Of the 15 patients, the distance between the lesion and LSA anchoring site 15 mm in 2. TSGP was carried out. The ostium of LSA was intentionally and completely covered by thoracic aortic stent-graft and left subclavian artery stent-graft placement was subsequently performed. The patients were kept under observation for symptoms of cerebral and upper limb ischemia. The postoperative complications such as endoleak and the patency of LSA were assessed with angiography. Results: Thoracic aortic stent-graft placement was successfully carried out in all 15 patients. In addition, one 'chimney' stent was properly implanted in LSA in each patient. After the procedure, no complications of nervous system or severe ischemia of upper extremity occurred. Follow-up examinations performed between 5 days to 3 months after the treatment revealed that the aortic stent-graft remained in stable condition and no type Ⅰ endoleak occurred, meanwhile the blood flow in 'chimney' stent was unobstructed. Conclusion: Intentional LSA coverage with 'chimney operation' can expand the applicability of TSGP with high tolerability. It is especially useful for patients with left vertebral artery blood supply dominance or with

FEATURES OF FORMATION OF COLLATERAL CIRCULATION IN PATIENTS WITH SUBCLAVIAN STEAL SYNDROME.

Science.gov (United States)

Kopolovets, I; Štefanič, P; Rusyn, V; Tóth, Š; Mashura, V; Berek, P

2017-12-01

To date in patients with subclavian steal syndrome diagnosis is only grade of stenosis or localization of occlusion described. Authors recommend to take into account also type of a collateral compensation of cerebral circulation for selection of an optimal treatment The objective of the research was to study the features of formation of collateral circulation in patients with subclavian steal syndrome. The authors described changes in the direction of blood flow in the extracranial vessels of 42 patients with subclavian steal syndrome. Latent subclavian steal syndrome was detected in 26.2% of patients, transient subclavian steal syndrome was found in 54.8% of patients, and a persistent course of the disease was observed in 19.9% of patients. Symptoms of vertebrobasilar insufficiency were detected in 26.6% of patients, and combination of chronic upper extremity ischemia and vertebrobasilar insufficiency was diagnosed in 73.8% of patients. When analyzing the features of collateral circulation in 64.3% of patients the extracranial compensatory mechanism was observed being provided by three main groups of collateral hemodynamic reallocation: the occipito-vertebral hemodynamic mechanism of compensation was detected in 38.1% of cases, the thyroid compensatory mechanism was found in 16.7% of cases, and the brain stem-occipital compensatory mechanism was observed in 9.5% of cases. In 35.7% of patients the intracranial compensatory mechanism was observed being provided by two main groups of collateral hemodynamic reallocation: the vertebro-vertebral compensatory mechanism was found in 21.4% of cases and cerebrobasilar compensatory mechanism was detected in 14.3% of cases. Consideration of the features of collateral circulation in patients with subclavian steal syndrome may serve as a prognostic criterion for selecting an optimal treatment tactics.Each of compensatory mechanisms has its own hemodynamic peculiarities. The occipito- vertebral compensatory mechanism has the

Percutaneous endovascular therapy for symptomatic chronic total occlusion of the left subclavian artery.

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Akif Cakar, Mehmet; Tatli, Ersun; Tokatli, Alptug; Kilic, Harun; Gunduz, Huseyin; Akdemir, Ramazan

2018-03-16

Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery. Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included. Overall, 16 patients (10 male, 6 female; mean age 56 ± 13 years) underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery - 6 (37.5%) had arm claudication, 8 (50.0%) had vertebrobasilar insufficiency and 2 (12.5%) had coronary steal. 18 balloon-expandable stents were implanted to 15 patients. The central luminal passage was not achieved in one patient because of the subintimal position of guidewire (procedural success rate 93.8%). There were no procedure-related complications. Mean preprocedural and postprocedural systolic blood pressure differences between the upper extremities were 37 ± 13 (range 25-60) mmHg and 11 ± 9 (range 5-38) mmHg, respectively; the improvement was statistically significant. Outpatient follow-up revealed one asymptomatic restenosis at two years. Patency rate at two years was 93.3%. Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results.

Penetrating spinal injuries and their management

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A Kumar

2011-01-01

Full Text Available Penetrating spinal trauma due to missile/gunshot injuries has been well reported in the literature and has remained the domain of military warfare more often. Civic society′s recent upsurge in gunshot injuries has created a dilemma for the treating neurosurgeon in many ways as their management has always involved certain debatable and controversial issues. Both conservative and surgical management of penetrating spinal injuries (PSI have been practiced widely. The chief neurosurgical concern in these types of firearm injuries is the degree of damage sustained during the bullet traversing through the neural tissue and the after-effects of the same in long term. We had an interesting case of a penetrating bullet injury to cervical spine at C2 vertebral level. He was operated and the bullets were removed from posterior midline approach. Usually, the management of such cases differs from region to region depending on the preference of the surgeon but still certain common principles are followed world over. Thus, we realized the need to review the literature regarding spinal injuries with special emphasis on PSI and to study the recent guidelines for their treatment in light of our case.

Thrombosis caused by polyurethane double-lumen subclavian superior vena cava catheter and hemodialysis

DEFF Research Database (Denmark)

Wanscher, Maria Rørbæk; Frifelt, J J; Smith-Sivertsen, C

1988-01-01

During an 18-month period, 82 consecutive patients (37 women and 45 men), with a mean age of 50 yr (range 15 to 74), underwent hemodialysis with 91 polyurethane double-lumen subclavian superior vena cava catheters inserted via the right subclavian vein. Upon catheter removal, venograms were...

The contemporary management of penetrating splenic injury.

Science.gov (United States)

Berg, Regan J; Inaba, Kenji; Okoye, Obi; Pasley, Jason; Teixeira, Pedro G; Esparza, Michael; Demetriades, Demetrios

2014-09-01

Selective non-operative management (NOM) is standard of care for clinically stable patients with blunt splenic trauma and expectant management approaches are increasingly utilised in penetrating abdominal trauma, including in the setting of solid organ injury. Despite this evolution of clinical practice, little is known about the safety and efficacy of NOM in penetrating splenic injury. Trauma registry and medical record review identified all consecutive patients presenting to LAC+USC Medical Center with penetrating splenic injury between January 2001 and December 2011. Associated injuries, incidence and nature of operative intervention, local and systemic complications and mortality were determined. During the study period, 225 patients experienced penetrating splenic trauma. The majority (187/225, 83%) underwent emergent laparotomy. Thirty-eight clinically stable patients underwent a deliberate trial of NOM and 24/38 (63%) were ultimately managed without laparotomy. Amongst patients failing NOM, 3/14 (21%) underwent splenectomy while an additional 6/14 (42%) had splenorrhaphy. Hollow viscus injury (HVI) occurred in 21% of all patients failing NOM. Forty percent of all NOM patients had diaphragmatic injury (DI). All patients undergoing delayed laparotomy for HVI or a splenic procedure presented symptomatically within 24h of the initial injury. No deaths occurred in patients undergoing NOM. Although the vast majority of penetrating splenic trauma requires urgent operative management, a group of patients does present without haemodynamic instability, peritonitis or radiologic evidence of hollow viscus injury. Management of these patients is complicated as over half may remain clinically stable and can avoid laparotomy, making them potential candidates for a trial of NOM. HVI is responsible for NOM failure in up to a fifth of these cases and typically presents within 24h of injury. Delayed laparotomy, within this limited time period, did not appear to increase

Penetrating abdominal injuries: management controversies

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Butt, Muhammad U; Zacharias, Nikolaos; Velmahos, George C

2009-01-01

Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries. PMID:19374761

Penetrating abdominal injuries: management controversies

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Velmahos George C

2009-04-01

Full Text Available Abstract Penetrating abdominal injuries have been traditionally managed by routine laparotomy. New understanding of trajectories, potential for organ injury, and correlation with advanced radiographic imaging has allowed a shift towards non-operative management of appropriate cases. Although a selective approach has been established for stab wounds, the management of abdominal gunshot wounds remains a matter of controversy. In this chapter we describe the rationale and methodology of selecting patients for non-operative management. We also discuss additional controversial issues, as related to antibiotic prophylaxis, management of asymptomatic thoracoabdominal injuries, and the use of colostomy vs. primary repair for colon injuries.

Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience

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Marjanović Ivan

2016-01-01

Full Text Available We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

Anatomical Arrangement of the Subclavian Artery Branches in the Rabbit and European Hare

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Maženský D.

2017-12-01

Full Text Available The aim of this study was to compare the anatomical arrangements of the branches arising from the subclavian arteries in the domesticated rabbit and hare. The study was carried out on ten adult rabbits and ten adult European hares using the corrosion cast technique. After the euthanasia, the vascular network was perfused with saline. The arterial system of the entire body was injected by Batson’s corrosion casting kit No. 17. After polymerization of the medium, the maceration was carried out in KOH solution. The arrangement of the origins of the branches of the bilateral subclavian arteries were more variable in the hare. The number of branches arising from the subclavian artery were more regular in the rabbit on the right side and in the hare on the left side. In the rabbit, we found in two cases, the origins of the branches of the left subclavian artery from the aortic arch. The anatomical found between the rabbit and the hare may possibly be associated with their different ways of life.

RIGHT-SIDED AORTIC ARCH WITH ABERRANT LEFT SUBCLAVIAN ARTERY AND DUPLICATION OF SUPERIOR VENA CAVA

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Parikhita Hazarika

2017-08-01

Full Text Available Right-sided aortic arch is a rare anatomical variant present in about 0.1% of the adult population.1,2 Half of the cases are associated with an aberrant left subclavian artery (0.05%-0.1%. Right-sided aortic arch with aberrant left subclavian artery is less common than left-sided aortic arch with aberrant right subclavian artery (0.5-2.0%.3,4 A rightsided aortic arch is an anatomic variant resulting from persistence of the right fourth aortic arch and involution of the left. It can be associated with an aberrant left subclavian artery arises from Kommerell’s diverticulum. It is usually asymptomatic and diagnosed incidentally during adult age. A 40-year-old male presented with cough and a hump in the back. The patient was evaluated for scoliosis and plain CT thorax was done.

Abduction of Arm Facilitates Correction of Kinked Peel-Away Sheath During Subclavian Central Line Placement.

Science.gov (United States)

Kim, Sunghoon

2015-12-01

A tunneled central line catheter placement using a subclavian vein approach can be complicated by an occurrence of peel-away sheath kink which prevents the advancement of the catheter through the sheath. The kink is created due to the angular junction of subclavian and brachiocephalic veins which meet at 90 degree angle. A technique is described which corrects the peel-away sheath kink by extending the subclavian/brachiocephalic vein angle to greater than 90 degrees by abducting the patient's arm. Copyright © 2015 Elsevier Inc. All rights reserved.

Hemodialysis shunts-related subclavian vein stenosis : treatment with self-expandable metallic stent

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Kim, Sang Gyee; Lee, Young Chul; Shin, Sang Soo; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun; Jeong, Sang Young; Choi, Su Jin Na [Chonnam Univ. College of Medicine, Kwangju (Korea, Republic of)

1999-04-01

To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-related subclavian vein stenosis. Self-expandable metallic stent was placed in nine patients with hemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stent placement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis after angioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and the measurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5 months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. The stenotic sites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomic narrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%;a resulting complication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this was removed by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosis developed in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases were treated by balloon dilatation. In hemodialytic shunt-related subclavian vein stenosis, treatment involving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has not responded to angioplasty with a high patency rate.

Hemodialysis shunts-related subclavian vein stenosis : treatment with self-expandable metallic stent

International Nuclear Information System (INIS)

Kim, Sang Gyee; Lee, Young Chul; Shin, Sang Soo; Kim, Yun Hyeon; Kim, Jae Kyu; Kang, Heoung Keun; Jeong, Sang Young; Choi, Su Jin Na

1999-01-01

To evaluate the usefulness of placement of self-expandable stents in hemodialytic shunt-related subclavian vein stenosis. Self-expandable metallic stent was placed in nine patients with hemodialytic shunt-related subclavian vein stenosis. In seven cases, angioplasty was attempted before stent placement; in five, stents were placed immediately after failed angioplasty; and in two, due to restenosis after angioplasty. Procedures involved a 10mm diameter, 7-10cm length Wallstent in eight cases, and a 10mm diameter, 8cm length Hanaro stent in one. In all cases, clinical follow-up, which included physical examination and the measurement of venous resistance pressure during hemodialysis, was performed. The follow-up period was between 5 months and 1 year 7 months. Repeated intervention was performed if restenosis was detected. The stenotic sites were in eight cases the site of a previous subclavian venous line, and in one, the site of anatomic narrowing at the thoracic inlet of the subclavian vein. The technical success rate was 100%;a resulting complication was stent migration into the right atrium in one case in which a Hanaro stent had been used; this was removed by snaring. During follow-up of the eight patients in whon stent placement was successful, restenosis developed in three cases. This occurred during the 7th, 8th, and 15th month, respectively. Two such cases were treated by balloon dilatation. In hemodialytic shunt-related subclavian vein stenosis, treatment involving the use of a self-expandable metallic stent is useful, especially for treating a lesion which has not responded to angioplasty with a high patency rate

Open Repair of a 12-cm Posttraumatic Aneurysm of Right Subclavian Artery

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Konstantinos Tigkiropoulos

2017-11-01

Full Text Available PurposeTo present a rare case of a patient with a 12-cm posttraumatic right subclavian artery aneurysm successfully treated with aneurysmectomy and innominate-axillary bypass.Case reportA 54-year-old man presented to the emergency department due to progressive dyspnea and hoarseness of voice. His medical record was unremarkable except that he had right-sided pneumothorax and multiple rib fractures from a car accident 16 years ago. A chest X-ray showed a mass in the upper lobe of the right lung, and the patient was hospitalized for further investigation. A computed tomography (CT with intravenous contrast of the thorax was performed, which depicted a giant aneurysm of the right subclavian artery. Vascular and cardiothoracic surgeons were consulted immediately, and the operation was scheduled. Aneurysmectomy and innominate-axillary bypass were performed. The patient had an uncomplicated progress and was discharged on 5 days followed by a single antiplatelet therapy and symptom-free.ConclusionPosttraumatic subclavian artery aneurysm is a rare entity. Imaging of the thorax is essential for the diagnosis and surgical preparation of the patient. Open repair remains the gold standard therapy for subclavian artery aneurysm despite the improvements in endovascular surgery in such huge aneurysms.

Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

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Wen-Hsien Lu

2006-04-01

Conclusion: In our study, we found that there was no statistically significant difference among the 4 SVC locations in effectiveness of operation or in risk of complication. There was a tendency to damage the subclavian arteries through the supraclavicular route.

Experience With The Management Of unusual Penetrating Chest ...

African Journals Online (AJOL)

The presentation shows how a victim of fall from height in the bush can sustain a penetrating chest injury on a dry stick of a shrub. Applications on the principles of management of penetrating chest injury is needed despite the grotesque clinical appearance. [Jnl College of Medicine Vol.7(1) 2002: 40-42] ...

Aberrant right subclavian artery causing megaoesophagus in three cats.

Science.gov (United States)

Cinti, F; Della Santa, D; Borgonovo, S; Bussadori, R; Troiano, D; Pisani, G

2018-05-07

Three entire, domestic, shorthair male cats (age range: 3 months to 5 years) were referred because of regurgitation. Megaoesophagus attributable to aberrant right subclavian artery, originating from the aorta at the level of the fourth intercostal space, was diagnosed in all cats using thoracic radiography and CT angiography. One cat had concurrent patent ductus arteriosus with a normal aortic arch. Three-dimensional volume-rendered CT images were used to assess the malformations and to plan surgery for the treatment of the vascular anomalies. Different surgical approaches were used in the two kittens. The third cat was not operated. CT angiography is well suited for preoperative planning in cats with aberrant right subclavian artery alone or in combination with other vascular anomalies. © 2018 British Small Animal Veterinary Association.

Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries

Science.gov (United States)

Demetriades, Demetrios; Hadjizacharia, Pantelis; Constantinou, Costas; Brown, Carlos; Inaba, Kenji; Rhee, Peter; Salim, Ali

2006-01-01

Objective: To assess the feasibility and safety of selective nonoperative management in penetrating abdominal solid organ injuries. Background: Nonoperative management of blunt abdominal solid organ injuries has become the standard of care. However, routine surgical exploration remains the standard practice for all penetrating solid organ injuries. The present study examines the role of nonoperative management in selected patients with penetrating injuries to abdominal solid organs. Patients and Methods: Prospective, protocol-driven study, which included all penetrating abdominal solid organ (liver, spleen, kidney) injuries admitted to a level I trauma center, over a 20-month period. Patients with hemodynamic instability, peritonitis, or an unevaluable abdomen underwent an immediate laparotomy. Patients who were hemodynamically stable and had no signs of peritonitis were selected for further CT scan evaluation. In the absence of CT scan findings suggestive of hollow viscus injury, the patients were observed with serial clinical examinations, hemoglobin levels, and white cell counts. Patients with left thoracoabdominal injuries underwent elective laparoscopy to rule out diaphragmatic injury. Outcome parameters included survival, complications, need for delayed laparotomy in observed patients, and length of hospital stay. Results: During the study period, there were 152 patients with 185 penetrating solid organ injuries. Gunshot wounds accounted for 70.4% and stab wounds for 29.6% of injuries. Ninety-one patients (59.9%) met the criteria for immediate operation. The remaining 61 (40.1%) patients were selected for CT scan evaluation. Forty-three patients (28.3% of all patients) with 47 solid organ injuries who had no CT scan findings suspicious of hollow viscus injury were selected for clinical observation and additional laparoscopy in 2. Four patients with a “blush” on CT scan underwent angiographic embolization of the liver. Overall, 41 patients (27

Aneurysm of the aberrant right subclavian artery – a case report

International Nuclear Information System (INIS)

Godlewski, Janusz; Widawski, Tomasz; Michalak, Maciej; Kmieć, Zbigniew

2010-01-01

The right subclavian artery, originating not from the brachiocephalic trunk but directly from the aortic arch, is a rare anatomical abnormality. ‘Arteria lusoria’ is the accepted name of the retroesophageal right subclavian artery. Such a vessel location, between the vertebral column and the esophagus, determines its course to the right. This defect may be asymptomatic, found during autopsy or coincidentally during diagnostic procedures. However, it may also be symptomatic. The course of this major blood vessel in the limited anatomical space may cause symptoms of mediastinal organ compression. The aim of this paper was to present two cases of abnormal anatomical course of the right subclavian artery and its aneurismal dilation. In this study, CT scans of the saccular aneurysm of the retroesophageal right subclavian artery were used: of a male patient diagnosed at Euromedic Diagnostics in Olsztyn and of a female patient, from the resources of the Radiological Dept. at MSWiA Hospital in Olsztyn An 85-year-old female was admitted to Hospital ER for congestive heart failure decompensation. Her chest X-ray revealed a round mass in the upper right mediastinum. Chest CT confirmed the presence of a saccular aneurysm of the lusory artery, 6.5 cm in diameter, partially filled with thrombotic material. The patient died in hospital from myocardial infarction that was not related to the aneurysm. A 61-year-old male patient had a chest X-ray which showed a round opacity on the apex of the right lung. The diagnostic process comprised also chest computed tomography. The examination showed an anomalous origin of the right subclavian artery, with aneurysmal dilation and compression of the oesophagus and of the trachea. An intraluminal thrombus was found. The patient remained under observation till the next CT examination, 6 months later. The presented rare cases of arteria lusoria aneurysm are not only casuistic reports. They also show the value of modern MDCT diagnostics

Subclavian Aberrant right artery aneurysm causing a common carotid trunk: findings in CT and MR

International Nuclear Information System (INIS)

Quiroga Gomez, S.; Alvarez Castells, A.; Dominguez Oronoz, R.; Gifre Bassols, L.

1995-01-01

We present a case of aberrant right subclavian artery aneurysm causing dysphagia, dysphonia, and Claude-Bernard-Horner's syndrome by compression of adjacent structures, initially diagnosed with plain chest radiography and barium-swallow examination. CT and MRI confirmed this vascular anomaly and showed a common carotid trunk, associated to aberrant subclavian artery in 29% of cases. (Author) 10 refs

Subclavian vein aneurysm secondary to a benign vessel wall hamartoma

Energy Technology Data Exchange (ETDEWEB)

Warren, Patrick [Nationwide Children' s Hospital, Section of Pediatric Interventional Radiology, Columbus, OH (United States); Spaeth, Maya [Nationwide Children' s Hospital, Section of Plastic and Reconstructive Surgery, Columbus, OH (United States); Prasad, Vinay [Nationwide Children' s Hospital, Section of Pediatric Pathology, Columbus, OH (United States); McConnell, Patrick [Nationwide Children' s Hospital, Section of Cardiothoracic Surgery, Columbus, OH (United States)

2013-11-15

Venous aneurysms are rare clinical entities, particularly in children, and their presentation and natural history often depend on the anatomical location and underlying etiology. We present a single case of a 12-year-old girl who presented with a palpable right supraclavicular mass. Imaging evaluation with CT, conventional venography, MRI and sonography revealed a large fusiform subclavian vein aneurysm with an unusual, mass-like fibrofatty component incorporated into the vessel wall. The girl ultimately required complete resection of the right subclavian vein with placement of a synthetic interposition graft. This case provides a radiology/pathology correlation of an entity that has not previously been described as well as an example of the utility of multiple imaging modalities to aid diagnosis and preoperative planning. (orig.)

Selective observational management of penetrating neck injury in ...

African Journals Online (AJOL)

Background. The most appropriate management of penetrating neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution. Methods. The study was conducted between 1991 and ...

Suicide by severing the arterio-venous subclavian dialysis catheter.

Science.gov (United States)

Edirisinghe, P A S; Busuttil, A

2006-02-01

Haemodialysis access is an essential requirement for haemodialysis treatment in end-stage renal disease. The common forms are arteriovenous fistula (AVF) and arteriovenous grafts in ante-cubital fossa, forearm and upper thigh. Sometimes temporary or immediate access is created via a subclavian catheter or internal jugular catheter. This report is on a 79-year-old man who was suffering from chronic renal failure with a non-functional peripheral AVF; he was being dialysed through a permanent subclavian catheter and he became depressed due to continuing deterioration of his health. He used the easily accessible haemodialysis site as the method of suicide by cutting the tube that connected with the main vessel in his chest and bled to death. This highlights the requirement to assess carefully the patient's mental state in those on chronic haemodialysis, even though very few similar fatal cases have been previously reported.

LAPAROSCOPIC MANAGEMENT OF RETROPERITONEAL INJURIES IN PENETRATING ABDOMINAL INJURIES.

Science.gov (United States)

Mosai, F

2017-09-01

Laparoscopy in penetrating abdominal injuries is now accepted and practiced in many modern trauma centres. However its role in evaluating and managing retroperitoneal injuries is not yet well established. The aim of this study was to document our experience in using laparoscopy in a setting of penetrating abdominal injuries with suspected retroperitoneal injury in haemodynamically stable patients. A retrospective descriptive study of prospectively collected data from a trauma unit at Dr George Mukhari Academic Hospital (DGMAH) was done. All haemodynamically stable patients with penetrating abdominal injury who were offered laparoscopy from January 2012 to December 2015 were reviewed and those who met the inclusion criteria were analysed. A total of 284 patients with penetrating abdominal injuries were reviewed and 56 met the inclusion criteria and were analysed. The median age was 30.8 years (15-60 years) and males constituted 87.5% of the study population. The most common mechanism of injury was penetrating stab wounds (62.5%). Forty-five patients (80.3%) were managed laparoscopically, of these n=16 (28.5%) had retroperitoneal injuries that required surgical intervention. The most commonly injured organ was the colon (19.6%). The conversion rate was 19.6% with most common indication for conversion been active bleeding (14%). The complication rate was 7.14% (N=4) and were all Clavien-Dindo grade 3. There were no recorded missed injuries and no mortality. The positive outcomes documented in this study with no missed injuries and absence of mortality suggests that laparoscopy is a feasible option in managing stable patients with suspected retroperitoneal injuries.

A Novel Combined Hybrid Approach to Enable Revascularisation of a Trauma-Induced Subclavian Artery Injury

Directory of Open Access Journals (Sweden)

C.N. Sabbagh

Full Text Available : Introduction: This case highlights the complexity of upper limb revascularization after a subclavian artery traumatic injury and strengthens the role of a hybrid/multi-disciplinary approach to such injuries. Report: A 45-year-old male patient presented with an acute right upper limb following a traumatic injury to the right subclavian artery due to a motor vehicle accident (MVA. Associated injuries included an unstable cervical spine injury, a large open right clavicular injury, and a brain injury, which limited the potential revascularisation options available. The arm was revascularised using a hybrid endovascular/open surgical approach, namely embolization of the proximal subclavian artery (just distal to vertebral artery and a right common femoral artery to distal axillary artery bypass using prosthetic material. Discussion: Blunt injuries to the subclavian artery are often high impact, complex and associated with multiple injuries to surrounding structures, which limit the role of standard procedures used in the elective setting. This case highlights the role of multidisciplinary team involvement, using a hybrid approach and a novel distal inflow site to restore upper limb perfusion. Keywords: Upper limb, Ischemia, Trauma, Revascularization

Traumatic partial avulsion of a single right subclavian artery from the aortic arch and definitive repair.

Science.gov (United States)

Kapetanakis, Emmanouil I; Sears-Rogan, Pamela; Young, Richard S; Kanda, Louis T; Ellis, Jennifer L

2006-01-01

Blunt injury to the right subclavian artery is a rare complication of severe deceleration trauma often associated with significant morbidity and mortality. We describe an atypical presentation in a patient who sustained a traumatic avulsion of his right subclavian artery arising off the aortic arch. An interposition graft was used to restore the continuity of the artery to the ascending thoracic aorta.

Arterial reconstruction of the brachiocephalic trunk and the subclavian arteries. 10 years' experience with a follow-up study

DEFF Research Database (Denmark)

Schroeder, T; Hansen, Hans Jørgen Buchardt

1980-01-01

During a 10-year period, 60 patients were operated on for occlusive lesions in the brachiocephalic trunk and/or the subclavian arteries proximal to the vertebral artery. Angiography showed 68 occlusive lesions, of which 64 were treated surgically. Of these, 47 exhibited subclavian steal. Sixty...

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma.

Science.gov (United States)

Noh, Dongsub; Lee, Chan-Kyu; Hwang, Jung Joo; Cho, Hyun Min

2018-04-01

Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. On postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation.

Nonoperative management of penetrating kidney injuries: a prospective audit.

Science.gov (United States)

Moolman, C; Navsaria, P H; Lazarus, J; Pontin, A; Nicol, A J

2012-07-01

The role of nonoperative management for penetrating kidney injuries is unknown. Therefore, we review the management and outcome of penetrating kidney injuries at a center with a high incidence of penetrating trauma. Data from all patients presenting with hematuria and/or kidney injury discovered on imaging or at surgery admitted to the trauma center at Groote Schuur Hospital in Cape Town, South Africa during a 19-month period (January 2007 to July 2008) were prospectively collected and reviewed. These data were analyzed for demographics, injury mechanism, perioperative management, nephrectomy rate and nonoperative success. Patients presenting with hematuria and with an acute abdomen underwent a single shot excretory urogram. Those presenting with hematuria without an indication for laparotomy underwent computerized tomography with contrast material. A total of 92 patients presented with hematuria following penetrating abdominal trauma. There were 75 (80.4%) proven renal injuries. Of the patients 84 were men and the median age was 26 years (range 14 to 51). There were 50 stab wounds and 42 gunshot renal injuries. Imaging modalities included computerized tomography in 60 cases and single shot excretory urography in 18. There were 9 patients brought directly to the operating room without further imaging. A total of 47 patients with 49 proven renal injuries were treated nonoperatively. In this group 4 patients presented with delayed hematuria, of whom 1 had a normal angiogram and 3 underwent successful angioembolization of arteriovenous fistula (2) and false aneurysm (1). All nonoperatively managed renal injuries were successfully treated without surgery. There were 18 nephrectomies performed for uncontrollable bleeding (11), hilar injuries (2) and shattered kidney (3). Post-nephrectomy complications included 1 infected renal bed hematoma requiring percutaneous drainage. Of the injuries found at laparotomy 12 were not explored, 2 were drained and 5 were treated with

A Right-sided Aortic Arch with Kommerell's Diverticulum of the Aberrant Left Subclavian Artery Presenting with Syncope

Directory of Open Access Journals (Sweden)

Ming-Hsun Yang

2009-05-01

Full Text Available A right-sided aortic arch with an aneurysm of the aberrant subclavian artery is a rare disease. We report a case of Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch. Fewer than 50 cases have been reported in the literature. A number of operative strategies are described. Right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy or sternotomy and thoracotomy. In our patient with symptoms of dysphagia, syncope, and left subclavian steal syndrome, a left thoracotomy was used. The repair was accomplished by division of a left ligamentum arteriosum, obliteration of the Kommerell's aneurysm, and an aorto-subclavian bypass. Postoperative complications included left vocal cord palsy and Horner's syndrome. Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up. We believe a left thoracotomy for direct repair of Kommerell's diverticulum is a simple and safe method without the increased morbidity found in other procedures.

Use of a Puncture Needle for Recanalization of an Occluded Right Subclavian Vein

International Nuclear Information System (INIS)

Gupta, Himanshu; Murphy, Timothy P.; Soares, Gregory M.

1998-01-01

We report a patient in whom we used a puncture needle to initiate percutaneous recanalization of a chronic occlusion of the junction between the right subclavian vein and the right brachiocephalic vein. Under fluoroscopic guidance, an 18-gauge needle was used to puncture the right subclavian vein. When contrast material injected through the needle confirmed intravascular location, the needle was advanced until it deflected and perforated an occlusion balloon target positioned within the right brachiocephalic vein. This technique may be useful in patients with central venous occlusions that are refractory to traversal using traditional catheter and guidewire techniques

Aberrant right subclavian artery- suggested mechanism for esophageal foreign body impaction: Case report

Directory of Open Access Journals (Sweden)

Best Lael A

2011-04-01

Full Text Available Abstract Aberrant right subclavian artery (ARSA is asymptomatic in most cases. This variant anatomy can cause dysphagia in elderly patients. Impaction of foreign body in the esophagus is rarely the presenting symptom of ARSA. We present an eighty four years old patient who first presented with esophageal foreign body impaction and was diagnosed with an aberrant right subclavian artery compressing the esophagus just below the site of impaction. We assume that the exact place of impaction was not incidental and that a relative narrowing of the esophagus caused by the vascular anomaly is responsible for this specific presentation.

Medicaid Managed Care Penetration Rates and Expansion Enr...

Data.gov (United States)

U.S. Department of Health & Human Services — The Medicaid managed care penetration rates and expansion enrollment by state charts are composed annually by the Data and System Group (DSG) of the Centers for...

Left subclavian artery revascularization as part of thoracic stent grafting

NARCIS (Netherlands)

Saouti, N.; Hindori, V.; Morshuis, W.J.; Heijmen, R.H.

2015-01-01

OBJECTIVES: Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our

Treatment of an Unusual Occurrence of a Complex Left Subclavian Artery/Left Internal Mammary Artery Bifurcation Stenosis in the Setting of Coronary Subclavian Steal Syndrome and Ischemic Left Ventricular Systolic Dysfunction

Directory of Open Access Journals (Sweden)

Michael J. Martinelli

2018-01-01

Full Text Available This case will illustrate the clinical and unique technical challenges, not previously reported, in a patient with a history of progressive left ventricular (LV systolic dysfunction, congestive heart failure (CHF, myocardial infarction (MI, and a complex bifurcation lesion of the left subclavian artery (SA involving the left internal mammary artery (LIMA in the setting of coronary subclavian steal syndrome (CSSS. The approach to this lesion is complicated by significant LIMA involvement requiring intervention directed toward both the SA and the LIMA in the presence of severe LV systolic dysfunction. This clinical scenario necessitates a careful technique, utilizing bifurcation methods similar to those used in coronary intervention.

The Effect of a Third Generation Hemostatic Dressing in a Subclavian Artery and Vein Transection Porcine Model

Science.gov (United States)

2014-04-01

small skin incision. The exposed subclavian vessels were treated with lidocaine , transected and allowed to free bleed for thirty seconds prior to...achieve hemorrhage control (Butler & Blackbourne, 2012) is typically ineffective in this region because pressure over the clavicle will not be...cavity depth, and cavity volume. The subclavian vessels were then immersed in 30 mL of 2% lidocaine (Phoenix Pharmaceuticals, St. Joseph, MO) for 10

Penetrating abdomino-thoracic injuries: report of four impressive, spectacular and representative cases as well as their challenging surgical management.

Science.gov (United States)

Eder, Frank; Meyer, Frank; Huth, Christof; Halloul, Zuhir; Lippert, Hans

2011-03-01

Gunshot wounds are rare events in European countries, but stab and impalement injuries occur more frequently and are often spectacular. The aim of the study was to describe several types of penetrating abdomino-thoracic injuries as well as the appropriate surgical interventions, including complex wound management. The representative case series includes four patients with abdomino-thoracic penetrating trauma (two impalements and two stabbings), who were treated in a surgical university hospital (tertiary) centre during a 12-month period. 1. A man was impaled on a steel pipe, which entered the body above the right kidney and behind the liver through the mediastinum via the right thorax, passing the heart and aortic arch up to the left clavicle. The rod was removed via sternotomy and median laparotomy. Only the left subclavian vein required repair. Postoperatively, a residual lesion of the left brachial plexus caused temporary pneumonia. 2. A leg of a collapsing chair drilled into a woman's left foramen obturatorium and exited the body at the right anterior iliac spine. At a regional hospital, the chair leg was removed and the canal caused by gluteal penetration was excised. Exploratory laparotomy revealed peritonitis resulting from a perforated ileum. The injury was repaired with segmental resection and anastomosis. Postoperative right inguinal wound necrosis necessitated excision and vacuum-assisted closure sealing. The patient has residual paresthesia in her left leg resulting from a sacral plexus lesion. 3. During an altercation, a man was stabbed twice in the right thorax. The right pulmonary lobe, the diaphragm, and the liver dome between segment VIII and V were injured. The patient also had a large scalp avulsion at the left and right parietooccipital site and transection of the biceps muscle at the middle third of the right humerus. The chest injuries, approached via right subcostal incision and right anterior thoracotomy were managed with liver packing (two

Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis.

Science.gov (United States)

Teixeira, Pedro Gr; Woo, Karen; Beck, Adam W; Scali, Salvatore T; Weaver, Fred A

2017-12-01

Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011-July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82-2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03-5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74-3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.

Giant aneurysm of the right intra thoracic sub-clavian artery ...

African Journals Online (AJOL)

Aneurysms of the intra-thoracic subclavian artery (SCA) are rare. They are often revealed by complications. Surgical treatment is always indicated. Endovascular treatment is a less invasive alternative. We report a case of a 60 years-old woman admitted for right chest pain and dysphonia. Laryngoscopy noted a right vocal ...

Changing Profiles of Diagnostic and Treatment Options in Subclavian Artery Aneurysms

NARCIS (Netherlands)

Vierhout, B. P.; Zeebregts, C. J.; van den Dungen, J. J. A. M.; Reijnen, M. M. P. J.

Background: Subclavian artery aneurysms (SAAs) are rare and may cause life- and limb-threatening complications. Therapeutic options greatly differ as do access alternatives. The aim of the study was to assess its clinical presentation, diagnostics and therapeutic options as reported in the

A composed graft for subclavian artery reconstruction in case of redo surgery for aortic coarctation

Directory of Open Access Journals (Sweden)

Fabrizio Sansone

2013-01-01

Full Text Available We report the case of a 66-year-old woman admitted to the intensive care unit (ICU for ongoing dyspnea and hemoptoe. She was operated upon in 1979 for aortic coarctation by the interposition of a 14 mm Dacron prosthesis from the left subclavian artery to descending aorta. Clinical evaluation performed over the years was normal with no signs of cardiac failure or prosthesis malfunctioning. The computed tomography scans (CT showed a progressive increase of the descending aorta diameters and the onset of a pseudo-aneurysm of 50 mm in diameter. Patient was re-operated through a median sternotomy enlarged by a left thoracotomy and intra-operative findings revealed the pseudo-aneurysm originating from a dehiscence of the proximal suture. In order to allow a safe reconstruction of the dilated subclavian artery, a T-shaped composed graft was confectioned and then sutured to the descending aorta and the subclavian artery, respectively. Post-operative course was uneventful and three months CT scan showed a normal position of the composed graft.

Subclavian vein pacing and venous pressure waveform measurement for phrenic nerve monitoring during cryoballoon ablation of atrial fibrillation.

Science.gov (United States)

Ghosh, Justin; Singarayar, Suresh; Kabunga, Peter; McGuire, Mark A

2015-06-01

The phrenic nerves may be damaged during catheter ablation of atrial fibrillation. Phrenic nerve function is routinely monitored during ablation by stimulating the right phrenic nerve from a site in the superior vena cava (SVC) and manually assessing the strength of diaphragmatic contraction. However the optimal stimulation site, method of assessing diaphragmatic contraction, and techniques for monitoring the left phrenic nerve have not been established. We assessed novel techniques to monitor phrenic nerve function during cryoablation procedures. Pacing threshold and stability of phrenic nerve capture were assessed when pacing from the SVC, left and right subclavian veins. Femoral venous pressure waveforms were used to monitor the strength of diaphragmatic contraction. Stable capture of the left phrenic nerve by stimulation in the left subclavian vein was achieved in 96 of 100 patients, with a median capture threshold of 2.5 mA [inter-quartile range (IQR) 1.4-5.0 mA]. Stimulation of the right phrenic nerve from the subclavian vein was superior to stimulation from the SVC with lower pacing thresholds (1.8 mA IQR 1.4-3.3 vs. 6.0 mA IQR 3.4-8.0, P phrenic nerve palsy. The left phrenic nerve can be stimulated from the left subclavian vein. The subclavian veins are the optimal sites for phrenic nerve stimulation. Monitoring the femoral venous pressure waveform is a novel technique for detecting impending phrenic nerve damage. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent

Energy Technology Data Exchange (ETDEWEB)

Maskovic, J.; Jankovic, S.; Lusic, I.; Cambj-Sapunar, L.; Mimica, Z.; Bacic, A

1999-09-01

A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results.

Subclavian artery stenosis caused by non-specific arteritis (Takayasu disease): treatment with Palmaz stent

International Nuclear Information System (INIS)

Maskovic, J.; Jankovic, S.; Lusic, I.; Cambj-Sapunar, L.; Mimica, Z.; Bacic, A.

1999-01-01

A 32-year old woman was admitted to the hospital with a sudden onset of right-sided hemiplegia and aphasia. Immediate angiographic examination revealed a severe form of type I Takayasu arteritis with occlusion of all supra-aortic vessels, with the exception of the left subclavian artery which was, however, almost completely occluded 1 cm proximal to the origin of the left vertebral artery. Since the latter provided the entire blood supply to the brain tissues, an immediate attempt was undertaken to dilate the left subclavian artery; when this was unrewarding, stenting of the lesion was successfully accomplished with excellent primary and 6-month follow-up results

Distribution Networks Management with High Penetration of Photovoltaic Panels

DEFF Research Database (Denmark)

Morais, Hugo

2013-01-01

The photovoltaic solar panels penetration increases significantly in recent years in several European countries, mainly in the low voltage and medium voltage networks supported by governmental policies and incentives. Consequently, the acquisition and installation costs of PV panels decrease...... and the know–how increase significantly. Presently is important the use of new management methodologies in distribution networks to support the growing penetration of PV panels. In some countries, like in Germany and in Italy, the solar generation based in photovoltaic panels supply 40% of the demand in some...

Internal Jugular and Subclavian Vein Thrombosis in a Case of Ovarian Cancer

Directory of Open Access Journals (Sweden)

Hiroto Moriwaki

2017-01-01

Full Text Available Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT. DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. A 47-year-old woman visited our department with painful swelling on the left side of her neck. Initial examination revealed swelling of the region extending from the left neck to the shoulder without any redness of the overlying skin. Laboratory tests showed a white blood cell count of 5,800/mm3 and an elevated serum C-reactive protein of 4.51 mg/dL. Computed tomography (CT of the neck revealed a vascular filling defect in the left internal jugular vein to left subclavian vein region, with the venous lumina completely occluded with dense soft tissue. On the basis of the findings, we made the diagnosis of thrombosis of the left internal jugular and left subclavian veins. The patient was begun on treatment with oral rivaroxaban, but the left shoulder pain worsened. She was then admitted to the hospital and treated by balloon thrombectomy and thrombolytic therapy, which led to improvement of the left subclavian venous occlusion. Histopathologic examination of the removed thrombus revealed adenocarcinoma cells, indicating hematogenous dissemination of malignant cells.

Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome

OpenAIRE

Dolapoglu, Ahmet; de la Cruz, Kim I.; Preventza, Ourania; Coselli, Joseph S.

2016-01-01

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were succe...

An integrated approach to fire penetration seal program management

International Nuclear Information System (INIS)

Rispoli, R.D.

1996-01-01

This paper discusses the utilization of a P.C. based program to facilitate the management of Entergy Operations Arkansas Nuclear One (ANO) fire barrier penetration seal program. The computer program was developed as part of a streamlining process to consolidate all aspects of the ANO Penetration Seal Program under one system. The program tracks historical information related to each seal such as maintenance activities, design modifications and evaluations. The program is integrated with approved penetration seal design details which have been substantiated by full scale fire tests. This control feature is intended to prevent the inadvertent utilization of an unacceptable penetration detail in a field application which may exceed the parameters tested. The system is also capable of controlling the scope of the periodic surveillance of penetration seals by randomly selecting the inspection population and generating associated inspection forms. Inputs to the data base are required throughout the modification and maintenance process to ensure configuration control and maintain accurate data base information. These inputs are verified and procedurally controlled by Fire Protection Engineering (FPE) personnel. The implementation of this system has resulted in significant cost savings and has minimized the allocation of resources necessary to ensure long term program viability

J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system

International Nuclear Information System (INIS)

Hama, Yukihiro; Kusano, Shoichi; Makita, Kohzoh

2004-01-01

The aim of this study was to verify the feasibility of using a J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system (RPCS). Twenty-five patients with various hepatic malignancies underwent percutaneous implantation of an RPCS through the left subclavian artery for regional chemotherapy. To successfully puncture the left subclavian artery, a J-tipped guidewire was used as a target with fluoroscopic guidance. Technical success and complication rates, and numbers of puncture failures, were retrospectively analyzed. Implantation of the RPCS was successful in all patients. Eight (32%) patients had minor complications and no patient had major complications. The number of puncture failures per patient was 0 to 1 (mean=0.32). The J-tipped guidewire is a safe and appropriate target for puncture of the subclavian artery in the placement of an RPCS. (orig.)

Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report

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Vučurević Goran

2011-01-01

Full Text Available Introduction. A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT supraaortic branches angiography. Case Outline. A 53-year-old female patient was examined at the Outpatients’ Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. Conclusion. A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.

Subclavian Vein Versus Arm Vein for Totally Implantable Central Venous Port for Patients with Head and Neck Cancer: A Retrospective Comparative Analysis

International Nuclear Information System (INIS)

Akahane, Akio; Sone, Miyuki; Ehara, Shigeru; Kato, Kenichi; Tanaka, Ryoichi; Nakasato, Tatsuhiko

2011-01-01

Purpose: This study was designed to compare central venous ports (CVP) from two different routes of venous access―the subclavian vein and arm vein―in terms of safety for patients with head and neck cancer (HNC). Methods: Patients with HNC who underwent image-guided implantations of CVPs were retrospectively evaluated. All CVPs were implanted under local anesthesia. Primary outcome measurements were rates and types of adverse events (AEs). Secondary outcomes included technical success and rate and reason of CVP removal. Results: A total of 162 patients (subclavian port group, 47; arm port group, 115) were included in this study. Technical success was achieved in all patients. The median follow-up period was 94 (range, 1–891) days. Two patients in the subclavian port group experienced periprocedural complications. Postprocedural AEs were observed in 8.5 and 22.6% of the subclavian port and arm port group patients, respectively (P = 0.044). Phlebitis and system occlusions were observed only in the arm port group. The rate of infection was not significantly different between the two groups. The CVP was removed in 34 and 39.1% of the subclavian port and arm port patients, respectively. Conclusions: Both subclavian and arm CVPs are feasible in patients with HNC. AEs were more frequent in the arm port group; thus, the arm port is not recommended as the first choice for patients with HNC. However, further experience is needed to improve the placement technique and the maintenance of CVPs and a prospective analysis is warranted.

Intrathoracic lipoma masquerading as subclavian artery trauma.

LENUS (Irish Health Repository)

Munro, P T

2012-02-03

A 58 year old man was admitted to the accident and emergency department following an industrial accident in which he sustained a three part fracture dislocation of his right humerus. Chest radiography revealed a large mass in the right upper hemithorax and, when the patient became hypotensive, an emergency thoracotomy was performed. The mass was found to be a massive intrathoracic lipoma. This case shows how preexisting intrathoracic lesions may be mistaken for subclavian or great vessel trauma following violent shoulder girdle injury. The differential diagnosis of traumatic and non-traumatic intrathoracic mass lesions in chest radiography should be considered carefully.

Bilateral subclavian origin of the bronchial arteries combined with absence of other origins.

Science.gov (United States)

Jie, Bing; Sun, Xi-Wen; Yu, Dong; Jiang, Sen

2014-08-01

There are numerous anatomical variations of the sites of origin of the bronchial arteries (BAs). A subclavian origin of a BA involves an aberrant artery that originates from the subclavian artery (SCA) or its branches. However, the aberrant artery usually originates directly from the SCA, and an SCA-origin BA arising from the branches of the SCA is rare. We herein present an extremely rare case of a right BA arising from the ipsilateral costocervical trunk, and a left BA arising from the ipsilateral thyrocervical trunk, in the absence of other origins of the BA. This anatomical variation was detected during pretherapeutic evaluation by multidetector-row computed tomography and confirmed by selective angiography. Recognition of these anatomic variations is important to surgical, diagnostic, and interventional radiologic procedures in the thorax.

Percutaneous transluminal angioplasty of stenoses of the proximal subclavian artery

International Nuclear Information System (INIS)

Grote, R.; Freyschmidt, J.; Walterbusch, G.; Medizinische Hochschule Hannover

1983-01-01

Between August 1980 and June 1982, 12 left-sided proximal subclavian stenoses were dilated with balloon catheters. The dilatation was successful in all patients. Differences in blood pressure in the arm could be demonstrated subsequently. Recurrences occurred in two patients after seven and eleven months. Follow-up of nine patients up to 24 months showed them to be symptom-free. (orig.)

Endovascular Treatment of an Iatrogenic Right Internal Jugular Vein- Right Subclavian Artery Fistula and Pseudoaneurysm During the Attempt of a Hemodialysis Catheter Insertion: A Case Report

International Nuclear Information System (INIS)

Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun

2009-01-01

Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils

Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management.

Science.gov (United States)

Perdonck, P; de Schoutheets, J C; Monsieurs, K G; Van Laer, C; Vander Poorten, V; Vanderveken, O

Penetrating and blunt trauma to the neck: clinical presentation, assessment ana emergency management. In Belgium, and even in Western Europe, penetrating and blunt injury to the neck is relatively uncommon in both the civilian and military populations. Pre-hospital and emergency assessment and management will therefore always prove challenging, as individual exposure to this specific type of injury remains low. Historically, the neck has been divided into three anatomical zones with specific landmarks to guide the diagnostic and therapeutic approach to penetrating neck injuries. Most penetrating injuries need to be explored surgically, although with the advent of multi-detector computed tomographic angiography (MDCTA), which yields high diagnostic sensitivity, this inflexible approach has recently changed to a more targeted management, based on clinical, radiographic and, if deemed necessary, endoscopic findings. However, some authors have addressed their concern about this novel, 'no-zone' approach, since the risk of missing less apparent aerodigestive tract injuries may increase. It is recommended, therefore, that all patients with penetrating neck injuries be closely observed, irrespective of the initial findings. The incidence of blunt neck injury is much lower, and this makes risk assessment and management even more difficult in comparison with penetrating injuries. Again, MDCTA is most often the first diagnostic tool if a blunt neck injury is suspected, due to its good sensitivity for blunt cerebrovascular injuries (BCVI) as well as for aerodigestive tract injuries. Specific patterns of injury and unexpected neurological and neuro-radiological findings in trauma patients should always warrant further investigation. Despite ongoing debate, systemic anticoagulation is recommended for most BCVI, sometimes combined with endovascular treatment. Aerodigestive tract injuries may present dramatically, but are often more subtle, making the diagnosis more difficult

Management of Penetrating Spinal Cord Injuries in a Non Spinal ...

African Journals Online (AJOL)

Management of Penetrating Spinal Cord Injuries in a Non Spinal Centre: Experience at Enugu, Nigeria. ... The thoracic spine{9(41%)}was most often involved. ... Five (23%) patients with injury at cervical level died from respiratory failure.

A conservative approach to a thoracic duct injury caused by left subclavian vein catheterization

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Vedran Premuzic

2018-01-01

Full Text Available Thoracic duct injury is a rare complication of left subclavian vein catheterization. A significant injury could lead to chylothorax, a condition with high mortality rate if not treated. It is diagnosed with lymphography or by laboratory tests of pleural fluid aspirate. A 51 year old Caucasian male with a history of unregulated hypertension presented to our Emergency department (ED with anginous symptoms and increased serum creatinine level. After the placement of a temporary central venous catheter for hemodialysis in left subclavian vein, he developed lymph leakage on puncture site beside the catheter, at drainage rate of 75 ml/h. In the absence of more serious clinical symptoms, conservative treatment with close patient monitoring and diet changes was chosen, rather than more invasive treatment options.

Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

International Nuclear Information System (INIS)

Smeenk, Robert M.; Kock, Mark C. J. M.; Elgersma, Otto E. H.; Schnater, Marco J.

2011-01-01

This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA.

Early surgical managment of penetrating ocular injuries involving the posterior segment.

Science.gov (United States)

Michels, R G

1976-09-01

Pars plana vitrectomy technic can be used in the early management of certain penetrating ocular injuries involving the posterior segment, including selected intraocular foreign bodies. This study reports the results of ten consecutive cases of intraocular foreign bodies in the posterior segment treated by a combination of vitrectomy (including lensectomy when necessary) and foreign-body extraction with forceps. The foreign body was successfully removed in nine of ten eyes, and nine of ten eyes were salvaged. This favorable experience using early vitreous surgery suggests that the vitrectomy technic can be used in other penetrating injuries involving the posterior segment that are not associated with intraocular foreign bodies. Possible indications for early vitrectomy are presented, including cases with a poor prognosis when managed by conventional methods.

Endovascular treatment of penetrating arterial trauma with stent grafts.

Science.gov (United States)

Biagioni, Rodrigo Bruno; Burihan, Marcelo Calil; Nasser, Felipe; Biagioni, Luisa Ciucci; Ingrund, José Carlos

2018-02-01

The endovascular management of arterial injuries has resulted in reduced operating time, blood loss, hospital mortality, lower incidence of sepsis, and decrease in mortality rates. For penetrating trauma, however, the benefits of endovascular therapy are questionable. Data were obtained by retrospective analysis of electronic medical records. All patients with vascular trauma seeking care at our institution from January 2010 to December 2015 were reviewed. A total of 223 vascular trauma patients were enrolled. Of these, 18 patients (8 %) were treated with endovascular techniques. The data related to clinical presentation, patient characteristics, technical aspects of the treatment, and follow-up were analysed. The mean patient age was 35.4 ± 17.8 years, 94 % were male. The mean injury severity score was 10.4 ± 2.5. The most commonly observed trauma mechanism was a gunshot in 10 cases (55 %), followed by lesions provoked by arterial catheter misplacement in five cases (27 %), and stab wounds in three cases (16.6 %). The main injury site was the subclavian artery, accounting for eight cases (44 %), followed by the superficial femoral artery and the tibiofibular trunk in two cases, respectively (18 %). The anterior tibial, fibular artery, axillary, common carotid, superior mesenteric, and profunda femoris were each affected once. Arteriovenous fistula was detected in nine cases (50 %), pseudoaneurysms in nine cases (50 %), and short occlusion in two cases (11 %). The mean follow-up duration was 753 days. The primary patency rate was 92.3 and 61.5 % after one and two years, respectively. The survival rate was 94.4 % after one and two years. Infection of the stents or limb amputations were not identified at follow-up. The endovascular treatment of penetrating arterial injuries with covered stents is feasible. However, the criteria used to choose the best method must be individualized.

Traumatic subclavian arteriovenous fistula in a young adult

International Nuclear Information System (INIS)

Nazario Dolz, Ana Maria; Ibannez Casero, Marlene; Rodriguez Fernandez, Zenen; Pichin Quesada, Alexis; Lopez Martin, Jose Carlos

2011-01-01

The case report of a 23 year-old patient who was admitted to the General Surgery Service of 'Saturnino Lora Torres' Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba with the diagnosis of traumatic pneumothorax is described, as consequence of stab wounds in the right anterior and superior region of the thorax; but then, after 48 hours, a right subclavian arteriovenous fistula, which was proven by means of x ray was diagnosed. The postoperative clinical course was favorable and the patient was discharged after 11 days, completely asymptomatic. His working activities began 2 months later.(author)

Subclavian artery dissection during catheterization in a patient after irradiation

International Nuclear Information System (INIS)

Kanazawa, Susumu; Hiraki, Yoshio; Fujie, Shunji; Sato, Nobuo.

1997-01-01

A 47-year-old woman with right breast cancer underwent partial mastectomy and had irradiations to the primary and metastatic sites, including the left supraclavicular region. During catheterization of the left internal mammary artery for arterial infusion therapy, the patient developed an iatrogenic dissection and subsequent occlusion of the left subclavian artery. Arterial infusion of tissue plasminogen activator into the artery resulted in recanalization and improvement of clinical signs and symptoms. (author)

Prenatal diagnosis of aberrant right subclavian artery in an unselected population

Energy Technology Data Exchange (ETDEWEB)

Song, Mi Jin; Han, Byoung Hee; Kim, Young Hwa; Yoon, So Young; Lee, Yoo Mi; Jeon, Hye Su; Park, Bo Kyung [Cheil General Hospital and Women' s Healthcare Center, Dankook University College of Medicine, Seoul (Korea, Republic of)

2017-07-15

The purpose of this study was to determine the frequency of aberrant right subclavian artery (ARSA) among unselected fetuses and to evaluate its association with chromosomal abnormalities and other congenital anomalies.In all, 7,547 fetuses (gestational age, 20 to 34 weeks) were examined using routine antenatal sonography at our institution between April 2014 and September 2015. The right subclavian artery was assessed using grayscale and color Doppler ultrasonography in the transverse 3-vessel and tracheal view, and confirmed in the coronal plane. ARSA was found in 28 fetuses (0.4%). Further, 27 of these 28 fetuses were euploid (96.4%). Trisomy 18 was the only chromosomal anomaly (3.6%) found in the study sample. ARSA was an isolated finding in 23 of the 28 cases (82.1%). In the remaining three cases (10.7%), ARSA was accompanied with extracardiac anomalies. Other cardiac defects were present in three cases (10.7%). Isolated ARSA does not seem to be associated with a significantly increased risk of aneuploidy. However, the possibility of fetal karyotyping, which is a more invasive procedure, should be discussed in the light of the overall risk of the fetus.

Ultrasound guided implantation of chest port systems via the lateral subclavian vein

International Nuclear Information System (INIS)

Zaehringer, M.; Hilgers, J.; Krueger, K.; Strohe, D.; Bangard, C.; Neumann, L.; Lackner, K.; Warm, M.; Reiser, M.; Toex, U.

2006-01-01

Purpose: Retrospective analysis of the success and complication rates of chest port implantation via the lateral subclavian vein. Materials and methods: Between January 2003 and June 2004, the lateral subclavian vein in 271 patients (186 women, 85 men, mean age 53.2 years) was punctured guided by ultrasound. This access was used to insert a port system, and the catheter tip was placed at the cavoatrial junction. The port reservoir was implanted in a subcutaneous infraclavicular pocket and fixed to the fascia of the pectoralis muscle. Indications for port implantation were chemotherapy (n=239), total parenteral nutrition (n=2) and intravenous medication (n=30). The patient follow-up was mainly performed either by the oncology division of the department of gynecology or by the department of internal medicine. Results: A chest port catheter system was successfully implanted in all patients. The catheter remained in place for a mean duration of 269.4 days (SD 192.3 days). No complications occurred during implantation. In the post-interventional period, 6 catheter dysfunctions were found (thrombotic 0.09 per 1000 catheter days; mechanic 0.05 per 1000 catheter days). While one local infection occurred in the early post-interventional period, 3 local and 15 systemic infections were independent of the port catheter placement (0.39 per 1000 catheter days). The rate of port catheter explantations due to dysfunction or infection was 0.07 per 1000 catheter days. Conclusion: Ultrasound-guided puncture of the lateral subclavian vein is a safe procedure for the insertion of central venous port catheter systems and had a very low complication rate in our study. For further evaluation of our port placement technique, prospective studies compared to placement through the internal jugular vein are necessary. (orig.)

A Rare Case of Esophageal Dysphagia in Children: Aberrant Right Subclavian Artery

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Claudia Barone

2016-01-01

Full Text Available Dysphagia is an impairment of swallowing that may involve any structures from the mouth to the stomach. Esophageal dysphagia presents with the sensation of food sticking, pain with swallowing, substernal pressure, or chronic heartburn. There are many causes of esophageal dysphagia, such as motility disorders and mechanical and inflammatory diseases. Infrequently dysphagia arises from extrinsic compression of the esophagus from any vascular anomaly of the aortic arch. The most common embryologic abnormality of the aortic arch is aberrant right subclavian artery, clinically known as arteria lusoria. This abnormality is usually silent. Here, we report a case of six-year-old child presenting to us with a history of progressive dysphagia without respiratory symptoms. A barium esophagogram showed an increase of the physiological esophageal narrowing at the level of aortic arch, while at esophagogastroduodenoscopy there was an extrinsic pulsatile compression of the posterior portion of the esophagus suggesting an extrinsic compression by an aberrant vessel. Angio-CT (computed tomography scan confirmed the presence of an aberrant right subclavian artery.

[Right-side aortic arch with aberrant left subclavian artery and Kommerell's diverticulum. A cause of vascular ring].

Science.gov (United States)

Tamayo-Espinosa, Tania; Erdmenger-Orellana, Julio; Becerra-Becerra, Rosario; Balderrabano-Saucedo, Norma; Segura-Standford, Begoña

The right-side aortic arch may be associated with aberrant left subclavian artery, in some cases this artery originates from an aneurismal dilation of the aorta called Kommerell's diverticulum. A report is presented on 2 cases of vascular ring formed by a right-side aortic arch, anomalous left subclavian artery, Kommerell's diverticulum and left patent ductus arteriosus. A review the literature was also performed as regards the embryological development and the imaging methods used to help in the diagnosis of this rare vascular anomaly. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

A Case of Unrecognized Intrathoracic Placement of a Subclavian Central Venous Catheter in a Patient with Large Traumatic Hemothorax

Directory of Open Access Journals (Sweden)

Dina Wallin

2015-01-01

Full Text Available Traditional recommendations suggest placement of a subclavian central venous catheter (CVC ipsilateral to a known pneumothorax to minimize risk of bilateral pneumothorax. We present the case of a 65-year-old male with a right hemopneumothorax who was found to have intrathoracic placement of his right subclavian CVC at thoracotomy despite successful aspiration of blood and transduction of central venous pressure (CVP. We thus recommend extreme caution with the interpretation of CVC placement by blood aspiration and CVP measurement alone in patients with large volume ipsilateral hemothorax.

Hybrid treatment of dysphagia lusoria: right carotid to subclavian bypass and endovascular insertion of an Amplatzer II Vascular Plug

Directory of Open Access Journals (Sweden)

Ernesto Cobos-González

Full Text Available Compression of the esophagus by a retroesophageal aberrant right subclavian artery (ARSA is a rare cause of dysphagia. We present the case of a 47-year-old female with symptoms of progressive dysphagia diagnosed with dysphagia lusoria using barium swallow and contrast computed tomography and successfully treated with a hybrid procedure: right carotid to subclavian bypass and endovascular insertion of an Amplatzer II Vascular Plug through the right superficial femoral artery. We consider this approach safer, less invasive and more complete to avoid recurrent dysphagia.

Management of penetrating colon and rectal injuries in the pediatric patient.

Science.gov (United States)

Haut, Elliott R; Nance, Michael L; Keller, Martin S; Groner, Jonathan I; Ford, Henri R; Kuhn, Ann; Tuchfarber, Barbara; Garcia, Victor; Schwab, C William; Stafford, Perry W

2004-09-01

Management of civilian penetrating colon injuries in the adult has evolved from the universal use of fecal diversion to the highly selective use of colostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. A retrospective review of pediatric patients (age trauma centers for the period January 1990 through June 2001. For the period of review, 53 children with a penetrating colorectal injury were identified. Firearms caused 89 percent of the injuries. The colon was injured in 83 percent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were treated with colostomy. The hospital length of stay was longer in the colostomy group (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy group (55 percent vs. 27 percent), which included two patients with stoma-related complications. There was no mortality in this series. Primary repair was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this series. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock, multiple blood transfusions, multiple other injuries, extensive contamination, and high-velocity weapons. In the absence of these associated factors, primary repair appears justified.

Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome.

Science.gov (United States)

Dolapoglu, Ahmet; de la Cruz, Kim I; Preventza, Ourania; Coselli, Joseph S

2016-10-01

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were successfully repaired by means of a surgical bypass technique in which a Dacron graft was placed between the carotid and brachial arteries. We also discuss our strategy for determining the optimal surgical approach in these patients.

Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience

International Nuclear Information System (INIS)

Brountzos, E. N.; Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A.

2004-01-01

Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions

Focal hot spot induced by a central subclavian line on bone scan.

Science.gov (United States)

Moslehi, Masood; Cheki, Mohsen; Dehghani, Tohid; Eftekhari, Mansoureh

2014-01-01

The diagnostic accuracy of nuclear medicine reporting can be improved by awareness of these instrument-related artifacts. Both awareness and experience are also important when it comes to detecting and identifying normal (and abnormal) variants. We present a case of hot spot on the upper right chest in the region of right subclavicular region resulting from injection of radiotracer from central subclavian line. A 52-year-old woman with a history of left breast cancer and recent bone pain was referred to our nuclear medicine department for skeletal survey. Anterior views of chest show a focus of increased radiotracer uptake corresponding to anterior arch of one of the right second rib. The nuclear physician reported it as a focal rib bony lesion and recommended radiological evaluation. As technician later explained, physicians realized that injection site was a central subclavian line on the right side and hot spot on that region is due to injection site. The appearance of both skeletal and soft-tissue uptake depends heavily on imaging technique (such as the route of radiotracer administration) and the interpreting physicians should be aware of the impact of technical factors on image quality.

Managed Care Penetration and the Use of Screening Mammography by Uninsured Women

National Research Council Canada - National Science Library

Garg, Pushkal

2003-01-01

..., and increased waiting times for mammography. In this study, we examined whether there was an association between managed care penetration and rates of mammography among uninsured women between 50 and 64 years of age...

The impact of mechanism on the management and outcome of penetrating colonic trauma.

Science.gov (United States)

Oosthuizen, G V; Kong, V Y; Estherhuizen, T; Bruce, J L; Laing, G L; Odendaal, J J; Clarke, D L

2018-02-01

Introduction In light of continuing controversy surrounding the management of penetrating colonic injuries, we set out to compare the outcome of penetrating colonic trauma according to whether the mechanism of injury was a stab wound or a gunshot wound. Methods Our trauma registry was interrogated for the 5-year period from January 2012 to December 2016. All patients over the age of 18 years with penetrating trauma (stab or gunshot) and with intraoperatively proven colonic injury were reviewed. Details of the colonic and concurrent abdominal injuries were recorded, together with the operative management strategy. In-hospital morbidities were divided into colon-related and non-colon related morbidities. The length of hospital stay and mortality were recorded. Direct comparison was made between patients with stab wounds and gunshot wounds to the colon. Results During the 5-year study period, 257 patients sustained a colonic injury secondary to penetrating trauma; 95% (244/257) were male and the mean age was 30 years. A total of 113 (44%) sustained a gunshot wound and the remaining 56% (144/257) sustained a stab wound. Some 88% (226/257) of all patients sustained a single colonic injury, while 12% (31/257) sustained more than one colonic injury. A total of 294 colonic injuries were found at laparotomy. Multiple colonic injuries were less commonly encountered in stab wounds (6%, 9/144 vs. 19%, 22/113, P colonic stab wounds and colonic gunshot wounds are different in terms of severity of the injury and in terms of outcome. While primary repair is almost always applicable to the management of colonic stab wounds, the same cannot be said for colonic gunshot wounds. The management of colonic gunshot wounds should be examined separately from that of stab wounds.

Relationship between National Institutes of Health research awards to US medical schools and managed care market penetration.

Science.gov (United States)

Moy, E; Mazzaschi, A J; Levin, R J; Blake, D A; Griner, P F

1997-07-16

Medical research conducted in academic medical centers is often dependent on support from clinical revenues generated in these institutions. Anecdotal evidence suggests that managed care has the potential to affect research conducted in academic medical centers by challenging these clinical revenues. To examine whether empirical evidence supports a relationship between managed care and the ability of US medical schools to sustain biomedical research. Data on annual extramural research grants awarded to US medical schools by the National Institutes of Health (NIH) from fiscal years 1986 to 1995 were obtained, and each medical school was matched to a market for which information about health maintenance organization (HMO) penetration in 1995 was available. Growth in total NIH awards, traditional research project (R01) awards, R01 awards to clinical and basic science departments, and changes in institutional ranking by NIH awards were compared among schools located in markets with low, medium, and high managed care penetration. Medical schools in all markets had comparable rates of growth in NIH awards from 1986 to 1990. Thereafter, medical schools in markets with high managed care penetration had slower growth in the dollar amounts and numbers of NIH awards compared with schools in markets with low or medium managed care penetration. This slower growth for schools in high managed care markets was associated with loss of share of NIH awards, equal to $98 million in 1995, and lower institutional ranking by NIH awards. Much of this revenue loss can be explained by the slower growth of R01 awards to clinical departments in medical schools in high managed care markets. These findings provide evidence of an inverse relationship between growth in NIH awards during the past decade and managed care penetration among US medical schools. Whether this association is causal remains to be determined.

Management of penetrating extraperitoneal rectal injuries: An Eastern Association for the Surgery of Trauma practice management guideline.

Science.gov (United States)

Bosarge, Patrick L; Como, John J; Fox, Nicole; Falck-Ytter, Yngve; Haut, Elliott R; Dorion, Heath A; Patel, Nimitt J; Rushing, Amy; Raff, Lauren A; McDonald, Amy A; Robinson, Bryce R H; McGwin, Gerald; Gonzalez, Richard P

2016-03-01

The management of penetrating rectal trauma invokes a complex decision tree that advocates the principles of proximal diversion (diversion) of the fecal stream, irrigation of stool from the distal rectum, and presacral drainage based on data from World War II and the Vietnam War. This guideline seeks to define the initial operative management principles for nondestructive extraperitoneal rectal injuries. A systematic review of the MEDLINE database using PubMed was performed. The search retrieved English language articles regarding penetrating rectal trauma from January 1900 to July 2014. Letters to the editor, case reports, book chapters, and review articles were excluded. Topics of investigation included the management principles of diversion, irrigation of stool from the distal rectum, and presacral drainage using the GRADE methodology. A total of 306 articles were screened leading to a full-text review of 56 articles. Eighteen articles were used to formulate the recommendations of this guideline. This guideline consists of three conditional evidence-based recommendations. First, we conditionally recommend proximal diversion for management of these injuries. Second, we conditionally recommend the avoidance of routine presacral drains and distal rectal washout in the management of these injuries.

Aberrant right subclavian artery aneurysm confirmed by computerized tomography. Aneurisma de arteria subclavia derecha aberrante

Energy Technology Data Exchange (ETDEWEB)

Arteche, M.D.; Tejera, E.; Vega-Hazas, G.

1991-01-01

We present a case of aberrant right subclavian artery aneurysm in an asymptomatic woman. This disorder was found by chance in a thorax radiography due to an upper right mediastinal mass. CT confirmed the vascular anomaly as well as the aneurysm occurrence. (Author)

Managed Care Penetration and the Use of Screening Mammography by Uninsured Women

National Research Council Canada - National Science Library

Garg, Pushkal

2002-01-01

..., and increased waiting times for mammography. In this study we propose to examine whether there is an association between managed care penetration and rates of mammography among uninsured women between 50 and 64 years of age...

Influence of Mechanical Ventilation on the Incidence of Pneumothorax During Infraclavicular Subclavian Vein Catheterization: A Prospective Randomized Noninferiority Trial.

Science.gov (United States)

Kim, Eugene; Kim, Hyun Joo; Hong, Deok Man; Park, Hee-Pyoung; Bahk, Jae-Hyon

2016-09-01

It remains unclear whether we have to interrupt mechanical ventilation during infraclavicular subclavian venous catheterization. In practice, the clinicians' choice about lung deflation depends on their own discretion. The purpose of this study was to assess the influence of mechanical ventilation on the incidence of pneumothorax during infraclavicular subclavian venous catheterization. A total of 332 patients, who needed subclavian venous catheterization, were randomly assigned to 1 of the 2 groups: catheterizations were performed with the patients' lungs under mechanical ventilation (ventilation group, n = 165) or without mechanical ventilation (deflation group, n = 167). The incidences of pneumothorax and other complications such as arterial puncture, hemothorax, or catheter misplacements and the success rate of catheterization were compared. The incidences of pneumothorax were 0% (0/165) in the ventilation group and 0.6% (1/167) in the deflation group. The incidence of pneumothorax in the deflation group was 0.6% higher than that in the ventilation group and the 2-sided 90% confidence interval for the difference was (-1.29% to 3.44%). Because the lower bound for the 2-sided 90% confidence interval, -1.29%, was higher than the predefined noninferiority margin of -3%, the inferiority of the ventilation group over the deflation group was rejected at the .05 level of significance. Other complication rates and success rates of catheterization were comparable between 2 groups. The oxygen saturation dropped below 95% in 9 patients in the deflation group, while none in the ventilation group (P = .007). The success and complication rates were similar regardless of mechanical ventilation. During infraclavicular subclavian venous catheterization, interruption of mechanical ventilation does not seem to be necessary for the prevention of pneumothorax.

"Classical Blalock-Taussig shunt" gone wrong: Confusing the right common carotid with right subclavian artery.

Science.gov (United States)

Idhrees, A Mohammed; Cherian, Vijay Thomas; Menon, Sabarinath; Mathew, Thomas; Dharan, Baiju S; Jayakumar, Karunakaran

2015-01-01

A 14-year-old girl underwent classical Blalock-Taussig shunt at 5 months of age. Computed tomography evaluation showed "Adachi type H" pattern of aortic arch vessels with the right common carotid artery being anastomosed to the right pulmonary artery mistaking it for the right subclavian artery.

Closure Using a Surgical Closure Device of Inadvertent Subclavian Artery Punctures During Central Venous Catheter Placement

International Nuclear Information System (INIS)

Berlet, Matthew H.; Steffen, Diana; Shaughness, George; Hanner, James

2001-01-01

Severe complications can and do occur when central venous catheters are inadvertently placed into subclavian arteries. Two cases are discussed that describe how these inadvertent arterial punctures can be closed using the Perclose device (Abbott Laboratories, Redwood City, CA, USA)

Subclavian vein thrombosis following fracture of the clavicle: case report

OpenAIRE

Terra, Bernardo Barcellos; Cocco, Luiz Fernando; Ejnisman, Benno; Fernandes, Hélio Jorge Alvachian; Reis, Fernando Baldy dos

2011-01-01

A trombose venosa profunda no membro superior não é frequente na literatura ortopédica. Relatamos um caso de trombose da veia subclávia durante o tratamento conservador de fratura do terço médio da clavícula. O diagnóstico é difícil e requer um alto grau de suspeição e o tratamento pode prevenir um tromboembolismo fatal. Há raros casos descritos associados à fratura de clavícula.Deep vein thrombosis in the upper limbs is uncommon in the orthopedic literature. We report on a case of subclavian...

"Classical Blalock-Taussig shunt" gone wrong: Confusing the right common carotid with right subclavian artery

Directory of Open Access Journals (Sweden)

A Mohammed Idhrees

2015-01-01

Full Text Available A 14-year-old girl underwent classical Blalock-Taussig shunt at 5 months of age. Computed tomography evaluation showed "Adachi type H" pattern of aortic arch vessels with the right common carotid artery being anastomosed to the right pulmonary artery mistaking it for the right subclavian artery.

CISO's guide to penetration testing a framework to plan, manage, and maximize benefits

CERN Document Server

Tiller, James S

2011-01-01

CISO's Guide to Penetration Testing: A Framework to Plan, Manage, and Maximize Benefits details the methodologies, framework, and unwritten conventions penetration tests should cover to provide the most value to your organization and your customers. Discussing the process from both a consultative and technical perspective, it provides an overview of the common tools and exploits used by attackers along with the rationale for why they are used. From the first meeting to accepting the deliverables and knowing what to do with the results, James Tiller explains what to expect from all phases of th

Subclavian artery aneurysm in a patient with vascular Ehlers-Danlos syndrome.

Science.gov (United States)

Yasuda, Shota; Imoto, Kiyotaka; Uchida, Keiji; Uranaka, Yasuko; Kurosawa, Kenji; Masuda, Munetaka

2016-02-01

We describe our experience of surgical treatment in a 28-year-old woman with vascular Ehlers-Danlos syndrome. A right subclavian artery aneurysm was detected. The right vertebral artery arose from the aneurysm. Digital subtraction angiography showed interruption of the left vertebral artery. The aneurysm was excised and the right vertebral artery was anastomosed end-to-side to the right common carotid artery under deep hypothermia and circulatory arrest. The patient remained very well 4 years after surgery, with no late vascular complication. © The Author(s) 2014.

Postoperative Chylothorax of Unclear Etiology in a Patient with Right-sided Subclavian Central Venous Catheter Placement.

Science.gov (United States)

Asghar, Samie; Shamim, Faisal

2017-01-01

A young male underwent decompressive craniotomy for an intracerebral bleed. A right-sided subclavian central venous catheter was placed in the operating room after induction of anesthesia. Postoperatively, he was shifted to Intensive Care Unit (ICU) for mechanical ventilation due to low Glasgow coma scale. He had an episode of severe agitation and straining on the tracheal tube in the evening same day. On the 2 nd postoperative day in ICU, his airway pressures were high, and chest X-ray revealed massive pleural effusion on right side. Under ultrasound guidance, 1400 milky white fluid was aspirated. It was sent for analysis (triglycerides) that confirmed chyle and hence, chylothorax was made as diagnosis. A duplex scan was done which ruled out thrombosis in subclavian vein. The catheter had normal pressure tracing with free aspiration of blood from all ports. Enteral feeding was continued as it is a controversial matter in the literature and he was monitored clinically and radiologically.

Non-operative management of right side thoracoabdominal penetrating injuries--the value of testing chest tube effluent for bile.

Science.gov (United States)

De Rezende Neto, João Baptista; Guimarães, Tiago Nunes; Madureira, João Lopo; Drumond, Domingos André Fernandes; Leal, Juliana Campos; Rocha, Aroldo; Oliveira, Rodrigo Guimarães; Rizoli, Sandro B

2009-05-01

While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients' chest tube effluent. We managed non-operatively all stable patients with a single RST penetrating injury. Chest tube effluent samples were obtained six times within (4-8 h; 12-16 h; 20-24 h; 28-32 h; 36-40 h; 48 h and 72 h) of admission for bilirubin measurement and blood for complete blood count, bilirubin, alanine (ALT) and aspartate aminotransferases (AST) assays. For comparison we studied patients with single left thoracic penetrating injury. Forty-two patients with RST injuries were included. All had liver and lung injuries confirmed by CT scans. Only one patient failed non-operative management. Chest tube bilirubin peaked at 48 h post-trauma (mean 3.3+/-4.1 mg/dL) and was always higher than both serum bilirubin (pchest tube effluent from control group (27 patients with left side thoracic trauma). Serum ALT and AST were higher in RST injury patients (ptrauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.

Poland syndrome associated with an aberrant subclavian artery and vascular abnormalities of the retina in a child exposed to misoprostol during pregnancy.

Science.gov (United States)

Rosa, Rafael Fabiano Machado; Travi, Giovanni M; Valiatti, Fabiana; Zen, Paulo Ricardo Gazzola; Pinto, Louise Lapagesse; Kiss, Andrea; Graziadio, Carla; Paskulin, Giorgio Adriano

2007-06-01

Poland syndrome has been attributed to a process of vascular disruption, and exposure to misoprostol at 6-8 weeks of gestation has been shown to produce defects attributed to vascular disruption. Herein we report the first case of a patient with Poland syndrome associated with an aberrant subclavian artery and vascular abnormalities of the retina, whose mother used misoprostol during pregnancy. A White boy of 1 year and 7 months of age, whose mother used misoprostol during the second month of pregnancy, presented with bilateral epicanthal folds, aplasia of the sternocostal head of the pectoralis major muscle with a hypoplastic nipple on the right side, and asymmetry between the upper limbs. The results of an angiotomographic study showed the presence of an aberrant right subclavian artery. Ultrasonographic evaluation showed turbulence and a high peak in the diastolic velocity in both carotid arteries, suggesting stenosis. Ophthalmologic assessment disclosed an intense bilateral tortuosity of the retinal blood vessels, with arterialnarrowing and rarefaction of the retinal pigment epithelium. This case suggests that the mechanism of vascular disruption of misoprostol could be related to the aberrant subclavian artery and the observed Poland syndrome. His retinal findings are different from those in cases described thus far in the literature, and this pattern of anomaly has never been associated with a gestational exposure to misoprostol. The possibility of a relationship of the aberrant right subclavian artery and the pattern of blood flow verified in the carotid arteries with the eye fundus abnormalities could be causally related or simply coincidental.

Managing high penetration of renewable energy in MV grid by electric vehicle storage

DEFF Research Database (Denmark)

Kordheili, Reza Ahmadi; Bak-Jensen, Birgitte; Pillai, Jayakrishnan Radhakrishna

2015-01-01

This paper proposes an intelligent algorithm for dealing with high penetration of renewable energy sources (RESs) in the medium voltage by intelligently managing electric vehicles (EVs), as one of the grid flexible loads. The MV grid used in this work is a CIGRE benchmark grid. Different...... residential and industrial loads are considered in this grid. The connection of medium voltage wind turbines to the grid is investigated. The solar panels in this study are residential panels. Also, EVs are located among the buses with residential demand. The study is done for different winter and summer...... scenarios, considering typical load profiles in Denmark. Different scenarios have been studied with different penetration level of RESs in the grid. The results show the capability of the proposed algorithm to reduce voltage deviations among the grid buses, as well as to increase the RES penetration...

Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

DEFF Research Database (Denmark)

Weigang, Ernst; Parker, Jack A T C; Czerny, Martin

2011-01-01

subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre...

The effect of lung deflation on the position and size of the subclavian vein in mechanically ventilated infants and children.

Science.gov (United States)

Lim, Kyung-Jee; Kim, Jin-Tae; Kim, Hee-Soo; Byon, Hyo-Jin; Lee, Soo-Kyung; Lee, Jung-Man

2011-06-01

If lung deflation increases the distance from the subclavian vein (SCV) to the pleura and the diameter of the vein, it might decrease the risk of pneumothorax and increase the success rate of subclavian venous cannulation. We evaluated the effect of lung deflation on the distance from the SCV to the pleura (SCV-pleura distance) and on the cross-sectional area (CSA) of the SCV in mechanically ventilated pediatric patients. Fifty patients (25 infants younger than 1 year and 25 children aged 1 to 8 years) were placed supine over a shoulder roll, and their lungs were ventilated with a tidal volume of 6 to 7 mL/kg. Lung deflation was achieved by opening the endotracheal tube to the atmosphere. The SCV-pleura distances and the SCV CSAs were measured using ultrasound at the end of inflation and 0, 30, 60, 90, and 120 seconds after lung deflation. A P value deflation. Neither the SCV-pleura distance nor the CSA showed any further increase with time. Lung deflation failed to increase the SCV-pleura distance and the CSA of the SCV. Its application is unlikely to be advantageous in avoiding pneumothorax or improving the success rate of subclavian venous cannulation.

Absent right common carotid artery associated with aberrant right subclavian artery.

Science.gov (United States)

Uchino, Akira; Uwabe, Kazuhiko; Osawa, Iichiro

2018-06-01

Rarely, the external and internal carotid arteries arise separately from the brachiocephalic trunk and right subclavian artery (SA) or the aortic arch and reflect the absence of a common carotid artery (CCA). We report a 45-year-old man with absent right CCA associated with aberrant right SA, an extremely rare combination, diagnosed by computed tomography (CT) angiography during follow-up for postoperative aortic dissection. Retrospective careful observation of preoperative postcontrast CT revealed the absent right CCA. Previously reported arch variations associated with absent CCA include cervical aortic arch, double aortic arch, and right aortic arch.

Computed tomography angiography reveals stenosis and aneurysmal dilation of an aberrant right subclavian artery causing systemic blood pressure misreading in an old Pekinese dog.

Science.gov (United States)

Kim, Jaehwan; Eom, Kidong; Yoon, Hakyoung

2017-06-16

A 14-year-old dog weighing 4 kg presented with hypotension only in the right forelimb. Thoracic radiography revealed a round soft tissue opacity near the aortic arch and below the second thoracic vertebra on a lateral view. Three-dimensional computed tomography angiography clearly revealed stenosis and aneurysmal dilation of an aberrant right subclavian artery. Stenosis and aneurysm of an aberrant subclavian artery should be included as a differential diagnosis in dogs showing a round soft tissue opacity near the aortic arch and below the thoracic vertebra on the lateral thoracic radiograph.

Results of subclavian to carotid artery bypass for occlusive disease of the common carotid artery: A retrospective cohort study.

Science.gov (United States)

Illuminati, Giulio; Pizzardi, Giulia; Calio, Francesco G; Masci, Federica; Pasqua, Rocco; Frezzotti, Francesca; Peschillo, Simone

2018-05-01

Optimal treatment of significant atherosclerosis of the common carotid artery (CCA) is not well-defined. The purpose of this study was to evaluate the long-term results of prosthetic subclavian to carotid bypass for occlusive disease of the CCA. From January 1994 to December 2015, 45 patients, mean age 67 years, underwent an ipsilateral subclavian to carotid bypass for occlusive disease of the CCA. Thirty-eight patients (84%) presented with neurologic symptoms, including transitory ischemic attacks in 29 cases and minor strokes in 9 cases. The graft material consisted of a 7 mm polytetrafluoroethylene conduit, and the distal anastomosis was done on the carotid bulb in 21 patients, on the internal carotid artery in 19 cases, and on the distal CCA in 5 cases. Median length of follow-up was 58 months. Study endpoints were the combined postoperative stroke/mortality rate, graft infection, overall late survival, freedom from ipsilateral stroke, and graft patency. Postoperative stroke/mortality rate was 2%. No graft infection was observed throughout follow-up. At 60 months, overall survival, freedom from stroke, and graft patency were 71% (standard error [SE] = 0.07), 98% (SE = 0.02), and 95.5% (SE = 0.06), respectively. Subclavian to carotid bypass allows very good patency rates and excellent protection from postoperative and late stroke, remaining a benchmark for any other treatment method. Copyright © 2018. Published by Elsevier Ltd.

Is guidewire exchange a better approach for subclavian vein re-catheterization for chronic hemodialysis patients?

Science.gov (United States)

Hou, Shaw-Min; Chou, Po-Ching; Huang, Chi-Hung; Chin, Chih-Hui; Wang, Pa-Chun; Chen, Ya-Hui

2006-01-01

The objectives of this study were to compare outcomes and survival rates of subclavian vein re-catheterization through guide wire exchange (GWE) or de novo insertion (DN). The study was conducted in a retrospective manner. Medical records of 36 patients who received percutaneous subclavian vein re-catheterization for hemodialysis in our institution during the period from April 1, 2001 to September 30, 2004 were reviewed. All patients had at least 2 catheter insertions records in our institute. Incidences of adverse events (infection, thrombosis) were compared between GWE and DN groups using x2 test. Predictors for adverse event occurrences were analyzed using logistic regression models. Cox proportional hazard model was used to investigate the predictors for adverse event-free catheter days. Kaplan-Meire survival curves were computed and compared using log rank test. Information were generated from 98 catheters (41 from DN, 57 from GWE groups). The average catheter usage was 2.8+/-0.9 devices per patient and the mean catheter-indwelling-day was 125.4+/-129.5 days in this cohort. We found GWE group had significantly lower thrombosis rate (49.1% vs. 85.4% for DN group, Prates for GWE were > or =30 days, 85.4%; > or =60 days, 75.5%; > or =90 days, 64.5%; > or =180 days, 44.3%. The actuarial survival rates for DN were > or =30 days, 70.7%; > or =60 days, 58.5%; > or =90 days, 34.2%; > or =180 days, 18.4%. GWE group catheters had significantly higher catheter survival rates (P=0.0009). Mahukar catheter (hazard ratio 0.514, P=0.03), non-shock (hazard ratio 3.358, P=0.04), and older age (hazard ratio 0.958, P=0.026) were predictors of adverse event-free remaining catheter days. We suggest that GWE might be a favorable option over DN insertion when revised subclavian vein catheterization is inevitable. GWE can be performed repeatedly without compromising catheter outcomes.

The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

Science.gov (United States)

Mobley, Lee R; Magnussen, Jon

2002-01-01

The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

A conservative approach to a thoracic duct injury caused by left subclavian vein catheterization

OpenAIRE

Vedran Premuzic; Ranko Smiljanic; Drazen Perkov

2018-01-01

Thoracic duct injury is a rare complication of left subclavian vein catheterization. A significant injury could lead to chylothorax, a condition with high mortality rate if not treated. It is diagnosed with lymphography or by laboratory tests of pleural fluid aspirate. A 51 year old Caucasian male with a history of unregulated hypertension presented to our Emergency department (ED) with anginous symptoms and increased serum creatinine level. After the placement of a temporary central venous c...

Isolation of the right subclavian artery in a patient with d-transposition of the great arteries.

Science.gov (United States)

Arunamata, Alisa; Perry, Stanton B; Kipps, Alaina K; Vasanawala, Shreyas S; Axelrod, David M

2015-01-01

Isolation of the right subclavian artery (RSCA) is rare, and this finding in association with d-transposition of the great arteries (d-TGA) is extremely unusual. We present a case of an isolated RSCA in a newborn with d-TGA in whom the clinical presentation was diagnostic. We discuss the imaging modalities used to confirm the diagnosis, the embryological basis of the finding, and the surgical repair.

Bile fistula after penetrating hepatic trauma with expectant management in the "era" of endoscopic treatment: clinical report

OpenAIRE

Armenta-Duran, Eduardo; Enríquez-Domínguez, Lenin; Díaz-Rosales, Juan de Dios; Duarte-Erives, Ever

2013-01-01

Objective: to report a clinical case of bile fistula after penetrating hepatic trauma given its low incidence, which was expectant managed by not having endoscopic retrograde cholangiopancreatography. Clinical case: we present a 28 years-old man, with biliary fistula resulting after a penetrating hepatic trauma. Discussion: bile leakage is a major complication after liver surgery and a rare one in complication of major hepatic trauma. Conventional treatment has consisted of surgical intervent...

Penetrating Brain Injury after Suicide Attempt with Speargun

Directory of Open Access Journals (Sweden)

John Ross Williams

2014-07-01

Full Text Available Penetrating cranial injury by mechanisms other than are exceedingly rare, and so strategies and guidelines for the management of PBI are largely informed by data from higher-velocity penetrating injuries. Here we present a case of penetrating brain injury by the low velocity mechanism of a harpoon from an underwater fishing speargun in an attempted suicide by a 56-year-old Caucasian male. The case raised a number of interesting points in management of lower-velocity penetrating brain injury (LVPBI, including benefit in delaying foreign body removal to allow for tamponade; the importance of history taking in establishing the social/legal significance of the events surrounding the injury; the use of cerebral angiogram in all cases of PBI; advantages of using DECT to reduce artifact when available; and antibiotic prophylaxis in the context of idiosyncratic histories of usage of penetrating objects before coming in contact with the intracranial environment. We present here the management of the case in full along with an extended discussion and review of existing literature regarding key points in management of LVPBI vs. higher velocity forms of intracranial injury.

Severe upper extremity polyneuropathy due to inferior brachial plexus compression as a result of left subclavian artery pseudoaneurism

Directory of Open Access Journals (Sweden)

George Kosmadakis

2012-01-01

Full Text Available In the present report, we describe the case of a 76-year-old hemodialysis patient who was admitted with clinical features of neurological thoracic exit syndrome due to subclavian artery pseudoaneurism following the insertion of a dual lumen vascular internal jugular catheter (vascath with excellent outcome after endo-arterial stent placement.

Ultrasound-guided catheterization of the left subclavian vein without recognition of persistent left superior vena cava

OpenAIRE

Park, Sun Young; Yoo, Jae Hwa; Kim, Mun Gyu; Kim, Sang Ho; Park, Byoung-Won; Oh, Hong Chul; Kim, Hojoon

2017-01-01

Abstract Rationale: A persistent left superior vena cava (PLSVC) is rare, but the most common thoracic venous anomaly. We report a case of PLSVC unrecognized during left subclavian vein catheterization using real-time ultrasound-guided supraclavicular approach. Patient concerns: A 79-year-old man with history of hypertension presented with traumatic subdural hemorrhage, subarachnoid hemorrhage, and epidural hemorrhage. Before the operation, a central venous catheter (CVC) was placed into the ...

Isolation of the right subclavian artery in a patient with d-transposition of the great arteries

Directory of Open Access Journals (Sweden)

Alisa Arunamata

2015-01-01

Full Text Available Isolation of the right subclavian artery (RSCA is rare, and this finding in association with d-transposition of the great arteries (d-TGA is extremely unusual. We present a case of an isolated RSCA in a newborn with d-TGA in whom the clinical presentation was diagnostic. We discuss the imaging modalities used to confirm the diagnosis, the embryological basis of the finding, and the surgical repair.

Management of penetrating heart and accompanying lung injuries

International Nuclear Information System (INIS)

Ekim, H.; Basel, H.; Odabasi, D.; Tuncer, M.; Gumrukcuoglu, H.A.

2010-01-01

Objective: Penetrating heart injury is potentially a life threatening condition due to cardiac tamponade or exsanguinating hemorrhage. The aim of this study was to evaluate victims who were referred to our hospital with penetrating heart and accompanying lung injuries and to review our overall outcome with this type of combined injuries. Methodology: Twenty patients with combined penetrating heart and lung injuries were operated at Yuzuncu Yil University Research Hospital, between May 1999 and January 2010. The diagnosis of combined heart and lung injuries was proved by surgical exploration in all cases. The surgical procedures mainly included the relief of cardiac tamponade, control of bleeding, repair of cardiac and pulmonary lacerations, and coronary artery bypass grafting if required. Results: In this series of 20 patients; there were 18 males and two females between the age of 14 to 60 years, with a mean age of 34.8+-13.5 years. Seventeen victims sustained stab wounds, and the remaining three were injured by a gunshot wounds. In 20 patients there were 22 cardiac chamber injuries. The most commonly injured cardiac chamber was the right ventricle followed by the left ventricle. In addition to the injuries to heart muscle, injuries to the coronary arteries were found in two patients. The most commonly injured lung lobe was the left upper lobe. Conclusion: Our experience shows that early diagnosis and immediate surgical intervention are the main factors affecting patient survival after penetrating heart and lung injuries. Therefore, heart injury should always be kept in mind in victims with penetrating thoracic injuries. (author)

Penetrating abdominal injuries in adults seen at two teaching ...

African Journals Online (AJOL)

Objective: To determine the pattern and management outcome of penetrating abdominal injuries (PAI) in the two main teaching hospitals in Ghana. Study Design: A prospective ... Conclusion: Stab wounds are the main penetrating abdominal injuries seen mostly among young male adults in Ghana. Management was by a ...

Quantitative penetration testing with item response theory

NARCIS (Netherlands)

Pieters, W.; Arnold, F.; Stoelinga, M.I.A.

2013-01-01

Existing penetration testing approaches assess the vulnerability of a system by determining whether certain attack paths are possible in practice. Therefore, penetration testing has thus far been used as a qualitative research method. To enable quantitative approaches to security risk management,

Management and outcome of low velocity penetrating head injury caused by impacted foreign bodies.

Science.gov (United States)

Moussa, Wael Mohamed Mohamed; Abbas, Mohamed

2016-05-01

Penetrating head injuries with impacted foreign bodies are rare, associated with a high incidence of morbidity and potentially life-threatening. In this study, we aimed at investigating the outcome of these cases as well as analyzing the factors affecting the prognosis. A retrospective study in which the records of 16 patients who had penetrating head injuries caused by low-velocity impacted foreign bodies were revised. All patients were males with a mean age of 28.9 years (range, 18 to 50 years). The follow-up period ranged from 4 to 13 months with a mean of 8.1 months. Causes of injury were construction accidents in 6 (37.5 %) patients, assault in 6 (37.5 %) and road traffic accidents in 4 (25 %). The impacted objects included a bar of iron, a piece of wood, a nail, a sickle and a piece of glass. Diagnostic computerized tomography (CT) of the brain was carried out on admission in all patients. Thirteen (81.3 %) patients were submitted to surgery, and all had the appropriate management in the form of antibiotics and dehydrating measures as required. The primary outcome measure was the Glasgow Outcome Scale (GOS) at the end of follow-up. At the end of follow-up, ten (62.5 %) patients had a GOS score of 5, two (12.5 %) patients had a score of 4, and four (25 %) patients had a score of 1. Low-velocity penetrating head injuries are most common in young adult males. With the appropriate management, a majority of even the most severe cases can have a favorable outcome.

Non-operative management for penetrating splenic trauma : how far can we go to save splenic function?

NARCIS (Netherlands)

Spijkerman, Roy; Teuben, Michel Paul Johan; Hoosain, Fatima; Taylor, Liezel Phyllis; Hardcastle, Timothy Craig; Blokhuis, Taco Johan; Warren, Brian Leigh; Leenen, Luke Petrus Hendrikus

2017-01-01

BACKGROUND: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim

Neurosurgical Management of Nonmissile Penetrating Cranial Lesions.

Science.gov (United States)

de Holanda, Luciano Ferreira; Pereira, Benedito Jamilson A; Holanda, Rafael Rodrigues; Neto, José Targino; de Holanda, Carlos Vanderlei M; Giudicissi Filho, Miguel; de Oliveira, Nathalia Ribeiro Cunha; de Oliveira, Jean G

2016-06-01

The objective of this study is to present a case series of nonmissile penetrating (NMP) injuries and to establish a workflow for an uncommon mechanism of traumatic head injury through the analysis of each case, classification of the type of lesion, management, and outcome score at follow-up. From January 1991 to December 2008, 36,000 patients presenting with traumatic brain injury (TBI) were admitted in the Department of Neurosurgery, Hospital Antônio Targino, Campina Grande-PB, Brazil. From these patients, 11 presenting with lesions caused by NMP objects were selected. Among the 11 patients, 9 were men and 2 were women. Their ages ranged from 7 to 74 years old (mean age ± SD, 29.1 ± 22.99 years). All patients underwent neuroradiologic evaluation. The entry point was classified as natural (orbit) or artificial (skull transfixation), and we also divided the patients presenting with secondary parenchymal or vascular damage from those presenting with only lesions caused by the primary penetration into the cranium and meninges. All patients were neurosurgically treated with removal of the foreign body through craniotomy, except the patient whose object (pen) was removed without craniotomy with local anesthesia. Glasgow Coma Scale (GCS) score on admission was a statistically significant factor on prognosis, and any patient who presented with a GCS score of 15 evolved satisfactorily, and there were no deaths in this group of patients (P = 0.04). TBIs caused by NMP objects are unusual and caused by aggression, self-inflicted harm (in the case of psychiatric patients), and accident. The foreign body may enter into the skull through a natural hole (orbit, nose, mouth, or ear) or crosses the skull, causing a fracture and creating an artificial hole. Preoperative neuroradiologic assessment is paramount for the correct neurosurgical approach. The main prognostic factor for these patients is the GCS score at admission. Copyright © 2016 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2014-05-27

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

Quantitative Penetration Testing with Item Response Theory

NARCIS (Netherlands)

Arnold, Florian; Pieters, Wolter; Stoelinga, Mariëlle Ida Antoinette

2014-01-01

Existing penetration testing approaches assess the vulnerability of a system by determining whether certain attack paths are possible in practice. Thus, penetration testing has so far been used as a qualitative research method. To enable quantitative approaches to security risk management, including

Quantitative penetration testing with item response theory

NARCIS (Netherlands)

Arnold, Florian; Pieters, Wolter; Stoelinga, Mariëlle

2013-01-01

Existing penetration testing approaches assess the vulnerability of a system by determining whether certain attack paths are possible in practice. Thus, penetration testing has so far been used as a qualitative research method. To enable quantitative approaches to security risk management, including

Review of Congestion Management Methods for Distribution Networks with High Penetration of Distributed Energy Resources

DEFF Research Database (Denmark)

Huang, Shaojun; Wu, Qiuwei; Liu, Zhaoxi

2014-01-01

This paper reviews the existing congestion management methods for distribution networks with high penetration of DERs documented in the recent research literatures. The congestion management methods for distribution networks reviewed can be grouped into two categories – market methods and direct...... control methods. The market methods consist of dynamic tariff, distribution capacity market, shadow price and flexible service market. The direct control methods are comprised of network reconfiguration, reactive power control and active power control. Based on the review of the existing methods...

Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back

Directory of Open Access Journals (Sweden)

Talayeh Rezayat, DO, MPH

2016-03-01

Full Text Available Despite multiple advantages, subclavian vein (SCV cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal “in-plane” technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself.

The relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

Science.gov (United States)

Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

2011-01-01

Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.

The market penetration of energy-efficiency programs

Energy Technology Data Exchange (ETDEWEB)

Berry, L.

1990-04-01

The focus of this report is on one source of resource planning uncertainty: the expected market penetration of DSM (Demand Site Management) programs. Its purpose is to help refine planning assumptions and reduce uncertainty about the market penetration of utility DSM programs by: (1) investigating concepts and definitions of market penetration, (2) reviewing data that characterize patterns of variation (including ranges, averages and maximum levels) in program participation rates, (3) identifying the factors that affect participation, and (4) reviewing the structure and data requirements of models that forecast market penetration. 84 refs., 14 figs., 16 tabs.

Management strategies for thoracic stent-graft repair of distal aortic arch lesions: is intentional subclavian artery occlusion a safe procedure?

Energy Technology Data Exchange (ETDEWEB)

Fanelli, Fabrizio; Salvatori, Filippo Maria; Pucci, Armando; Lucatelli, Pierleone; Rossi, Plinio; Passariello, Roberto [University of Rome La Sapienza, Department of Radiological Sciences, Rome (Italy); Dake, Michael D. [Stanford University School of Medicine, Department of Cardiothoracic Surgery Radiology, Stanford, CA (United States); Mazzesi, Giuseppe [University of Rome La Sapienza, Institute of Heart and Great Vessels, Rome (Italy)

2009-10-15

The aim of this retrospective analysis was to assess the clinical consequences after intentional left subclavian artery (LSA) occlusion. Thirty-seven patients, 27 type B dissection and 10 thoracic aneurysm, with short proximal neck (less than 2 cm) underwent endovascular treatment with intentional exclusion of LSA origin. No immediate complications occurred. Mean arterial pressure gradient, between right and left arms, ranged from 15 to 45 mmHg. After a mean follow-up of 43.70{+-}24.01 months, mild left arm symptoms secondary to flow reduction occurred in eight cases (21.6%) but only one required LSA transposition, after 8 months, for visual impairment. Type II endoleaks from excluded LSA occurred in 10 cases (27.0%): in seven patients, leaks were treated with coils and/or glue embolization; in one case, leak sealed spontaneously; one patient died before leak embolization could occur; one patient refused any further treatment. Intentional exclusion of the LSA may be justified when a longer proximal landing zone in the aortic arch is required. (orig.)

Control of penetration zone GMAW

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Віталій Петрович Iванов

2016-11-01

Full Text Available Thermal properties of the base metal, shielding medium and the nature of the electrode metal transfer to a great extent determine the penetration area formation in gas-arc welding. It is not always possible to take into account the influence of these factors on penetration front forming within the existing models. The aim of the work was to research the penetration area forming in gas-arc welding. The research of the penetration area forming in gas-arc welding of CrNi austenitic steels was made. The parameters of the regime as well as the kind of the gaseous medium influence on the formation of the penetration zone were studied. The article shows a linear proportional relationship between the electrode feed rate and the size of the base metal plate. The penetration area formation mode for welding in argon and carbon dioxide have been worked out. Diameter, feed rate and the speed of the electrode movement have been chosen as the main input parameters. Multiple regression analysis method was used to make up the modes. The relations of the third order that make it possible to take into account the electrode metal transfer and thermal properties change of the materials to be welded were used. These relationships show quite good agreement with the experimental measurements in the calculation of the fusion zone shape with consumable electrode in argon and carbon dioxide. It was determined that the shape of the melting front curve can be shown as a generalized function in which the front motion parameters depend on feed rate and the diameter of the electrode. Penetration zone growth time is determined by the welding speed and is calculated as a discrete function of the distance from the electrode with the spacing along the movement coordinate. The influence of the mode parameters on the formation of the fusion zone has been investigated and the ways to manage and stabilize the weld pool formation have been identified. The modes can be used to develop

Irradiation-induced changes in the subclavian and axillary arteries after radiotherapy for carcinoma of the breast

International Nuclear Information System (INIS)

Kretschmer, G.; Niederle, B.; Polterauer, P.; Waneck, R.

1986-01-01

Three case reports are reviewed to illustrate the possibility of treating irradiation-induced lesions of the subclavian-brachial vascular segment (aneurysm and segmental occlusions) 14, 20, and 26 years after radical mastectomy and subsequent radiotherapy. All patients had an extraanatomic vein bypass graft from the carotid to the brachial artery crossing the shoulder near the acromioclavicular joint, with the advantage that the tissue changed by radiotherapy or infected by ulceration could be circumvented. There were no postoperative complications, with adequate function of the grafts (follow-up, 17, 24, and 20 months, respectively)

Penetrating chest injury: A miraculous life salvage

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Santosh B Dalavi

2013-01-01

Full Text Available An unusual penetrating chest injury was caused by high velocity road traffic accident. An 18-year-old had a four wheeler accident and was brought in emergency department with a ′bamboo′ stick on the left side chest exiting through back. After the stabilization of vital parameters, an inter-costal tube drainage was done on the left side. Except the minor brochopleural fistula which healed by 10 th day, his recovery was uneventful. The outcome was consistent with current aggressive management of penetrating chest injuries. Management of penetrating chest injury involving pulmonary trauma is based on three principles. One is stabilization of hemodynamics of patient with proper clinical evaluation. Second, a mere intercostal tube drainage sufficient for majority of the cases. Third, post-operative active as well as passive physiotherapy is necessary for speedy recovery.

The selective conservative management of penetrating thoracic trauma is still appropriate in the current era.

Science.gov (United States)

Kong, Victor Y; Sartorius, Benn; Clarke, Damian L

2015-01-01

Traumatic pleural collections secondary to penetrating chest trauma are generally managed by intercostal chest drainage (ICD), but these protocols were developed a few decades ago when stabs (SWs) predominated over gunshot wounds (GSWs). This study reviews the outcome of a selective conservative approach to penetrating thoracic trauma to establish if it is still appropriate in the current era. We reviewed 827 patients over a four-year period with penetrating unilateral non-cardiac wounds of the chest in order to review the efficacy of our policy and to define the differences in the spectrum of injury between SWs and GSWs. Ninety-two per cent (764/827) were males, and the median age was 24 years. Seventy-six per cent (625/827) sustained SWs and twenty-four per cent (202/827) GSWs. Chest pathologies were: pneumothorax (PTX): 362 (44%), haemothorax (HTX): 150 (18%) and haemopneumothorax (HPTX): 315 (38%). Ninety-six per cent of patients were managed non-operatively. Four per cent (36/827) were subjected to a thoracotomy [31 SWs and 5 GSWs]. No difference was observed in terms of the need for operative intervention: 5% vs. 3% [p=0.202]. PTX was seen exclusively in SWs: 58% vs. 0% and there were significantly more HPTXs seen in the GSWs: HPTX: 24% vs. 81% [p<0.001]. The median days of ICD in situ were significantly longer in GSWs compared to SWs for all pathologies. For HTX: 4.5 (interquartile range [IQR]: 3-6) vs. 3.5 (IQR: 0-5) days, p=0.001 and HPTX: 4 (IQR: 3-5) vs. 3.0 (IQR: 3-4) days, p<0.001. There were seven (15%) complications. A total of five (13%) patients died and all deaths were confined to the operative group. SWs continue to predominate over GSWs. PTXs were more commonly associated with SWs, whilst HPTX are more commonly associated with GSWs. A policy of selective conservatism is still applicable to the management of traumatic pleural collections. Copyright © 2014 Elsevier Ltd. All rights reserved.

Tube thorocostomy: management and outcome in patients with penetrating chest trauma.

Science.gov (United States)

Muslim, Muhammad; Bilal, Amer; Salim, Muhammad; Khan, Muhammad Abid; Baseer, Abdul; Ahmed, Manzoor

2008-01-01

Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six (92%) patients in group I and thirty seven (74%) in group II. Partial lung

PETA: Methodology of Information Systems Security Penetration Testing

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Tomáš Klíma

2016-12-01

Full Text Available Current methodologies of information systems penetration testing focuses mainly on a high level and technical description of the testing process. Unfortunately, there is no methodology focused primarily on the management of these tests. It often results in a situation when the tests are badly planned, managed and the vulnerabilities found are unsystematically remediated. The goal of this article is to present new methodology called PETA which is focused mainly on the management of penetration tests. Development of this methodology was based on the comparative analysis of current methodologies. New methodology incorporates current best practices of IT governance and project management represented by COBIT and PRINCE2 principles. Presented methodology has been quantitatively evaluated.

Study on Penetration Characteristics of Tungsten Cylindrical Penetrator

Energy Technology Data Exchange (ETDEWEB)

Jo, Jong Hyun; Lee, Young Shin; Kim, Jae Hoon [Chungnam Nat' l Univ., Daejeon (Korea, Republic of); Bae, Yong Woon [Agency for Defense Development, Daejeon (Korea, Republic of)

2013-09-15

The design of missile require extremely small warheads that must be highly efficient and lethal. The penetration characteristics of each penetrator and the total number of penetrators on the warhead are obvious key factors that influence warhead lethality. The design of the penetrator shape and size are directly related to the space and weight of the warhead. The design of the penetrator L/D was directly related to the space and weight of the warhead. L and D are the length and the diameter of the projectile, respectively. The AUTODYN-3a code was used to study the effect of penetrator penetration. The objective of numerical analysis was to determine the penetration characteristics of penetrator produced by hypervelocity impacts under different initial conditions such as initial velocity, obliquity angle and L/D of penetrator. The residual velocity and residual mass were decreased with increasing initial impact velocity under L/D{<=}4.

Update on the Management of High-Risk Penetrating Keratoplasty.

Science.gov (United States)

Jabbehdari, Sayena; Rafii, Alireza Baradaran; Yazdanpanah, Ghasem; Hamrah, Pedram; Holland, Edward J; Djalilian, Ali R

2017-03-01

In this article, we review the indications and latest management of high-risk penetrating keratoplasty. Despite the immune-privilege status of the cornea, immune-mediated graft rejection still remains the leading cause of corneal graft failure. This is particularly a problem in the high-risk graft recipients, namely patients with previous graft failure due to rejection and those with inflamed and vascularized corneal beds. A number of strategies including both local and systemic immunosuppression are currently used to increase the success rate of high-risk corneal grafts. Moreover, in cases of limbal stem cell deficiency, limbal stem cells transplantation is employed. Corticosteroids are still the top medication for prevention and treatment in cases of corneal graft rejection. Single and combined administration of immunosuppressive agents e.g. tacrolimus, cyclosporine and mycophenolate are promising adjunctive therapies for prolonging graft survival. In the future, cellular and molecular therapies should allow us to achieve immunologic tolerance even in high-risk grafts.

The Association between Medicare Advantage Market Penetration and Diabetes in the United States.

Science.gov (United States)

Howard, Steven W; Bernell, Stephanie Lazarus; Wilmott, Jennifer; Casim, M Faizan; Wang, Jing; Pearson, Lindsey; Byler, Caitlin M; Zhang, Zidong

2015-01-01

The objective of this study is to explore the extent to which managed care market penetration in the United States is associated with the presence of chronic disease. Diabetes was selected as the chronic disease of interest due to its increasing prevalence as well as the disease management protocols that can lessen disease complications. We hypothesized that greater managed care market penetration would be associated with (1) lower prevalence of diabetes and (2) lower prevalence of diabetes-related comorbidities (DRCs) among diabetics. Data for this analysis came from two sources. We merged Medicare Advantage (MA) market penetration data from the Centers for Medicare and Medicaid Services (CMS) with data from the Medical Expenditure Panel Survey (MEPS) (2004-2008). Results suggest that county-level MA market penetration is not significantly associated with prevalence of diabetes or DRCs. That finding is quite interesting in that managed care market penetration has been shown to have an effect on utilization of inpatient services. It may be that managed care protocols do not offer the same benefits beyond the inpatient setting.

Quantitative penetration testing with item response theory (extended version)

NARCIS (Netherlands)

Arnold, Florian; Pieters, Wolter; Stoelinga, Mariëlle Ida Antoinette

2013-01-01

Existing penetration testing approaches assess the vulnerability of a system by determining whether certain attack paths are possible in practice. Therefore, penetration testing has thus far been used as a qualitative research method. To enable quantitative approaches to security risk management,

Management of blunt and penetrating biliary tract trauma.

Science.gov (United States)

Thomson, Benjamin N J; Nardino, Benson; Gumm, Kellie; Robertson, Amanda J; Knowles, Brett P; Collier, Neil A; Judson, Rodney

2012-06-01

Penetrating or blunt injury to the biliary tree remains a rare complication of trauma occurring in 0.1% of trauma admissions. Because of the different presentations, sites of biliary tract injury, and associated organ injury, there are many possible management pathways to be considered. A retrospective analysis of prospectively gathered data was performed for all gallbladder and biliary tract injuries presenting to the trauma service or hepatobiliary unit of the Royal Melbourne Hospital between January 1, 1999, and March 30, 2011. There were 33 biliary injuries in 30 patients (0.1%) among 26,014 trauma admissions. Three of the 30 patients (10%) died. Of 10 gallbladder injuries, 8 were managed with cholecystectomy. There were 23 injuries to the biliary tree. Fourteen patients had injuries to the intrahepatic biliary tree of which seven involved segmental ducts. Of these, four segmental duct injuries required hepatic resection or debridement. Nine patients had injury to the extrahepatic biliary tree of which five required T-tube placement ± bilioenteric anastomosis and one a pancreaticoduodenectomy. Biliary injury is a rare but important consequence of abdominal trauma, and good outcomes are possible when a major trauma center and hepatopancreaticobiliary service coexist. Cholecystectomy remains the gold standard for gallbladder injury. Drainage with or without endoscopic stenting will resolve the majority of intrahepatic and partial biliary injuries. Hepaticojejunostomy remains the gold standard for complete extrahepatic biliary disruption. Hepatic and pancreatic resection are only required in the circumstances of unreconstructable biliary injury. Therapeutic study, level V. Copyright © 2012 by Lippincott Williams & Wilkins.

Penetrating ureteral trauma

Directory of Open Access Journals (Sweden)

Gustavo P. Fraga

2007-04-01

Full Text Available OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90% and stab wounds in two (10%. All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%. Two ureteral injuries (10% were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.

Cutaneous mucormycosis secondary to penetrative trauma.

Science.gov (United States)

Zahoor, Bilal; Kent, Stephen; Wall, Daryl

2016-07-01

Mucormycosis is a rare but serious sequelae of penetrating trauma [1-5]. In spite of aggressive management, mortality remains high due to dissemination of infection. We completed a review of literature to determine the most optimal treatment of cutaneous mucormycosis which occurs secondary to penetrating trauma. We completed a review regarding the management of mucormycosis in trauma patients. We selected a total of 36 reports, of which 18 were case-based, for review. Surgical debridement is a primary predictor of improved outcomes in the treatment of mucormycosis [3,6,7]. Anti-fungal therapy, especially lipid soluble formulation of Amphotericin B, is helpful as an adjunct or when surgical debridement has been maximally achieved. Further research is needed to fully evaluate the impact of topical dressings; negative pressure wound therapy is helpful. An aggressive and early surgical approach, even at the expense of disfigurement, is necessary to reduce mortality in the setting of cutaneous mucormycosis that results from penetrating trauma [4,8,9]. Anti-fungal therapy and negative pressure wound therapy are formidable adjuncts. Copyright © 2016 Elsevier Ltd. All rights reserved.

Forty hours with a traumatic carotid transection: A diagnostic caveat and review of the contemporary management of penetrating neck trauma.

Science.gov (United States)

Ng, Eugene; Campbell, Ian; Choong, Andrew; Kruger, Allan; Walker, Philip J

2018-02-20

Although penetrating neck trauma (PNT) is uncommon, it is associated with the significant morbidity and mortality. The management of PNT has changed significantly over the past 50 years. A radiological assessment now is a vital part of the management with a traditional surgical exploration. A 22 years old male was assaulted by a screwdriver and sustained multiple penetrating neck injuries. A contrast CT scan revealed a focal pseudoaneurysm in the left common carotid artery bulb. There was no active bleeding or any other vascular injuries and the patient remained haemodynamically stable. In view of these findings, he was initially managed conservatively without an open surgical exploration. However, the patient was noted to have an acute drop in his hemoglobin count overnight post injury and the catheter directed angiography showed active bleeding from the pseudoaneurysm. Surgical exploration 40 hours following the initial injury revealed a penetrating injury through both arterial walls of the left carotid bulb which was repaired with a great saphenous vein patch. A percutaneous drain was inserted in the carotid triangle and a course of intravenous antibiotics for five days was commenced. The patient recovered well with no complications and remained asymptomatic at five months followup. Copyright © 2018 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. All rights reserved.

Sheath rendezvous method: a novel distal protection technique during endovascular treatment of subclavian artery occlusions.

Science.gov (United States)

Haraguchi, Takuya; Urasawa, Kazushi; Nakama, Tatsuya; Nakagawa, Yuya; Tan, Michinao; Koshida, Ryoji; Sato, Katsuhiko

2016-10-01

To describe an innovative distal protection technique, "sheath rendezvous method", during endovascular treatment for subclavian arterial occlusions. 4.5F and 6F guiding sheath were inserted from left brachial and common femoral artery, respectively. 0.014″ guidewire retrogradely passed through occlusion and into antegrade sheath to establish a pull-through system. 3.0 mm balloon was used to expand occlusion and anchor to deliver retrograde sheath into antegrade one. Both sheaths locked by balloon dilatation crossed occlusion until antegrade sheath passed over lesion. Balloon expandable stent was delivered within antegrade sheath. Sheath was removed, and stent was implanted. We obtained an excellent outcome without complications.

Aberrant right vertebral artery originating from the aortic arch distal to the left subclavian artery: A case report

Energy Technology Data Exchange (ETDEWEB)

Baek, Soo Heui; Baek, Hye Jin [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

2014-03-15

We present a rare case of an aberrant right vertebral artery originated from the distal aortic arch. This issue has been incidentally detected on a preoperative CT angiography after a stabbing injury of the cervical spinal cord. Normally, the right vertebral artery originates from the right subclavian artery. Therefore, in this case report we will review the incidence and the embryological mechanism of this aberrant course of the right vertebral artery and we will discuss as well the clinical importance of this variation.

Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function.

Science.gov (United States)

Stone, David H; Scali, Salvatore T; Bjerk, Aja A; Rzucidlo, Eva; Chang, Catherine K; Goodney, Philip P; Nolan, Brian W; Walsh, Daniel B

2010-07-01

While much attention has been devoted toward treatment paradigms for idiopathic axillo-subclavian vein thrombosis (ASVT), little has focused on long-term durability of aggressive treatment and its associated functional outcomes. The purpose of this study was to review our own surgical therapeutic algorithm and its associated durability and functional outcomes. All patients treated with combined endovascular and open surgery at Dartmouth-Hitchcock Medical Center for ASVT from 1988 to 2008 were identified. Patient demographics, comorbidities, and operative techniques were recorded. Patency, freedom from reintervention, and functional outcomes were documented. Follow-up via telephone and clinic visit allowed quantitative comparison of functional status, pre- and postoperatively. Thirty-six patients were treated for ASVT throughout the study interval. Seven patients (19.4%) were lost to follow-up. Most patients were male (66%; N = 24); mean age was 32 years. Catheter-directed thrombolysis was utilized in the majority of patients (83.3%; N = 30) with an average time from symptom onset to lysis of 12 days. Surgical decompression was undertaken in all patients via transaxillary (52%; N = 19), supraclavicular (31%; N = 11), or infraclavicular approaches (17%; N = 6). Eleven stents were placed in 11 patients (30.5%) for residual stenotic disease. Mean follow-up was 65 months, with 1- and 5-year overall patency at 100% and 94%, respectively. Freedom from reintervention was 100% and 74.4% at 1 and 5 years, respectively. Seven patients (19.4%) required postoperative reintervention with four receiving additional lytic therapy, two requiring a stent, and one venoplasty. At presentation, 65.5% (N = 19) of patients were unable to work or perform routine activities. After treatment, 86% (N = 25) returned to their employment and have experienced sustained symptomatic and functional improvement. Patients with symptomatic idiopathic axillo-subclavian vein thrombosis can expect durable

Primary repair of penetrating colon injuries: a systematic review.

Science.gov (United States)

Singer, Marc A; Nelson, Richard L

2002-12-01

Primary repair of penetrating colon injuries is an appealing management option; however, uncertainty about its safety persists. This study was conducted to compare the morbidity and mortality of primary repair with fecal diversion in the management of penetrating colon injuries by use of a meta-analysis of randomized, prospective trials. We searched for prospective, randomized trials in MEDLINE (1966 to November 2001), the Cochrane Library, and EMBase using the terms colon, penetrating, injury, colostomy, prospective, and randomized. Studies were included if they were randomized, controlled trials that compared the outcomes of primary repair with fecal diversion in the management of penetrating colon injuries. Five studies were included. Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index, and length of stay. Peto odds ratios for combined effect were calculated with a 95 percent confidence interval for each outcome. Heterogeneity was also assessed for each outcome. The penetrating abdominal trauma index of included subjects did not differ significantly between studies. Mortality was not significantly different between groups (odds ratio, 1.70; 95 percent confidence interval, 0.51-5.66). However, total complications (odds ratio, 0.28; 95 percent confidence interval, 0.18-0.42), total infectious complications (odds ratio, 0.41; 95 percent confidence interval, 0.27-0.63), abdominal infections including dehiscence (odds ratio, 0.59; 95 percent confidence interval, 0.38-0.94), abdominal infections excluding dehiscence (odds ratio, 0.52; 95 percent confidence interval, 0.31-0.86), wound complications including dehiscence (odds ratio, 0.55; 95 percent confidence interval, 0.34-0.89), and wound complications excluding dehiscence (odds ratio, 0.43; 95 percent confidence interval, 0

Aneurysmatic dissection of an aberrant right subclavian artery; Disseziierendes Aneurysma einer aberranten Arteria subclavia dextra: Diagnose mittels Ultrafast-CT

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Reittner, P. [Universitaetsklinik fuer Radiologie, Graz (Austria). Abt. fuer Allgemeine Radiologie; Stacher, R. [Universitaetsklinik fuer Radiologie, Graz (Austria). Abt. fuer Allgemeine Radiologie

1996-01-01

Diagnosis with Ultrafast-CT: An aneurysm of an aberrant right subclavian artery is a very rare cause for dysphagia. We describe such a case in a 67-year-old patient, diagnosed with Ultrafast-CT and discuss it together in concert with the embryology and the radiological findings. (orig.) [Deutsch] Eine aberrierende Arteria subclavia dextra ist eine seltene Ursache fuer Dysphagie. Anhand eines 67jaehrigen Patienten werden Embryologie und radiologische Charakteristika, diagnostiziert mittels Ultrafast-CT, diskutiert. (orig.)

Ultrasound guided implantation of chest port systems via the lateral subclavian vein; Die sonographisch gezielte Implantation von Portkathetersystemen ueber die laterale Vena subclavia

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Zaehringer, M.; Hilgers, J.; Krueger, K.; Strohe, D.; Bangard, C.; Neumann, L.; Lackner, K. [Inst. fuer Radiologische Diagnostik, Univ. zu Koeln (Germany); Warm, M. [Gynaekologie, Univ. zu Koeln (Germany); Reiser, M. [Medizinische Klinik I, Univ. zu Koeln (Germany); Toex, U. [Medizinische Klinik IV, Univ. zu Koeln (Germany)

2006-03-15

Purpose: Retrospective analysis of the success and complication rates of chest port implantation via the lateral subclavian vein. Materials and methods: Between January 2003 and June 2004, the lateral subclavian vein in 271 patients (186 women, 85 men, mean age 53.2 years) was punctured guided by ultrasound. This access was used to insert a port system, and the catheter tip was placed at the cavoatrial junction. The port reservoir was implanted in a subcutaneous infraclavicular pocket and fixed to the fascia of the pectoralis muscle. Indications for port implantation were chemotherapy (n=239), total parenteral nutrition (n=2) and intravenous medication (n=30). The patient follow-up was mainly performed either by the oncology division of the department of gynecology or by the department of internal medicine. Results: A chest port catheter system was successfully implanted in all patients. The catheter remained in place for a mean duration of 269.4 days (SD 192.3 days). No complications occurred during implantation. In the post-interventional period, 6 catheter dysfunctions were found (thrombotic 0.09 per 1000 catheter days; mechanic 0.05 per 1000 catheter days). While one local infection occurred in the early post-interventional period, 3 local and 15 systemic infections were independent of the port catheter placement (0.39 per 1000 catheter days). The rate of port catheter explantations due to dysfunction or infection was 0.07 per 1000 catheter days. Conclusion: Ultrasound-guided puncture of the lateral subclavian vein is a safe procedure for the insertion of central venous port catheter systems and had a very low complication rate in our study. For further evaluation of our port placement technique, prospective studies compared to placement through the internal jugular vein are necessary. (orig.)

The effect of lung deflation on the position of the pleura during subclavian vein cannulation in infants receiving mechanical ventilation: an ultrasound study.

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Jang, Y-E; Lee, J-H; Park, Y-H; Byon, H-J; Kim, H-S; Kim, C-S; Kim, J-T

2013-10-01

We evaluated the effect of lung deflation on the relative position of the pleura compared with a reference line during supra- and infraclavicular approaches to the right subclavian vein. The reference line was drawn relative to the predicted pathway of the needle. The distances between the pleura and the reference line for supra- and infraclavicular approaches were measured during inspiration and expiration in 41 infants. Measurements were repeated with the application of 5 cmH2O positive end-expiratory pressure (PEEP) and in the Trendelenburg position. Lung deflation during the supraclavicular approach significantly decreased the volume of lung crossing the reference line by a median (IQR [range]) of 1.0 (0.6 to 1.3 [0.0 to 4.8]) mm, p deflation showed no change in the distance of the pleura from the reference line regardless of PEEP or patient position. We conclude that lung deflation moves the lung apex caudally and can reduce the potential risk of pneumothorax during a supraclavicular approach to the right subclavian vein in infants. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Initial and Long-Term Results of Endovascular Therapy for Chronic Total Occlusion of the Subclavian Artery

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Babic, Srdjan; Sagic, Dragan; Radak, Djordje; Antonic, Zelimir; Otasevic, Petar; Kovacevic, Vladimir; Tanaskovic, Slobodan; Ruzicic, Dusan; Aleksic, Nikola; Vucurevic, Goran

2012-01-01

Purpose: To study the initial and long-term results of angioplasty and primary stenting for the treatment of chronic total occlusion (CTO) of the subclavian artery (SA). Materials and Methods: From January 1999 to February 2010, 56 patients (25 men with a mean age of 58 ± 8 years) underwent endovascular treatment for CTO of the SA. Duplex scans and arteriograms confirmed occlusion in all cases. Indications for recanalization were subclavian steal syndrome in 33 patients (58.1%), arm claudication in 13 patients (23.2%), and coronary ischemia in 7 patients (12.5%) who had a history of previous coronary artery bypass grafting that included left internal thoracic artery graft. Three patients (5.4%) were treated before the scheduled coronary artery bypass surgery, which included left internal thoracic artery graft. After successful recanalization, all arteries were stented, and all of the patients were followed-up at 1, 3, 6, and 12 months after surgery and annually thereafter. Results: Successful recanalization of the SA was achieved in 46 patients (82.1%), and the complication rate was 7.1%. During follow-up (mean 40 ± 26 months; range 2 to 125), the primary patency rates after 1 and 3 years were 97.9% and 82.7%, respectively. At the end of follow-up, 76% of the arteries showed no evidence of restenosis. Univariate analysis failed to identify any variable predictive of long-term patency of successfully recanalized SA. Conclusion: Percutaneous transluminal angioplasty with stenting of the complete total occlusion of the SA is a safe and effective procedure associated with low risks and good long-term results.

Management of the difficult duodenal stump in penetrating duodenal ulcer disease: a comparative analysis of duodenojejunostomy with "classical" stump closure (Nissen-Bsteh).

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Vashist, Yogesh K; Yekebas, Emre F; Gebauer, Florian; Tachezy, Michael; Bachmann, Kai; König, Alexandra; Kutup, Asad; Izbicki, Jakob R

2012-12-01

Duodenal stump insufficiency after surgery for penetrating gastroduodenal ulcer is associated with substantial mortality. "Classical" technique of closing a difficult duodenal stump (Nissen-Bsteh) has, up to now, not been compared with duodenojejunostomy (DJ) in larger patient sets. This also refers to the potential benefit of a gastric and biliary diversion under such conditions. The aim of the present study was to compare classical duodenal closure (CC) with DJ and to evaluate the impact of gastric and biliary diversion on postoperative outcome after surgery for penetrating, high-risk duodenal ulcer in a matched control study. Out of 321 patients, treated for penetrating duodenal ulcer disease, the perioperative outcome of 62 DJ patients was compared with 62 patients undergoing CC matched for age, gender, biliary diversion, and the operating surgeon collective. A total of 70 patients, equally distributed between DJ and CC subsets, received temporary biliary diversion. Overall perioperative mortality was 10.5%. However, DJ significantly reduced the mortality rate (4.8%) associated with penetrating duodenal ulcer compared to CC (16.1%, P management of penetrating duodenal ulcer.

Espessamento médio-intimal na origem da artéria subclávia direita como marcador precoce de risco cardiovascular Intima-media thickness in the origin of right subclavian artery as an early marker of cardiovascular risk

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Carlos Alberto Engelhorn

2006-11-01

EMI na origem da artéria subclávia direita pode ser considerado um marcador mais precoce para avaliação de risco cardiovascular.OBJECTIVE: Common carotid artery intima-media thickness (IMT is considered a factor of cardiovascular risk and an early marker of coronary artery disease. This study aimed to investigate the existence of a correlation between IMT in the carotid arteries and at the origin of the right subclavian artery, as well as to evaluate IMT in the subclavian artery as an earlier marker of cardiovascular risk. METHODS: One hundred and six consecutive patients, 52 males and 54 females, average age 51 years, underwent color Doppler ultrasonography to evaluate carotid and right subclavian arteries. The relationship between carotid IMT and right subclavian IMT was assessed using the Pearson's correlation coefficient analysis and a 95% confidence interval. Reliability of right subclavian artery IMT measurement for the diagnosis of early thickening (considering a > 0.8 mm carotid thickness as reference was described as to sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Cut-off values for the right subclavian IMT were indicated by the ROC curve, and p values 0.8 mm. The mean IMT value for the carotid artery was 0.87 mm (SD = 0.23 and for the subclavian artery, 1.17 mm (SD = 0.46, with a 0.31 correlation coefficient (95% CI: 0.12; 0.47. The ROC curve analysis indicated a cut-off value of 0.7 mm for the right subclavian artery IMT, using as reference a 0.8 mm cut-off value for the carotid artery (91% sensitivity, 27% specificity, 66% PPV, 65% NPV, and 66% accuracy. CONCLUSION: Our study showed that carotid artery IMT correlates well with right subclavian artery IMT. With a 0.7 mm cut-off value, it is possible to detect IMT in the right subclavian artery earlier than in the carotid arteries. The IMT at the origin of the right subclavian artery can be considered an earlier marker for the assessment of cardiovascular

[Subclavian artery rupture after road crash: many similitaries].

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Rulliat, E; Ndiaye, A; David, J-S; Voiglio, E J; Lieutaud, T

2011-12-01

Traumatic Subclavian Arterial Ruptures (TSCAR) are rare and with a poor prognosis. The aim of this study was to describe the epidemiological data and the medical charts of the initial care of each patient suffering a TSCAR following a traffic accident. Using the register of the road crash in the Rhone department (France) that records every casualty using the AIS codes, we retrospectively reviewed the prehospital and intrahospital medical, biological and radiological charts of every patient. Follow-up was obtained at day 60 post-trauma. Among the 1181 severe traumatic injuries, five casualties have been recorded in the register with a TSCAR (0.4%). Four of the five patients died in an early dramatic fatal hemorrhagic shock. Similarities between casualties were observed for patients still alive at hospital arrival that associate 1) a two-wheel motorized rider (2-WMR) crashing without antagonist 2) a severe polytraumatism including thoracic and 3) orthopaedic lesions; 4) clinical and biological signs of a severe haemorrhagic shock; 5) radiological signs of scapulothoracic dissociation. TSCAR are rare with a high mortality. We recommend improving the early care by the recognition of the triad associating early severe shock, polytraumatism (thorax and superior limb) and radiological signs evocating scapulothoracic dissociation in a 2-WMR. These signs must lead to the operating theatre as fast as possible in association with early massive transfusions. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Penetrating abdominal trauma.

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Henneman, P L

1989-08-01

The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

Severe tracheobronchial compression in a patient with Turner′s syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives

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Christopher C .C. Hudson

2014-01-01

Full Text Available We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

Perioperative Care for Pediatric Patients With Penetrating Brain Injury: A Review.

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Mikhael, Marco; Frost, Elizabeth; Cristancho, Maria

2017-05-19

Traumatic brain injury (TBI) continues to be the leading cause of death and acquired disability in young children and adolescents, due to blunt or penetrating trauma, the latter being less common but more lethal. Penetrating brain injury (PBI) has not been studied extensively, mainly reported as case reports or case series, due to the assumption that both types of brain injury have common pathophysiology and consequently common management. However, recommendations and guidelines for the management of PBI differ from those of blunt TBI in regards to neuroimaging, intracranial pressure (ICP) monitoring, and surgical management including those pertaining to vascular injury. PBI was one of the exclusion criteria in the second edition of guidelines for the acute medical management of severe TBI in infants, children, and adolescents that was published in 2012 (it is referred to as "pediatric guidelines" in this review). Many reviews of TBI do not differentiate between the mechanisms of injury. We present an overview of PBI, its presenting features, epidemiology, and causes as well as an analysis of case series and the conclusions that may be drawn from those and other studies. More clinical trials specific to penetrating head injuries in children, focusing mainly on pathophysiology and management, are needed. The term PBI is specific to penetrating injury only, whereas TBI, a more inclusive term, describes mainly, but not only, blunt injury.

Management of penetrating ocular injuries and endophthalmitis in thirteen-year follow-up period

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Vukosavljević Miroslav

2006-01-01

Full Text Available Introduction: Ocular trauma is one of the most common causes of unilateral morbidity and blindness in the world today. Objective: Frequency of penetrating ocular injuries and endophthalmitis after injuries caused by explosive weapons during the war in former Yugoslavia in the period 1991-1999 as well as eye injuries in the period 2000-2004 was examined. Method: During 1991-1999, 647 patients with eye injuries were hospitalized at Eye Clinic, MMA, out of whom 500 cases with penetrating eye injuries. In 2000-2004 period, 601 patients with eye injuries were treated, out of whom 297 had penetrating eye injuries (including patients from Montenegro and Republica Srpska. All patients underwent thorough ophthalmological examination, antibiotic treatment and VPP or other required surgical interventions. Results: All 500 patients from the first period had severe penetrating eye injuries. Intrabulbar foreign bodies (IFB were detected in 286 cases, while 214 cases with penetrating eye injuries had no intrabulbar foreign bodies. Almost all patients had multiple head and body injuries as well. Endophthalmitis was observed in 29 eyes (5.2% upon admission to hospital. In the second observed period (2000-2004, 196 (66% out of 297 penetrating eye injuries had IOFB, and 101 (34% was without IOFB. Endophthalmitis was observed in 34 eyes (8.4%. Conclusion: War eye injuries are a special group of injuries. Relatively low percent of posttraumatic endophthalmitis is definitely worth attention, especially in comparison with peacetime eye penetrating injuries.

[Management of penetrating ocular injuries and endophthalmitis in thirteen-year follow-up period].

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Vukosavljević, Miroslav

2006-01-01

Ocular trauma is one of the most common causes of unilateral morbidity and blindness in the world today. Frequency of penetrating ocular injuries and endophthalmitis after injuries caused by explosive weapons during the war in former Yugoslavia in the period 1991-1999 as well as eye injuries in the period 2000-2004 was examined. During 1991-1999, 647 patients with eye injuries were hospitalized at Eye Clinic, MMA, out of whom 500 cases with penetrating eye injuries. In 2000-2004 period, 601 patients with eye injuries were treated, out of whom 297 had penetrating eye injuries (including patients from Montenegro and Republica Srpska). All patients underwent thorough ophthalmological examination, antibiotic treatment and VPP or other required surgical interventions. All 500 patients from the first period had severe penetrating eye injuries. Intrabulbar foreign bodies (IFB) were detected in 286 cases, while 214 cases with penetrating eye injuries had no intrabulbar foreign bodies. Almost all patients had multiple head and body injuries as well. Endophthalmitis was observed in 29 eyes (5.2%) upon admission to hospital. In the second observed period (2000-2004), 196 (66%) out of 297 penetrating eye injuries had IOFB, and 101 (34%) was without IOFB. Endophthalmitis was observed in 34 eyes (8.4%). War eye injuries are a special group of injuries. Relatively low percent of posttraumatic endophthalmitis is definitely worth attention, especially in comparison with peacetime eye penetrating injuries.

Long-term behavior of aortic intramural hematomas and penetrating ulcers.

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Chou, Alan S; Ziganshin, Bulat A; Charilaou, Paris; Tranquilli, Maryann; Rizzo, John A; Elefteriades, John A

2016-02-01

For intramural hematoma and penetrating atherosclerotic ulcer, long-term behavior and treatment are controversial. This study evaluates the long-term behavior of intramural hematoma and penetrating atherosclerotic ulcer, including radiologic follow-up and survival analysis. Between 1995 and 2014, 108 patients (mean age, 70.8 ± 10 years; 56% female) presented with intramural hematoma or penetrating atherosclerotic ulcer to Yale-New Haven Hospital (New Haven, Conn). We reviewed the medical records, radiology, and online mortality databases. Ten of 55 patients (18%) with intramural hematoma and 17 of 53 patients (32%) with penetrating atherosclerotic ulcer had rupture state symptoms on admission, both greater than type A (8%) or type B dissection (4%) (P hematoma with follow-up imaging, 8 of 14 (57%) worsened (mean follow-up, 9.4 months) and 6 (43%) underwent late surgery. For patients with penetrating atherosclerotic ulcer with follow-up imaging, 6 of 20 (30%) worsened and underwent late surgery, and 11 (55%) showed no change (mean follow-up, 34.3 months). Overall survivals were 77%, 70%, 58%, and 33% at 1, 3, 5, and 10 years, respectively. No operative deaths occurred for patients with nonrupture state. Patients with penetrating atherosclerotic ulcer with initial surgical treatment had better long-term survival than patients treated medically (P = .037). In the intramural hematoma group, no such difference was observed (P = .10). At presentation, the incidence of early rupture of intramural hematoma and penetrating atherosclerotic ulcer was higher than for typical dissection. For branch vessels, intramural hematoma never occludes branch arteries. On imaging follow-up, patients with intramural hematoma and penetrating atherosclerotic ulcer rarely improved, with late surgery commonly needed. Better survival was observed for the initial surgical management of patients with penetrating atherosclerotic ulcer compared with initial medical management. Copyright © 2016

HMO penetration: has it hurt public hospitals?

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Clement, J P; Grazier, K L

2001-01-01

The purpose of this study is to determine the extent to which health maintenance organization (HMO) penetration within the public hospitals' market area affects the financial performance and viability of these institutions, relative to private hospitals. Hospital- and market-specific measures are examined in a fully interacted model of over 2,300 hospitals in 321 metropolitan statistical areas (MSAs) in 1995. Although hospitals located in markets with higher HMO penetration have lower financial performance as reflected in revenues, expenses and operating margin, public hospitals are not more disadvantaged than other hospitals by managed care.

Novel experience of laser-assisted 'inside-out' central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation.

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Aye, Thandar; Phan, Thanh Trung; Muir, Douglas Findlay; Linker, Nicholas John; Hartley, Richard; Turley, Andrew John

2017-10-01

This new laser facilitated 'inside-out' technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach. Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion. When encountered with impenetrable resistance, 1.4 mm Excimer laser helped delivery of a Pilot 200 wire, which then progressed towards the distal edge of occlusion. Serial balloon dilatations allowed wire tracked into subintimal plane, advanced towards left clavicle using knuckle wire technique, which was then externalized with blunt dissection from infraclavicular pocket area. It was later changed to Amplatz superstiff wire exiting from both ends to form a rail, which ultimately allowed passage of pacing leads after serial balloon dilatation from clavicular end. Our hybrid 'inside-out' technique permitted transvenous pacemaker insertion without complication and this is, to our knowledge, the first case using laser in this context. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Management of a Low-Energy Penetrating Brain Injury Caused by a Nail

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V. R. Ferraz

2016-01-01

Full Text Available Low-energy penetrating nail injury to the brain is an extremely rare neurosurgical emergency. The most common cause of nail gun injury is work related accidents; other causes result from accidental firing of a nail gun, suicide attempts by firing nail guns into the brain, and bomb blasts containing pieces of nails. Neurosurgical treatment performed by craniotomy still seems to be the safest one; there are reports of complications such as subdural hematoma and intraparenchymal hemorrhages following the blind removal of foreign bodies leading to suggestions that all penetrating foreign bodies should be removed under direct vision. We report a rarely described neurosurgical approach for removal of a penetrating nail from the brain and skull without evidence of associated hematoma and other brain lesions.

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

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Ahmed, Ahmed T.; Mohammed, Khaled; Chehab, Monzer; Brinjikji, Waleed; Hassan Murad, M.; Cloft, Harry; Bjarnason, Haraldur

2016-01-01

Background and PurposeSubclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.Materials and MethodsWe searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.ResultsA total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.ConclusionStent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Comparing Percutaneous Transluminal Angioplasty and Stent Placement for Treatment of Subclavian Arterial Occlusive Disease: A Systematic Review and Meta-Analysis

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Ahmed, Ahmed T., E-mail: Ahmed.Ahmed1@mayo.edu; Mohammed, Khaled, E-mail: Mohammed.Khaled@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Chehab, Monzer, E-mail: moe.chehab@beumont.edu [Oakland University William Beaumont School of Medicine, Department of Diagnostic Radiology and Molecular Imaging (United States); Brinjikji, Waleed, E-mail: Brinjikji.Waleed@mayo.edu [Mayo Clinic, Department of Radiology (United States); Hassan Murad, M., E-mail: Murad.Mohammad@mayo.edu [Mayo Clinic, Evidence-Based Practice Research Program (United States); Cloft, Harry, E-mail: Cloft.Harry@mayo.edu; Bjarnason, Haraldur, E-mail: Bjarnason.Haraldur@mayo.edu [Mayo Clinic, Department of Radiology (United States)

2016-05-15

Background and PurposeSubclavian artery occlusive disease (SAOD) is often associated with cerebrovascular symptoms such as subclavian steal syndrome and stroke. We conducted a systematic review and meta-analysis to compare percutaneous transluminal angioplasty (PTA) and stent placement for the treatment of SAOD.Materials and MethodsWe searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through October 16, 2014. From each study, we abstracted baseline patient characteristics, study design variables, and outcome data including rates of technical success, primary patency (≤2 and >2 years follow-up), symptom resolution, and complications. Meta-analysis was performed using a random-effects model.ResultsA total of 35 non-comparative studies with 1726 patients were included. Technical success rate was significantly higher in the stent group than the PTA group (92.8 vs 86.8 %, p = 0.007). Long-term primary patency rates (76.9 vs 79.6 %, p = 0.729) and symptom resolution rates (82.2 vs 73.0 %, p = 0.327) were not statistically different. There was no statistically significant difference in the rates of stroke or death.ConclusionStent placement for treatment of SAOD may be associated with higher rates of technical success but similar rates of symptom resolution and long-term outcomes. The confidence in the available estimates is low. Further comparative studies are needed to guide patients and clinicians in shared decision making.

Laparoscopic management of retroperitoneal injuries from penetrating abdominal trauma in haemodynamically stable patients.

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Koto, Modise Zacharia; Matsevych, Oleh Y; Mosai, Fusi; Balabyeki, Moses; Aldous, Colleen

2018-02-27

Laparoscopy is increasingly utilised in the trauma setting. However, its safety and reliability in evaluating and managing retroperitoneal injuries are not known. The aim of this study was to analyse our experience with laparoscopic management of retroperitoneal injuries due to penetrating abdominal trauma (PAT) and to investigate its feasibility, safety and accuracy in haemodynamically stable patients. Over a 4-year period, patients approached laparoscopically with retroperitoneal injuries were analysed. Mechanism, location and severity of injuries were recorded. Surgical procedures, conversion rate and reasons for conversion and outcomes were described. Of the 284 patients with PAT, 56 patients had involvement of retroperitoneum. Stab wounds accounted 62.5% of patients. The mean Injury Severity Score was 7.4 (4-20). Among retroperitoneal injuries, the colon (27%) was the most commonly involved hollow viscera followed by duodenum (5%). The kidney (5%) and the pancreas (4%) were the injured solid organs. The conversion rate was 19.6% and was mainly due to active bleeding (73%). Significantly more patients with gunshot wound were converted to laparotomy (38% vs. 9%). Therapeutic laparoscopy was performed in 36% of patients. There were no recorded missed injuries or mortality. Five (9%) patients developed the Clavien-Dindo Grade 3 complications, three were managed with reoperation, one with drainage/debridement and one with endovascular technique. Laparoscopic management of retroperitoneal injuries is safe and feasible in haemodynamically stable patients with PAT. However, a high conversion rate indicates difficulties in managing these injuries. The requirements are the dexterity in laparoscopy and readiness to convert in the event of bleeding.

Penetrating abdomino-thoracic injury with an iron rod: An anaesthetic challenge

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Kiranpreet Kaur

2014-01-01

Full Text Available Penetrating abdomino-thoracic injuries are potentially life-threatening due to the associated haemorrhagic shock and visceral injury. The management of these injuries poses specific challenges in pre-hospital care, transport, and management strategies. We report a 35-year-old male having impalement injury of the left thorax and left upper arm with a metallic rod used for construction of the house after a fall from height. One rod penetrated thorax from left shoulder and exit point was present just above the iliac crest and second rod was seen piercing left upper arm. Patient was successfully managed without any intraoperative, post-operative surgical complications, neurological damage or permanent injuries.

Bedside prediction of right subclavian venous catheter insertion length

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Yoon Ji Choi

2014-12-01

Full Text Available Background and objective: The present study aimed to evaluate whether right subclavian vein (SCV catheter insertion depth can be predicted reliably by the distances from the SCV insertion site to the ipsilateral clavicular notch directly (denoted as I-IC, via the top of the SCV arch, or via the clavicle (denoted as I-T-IC and I-C-IC, respectively. Method: In total, 70 SCV catheterizations were studied. The I-IC, I-T-IC, and I-C-IC distances in each case were measured after ultrasound-guided SCV catheter insertion. The actual length of the catheter between the insertion site and the ipsilateral clavicular notch, denoted as L, was calculated by using chest X-ray. Results: L differed from the I-T-IC, I-C-IC, and I-IC distances by 0.14±0.53, 2.19±1.17, and -0.45 ±0.68 cm, respectively. The mean I-T-IC distance was the most similar to the mean L (intraclass correlation coefficient = 0.89. The mean I-IC was significantly shorter than L, while the mean I-C-IC was significantly longer. Linear regression analysis provided the following formula: Predicted SCV catheter insertion length (cm = -0.037 + 0.036 × Height (cm + 0.903 × I-T-IC (cm (adjusted r2 =0.64. Conclusion: The I-T-IC distance may be a reliable bedside predictor of the optimal insertion length for a right SCV cannulation.

Surgical management of penetrating pelvic trauma: a case report and literature review

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ZHANG Peng

2012-12-01

Full Text Available 【Abstract】 High-velocity penetrating pelvic injury is one of the most difficult challenges to trauma surgeons. The injury sites frequently include soft tissue, pelvis, geni-tourinary tract, vascular structures and intraabdominal viscera. We present an unusual case of a male patient suf-fering a collision at night with a deformed steel bar penetrat-ing into his right groin. Careful planning of the surgical approach is important before extracting the foreign body. The possibility of multiorgan damage to intrapelvic struc-tures such as colon, urinary bladder, vessels and nerves, frequently necessitates a multidisciplinary involvement and systematic approach. Besides, limited incision as well as modification should be considered, and debridement and perioperative antibiotics can be used to reduce the risk of serious wound infection. Key words: Pelvis; Debridement; Wounds, penetrating

Does Medicaid managed care market penetration impact provider participation, costs, utilization, and access?

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Minott, Jenny

2010-09-01

Key findings. (1) An increase in commercial plan penetration increased the liklihood [sic] that a physician would accept new Medicaid patients, but this did not significantly impact enrollee costs. (2) An increase in Medicaid-dominant HMO market penetration increased the probability that individuals reported using the ED as their primary source of care.

A future Demand Side Management (DSM) opportunity for utility as variable renewable penetrate scale up using agriculture.

Science.gov (United States)

Ines, A.; Bhattacharjee, A.; Modi, V.; Robertson, A. W.; Lall, U.; Kocaman Ayse, S.; Chaudhary, S.; Kumar, A.; Ganapathy, A.; Kumar, A.; Mishra, V.

2015-12-01

Energy demand management, also known as demand side management (DSM), is the modification of consumer demand for energy through various methods such as smart metering, incentive based schemes, payments for turning off loads or rescheduling loads. Usually, the goal of demand side management is to encourage the consumer to use less power during periods of peak demand, or to move the time of energy use to off-peak times. Peak demand management does not necessarily decrease total energy consumption, but could be expected to reduce the need for investments in networks and/or power plants for meeting peak demands. Electricity use can vary dramatically on short and medium time frames, and the pricing system may not reflect the instantaneous cost as additional higher-cost that are brought on-line. In addition, the capacity or willingness of electricity consumers to adjust to prices by altering elasticity of demand may be low, particularly over short time frames. In the scenario of Indian grid setup, the retail customers do not follow real-time pricing and it is difficult to incentivize the utility companies for continuing the peak demand supply. A question for the future is how deeper penetration of renewable will be handled? This is a challenging problem since one has to deal with high variability, while managing loss of load probabilities. In the case of managing the peak demand using agriculture, in the future as smart metering matures with automatic turn on/off for a pump, it will become possible to provide an ensured amount of water or energy to the farmer while keeping the grid energized for 24 hours. Supply scenarios will include the possibility of much larger penetration of solar and wind into the grid. While, in absolute terms these sources are small contributors, their role will inevitably grow but DSM using agriculture could help reduce the capital cost. The other option is of advancing or delaying pump operating cycle even by several hours, will still ensure

Correlation Between Cone Penetration Rate And Measured Cone Penetration Parameters In Silty Soils

DEFF Research Database (Denmark)

Poulsen, Rikke; Nielsen, Benjaminn Nordahl; Ibsen, Lars Bo

2013-01-01

This paper shows, how a change in cone penetration rate affects the cone penetration measurements, hence the cone resistance, pore pressure, and sleeve friction in silty soil. The standard rate of penetration is 20 mm/s, and it is generally accepted that undrained penetration occurs in clay while...... drained penetration occurs in sand. When lowering the penetration rate, the soil pore water starts to dissipate and a change in the drainage condition is seen. In intermediate soils such as silty soils, the standard cone penetration rate may result in a drainage condition that could be undrained......, partially or fully drained. However, lowering the penetration rate in silty soils has a great significance because of the soil permeability, and only a small change in penetration rate will result in changed cone penetration measurements. In this paper, analyses will be done on data from 15 field cone...

Transactive Demand Side Management Programs in Smart Grids with High Penetration of EVs

Directory of Open Access Journals (Sweden)

Poria Hasanpor Divshali

2017-10-01

Full Text Available Due to environmental concerns, economic issues, and emerging new loads, such as electrical vehicles (EVs, the importance of demand side management (DSM programs has increased in recent years. DSM programs using a dynamic real-time pricing (RTP method can help to adaptively control the electricity consumption. However, the existing RTP methods, particularly when they consider the EVs and the power system constraints, have many limitations, such as computational complexity and the need for centralized control. Therefore, a new transactive DSM program is proposed in this paper using an imperfect competition model with high EV penetration levels. In particular, a heuristic two-stage iterative method, considering the influence of decisions made independently by customers to minimize their own costs, is developed to find the market equilibrium quickly in a distributed manner. Simulations in the IEEE 37-bus system with 1141 customers and 670 EVs are performed to demonstrate the effectiveness of the proposed method. The results show that the proposed method can better manage the EVs and elastic appliances than the existing methods in terms of power constraints and cost. Also, the proposed method can solve the optimization problem quick enough to run in real-time.

Management of vaginal penetration phobia in Arab women: a retrospective study.

Science.gov (United States)

Muammar, Tarfah; McWalter, Patricia; Alkhenizan, Abdullah; Shoukri, Mohamed; Gabr, Alia; Bin, Abdulaziz AlDanah

2015-01-01

Vaginal penetration phobia is a common and distressing problem world.wide. It interferes with vaginal penetrative sexual relations, and leads to unconsummated marriage (UCM). This problem may be heightened in Arab women, due to cultural taboos about pain and bleeding, that may be associated with the first coital experience after marriage. Data about this problem is scarce in Arab societies. The aim of this study was to evaluate the response of these women and their husbands to an individualized, psychotherapeutic assessment and treatment to resolve this problem. Retrospective descriptive in a general gynecology community setting over a 6-year period. The study involved a retrospective sequential cohort of 100 Arab couples with UCM due to the woman's VPP. They were evaluated by a female gynecologist in out patient clinics. Data was collected through chart review, and telephone interviews. Final analysis was performed on 100 Arab couples, who satisfied the inclusion criteria. They were followed up to assess their response to an individualized, structured treatment protocol. The treatment combined sex education with systematic desensitization, targeting fear and anxiety as.sociated with vaginal penetration. A total of 96% of the studied group had a successful outcome after an average of 4 sessions. Penetrative intercourse was reported by the tolerance of these women; further pregnancy was achieved in 77.8 % of the infertile couples. Insufficient knowledge of sexual intercourse is a major contributor to the development of VPP in the sampled population. It appears that they respond well to an individualized, structured treatment protocol as described by Hawten 1985 (regardless of other risk factors associated with vaginismus).

Vertebral and carotid artery anomalies in patients with aberrant right subclavian arteries

International Nuclear Information System (INIS)

Tsai, I.C.; Lee, Tain; Tzeng, Wen-Sheng; Jan, Sheng-Lin; Fu, Yun-Ching; Chen, Min-Chi; Lin, Pao-Chun; Liao, Wan-Chun; Chen, C.C.C.

2007-01-01

There is little published evidence regarding the patterns and prevalence of vertebral artery (VA) and common carotid artery (CCA) anomalies in patients with an aberrant right subclavian artery (ARSCA). To study the patterns and prevalence of VA and CCA anomalies in patients with ARSCA. In a 2-year period we reviewed the children referred with suspected vascular ring who had undergone multidetector-row CT. Patients with ARSCA were reviewed for VA and CCA patterns and their prevalence and relevance were calculated. In total, 102 patients with ARSCA were identified. VA anomalies were present in 16 patients (15.7%), and CCA anomalies (common carotid trunk) in 21 patients (20.6%). In some patients with VA anomalies, the right VA arose from the right CCA and in some the left VA arose from the aortic arch. When the left VA arose from the aortic arch it was situated between the left CCA and the left SCA or between the left SCA and the ARSCA. If neurointerventionalists understand these potential anomalies and their prevalence, time and contrast medium could be saved when catheterizing the VA and CCA in patients with ARSCA. (orig.)

The Role of Multi-slice Spiral CT Angiography in Patient Management After Endovascular Therapy

International Nuclear Information System (INIS)

Peloschek, P.; Sailer, J.; Loewe, C.; Schillinger, M.; Lammer, J.

2006-01-01

Objectives. To bring out the role of multi-slice spiral CT angiography (MS-CTA) in patient management after endovascular therapy of subclavian artery stenosis. Methods. Twenty-one consecutive patients with clinically suspected restenosis after endovascular treatment of subclavian artery stenosis or occlusion were included in the study. Eleven patients had been treated with percutaneous transluminal angioplasty (PTA) alone and 10 with PTA and stenting. The mean follow-up period after PTA or stenting was 57 (±27 SD) months. CTA was performed using a bolus-triggered high-resolution protocol with biphasic intravenous contrast medium injection. Axial images and curved planar reformations (CPRs) were rated by three readers with regard to patency of supra-aortic vessels. Imaging findings were correlated with a standardized clinical assessment. Results. All examinations were of diagnostic quality. Of 21 referred patients, 7 had significant reobstruction of the treated subclavian artery. Six of the 7 patients with significant restenosis on CTA were treated conservatively (antiplatelet agents), despite 2 of them being symptomatic on the standardized clinical assessment, which showed a sensitivity and specificity of 86% in predicting stenosis. One patient was treated with PTA and stent deployment because of strong subjective suffering. Conclusion. MS-CTA is useful for exclusion or quantification of clinically suspected restenosis in carefully selected patients after endovascular therapy where ultrasound is inconclusive and/or contrast-enhanced magnetic resonance angiography is contraindicated

Impact of location on outcome after penetrating colon injuries.

Science.gov (United States)

Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Zarzaur, Ben L; Shahan, Charles P; Parks, Nancy A; Fabian, Timothy C; Croce, Martin A

2012-12-01

Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries. Consecutive patients with full thickness penetrating colon injuries for 13 years were stratified by age, injury location and mechanism, and severity of shock. According to the algorithm, patients with nondestructive injuries underwent primary repair. Destructive wounds underwent resection plus anastomosis in the absence of comorbidities or large preoperative or intraoperative transfusion requirements (>6 U of packed red blood cells); otherwise, they were diverted. Injury location was defined as ascending, transverse, descending (including splenic flexure), and sigmoid. Multivariable logistic regression was performed to determine whether injury location was an independent predictor of either morbidity or mortality. Four hundred sixty-nine patients were identified: 314 (67%) underwent primary repair and 155 (33%) underwent resection. Most injuries involved the transverse colon (39%), followed by the ascending colon (26%), the descending colon (21%), and the sigmoid colon (14%). Overall, there were 13 suture line failures (3%) and 72 abscesses (15%). Most suture line failures involved injuries to the descending colon (p = 0.06), whereas most abscesses followed injuries to the ascending colon (p = 0.37). Multivariable logistic regression failed to identify injury location as an independent predictor of either morbidity or mortality after adjusting for 24-hour transfusions, base excess, shock index, injury mechanism, and operative management. Injury location did not affect morbidity or mortality after penetrating colon injuries. Nondestructive injuries should be primarily

The role of diagnostic VATS in penetrating thoracic injuries

Directory of Open Access Journals (Sweden)

Guasti Guido

2006-10-01

Full Text Available Abstract Background Penetrating chest injuries account for 1–13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18–30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4–23% of chest injury patients present persistent pneumothorax and 15–59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. Methods 1270 patients who sustained thoracic trauma were admitted to our hospital between 1994 and 2004. Of these, 16 patients had penetrating injuries: thirteen were surgically explored by means of Video Assisted Thoracic Surgery (VATS, and 3 with thoracotomy due to hemodynamic instability or suspected lesion of the heart or great vessels. Results In the 13 patients who underwent VATS, 5 injuries to the diaphragm, 3 lesions to an intercostal artery, and 1 lesion to the diaphragmatic artery were detected. In 12 of these patients a laceration of the pulmonary parenchyma was also present. A conversion to thoracotomy was necessary due to a broad laceration of the diaphragm and due to hemostasis of an intercostal artery. In all but one case, which was later converted, diagnostic imaging missed the diagnosis of laceration of the diaphragm. There was no intra- or postoperative mortality, and average hospital stay was five days. Conclusion VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries, and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.

A review of penetration mechanisms and dynamic properties of tungsten and depleted uranium penetrators

International Nuclear Information System (INIS)

Andrew, S.P.; Caligiuri, R.D.; Eiselstein, L.E.

1991-01-01

Kinetic energy penetrators must posses the best possible combination of hardness, stiffness, strength, and fracture toughness characteristics to be effective against modern armor systems. Over the last decade, depleted uranium (DU) and tungsten alloys have been the materials of choice for kinetic energy penetrators. Du and tungsten perform abut the same against semi-infinite targets, and DU outperforms tungsten penetrators in oblique, spaced array targets, but because of environmental and subsequent cost concerns, effort has focused on improving the performance of tungsten penetrators over the last few years. However, despite recent improvements in material properties, the penetration performance of tungsten still lags behind that of DU. One possible reason is the difference in deformation mechanisms at the leading edge of the penetrator during the penetration process-DU alloys tend to shear band and sharpen as they penetrate the target material, whereas tungsten penetrators tend to mushroom and blunt. As a first step to determine whether shear banding is truly the reason for superior DU performance, a review of the fabrication, high strain-rate properties, and penetration phenomena of penetrators manufactured from both tungsten and DU alloys. Specifically, the effects of composition, processing, and heat treatment on material properties and penetration mechanisms of these alloys are discussed

Echocolor Doppler morpho-functional study of the jugulo-subclavian confluence in chronic cerebro-spinal venous insufficiency and multiple sclerosis patients.

Science.gov (United States)

Mandolesi, Sandro; d'Alessandro, Aldo; Desogus, Antonello Ignazio; Ciccone, Marco Matteo; Zito, Annapaola; Stammegna, Immacolata; Niglio, Tarcisio; Orsini, Augusto; Mandolesi, Dimitri; d'Alessandro, Alessandro; Revelli, Luca

2017-01-01

The aim of this work is to measure the mean diameter of the confluence jugulo- subclavian, the impact of different types of jugular confluences and the correlation between the types of confluences and the Valsalva maneuver (jugular reflux) in subjects with Chronic Cerebro-Spinal Venous Insufficiency (CCSVI) and Multiple Sclerosis. We investigated by Echo-Color-Doppler (ECD) 103 subjects (67 F 36M) of mean age 45 ± 12 years (a minimum of 22 to a maximum of 79 years, with a median of 44 and a modal value 42 years), mean EDSS of 4.7 and average disease duration of 12 years. The 103 right jugular veins investigated had an average diameter of 8.4 ± 2.4 mm (minimum 4.0, maximum 14.9 mm; median 7.9; modal value 7.6 mm). Three form types were found: 56 cylindrical, 29 conical and 18 funnel. Valsalva maneuver was positive in 30 patients. The 103 left jugular investigated had an average diameter of 8.9 ± 2.4 mm (minimum 2.8, maximum 14.4 mm; median of 8.8; modal value 8.7 mm). The form types were found: 42 cylindrical, 45 conical and 16 funnel. Valsalva maneuver was positive in 30 patients. The mean diameter of the jugular veins was 8.7 mm. Internal jugular veins with cylindrical morphology have a diameter smaller than other forms; this difference is statistically significant. The different morphology of the jugular vein confluence does not increase the possibility of a reflux because the positive Valsalva maneuvers are not statistically significant when compared to the various types. CCSVI, EchoColorDoppler Map, Jugulo-Subclavian Confluence Diameter.

Improving Outcomes Following Penetrating Colon Wounds

Science.gov (United States)

Miller, Preston R.; Fabian, Timothy C.; Croce, Martin A.; Magnotti, Louis J.; Elizabeth Pritchard, F.; Minard, Gayle; Stewart, Ronald M.

2002-01-01

Introduction During World War II, failure to treat penetrating colon injuries with diversion could result in court martial. Based on this wartime experience, colostomy for civilian colon wounds became the standard of care for the next 4 decades. Previous work from our institution demonstrated that primary repair was the optimal management for nondestructive colon wounds. Optimal management of destructive wounds requiring resection remains controversial. To address this issue, we performed a study that demonstrated risk factors (pre or intraoperative transfusion requirement of more than 6 units of packed red blood cells, significant comorbid diseases) that were associated with a suture line failure rate of 14%, and of whom 33% died. Based on these outcomes, a clinical pathway for management of destructive colon wounds was developed. The results of the implementation of this pathway are the focus of this report. Methods Patients with penetrating colon injury were identified from the registry of a level I trauma center over a 5-year period. Records were reviewed for demographics, injury characteristics, and outcome. Patients with nondestructive injuries underwent primary repair. Patients with destructive wounds but no comorbidities or large transfusion requirement underwent resection and anastomosis, while patients with destructive wounds and significant medical illness or transfusion requirements of more than 6 units/blood received end colostomy. The current patients (CP) were compared to the previous study (PS) to determine the impact of the clinical pathway. Outcomes examined included colon related mortality and morbidity (suture line leak and abscess). Results Over a 5.5-year period, 231 patients had penetrating colon wounds. 209 survived more 24 hours and comprise the study population. Primary repair was performed on 153 (73%) patients, and 56 patients had destructive injuries (27%). Of these, 40 (71%) had resection and anastomosis and 16 (29%) had diversion

A ten-year study of penetrating injuries of the colon.

Science.gov (United States)

Adesanya, Adedoyin A; Ekanem, Ekanem E

2004-12-01

Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries. Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied. Colon wounds were caused by gunshots in 55 (91.7 percent) patients and knife stabs in 5 (8.3 percent). There was a delay of more than 12 hours before laparotomy in 30 (50 percent) patients. Moderate or major fecal contamination of the peritoneal cavity occurred in 58 (96.7 percent) patients. The average penetrating abdominal trauma index score was 25.9 and 20 (33.3 percent) patients sustained Flint Grade 3 colon injury. Associated intra-abdominal injuries occurred in the small bowel (73.3 percent), liver (25 percent), stomach (23.3 percent), and mesentery (16.7 percent). Right colon wounds (35) were managed by primary repair in 24 (68.6 percent) patients and proximal diverting colostomy in 11 (31.4 percent), whereas left colon wounds (25) were managed by diverting colostomy in 22 (88.0 percent) patients and primary repair in 3 (12.0 percent) patients. Common complications included wound infection (56.7 percent), septicemia (31.7 percent), and enterocutaneous fistula (16.7 percent). The overall mortality rate was 33.3 percent and colon injury-related mortality was 21.7 percent. Presence of destructive colon injury was associated with a greater than fourfold increased incidence of death. Other significant risk factors included shock on admission, major fecal contamination, duration of operation more than four hours, penetrating abdominal trauma index score >25, and more than two postoperative complications. There was no difference in outcome between patients who had primary repair and those undergoing diverting colostomy. Colostomy closure-related morbidity was 21 percent and mortality was 5.3 percent. A more liberal

Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot

Directory of Open Access Journals (Sweden)

Christos Stefanou

2016-01-01

Full Text Available Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically.

Influence of jet thrust on penetrator penetration when studying the structure of space object blanket

Directory of Open Access Journals (Sweden)

N. A. Fedorova

2014-01-01

Full Text Available The article presents the calculation-and-theory-based research results to examine the possibility for using the jet thrust impulse to increase a penetration depth of high-velocity penetrator modules. Such devices can be used for studies of Earth surface layer composition, and in the nearest future for other Solar system bodies too. Research equipment (sensors and different instruments is housed inside a metal body of the penetrator with a sharpened nose that decreases drag force in soil. It was assumed, that this penetrator is additionally equipped with the pulse jet engine, which is fired at a certain stage of penetrator motion into target.The penetrator is considered as a rigid body of variable mass, which is subjected to drag force and reactive force applied at the moment the engine fires. A drag force was represented with a binomial empirical law, and penetrator nose part was considered to be conical. The jet thrust force was supposed to be constant during its application time. It was in accordance with assumption that mass flow and flow rate of solid propellant combustion products were constant. The amount of propellant in the penetrator was characterized by Tsiolkovsky number Z, which specifies the ratio between the fuel mass and the penetrator structure mass with no fuel.The system of equations to describe the penetrator dynamics was given in dimensionless form using the values aligned with penetration of an equivalent inert penetrator as the time and penetration depth scales. Penetration dynamics of penetrator represented in this form allowed to eliminate the influence of penetrator initial mass and its cross-section diameter on the solution results. The lack of such dependency is convenient for comparing the calculation results since they hold for penetrators of various initial masses and cross-sections.To calculate the penetration a lunar regolith was taken as a soil material. Calculations were carried out for initial velocities of

A review of penetration mechanisms and dynamic properties of tungsten and depleted uranium penetrators

International Nuclear Information System (INIS)

Andrew, S.P.; Caligiuri, R.D.; Eiselstein, L.E.

1991-01-01

Over the last decade, depleted uranium (DU) and tungsten alloys have been the materials of choice for kinetic energy penetrators. However, despite improvements in mechanical properties in recent years, the penetration performance of tungsten still lags behind that of DU. One possible reason is the difference in deformation mechanisms- DU alloys tend to shear band as they penetrate the target material, whereas tungsten penetrators tend to mushroom. As a first step to determining whether shear banding is truly the reason for superior DU performance, a review and summary of the available information was performed. This paper presents a state-of-the-art review of the formulation, high strain- rate properties, and penetration phenomena of penetrators manufactured from both tungsten and DU alloys. Specifically, the effects of composition, processing, and heat treatment on mechanical properties and penetration mechanisms of these alloys are discussed. Penetration data and models for penetration mechanisms (in particular shear banding) are also presented, as well as the applicability of these models and their salient features

Do HMO penetration and hospital competition impact quality of hospital care?

Science.gov (United States)

Rivers, P A; Fottler, M D

2004-11-01

This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

Physical Penetration Testing: A Whole New Story in Penetration Testing

NARCIS (Netherlands)

Dimkov, T.; Pieters, Wolter

2011-01-01

Physical penetration testing plays an important role in assuring a company that the security policies are properly enforced and that the security awareness of the employees is on the appropriate level. In physical penetration tests the tester physically enters restricted locations and directly

Antibiotic penetration into bone in relation to the immediate management of open fractures: a review.

Science.gov (United States)

Hughes, S P

1992-01-01

Bone is a vascular structure, which is capable of responding to changes in the systemic circulation. Antibiotics carried within the systemic circulation reach the capillaries in bone, and depending on molecular size, pass through the capillary walls to enter the fluid space. Following an open fracture, contamination with pathogenic organisms can occur both at the moment of injury, but also in the hospital, which is a particular problem in grade III fractures in which extensive soft tissue damage can occur in combination with an exposed wound. Antibiotics administered intravenously can be measured in bone by both bioassay and radioactive isotope techniques and are shown to reach bone in effective concentrations. It is apparent that short-course high-dose antibiotic therapy is appropriate for open fractures, and need not be continued as long as the normal fracture-healing process continues. However if infection in bone develops, further surgery is important to remove new dead tissue to allow adequate antibiotic penetration into bone. Thus antibiotics are useful when combined with effective surgical management, but do not on their own offer the only answer to management of the patient.

Factors affecting flood insurance penetration in residential properties in Johor Malaysia

Science.gov (United States)

Godwin Aliagha, U.; Ewe Jin, T.; Weng Choong, W.; Nadzri Jaafar, M.

2014-04-01

High impact flood has virtually become an annual experience in Malaysia, yet flood insurance has remained a grossly neglected part of comprehensive integrated flood risk management. Using discriminant analysis, this study seeks to indentify the demand-side variables that best predict flood insurance penetration and risk aversion between two groups of residential homeowners in three districts of Johor State, Malaysia: those who purchased flood insurance and the group that did not. Our result revealed 34% penetration rate with Kota Tinggi district having the highest penetration (44%) and thus, the highest degree of flood risk aversion. The Wilks' Lambda F test for equality of group means, SCDFC, structure correlation and canonical correlation have clearly shown that there are strong significant attribute differences between the two groups of homeowners based on measures of objective flood risk exposure, subjective risk perception, and socio-economic cum demographic variables. However, measures of subjective risk perception were found more predictive of flood insurance penetration and flood risk aversion.

Rapid penetration into granular media visualizing the fundamental physics of rapid earth penetration

CERN Document Server

Iskander, Magued

2015-01-01

Rapid Penetration into Granular Media: Visualizing the Fundamental Physics of Rapid Earth Penetration introduces readers to the variety of methods and techniques used to visualize, observe, and model the rapid penetration of natural and man-made projectiles into earth materials. It provides seasoned practitioners with a standard reference that showcases the topic's most recent developments in research and application. The text compiles the findings of new research developments on the subject, outlines the fundamental physics of rapid penetration into granular media, and assembles a com

Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Paula M. Jaramillo

2018-01-01

Full Text Available Introduction. Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. Presentation of the Case. A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established. Discussion. Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery. Conclusion. Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies.

Selective Nonoperative Management of Penetrating Torso Injury From Combat Fragmentation Wounds

Science.gov (United States)

2008-02-01

outlines the paradigm of care: “Penetrating inju- ries below the nipples , above the symphysis pubis, and between the posterior axillary lines must be...abdo- men and were hemodynamically stable and without abdom- inal pain or tenderness. CT scan of some of these casualties revealed fragments in the lumen

Multi-detector row computed tomographic evaluation of a rare type of complete vascular ring: Double aortic arch with atretic left arch distal to the origin of left subclavian artery

Energy Technology Data Exchange (ETDEWEB)

Hung, Ying Ying; Fu, Ching Yun; Wei, Hao Ji; Tsai, I Chen; Chen, Clayton Chi Chang [Taichung Veterans General Hospital, Taichung (China)

2013-10-15

Double aortic arch with an atretic left arch distal to the origin of left subclavian artery was diagnosed with multi-detector row computed tomography (MDCT) in two children with dysphagia. This rare type of complete vascular ring is clinically important because it may be confused with right aortic arch in mirror imaging. Anatomic details of this rare type of complete vascular ring demonstrated on MDCT facilitated appropriate surgical treatment.

Penetrating atherosclerotic ulcer of the aorta: A continuing debate

International Nuclear Information System (INIS)

Patatas, K.; Shrivastava, V.; Ettles, D.F.

2013-01-01

Aortic penetrating atherosclerotic ulcer (PAU) is a relatively common incidental finding on thoracic computed tomography (CT) examinations. This is likely to relate to the steady increase in the number of CT examinations performed and also due, in part, to the increasing age of the general population. There is as yet no consensus on the management of incidental PAUs in asymptomatic patients. This article aims to review the literature and discuss the natural history, prognosis, and management of incidental PAU

Tumor penetrating peptides

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Tambet eTeesalu

2013-08-01

Full Text Available Tumor-homing peptides can be used to deliver drugs into tumors. Phage library screening in live mice has recently identified homing peptides that specifically recognize the endothelium of tumor vessels, extravasate, and penetrate deep into the extravascular tumor tissue. The prototypic peptide of this class, iRGD (CRGDKGPDC, contains the integrin-binding RGD motif. RGD mediates tumor homing through binding to αv integrins, which are selectively expressed on various cells in tumors, including tumor endothelial cells. The tumor-penetrating properties of iRGD are mediated by a second sequence motif, R/KXXR/K. This C-end Rule (or CendR motif is active only when the second basic residue is exposed at the C-terminus of the peptide. Proteolytic processing of iRGD in tumors activates the cryptic CendR motif, which then binds to neuropilin-1 activating an endocytic bulk transport pathway through tumor tissue. Phage screening has also yielded tumor-penetrating peptides that function like iRGD in activating the CendR pathway, but bind to a different primary receptor. Moreover, novel tumor-homing peptides can be constructed from tumor-homing motifs, CendR elements and protease cleavage sites. Pathologies other than tumors can be targeted with tissue-penetrating peptides, and the primary receptor can also be a vascular zip code of a normal tissue. The CendR technology provides a solution to a major problem in tumor therapy, poor penetration of drugs into tumors. The tumor-penetrating peptides are capable of taking a payload deep into tumor tissue in mice, and they also penetrate into human tumors ex vivo. Targeting with these peptides specifically increases the accumulation in tumors of a variety of drugs and contrast agents, such as doxorubicin, antibodies and nanoparticle-based compounds. Remarkably the drug to be targeted does not have to be coupled to the peptide; the bulk transport system activated by the peptide sweeps along any compound that is

Percutaneous aortic valve implantation of the Medtronic CoreValve self-expanding valve prosthesis via left subclavian artery access: the first case report in Greece.

Science.gov (United States)

Karavolias, George K; Georgiadou, Panagiota; Houri, Mazen; Sbarouni, Eftihia; Thomopoulou, Sofia; Tsiapras, Dimitrios; Smirli, Anna; Balanika, Marina; Voudris, Vassilis

2010-01-01

This case report describes a percutaneous aortic valve implantation with the Medtronic CoreValve selfexpanding valve prosthesis in a patient with severe aortic stenosis. The approach was made via the left subclavian artery because of the lack of femoral vessel access. The patient was a 78-year-old female with breathlessness on minimal effort, a recent hospitalisation due to pulmonary oedema, and frequent episodes of pre-syncope; surgical valve replacement had been ruled out. The prosthetic valve was successfully implanted with mild paravalvular aortic regurgitation. At 30 days, the patient's clinical condition had significantly improved, with excellent functioning of the aortic valve prosthesis.

Deep ocean model penetrator experiments

International Nuclear Information System (INIS)

Freeman, T.J.; Burdett, J.R.F.

1986-01-01

Preliminary trials of experimental model penetrators in the deep ocean have been conducted as an international collaborative exercise by participating members (national bodies and the CEC) of the Engineering Studies Task Group of the Nuclear Energy Agency's Seabed Working Group. This report describes and gives the results of these experiments, which were conducted at two deep ocean study areas in the Atlantic: Great Meteor East and the Nares Abyssal Plain. Velocity profiles of penetrators of differing dimensions and weights have been determined as they free-fell through the water column and impacted the sediment. These velocity profiles are used to determine the final embedment depth of the penetrators and the resistance to penetration offered by the sediment. The results are compared with predictions of embedment depth derived from elementary models of a penetrator impacting with a sediment. It is tentatively concluded that once the resistance to penetration offered by a sediment at a particular site has been determined, this quantity can be used to sucessfully predict the embedment that penetrators of differing sizes and weights would achieve at the same site

The penetrating depth analysis of Lunar Penetrating Radar onboard Chang’e-3 rover

Science.gov (United States)

Xing, Shu-Guo; Su, Yan; Feng, Jian-Qing; Dai, Shun; Xiao, Yuan; Ding, Chun-Yu; Li, Chun-Lai

2017-04-01

Lunar Penetrating Radar (LPR) has successfully been used to acquire a large amount of scientific data during its in-situ detection. The analysis of penetrating depth can help to determine whether the target is within the effective detection range and contribute to distinguishing useful echoes from noise. First, this study introduces two traditional methods, both based on a radar transmission equation, to calculate the penetrating depth. The only difference between the two methods is that the first method adopts system calibration parameters given in the calibration report and the second one uses high-voltage-off radar data. However, some prior knowledge and assumptions are needed in the radar equation and the accuracy of assumptions will directly influence the final results. Therefore, a new method termed the Correlation Coefficient Method (CCM) is provided in this study, which is only based on radar data without any a priori assumptions. The CCM can obtain the penetrating depth according to the different correlation between reflected echoes and noise. To be exact, there is a strong correlation in the useful reflected echoes and a random correlation in the noise between adjacent data traces. In addition, this method can acquire a variable penetrating depth along the profile of the rover, but only one single depth value can be obtained from traditional methods. Through a simulation, the CCM has been verified as an effective method to obtain penetration depth. The comparisons and analysis of the calculation results of these three methods are also implemented in this study. Finally, results show that the ultimate penetrating depth of Channel 1 and the estimated penetrating depth of Channel 2 range from 136.9 m to 165.5 m ({\\varepsilon }r=6.6) and from 13.0 m to 17.5 m ({\\varepsilon }r=2.3), respectively.

Penetrating abdominal war injuries among the war victims at Lacor ...

African Journals Online (AJOL)

hospital for prompt and appropriate treatment. All cases of such injuries should have exploratory laparotomy as soon as possible. Introduction. Penetrating abdominal injuries among the war wounded present a challenge in its management especially in a situation with limited human and financial resources such as ours.

In-place HEPA filter penetration test

International Nuclear Information System (INIS)

Bergman, W.; Wilson, K.; Elliott, J.; Bettencourt, B.; Slawski, J.W.

1997-01-01

We have demonstrated the feasibility of conducting penetration tests on high efficiency particulate air (HEPA) filters as installed in nuclear ventilation systems. The in-place penetration test, which is designed to yield equivalent penetration measurements as the standard DOP efficiency test, is based on measuring the aerosol penetration of the filter installation as a function of particle size using a portable laser particle counter. This in-place penetration test is compared to the current in-place leak test using light scattering photometers for single HEPA filter installations and for HEPA filter plenums using the shroud method. Test results show the in-place penetration test is more sensitive than the in-place leak test, has a similar operating procedure, but takes longer to conduct. Additional tests are required to confirm that the in-place penetration test yields identical results as the standard dioctyl phthalate (DOP) penetration test for HEPA filters with controlled leaks in the filter and gasket and duct by-pass leaks. Further development of the procedure is also required to reduce the test time before the in- place penetration test is practical

Penetration portion shielding structure

International Nuclear Information System (INIS)

Hayashi, Katsumi; Narita, Hitoshi; Handa, Hiroyuki; Takeuchi, Jun; Tozuka, Fumio.

1994-01-01

Openings of a plurality of shieldings for penetration members are aligned to each other, and penetration members are inserted from the openings. Then, the openings of the plurality of shielding members are slightly displaced with each other to make the penetration portions into a helical configuration, so that leakage of radiation is reduced. Upon removal of the members, reverse operation is conducted. When a flowable shielding material is used, the penetration portions are constituted with two plates having previously formed openings and pipes for connecting the openings with each other and a vessel covering the entire of them. After passing the penetration members such as a cable, the relative position of the two plates is changed by twisting, to form a helical configuration which reduces radiation leakage. Since they are bent into the helical configuration, shielding performance is extremely improved compared with a case that radiation leakage is caused from an opening of a straight pipe. In addition, since they can be returned to straight pipes, attachment, detachment and maintenance can be conducted easily. (N.H.)

Pitfalls in penetrating thoracic trauma (lessons we learned the hard way...).

Science.gov (United States)

Degiannis, Elias; Zinn, Richard Joseph

2008-10-01

The majority of patients with penetrating thoracic trauma are managed non-operatively. Those requiring surgery usually go to theater with physiological instability. The critical condition of these patients coupled with the rarity of penetrating thoracic trauma in most European countries makes their surgical management challenging for the occasional trauma surgeon, who is usually trained as a general surgeon. Most general surgeons have a general knowledge of basic cardiothoracic operative surgery, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide him with enough armamentaria to tackle the difficult case. In this anatomical region, their operative dexterity and knowledge cannot be compared to that of their cardiothoracic colleagues, something that is taken for granted in their cardiothoracic trauma textbooks. Techniques that are considered basic and easy by the cardiothoracic surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and the pitfalls that will be encountered in cardiothoracic trauma surgery will help them to avoid intraoperative errors and improve patient outcome. The purpose of this manuscript is to highlight the commonly encountered pitfalls by trauma surgeons operating on penetrating trauma to the chest.

In-place HEPA filter penetration test

Energy Technology Data Exchange (ETDEWEB)

Bergman, W.; Wilson, K.; Elliott, J. [Lawrence Livermore National Lab., CA (United States)] [and others

1997-08-01

We have demonstrated the feasibility of conducting penetration tests on high efficiency particulate air (HEPA) filters as installed in nuclear ventilation systems. The in-place penetration test, which is designed to yield equivalent penetration measurements as the standard DOP efficiency test, is based on measuring the aerosol penetration of the filter installation as a function of particle size using a portable laser particle counter. This in-place penetration test is compared to the current in-place leak test using light scattering photometers for single HEPA filter installations and for HEPA filter plenums using the shroud method. Test results show the in-place penetration test is more sensitive than the in-place leak test, has a similar operating procedure, but takes longer to conduct. Additional tests are required to confirm that the in-place penetration test yields identical results as the standard dioctyl phthalate (DOP) penetration test for HEPA filters with controlled leaks in the filter and gasket and duct by-pass leaks. Further development of the procedure is also required to reduce the test time before the in-place penetration test is practical. 14 refs., 14 figs., 3 tabs.

[Professor WU Zhongchao's experience of penetration needling].

Science.gov (United States)

Zhang, Ning; Wang, Bing; Zhou, Yu

2016-08-12

Professor WU Zhongchao has unique application of penetration needling in clinical treatment. Professor WU applies penetration needling along meridians, and the methods of penetration needling include self-meridian penetration, exterior-interior meridian penetration, identical-name meridian penetration, different meridian penetration. The meridian differentiation is performed according to different TCM syndromes, locations and natures of diseases and acupoint nature, so as to make a comprehensive assessment. The qi movement during acupuncture is focused. In addition, attention is paid on anatomy and long-needle penetration; the sequence and direction of acupuncture is essential, and the reinforcing and reducing methods have great originality, presented with holding, waiting, pressing and vibrating. Based on classical acupoint, the acupoint of penetration needling is flexible, forming unique combination of acupoints.

Metasploit penetration testing cookbook

CERN Document Server

Agarwal, Monika

2013-01-01

This book follows a Cookbook style with recipes explaining the steps for penetration testing with WLAN, VOIP, and even cloud computing. There is plenty of code and commands used to make your learning curve easy and quick.This book targets both professional penetration testers as well as new users of Metasploit, who wish to gain expertise over the framework and learn an additional skill of penetration testing, not limited to a particular OS. The book requires basic knowledge of scanning, exploitation, and the Ruby language.

Modeling of Oblique Penetration into Geologic Targets Using Cavity Expansion Penetrator Loading with Target free-Surface Effects

Energy Technology Data Exchange (ETDEWEB)

Jung, Joe; Longcope, Donald B.; Tabbara, Mazen R.

1999-05-03

A procedure has been developed to represent the loading on a penetrator and its motion during oblique penetration into geologic media. The penetrator is modeled with the explicit dynamics, finite element computer program PRONTO 3D and the coupled pressure on the penetrator is given in a new loading option based on a separate cavity expansion (CE) solution that accounts for the pressure-reduction from a nearby target free surface. The free-surface influ- ence distance is selected in a predictive manner by considering the pressure to expand a spherical cavity in a finite radius sphere of the target material. The CE/PRONTO 3D procedure allows a detailed description of the penetrator for predicting shock environments or structural failure dur- ing the entire penetration event and is sufficiently rapid to be used in design optimization. It has been evaluated by comparing its results with data from two field tests of a full-scale penetrator into frozen soil at an impact angles of 49.6 and 52.5 degrees from the horizontal. The measured penetrator rotations were 24 and 22 degrees, respectively. In the simulation, the rotation was21 degrees and predominately resulted from the pressure reduction of the free surface. Good agree- ment was also found for the penetration depth and axial and lateral acceleration at two locations in the penetrator.

A Mass Loss Penetration Model to Investigate the Dynamic Response of a Projectile Penetrating Concrete considering Mass Abrasion

Directory of Open Access Journals (Sweden)

NianSong Zhang

2015-01-01

Full Text Available A study on the dynamic response of a projectile penetrating concrete is conducted. The evolutional process of projectile mass loss and the effect of mass loss on penetration resistance are investigated using theoretical methods. A projectile penetration model considering projectile mass loss is established in three stages, namely, cratering phase, mass loss penetration phase, and remainder rigid projectile penetration phase.

FAA Fluorescent Penetrant Activities - An Update

Energy Technology Data Exchange (ETDEWEB)

Moore, D.G.

1998-10-20

The Federal Aviation Administration's Airworthiness Assurance NDI Validation Center (AANC) is currently characterizing low cycle fatigue specimens that will support the needs of penetrant manufacturers, commercial airline industry and the Federal Aviation Administration. The main focus of this characterization is to maintain and enhance the evaluation of penetrant inspection materials and apply resources to support the aircraft community needs. This paper discusses efforts to-date to document the Wright Laboratory penetrant evaluation process and characterize penetrant brightness readings in the initial set of sample calibration panels using Type 1 penetrant.

Penetration Tester's Open Source Toolkit

CERN Document Server

Faircloth, Jeremy

2011-01-01

Great commercial penetration testing tools can be very expensive and sometimes hard to use or of questionable accuracy. This book helps solve both of these problems. The open source, no-cost penetration testing tools presented do a great job and can be modified by the user for each situation. Many tools, even ones that cost thousands of dollars, do not come with any type of instruction on how and in which situations the penetration tester can best use them. Penetration Tester's Open Source Toolkit, Third Edition, expands upon existing instructions so that a professional can get the most accura

Effect of compressibility on the hypervelocity penetration

Science.gov (United States)

Song, W. J.; Chen, X. W.; Chen, P.

2018-02-01

We further consider the effect of rod strength by employing the compressible penetration model to study the effect of compressibility on hypervelocity penetration. Meanwhile, we define different instances of penetration efficiency in various modified models and compare these penetration efficiencies to identify the effects of different factors in the compressible model. To systematically discuss the effect of compressibility in different metallic rod-target combinations, we construct three cases, i.e., the penetrations by the more compressible rod into the less compressible target, rod into the analogously compressible target, and the less compressible rod into the more compressible target. The effects of volumetric strain, internal energy, and strength on the penetration efficiency are analyzed simultaneously. It indicates that the compressibility of the rod and target increases the pressure at the rod/target interface. The more compressible rod/target has larger volumetric strain and higher internal energy. Both the larger volumetric strain and higher strength enhance the penetration or anti-penetration ability. On the other hand, the higher internal energy weakens the penetration or anti-penetration ability. The two trends conflict, but the volumetric strain dominates in the variation of the penetration efficiency, which would not approach the hydrodynamic limit if the rod and target are not analogously compressible. However, if the compressibility of the rod and target is analogous, it has little effect on the penetration efficiency.

Cs and Cl penetration estimation in mortar from fly ash of MSWI

International Nuclear Information System (INIS)

Yamada, K.; Hosokawa, Y.; Haga, K.; Osako, M.

2015-01-01

By the Fukushima Daiichi accident, radioactive Cs was scattered widely in East Japan. From the viewpoint of radionuclide contaminated wastes management, water soluble Cs in the fly ash of incineration of municipal solid wastes (MSWI-FA) is the most serious problem. When final disposal of MSWI-FA contaminated by radioactive Cs in concrete pit is considered, it is necessary to understand the characteristics of MSWI-FA and Cs penetration behavior into concrete. In this study, the expected solution generated from MSWI-FA is analyzed and immersion test of mortar in this model solution was carried out for several kinds of cement and sand types. Cs showed similar penetration profiles with Cl regardless of cement and sand types. By using fly ash cement, the penetration depth of Cs decreased less than half compared to ordinary Portland cement (OPC). Clay mineral in sand did not affect the penetration of Cs possible because of the competing effect of potassium for Cs adsorption. Assuming a diffusion equation considering non-linear binding, from the measured profiles, diffusion coefficient and parameters of binding were obtained by fitting. Then, the Cs and Cl profiles after 30 years are estimated and penetration depths of Cs and Cl were only 15 mm for fly ash mortar. (authors)

Pediatric gunshot penetrating head injury: a case report with 2-year follow-up

OpenAIRE

Steven Tandean; Marsal Risfandi; Iskandar Japardi

2018-01-01

Gunshot is a rare subset of penetrating head injury, and generally the victim dies before arriving at the hospital. This paper reported a case of an intracranial gunshot injury in a 12 year-old boy that was shot by his friend, whose primary intention was to play around, using a revolver. A missile projectile penetrated from mid frontal and came out from right occipital. Vital signs were stable with GCS 8 from physical examination. A rational management strategy should permit a good outcome. T...

Web penetration testing with Kali Linux

CERN Document Server

Muniz, Joseph

2013-01-01

Web Penetration Testing with Kali Linux contains various penetration testing methods using BackTrack that will be used by the reader. It contains clear step-by-step instructions with lot of screenshots. It is written in an easy to understand language which will further simplify the understanding for the user.""Web Penetration Testing with Kali Linux"" is ideal for anyone who is interested in learning how to become a penetration tester. It will also help the users who are new to Kali Linux and want to learn the features and differences in Kali versus Backtrack, and seasoned penetration testers

Ballistic Phonon Penetration Depth in Amorphous Silicon Dioxide.

Science.gov (United States)

Yang, Lin; Zhang, Qian; Cui, Zhiguang; Gerboth, Matthew; Zhao, Yang; Xu, Terry T; Walker, D Greg; Li, Deyu

2017-12-13

Thermal transport in amorphous silicon dioxide (a-SiO 2 ) is traditionally treated as random walks of vibrations owing to its greatly disordered structure, which results in a mean free path (MFP) approximately the same as the interatomic distance. However, this picture has been debated constantly and in view of the ubiquitous existence of thin a-SiO 2 layers in nanoelectronic devices, it is imperative to better understand this issue for precise thermal management of electronic devices. Different from the commonly used cross-plane measurement approaches, here we report on a study that explores the in-plane thermal conductivity of double silicon nanoribbons with a layer of a-SiO 2 sandwiched in-between. Through comparing the thermal conductivity of the double ribbon samples with that of corresponding single ribbons, we show that thermal phonons can ballistically penetrate through a-SiO 2 of up to 5 nm thick even at room temperature. Comprehensive examination of double ribbon samples with various oxide layer thicknesses and van der Waals bonding strengths allows for extraction of the average ballistic phonon penetration depth in a-SiO 2 . With solid experimental data demonstrating ballistic phonon transport through a-SiO 2 , this work should provide important insight into thermal management of electronic devices.

Percutaneous penetration studies for risk assessment

DEFF Research Database (Denmark)

Sartorelli, Vittorio; Andersen, Helle Raun; Angerer, Jürgen

2000-01-01

. In order to predict the systemic risk of dermally absorbed chemicals and to enable agencies to set safety standards, data is needed on the rates of percutaneous penetration of important chemicals. Standardization of in vitro tests and comparison of their results with the in vivo data could produce...... internationally accepted penetration rates and/or absorption percentages very useful for regulatory toxicology. The work of the Percutaneous Penetration Subgroup of EC Dermal Exposure Network has been focussed on the standardization and validation of in vitro experiments, necessary to obtain internationally...... accepted penetration rates for regulatory purposes. The members of the Subgroup analyzed the guidelines on percutaneous penetration in vitro studies presented by various organizations and suggested a standardization of in vitro models for percutaneous penetration taking into account their individual...

Penetration of Photovoltaics in Greece

Directory of Open Access Journals (Sweden)

Eugenia Giannini

2015-06-01

Full Text Available Recently, an interesting experiment was completed in Greece concerning photovoltaic penetration into the electricity production sector. Based on the relevant laws and in accordance to the related European directives, an explosive penetration process was completed in less than three years, resulting in a 7% share of photovoltaics in electricity production instead of the previous negligible share. The legislation was based on licensing simplification and generous feed-in-tariffs. This approach transformed photovoltaic technology from a prohibitively expensive to a competitive one. This work aims to summarize the relevant legislation and illustrate its effect on the resulting penetration. A sigmoid-shape penetration was observed which was explained by a pulse-type driving force. The return on investment indicator was proposed as an appropriate driving force, which incorporates feed-in-tariffs and turnkey-cost. Furthermore, the resulting surcharge on the electricity price due to photovoltaic penetration was also analyzed.

http://www.bioline.org.br/js 104 Penetrating Tracheal Injuries – A ...

African Journals Online (AJOL)

jen

airway and prompt repair is the mainstay of management of penetrating tracheal injuries. Introduction ... tracheal injury was made in the 16th century ... Pearson 7 Harrington8 Sheely9 and Hood10 ..... Ed Am Col Surg (Chicago) .p.391. 12.

Modeling of Oblique Penetration into Geologic Targets Using Cavity Expansion Penetrator Loading with Target free-Surface Effects

Energy Technology Data Exchange (ETDEWEB)

Jung, Joe; Longcope, Donald B.; Tabbara, Mazen R.

1999-06-01

A procedure has been developed to represent the loading on a penetrator and its motion during oblique penetration into geologic media. The penetrator is modeled with the explicit dynamics, finite element computer program PRONTO 3D and the coupled pressure on the penetrator is given in a new loading option based on a separate cavity expansion (CE) solution that accounts for the pressure reduction from a nearby target free surface. The free-surface influence distance is selected in a predictive manner by considering the pressure to expand a spherical cavity in a finite radius sphere of the target material. The CE/PRONTO 3D procedure allows a detailed description of the penetrator for predicting shock environments or structural failure during the entire penetra- tion event and is sufficiently rapid to be used in design optimization. It has been evaluated by comparing its results with data from two field tests of a full-scale penetrator into frozen soil at an impact angles of 49.6 and 52.5 degrees from the horizontal. The measured penetrator rotations were 24 and 22 degrees, respectively. In the simulation, the rotation was 21 degrees and predom- inately resulted from the pressure reduction of the free surface. Good agreement was also found for the penetration depth and axial and lateral acceleration at two locations in the penetrator.

Environmental acceptability of high-performance alternatives for depleted uranium penetrators

Energy Technology Data Exchange (ETDEWEB)

Kerley, C.R.; Easterly, C.E.; Eckerman, K.F. [and others

1996-08-01

The Army`s environmental strategy for investigating material substitution and management is to measure system environmental gains/losses in all phases of the material management life cycle from cradle to grave. This study is the first in a series of new investigations, applying material life cycle concepts, to evaluate whether there are environmental benefits from increasing the use of tungsten as an alternative to depleted uranium (DU) in Kinetic Energy Penetrators (KEPs). Current military armor penetrators use DU and tungsten as base materials. Although DU alloys have provided the highest performance of any high-density alloy deployed against enemy heavy armor, its low-level radioactivity poses a number of environmental risks. These risks include exposures to the military and civilian population from inhalation, ingestion, and injection of particles. Depleted uranium is well known to be chemically toxic (kidney toxicity), and workplace exposure levels are based on its renal toxicity. Waste materials containing DU fragments are classified as low-level radioactive waste and are regulated by the Nuclear Regulatory Commission. These characteristics of DU do not preclude its use in KEPs. However, long-term management challenges associated with KEP deployment and improved public perceptions about environmental risks from military activities might be well served by a serious effort to identify, develop, and substitute alternative materials that meet performance objectives and involve fewer environmental risks. Tungsten, a leading candidate base material for KEPS, is potentially such a material because it is not radioactive. Tungsten is less well studied, however, with respect to health impacts and other environmental risks. The present study is designed to contribute to the understanding of the environmental behavior of tungsten by synthesizing available information that is relevant to its potential use as a penetrator.

Penetration Testing Curriculum Development in Practice

Directory of Open Access Journals (Sweden)

Chengcheng Li

2015-04-01

report for the management team to aid in strengthening the system, never to cause any real damages. This paper introduces the development of a penetration testing curriculum as a core class in an undergraduate cybersecurity track in Information Technology. The teaching modules are developed based on the professional penetration testing life cycle. The concepts taught in the class are enforced by hands-on lab exercises. This paper also shares the resources that are available to institutions looking for teaching materials and grant opportunities to support efforts when creating a similar curriculum in cybersecurity.

Dealing with the Surgical and Medical Challenges of Penetrating Brain Injuries

Directory of Open Access Journals (Sweden)

Nikolaos Syrmos

2013-01-01

Full Text Available Peacetime has reduced the overall incidence of penetrating brain injuries (PBI, and those related to missile penetration are not common anymore at least in western countries. Nevertheless, PBI still occur, and car crashes or work accidents are their main causes. The management of such cases is characterized by many challenges, not only from a surgical and medical point of view, but also for the different and sometimes bizarre dynamics by which they present. Herein we report an unusual deep penetrating brain injury, due to a high-energy crash against a metallic rod in a construction site, with a good surgical outcome despite dramatic clinical conditions on admission. A discussion of the surgical results and functional outcome related to PBI, as found in the English medical literature, is provided. Moreover the most common postoperative complications along with the diagnostic flow charts and therapeutic options useful to prevent inappropriate treatment are highlighted.

Barrier penetration database

International Nuclear Information System (INIS)

Fainberg, A.; Bieber, A.M. Jr.

1978-11-01

This document is intended to supply the NRC and nuclear power plant licensees with basic data on the times required to penetrate forcibly the types of barriers commonly found in nuclear plants. These times are necessary for design and evaluation of the physical protection system required under 10CFR73.55. Each barrier listed is described in detail. Minor variations in basic barrier construction that result in the same penetration time, are also described

Penetrating Maxillary Sinus Injury With Loss Of Vision Caused By An ...

African Journals Online (AJOL)

Good visual outcome following ocular emergencies will depend on prompt presentation, recognition and assessment as well as initial management. Penetrating injury of the orbit involving paranasal sinuses with retained foreign body in the orbito-maxillary region are uncommon.Thirty to fifty percent of all ocular traumas are ...

Tracheal Penetration and Tracheoesophageal Fistula Caused by an Esophageal Self-Expanding Metallic Stent

Directory of Open Access Journals (Sweden)

Karan Madan

2014-01-01

Full Text Available Tracheal penetration of esophageal self-expanding metallic stents (SEMS with/without tracheoesophageal fistula (TEF formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy.

The impact of HMO penetration on the relationship between nurse staffing and quality.

Science.gov (United States)

Mark, Barbara A; Harless, David W; McCue, Michael

2005-07-01

While there are a number of studies examining the relationship between nurse staffing and quality, none has examined structural differences in the relationship between nurse staffing and quality contingent upon the level of managed care penetration. We used administrative data, and a dynamic panel data model to examine this relationship in a panel of 422 acute care hospitals from 1990 to 1995. We found that there were significant differences in the relationship between nurse staffing and both mortality and length of stay depending upon the level of HMO penetration in the hospital's market.

Diffusion of radioactively tagged penetrants through rubbery polymers. II. Dependence on molecular length of penetrant

International Nuclear Information System (INIS)

Rhee, C.K.; Ferry, J.D.; Fetters, L.J.

1977-01-01

The diffusion of radioactively tagged n-hexadecane, n-dotriacontane, and a polybutadiene oligomer with molecular weight 1600 has been studied in 12 rubbery polymers. Diffusion coefficients were obtained from the theory for the thin smear method: for n-hexadecane and for n-dotriacontane (with one exception), in the form appropriate for a completely miscible polymer-penetrant pair, and for the oligomer in the form appropriate for slow entry of the pentrant across the penetrant-polymer interface. For the four flexible linear penetrants, n-dodecane, n-hexadecane, n-dotriacontane, and oligomer, the ratios of diffusion coefficients (or translational friction coefficients) are nearly the same in every polymer. It is concluded that these penetrants travel with similar segmentwise motions, although that is not the case with bulkier, more rigid penetrants. For the three normal paraffins, the friction coefficient is approximately proportional to molecular weight, but that for the oligomer is smaller than would be predicted on this basis

Kali Linux wireless penetration testing essentials

CERN Document Server

Alamanni, Marco

2015-01-01

This book is targeted at information security professionals, penetration testers and network/system administrators who want to get started with wireless penetration testing. No prior experience with Kali Linux and wireless penetration testing is required, but familiarity with Linux and basic networking concepts is recommended.

Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).

Science.gov (United States)

Velopulos, Catherine G; Shihab, Hasan M; Lottenberg, Lawrence; Feinman, Marcie; Raja, Ali; Salomone, Jeffrey; Haut, Elliott R

2018-05-01

Spine immobilization in trauma has remained an integral part of most emergency medical services protocols despite a lack of evidence for efficacy and concern for associated complications, especially in penetrating trauma patients. We reviewed the published evidence on the topic of prehospital spine immobilization or spinal motion restriction in adult patients with penetrating trauma to structure a practice management guideline. We conducted a Cochrane style systematic review and meta-analysis and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology to construct recommendations. Qualitative and quantitative analyses were used to evaluate the literature on the critical outcomes of mortality, neurologic deficit, and potentially reversible neurologic deficit. A total of 24 studies met inclusion criteria, with qualitative review conducted for all studies. We used five studies for the quantitative review (meta-analysis). No study showed benefit to spine immobilization with regard to mortality and neurologic injury, even for patients with direct neck injury. Increased mortality was associated with spine immobilization, with risk ratio [RR], 2.4 (confidence interval [CI], 1.07-5.41). The rate of neurologic injury or potentially reversible injury was very low, ranging from 0.002 to 0.076 and 0.00034 to 0.055, with no statistically significant difference for neurologic deficit or potentially reversible deficit, RR, 4.16 (CI, 0.56-30.89), and RR, 1.19 (CI, 0.83-1.70), although the point estimates favored no immobilization. Spine immobilization in penetrating trauma is associated with increased mortality and has not been shown to have a beneficial effect on mitigating neurologic deficits, even potentially reversible neurologic deficits. We recommend that spine immobilization not be used routinely for adult patients with penetrating trauma. Systematic review with meta-analysis study, level III.

Current management of penetrating torso trauma: nontherapeutic is not good enough anymore.

Science.gov (United States)

Ball, Chad G

2014-04-01

A highly organized approach to the evaluation and treatment of penetrating torso injuries based on regional anatomy provides rapid diagnostic and therapeutic consistency. It also minimizes delays in diagnosis, missed injuries and nontherapeutic laparotomies. This review discusses an optimal sequence of structured rapid assessments that allow the clinician to rapidly proceed to gold standard therapies with a minimal risk of associated morbidity.

Market penetration rates of new energy technologies

International Nuclear Information System (INIS)

Lund, Peter

2006-01-01

The market penetration rates of 11 different new energy technologies were studied covering energy production and end-use technologies. The penetration rates were determined by fitting observed market data to an epidemical diffusion model. The analyses show that the exponential penetration rates of new energy technologies may vary from 4 up to over 40%/yr. The corresponding take-over times from a 1% to 50% share of the estimated market potential may vary from less than 10 to 70 years. The lower rate is often associated with larger energy impacts. Short take-over times less than 25 years seem to be mainly associated with end-use technologies. Public policies and subsides have an important effect on the penetration. Some technologies penetrate fast without major support explained by technology maturity and competitive prices, e.g. compact fluorescent lamps show a 24.2%/yr growth rate globally. The penetration rates determined exhibit some uncertainty as penetration has not always proceeded close to saturation. The study indicates a decreasing penetration rate with increasing time or market share. If the market history is short, a temporally decreasing functional form for the penetration rate coefficient could be used to anticipate the probable behavior

Ethical hacking and penetration testing guide

CERN Document Server

Baloch, Rafay

2014-01-01

Requiring no prior hacking experience, Ethical Hacking and Penetration Testing Guide supplies a complete introduction to the steps required to complete a penetration test, or ethical hack, from beginning to end. You will learn how to properly utilize and interpret the results of modern-day hacking tools, which are required to complete a penetration test. The book covers a wide range of tools, including Backtrack Linux, Google reconnaissance, MetaGooFil, dig, Nmap, Nessus, Metasploit, Fast Track Autopwn, Netcat, and Hacker Defender rootkit. Supplying a simple and clean explanation of how to effectively utilize these tools, it details a four-step methodology for conducting an effective penetration test or hack.Providing an accessible introduction to penetration testing and hacking, the book supplies you with a fundamental understanding of offensive security. After completing the book you will be prepared to take on in-depth and advanced topics in hacking and penetration testing. The book walks you through each ...

Projectile penetration into ballistic gelatin.

Science.gov (United States)

Swain, M V; Kieser, D C; Shah, S; Kieser, J A

2014-01-01

Ballistic gelatin is frequently used as a model for soft biological tissues that experience projectile impact. In this paper we investigate the response of a number of gelatin materials to the penetration of spherical steel projectiles (7 to 11mm diameter) with a range of lower impacting velocities (projectile velocity are found to be linear for all systems above a certain threshold velocity required for initiating penetration. The data for a specific material impacted with different diameter spheres were able to be condensed to a single curve when the penetration depth was normalised by the projectile diameter. When the results are compared with a number of predictive relationships available in the literature, it is found that over the range of projectiles and compositions used, the results fit a simple relationship that takes into account the projectile diameter, the threshold velocity for penetration into the gelatin and a value of the shear modulus of the gelatin estimated from the threshold velocity for penetration. The normalised depth is found to fit the elastic Froude number when this is modified to allow for a threshold impact velocity. The normalised penetration data are found to best fit this modified elastic Froude number with a slope of 1/2 instead of 1/3 as suggested by Akers and Belmonte (2006). Possible explanations for this difference are discussed. © 2013 Published by Elsevier Ltd.

Subcutaneous emphysema of the upper extremity following penetrating blackthorn injury to the wrist.

LENUS (Irish Health Repository)

Tiong, W H C

2009-02-01

SUMMARY: Noninfective subcutaneous emphysema of the upper extremity, albeit rare, has to be borne in mind when treating patients with subcutaneous emphysema. The misdiagnosis of this condition as its serious infective counterpart often leads to unnecessary aggressive treatment. Noninfective subcutaneous emphysema often accompanies a patient who has no systemic symptoms of illness. Unfortunately, the distinction is not always easy especially when history of injury suggests involvement of an infective or reactive element. Penetrating blackthorn injury is common, especially in rural communities, and often occurs from farming or gardening activities. Blackthorn penetration can cause numerous tissue reactions once embedded under the skin and they are often contaminated with soil. Here we present, for the first time, a case where penetrating blackthorn injury to the wrist resulted in noninfective subcutaneous emphysema involving the whole upper limb and neck, and its subsequent management.

The Basics of Hacking and Penetration Testing Ethical Hacking and Penetration Testing Made Easy

CERN Document Server

Engebretson, Patrick

2011-01-01

The Basics of Hacking and Penetration Testing serves as an introduction to the steps required to complete a penetration test or perform an ethical hack. You learn how to properly utilize and interpret the results of modern day hacking tools; which are required to complete a penetration test. Tool coverage will include, Backtrack Linux, Google, Whois, Nmap, Nessus, Metasploit, Netcat, Netbus, and more. A simple and clean explanation of how to utilize these tools will allow you  to gain a solid understanding of each of the four phases and prepare them to take on more in-depth texts and topi

Price Forecasting of Electricity Markets in the Presence of a High Penetration of Wind Power Generators

OpenAIRE

Saber Talari; Miadreza Shafie-khah; Gerardo J. Osório; Fei Wang; Alireza Heidari; João P. S. Catalão

2017-01-01

Price forecasting plays a vital role in the day-ahead markets. Once sellers and buyers access an accurate price forecasting, managing the economic risk can be conducted appropriately through offering or bidding suitable prices. In networks with high wind power penetration, the electricity price is influenced by wind energy; therefore, price forecasting can be more complicated. This paper proposes a novel hybrid approach for price forecasting of day-ahead markets, with high penetration of wind...

Low Force Penetration of Icy Regolith

Science.gov (United States)

Mantovani, J. G.; Galloway, G. M.; Zacny, K.

2016-01-01

A percussive cone penetrometer measures the strength of granular material by using percussion to deliver mechanical energy into the material. A percussive cone penetrometer was used in this study to penetrate a regolith ice mixture by breaking up ice and decompacting the regolith. As compared to a static cone penetrometer, percussion allows low reaction forces to push a penetrometer probe tip more easily into dry regolith in a low gravity environment from a planetary surface rover or a landed spacecraft. A percussive cone penetrates icy regolith at ice concentrations that a static cone cannot penetrate. In this study, the percussive penetrator was able to penetrate material under 65 N of down-force which could not be penetrated using a static cone under full body weight. This paper discusses using a percussive cone penetrometer to discern changes in the concentration of water-ice in a mixture of lunar regolith simulant and ice to a depth of one meter. The rate of penetration was found to be a function of the ice content and was not significantly affected by the down-force. The test results demonstrate that this method may be ideal for a small platform in a reduced gravity environment. However, there are some cases where the system may not be able to penetrate the icy regolith, and there is some risk of the probe tip becoming stuck so that it cannot be retracted. It is also shown that a percussive cone penetrometer could be used to prospect for water ice in regolith at concentrations as high as 8 by weight.

Ground penetrating radar

CERN Document Server

Daniels, David J

2004-01-01

Ground-penetrating radar has come to public attention in recent criminal investigations, but has actually been a developing and maturing remote sensing field for some time. In the light of recent expansion of the technique to a wide range of applications, the need for an up-to-date reference has become pressing. This fully revised and expanded edition of the best-selling Surface-Penetrating Radar (IEE, 1996) presents, for the non-specialist user or engineer, all the key elements of this technique, which span several disciplines including electromagnetics, geophysics and signal processing. The

Long-rod penetration: the transition zone between rigid and hydrodynamic penetration modes

Directory of Open Access Journals (Sweden)

Jian-feng Lou

2014-06-01

Full Text Available Long-rod penetration in a wide range of velocity means that the initial impact velocity varies in a range from tens of meters per second to several kilometers per second. The long rods maintain rigid state when the impact velocity is low, the nose of rod deforms and even is blunted when the velocity gets higher, and the nose erodes and fails to lead to the consumption of long projectile when the velocity is very high due to instantaneous high pressure. That is, from low velocity to high velocity, the projectile undergoes rigid rods, deforming non-erosive rods, and erosive rods. Because of the complicated changes of the projectile, no well-established theoretical model and numerical simulation have been used to study the transition zone. Based on the analysis of penetration behavior in the transition zone, a phenomenological model to describe target resistance and a formula to calculate penetration depth in transition zone are proposed, and a method to obtain the boundary velocity of transition zone is determined. A combined theoretical analysis model for three response regions is built by analyzing the characteristics in these regions. The penetration depth predicted by this combined model is in good agreement with experimental result.

Plutonium in depleted uranium penetrators

International Nuclear Information System (INIS)

McLaughlin, J.P.; Leon-Vintro, L.; Smith, K.; Mitchell, P.I.; Zunic, Z.S.

2002-01-01

Depleted Uranium (DU) penetrators used in the recent Balkan conflicts have been found to be contaminated with trace amounts of transuranic materials such as plutonium. This contamination is usually a consequence of DU fabrication being carried out in facilities also using uranium recycled from spent military and civilian nuclear reactor fuel. Specific activities of 239+240 Plutonium generally in the range 1 to 12 Bq/kg have been found to be present in DU penetrators recovered from the attack sites of the 1999 NATO bombardment of Kosovo. A DU penetrator recovered from a May 1999 attack site at Bratoselce in southern Serbia and analysed by University College Dublin was found to contain 43.7 +/- 1.9 Bq/kg of 239+240 Plutonium. This analysis is described. An account is also given of the general population radiation dose implications arising from both the DU itself and from the presence of plutonium in the penetrators. According to current dosimetric models, in all scenarios considered likely ,the dose from the plutonium is estimated to be much smaller than that due to the uranium isotopes present in the penetrators. (author)

Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center.

Science.gov (United States)

Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, Cemal

2011-09-01

Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 9.33 (range, 15–54) years. The mean LOS was 10.65 8.30 (range, 5–65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 9.92 days; stab wound, 8.76 6.42 days, p chest AIS score (p chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury.

Chylous ascites associated with chylothorax; a rare sequela of penetrating abdominal trauma: a case report

Directory of Open Access Journals (Sweden)

Plummer Joseph M

2007-11-01

Full Text Available Abstract We present the case of a patient with the rare combination of chylous ascites and chylothorax resulting from penetrating abdominal injury. This patient was successfully managed with total parenteral nutrition. This case report is used to highlight the clinical features and management options of this uncommon but challenging clinical problem.

Complications of Central Venous Totally Implantable Access Port: Internal Jugular Versus Subclavian Access

Directory of Open Access Journals (Sweden)

Pil Young Jung

Full Text Available Background: Totally implantable access port (TIAP provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. Methods: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92 and subclavian approach (Group 2, n = 79 between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. Results: Median follow-up for TIAP was 278 days (range, 1-1868. Twenty four complications were occurred (14.0%, including pneumothorax (n = 1, 0.6%, migration/malposition (n = 4, 2.3%, pinch-off syndrome (n = 4, 2.3%, malfunction (n = 2, 1.1%, infection (n = 8, 4.7%, and venous thrombosis (n = 5, 2.9%. The overall incidence was 8.7% and 20.3% in each group (p = 0.030. Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033. The mechanical complication free probability is significantly higher in group 1 (p = 0.040. Conclusions: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.

Ethical Dilemmas and Dimensions in Penetration Testing

OpenAIRE

Faily, Shamal; McAlaney, John; Iacob, C.

2015-01-01

Penetration testers are required to attack systems to evaluate their security, but without engaging in unethical behaviour while doing so. Despite work on hacker values and studies into security practice, there is little literature devoted to the ethical pressures associated with penetration testing. This paper presents several ethical dilemmas and dimensions associated with penetration testing;\\ud these shed light on the ethical positions taken by Penetration testers, and help identify poten...

Skull penetrating wound

International Nuclear Information System (INIS)

Gonzalez Orlandi, Yvei; Junco Martin, Reinel; Rojas Manresa, Jorge; Duboy Limonta, Victor; Matos Herrera, Omar; Saez Corvo, Yunet

2011-01-01

The cranioencephalic trauma is common in the emergence centers to care for patients with multiple traumata and it becames in a health problem in many countries. Skull penetrating trauma is located in a special place due to its low frequency. In present paper a case of male patient aged 52 severely skull-injured with penetrating wound caused by a cold steel that remained introduced into the left frontotemporal region. After an imaging study the emergence surgical treatment was applied and patient evolves adequately after 25 days of hospitalization. Nowadays, she is under rehabilitation treatment due to a residual right hemiparesis.(author)

Mastering Kali Linux for advanced penetration testing

CERN Document Server

Beggs, Robert W

2014-01-01

This book provides an overview of the kill chain approach to penetration testing, and then focuses on using Kali Linux to provide examples of how this methodology is applied in the real world. After describing the underlying concepts, step-by-step examples are provided that use selected tools to demonstrate the techniques. If you are an IT professional or a security consultant who wants to maximize the success of your network testing using some of the advanced features of Kali Linux, then this book is for you. This book will teach you how to become an expert in the pre-engagement, management,

Branch retinal artery occlusion post-penetrating globe injury with intraocular foreign body.

Science.gov (United States)

Nagpal, Manish; Chaudhary, Pranita; Jain, Ashish

2018-01-01

Intraocular foreign body (IOFB) in cases of penetrating eye injury accounts for an important indication of vitreoretinal intervention following ocular trauma. Vascular occlusion as a complication of IOFB is rare. Here we present a case of a 34-year-old male with post-traumatic cataract and an intraocular metallic foreign body (IOFB) lodged in the superficial layers of the retina inferotemporal to the disc, causing an inferotemporal branch retinal artery occlusion. The case was managed by lensectomy with pars plana vitrectomy and IOFB removal followed by a second procedure of secondary IOL implantation. Final best-corrected visual acuity improved to 6/24. This case highlights an unusual sequelae following penetrating ocular trauma.

Branch retinal artery occlusion post-penetrating globe injury with intraocular foreign body

Directory of Open Access Journals (Sweden)

Manish Nagpal

2018-01-01

Full Text Available Intraocular foreign body (IOFB in cases of penetrating eye injury accounts for an important indication of vitreoretinal intervention following ocular trauma. Vascular occlusion as a complication of IOFB is rare. Here we present a case of a 34-year-old male with post-traumatic cataract and an intraocular metallic foreign body (IOFB lodged in the superficial layers of the retina inferotemporal to the disc, causing an inferotemporal branch retinal artery occlusion. The case was managed by lensectomy with pars plana vitrectomy and IOFB removal followed by a second procedure of secondary IOL implantation. Final best-corrected visual acuity improved to 6/24. This case highlights an unusual sequelae following penetrating ocular trauma.

"Luck's always to blame": silent wounds of a penetrating gunshot trauma sustained 20 years ago.

Science.gov (United States)

Tomos, Ioannis; Manali, Effrosyni D; Argentos, Stylianos; Raptakis, Thomas; Papiris, Spyros A

2015-01-01

Gunshot tracheal injuries represent life-threatening events and usually necessitate emergent surgical intervention. We report a case of an exceptional finding of a patient with retained ballistic fragments in the soft tissues of the thorax, proximal to the right subclavian artery and the trachea, carrying silently his wounds for two decades without any medical or surgical intervention. The bullet pellet on the upper part of the trachea seen accidentally in the chest computed tomography, was also found during bronchoscopy. In short "luck's always to blame".

MDCT diagnosis of penetrating diaphragm injury

Energy Technology Data Exchange (ETDEWEB)

Bodanapally, Uttam K.; Shanmuganathan, Kathirkamanathan; Mirvis, Stuart E.; Sliker, Clint W.; Fleiter, Thorsten R.; Sarada, Kamal; Miller, Lisa A. [University of Maryland School of Medicine, Department of Diagnostic Radiology, Baltimore, MD (United States); Stein, Deborah M. [University of Maryland, Department of Surgery, Shock Trauma Center, Baltimore, MD (United States); Alexander, Melvin [National Study Center for Trauma and Emergency Medical Systems, Baltimore, MD (United States)

2009-08-15

The purpose of the study was to determine the diagnostic sensitivity and specificity of multidetector CT (MDCT) in detection of diaphragmatic injury following penetrating trauma. Chest and abdominal CT examinations performed preoperatively in 136 patients after penetrating trauma to the torso with injury trajectory in close proximity to the diaphragm were reviewed by radiologists unaware of surgical findings. Signs associated with diaphragmatic injuries in penetrating trauma were noted. These signs were correlated with surgical diagnoses, and their sensitivity and specificity in assisting the diagnosis were calculated. CT confirmed diaphragmatic injury in 41 of 47 injuries (sensitivity, 87.2%), and an intact diaphragm in 71 of 98 patients (specificity, 72.4%). The overall accuracy of MDCT was 77%. The most accurate sign helping the diagnosis was contiguous injury on either side of the diaphragm in single-entry penetrating trauma (sensitivity, 88%; specificity, 82%). Thus MDCT has high sensitivity and good specificity in detecting penetrating diaphragmatic injuries. (orig.)

MDCT diagnosis of penetrating diaphragm injury

International Nuclear Information System (INIS)

Bodanapally, Uttam K.; Shanmuganathan, Kathirkamanathan; Mirvis, Stuart E.; Sliker, Clint W.; Fleiter, Thorsten R.; Sarada, Kamal; Miller, Lisa A.; Stein, Deborah M.; Alexander, Melvin

2009-01-01

The purpose of the study was to determine the diagnostic sensitivity and specificity of multidetector CT (MDCT) in detection of diaphragmatic injury following penetrating trauma. Chest and abdominal CT examinations performed preoperatively in 136 patients after penetrating trauma to the torso with injury trajectory in close proximity to the diaphragm were reviewed by radiologists unaware of surgical findings. Signs associated with diaphragmatic injuries in penetrating trauma were noted. These signs were correlated with surgical diagnoses, and their sensitivity and specificity in assisting the diagnosis were calculated. CT confirmed diaphragmatic injury in 41 of 47 injuries (sensitivity, 87.2%), and an intact diaphragm in 71 of 98 patients (specificity, 72.4%). The overall accuracy of MDCT was 77%. The most accurate sign helping the diagnosis was contiguous injury on either side of the diaphragm in single-entry penetrating trauma (sensitivity, 88%; specificity, 82%). Thus MDCT has high sensitivity and good specificity in detecting penetrating diaphragmatic injuries. (orig.)

Age-associated impact on presentation and outcome for penetrating thoracic trauma in the adult and pediatric patient populations.

Science.gov (United States)

Mollberg, Nathan M; Tabachnick, Deborah; Lin, Fang-Ju; Merlotti, Gary J; Varghese, Thomas K; Arensman, Robert M; Massad, Malek G

2014-02-01

Studies reporting on penetrating thoracic trauma in the pediatric population have been limited by small numbers and implied differences with the adult population. Our objectives were to report on a large cohort of pediatric patients presenting with penetrating thoracic trauma and to determine age-related impacts on management and outcome through comparison with an adult cohort. A Level I trauma center registry was queried between 2006 and 2012. All patients presenting with penetrating thoracic trauma were identified. Patient demographics, injury mechanism, injury severity, admission physiology, and outcome were recorded. Patients were compared, and outcomes were analyzed based on age at presentation, with patients 17 years or younger defining our pediatric cohort. A total of 1,423 patients with penetrating thoracic trauma were admitted during the study period. Two hundred twenty patients (15.5%) were pediatric, with 205 being adolescents (13-17 years) and 15 being children (≤ 12 years). In terms of management for the pediatric population, tube thoracostomy alone was needed in 32.7% (72 of 220), whereas operative thoracic exploration was performed in 20.0% (44 of 220). Overall mortality was 13.6% (30 of 220). There was no significant difference between the pediatric and adult population with regard to injury mechanism or severity, need for therapeutic intervention, operative approach, use of emergency department thoracotomy, or outcome. Stepwise logistic regression failed to identify age as a predictor for the need for either therapeutic intervention or mortality between the two age groups as a whole. However, subgroup analysis revealed that being 12 years or younger (odds ratio, 3.84; 95% confidence interval, 1.29-11.4) was an independent predictor of mortality. Management of traumatic penetrating thoracic injuries in terms of the need for therapeutic intervention and operative approach was similar between the adult and pediatric populations. Mortality from

FAA Fluorescent Penetrant Laboratory Inspections

Energy Technology Data Exchange (ETDEWEB)

WINDES,CONNOR L.; MOORE,DAVID G.

2000-08-02

The Federal Aviation Administration Airworthiness Assurance NDI Validation Center currently assesses the capability of various non-destructive inspection (NDI) methods used for analyzing aircraft components. The focus of one such exercise is to evaluate the sensitivity of fluorescent liquid penetrant inspection. A baseline procedure using the water-washable fluorescent penetrant method defines a foundation for comparing the brightness of low cycle fatigue cracks in titanium test panels. The analysis of deviations in the baseline procedure will determine an acceptable range of operation for the steps in the inspection process. The data also gives insight into the depth of each crack and which step(s) of the inspection process most affect penetrant sensitivities. A set of six low cycle fatigue cracks produced in 6.35-mm thick Ti-6Al-4V specimens was used to conduct the experiments to produce sensitivity data. The results will document the consistency of the crack readings and compare previous experiments to find the best parameters for water-washable penetrant.

Surgical treatment for the subclavian steal syndrome. Surgical indication and selection of procedures by {sup 123}I-IMP-SPECT imaging and {sup 99m}Tc-HSA accumulation curve in upper extremities

Energy Technology Data Exchange (ETDEWEB)

Fujita, Toyohisa; Tokunaga, Hidemori; Akita, Nobuhisa; Nonaka, Masahiro [Saiseikai Chuwa Hospital, Sakurai, Nara (Japan)

1998-03-01

To select reasonable operative procedures in the respective patients, we have studied the cerebral blood flow, especially in the posterior circulation, by {sup 123}I-IMP-SPECT imaging, and the blood flow in the upper extremities by {sup 99m}Tc-HSA accumulation curve in 11 patients with subclavian steal syndrome. Although all patients presented distinct symptoms and signs of vertebrobasilar insufficiency, {sup 123}I-IMP-SPECT early image demonstrated no evident finding of decreased blood flow in the posterior circulation. However, in the delayed image 5 out of 11 patients revealed laterality of IMP uptake in cerebellar hemisphere. Four patients presented symptoms of the upper extremities including arm claudication, and all of them revealed {sup 99m}Tc-HSA accumulation curve indicated decreased blood flow in the affected side of arm and forearm. We performed transposition of vertebral artery to common carotid artery in 7 patients without evidence of decreased blood flow in the upper extremities by {sup 99m}Tc-HSA accumulation curve, common carotid-subclavian dacron graft bypass in 3 cases with evidence of decreased blood flow in the upper extremities, and arch aorta-common carotid dacron graft bypass for the innominate artery occlusion. When the ischemia in the anterior circulation had existed in patients with multiple cerebrovascular occlusive disease, we first corrected the anterior circulation, and then performed the revascularization for the posterior circulation mentioned above by staged operation, resulting in successful treatment of all patients. (K.H.)

Penetrating performance and “self-sharpening” behavior of fine-grained tungsten heavy alloy rod penetrators

Energy Technology Data Exchange (ETDEWEB)

Luo, Rongmei, E-mail: luorm_1999@126.com [School of Energy and Power Engineering, Nanjing University of Science and Technology, Nanjing 210094, Jiangsu (China); College of Equipment Engineering, Shenyang Ligong University, Shenyang 110159, Liaoning (China); Huang, Dewu; Yang, Mingchuan; Tang, Enling; Wang, Meng; He, Liping [College of Equipment Engineering, Shenyang Ligong University, Shenyang 110159, Liaoning (China)

2016-10-15

Rod penetrators with 95W–3.75Ni–1.25Fe fine-grained tungsten heavy alloy (fine-grained 95W) and conventional tungsten heavy alloy rod penetrators with the same chemical composition (conventional 95W) were subjected to ballistic impact to compare their penetration performance. “Self-sharpening” behavior and an average 10.5% increase in penetration depth compared to conventional 95W penetrators. An acute head remained on the fine-grained 95W rod with SEM results revealing many micro-cracks and small debris on surface layer of the rod head. The stress-strain curves collected in the Split Hopkinson Pressure Bar (SHPB) experiment showed that critical failure strain values of the fine-grained 95W were 0.12 and 0.39 at strain rate of 2×10{sup 3} s{sup −1} and 3.9×10{sup 3} s{sup −1}, respectively, approximately 40% and 10% lower than those of the conventional 95W. The dynamic strength values of fine-grained 95W were 2100 MPa and 2520 MPa, respectively, which were 500 MPa and 520 MPa higher than those of the conventional 95W. The relationship among microstructure, mechanical property and “self-sharpening” behavior of fine-grained 95W is discussed in this work.

Operating methods to remove the excess of penetrant in surface. Preponderant and characteristic part of water for water washable penetrants

International Nuclear Information System (INIS)

Dubosc, P.

1985-01-01

Penetrant use for quality control, although very well known (nuclear, space industries, offshore platforms) is often poorly practiced. This is largely due to a lack of understanding by the users the way that the different components of the system (penetrants, solvents, emulsifiers, and developers) function. In this talk, we shall explain a particular characteristic that the manufacturers of reputable penetrant seek to build into their water washable penetrants. It is a viscosity curve which has the function of keeping water in a well defined form. We show why the form of the curve is crucial, which reaction between water and penetrant it corresponds to, and we deduce the practical consequences of bringing into play procedures for removing excess penetrant with or without water [fr

Varieties of cognitive penetration in visual perception.

Science.gov (United States)

Vetter, Petra; Newen, Albert

2014-07-01

Is our perceptual experience a veridical representation of the world or is it a product of our beliefs and past experiences? Cognitive penetration describes the influence of higher level cognitive factors on perceptual experience and has been a debated topic in philosophy of mind and cognitive science. Here, we focus on visual perception, particularly early vision, and how it is affected by contextual expectations and memorized cognitive contents. We argue for cognitive penetration based on recent empirical evidence demonstrating contextual and top-down influences on early visual processes. On the basis of a perceptual model, we propose different types of cognitive penetration depending on the processing level on which the penetration happens and depending on where the penetrating influence comes from. Our proposal has two consequences: (1) the traditional controversy on whether cognitive penetration occurs or not is ill posed, and (2) a clear-cut perception-cognition boundary cannot be maintained. Copyright © 2014 Elsevier Inc. All rights reserved.

Auditing Albaha University Network Security using in-house Developed Penetration Tool

Science.gov (United States)

Alzahrani, M. E.

2018-03-01

Network security becomes very important aspect in any enterprise/organization computer network. If important information of the organization can be accessed by anyone it may be used against the organization for further own interest. Thus, network security comes into it roles. One of important aspect of security management is security audit. Security performance of Albaha university network is relatively low (in term of the total controls outlined in the ISO 27002 security control framework). This paper proposes network security audit tool to address issues in Albaha University network. The proposed penetration tool uses Nessus and Metasploit tool to find out the vulnerability of a site. A regular self-audit using inhouse developed tool will increase the overall security and performance of Albaha university network. Important results of the penetration test are discussed.

Woody plant roots fail to penetrate a clay-lined landfill: Managment implications

Science.gov (United States)

Robinson, George R.; Handel, Steven N.

1995-01-01

In many locations, regulatory agencies do not permit tree planting above landfills that are sealed with a capping clay, because roots might penetrate the clay barrier and expose landfill contents to leaching. We find, however, no empirical or theoretical basis for this restriction, and instead hypothesize that plant roots of any kind are incapable of penetrating the dense clays used to seal landfills. As a test, we excavated 30 trees and shrubs, of 12 species, growing over a clay-lined municipal sanitary landfill on Staten Island, New York. The landfill had been closed for seven years, and featured a very shallow (10 to 30-cm) soil layer over a 45-cm layer of compacted grey marl (Woodbury series) clay. The test plants had invaded naturally from nearby forests. All plants examined—including trees as tall as 6 m—had extremely shallow root plates, with deformed tap roots that grew entirely above and parallel to the clay layer. Only occasional stubby feeder roots were found in the top 1 cm of clay, and in clay cracks at depths to 6 cm, indicating that the primary impediment to root growth was physical, although both clay and the overlying soil were highly acidic. These results, if confirmed by experimental research should lead to increased options for the end use of many closed sanitary landfills.

Improving outcomes following penetrating colon wounds: application of a clinical pathway.

Science.gov (United States)

Miller, Preston R; Fabian, Timothy C; Croce, Martin A; Magnotti, Louis J; Elizabeth Pritchard, F; Minard, Gayle; Stewart, Ronald M

2002-06-01

During World War II, failure to treat penetrating colon injuries with diversion could result in court martial. Based on this wartime experience, colostomy for civilian colon wounds became the standard of care for the next 4 decades. Previous work from our institution demonstrated that primary repair was the optimal management for nondestructive colon wounds. Optimal management of destructive wounds requiring resection remains controversial. To address this issue, we performed a study that demonstrated risk factors (pre or intraoperative transfusion requirement of more than 6 units of packed red blood cells, significant comorbid diseases) that were associated with a suture line failure rate of 14%, and of whom 33% died. Based on these outcomes, a clinical pathway for management of destructive colon wounds was developed. The results of the implementation of this pathway are the focus of this report. Patients with penetrating colon injury were identified from the registry of a level I trauma center over a 5-year period. Records were reviewed for demographics, injury characteristics, and outcome. Patients with nondestructive injuries underwent primary repair. Patients with destructive wounds but no comorbidities or large transfusion requirement underwent resection and anastomosis, while patients with destructive wounds and significant medical illness or transfusion requirements of more than 6 units/blood received end colostomy. The current patients (CP) were compared to the previous study (PS) to determine the impact of the clinical pathway. Outcomes examined included colon related mortality and morbidity (suture line leak and abscess). Over a 5.5-year period, 231 patients had penetrating colon wounds. 209 survived more 24 hours and comprise the study population. Primary repair was performed on 153 (73%) patients, and 56 patients had destructive injuries (27%). Of these, 40 (71%) had resection and anastomosis and 16 (29%) had diversion. More destructive injuries were

Initial response of a rock penetrator

International Nuclear Information System (INIS)

Longcope, D.B.; Grady, D.E.

1977-12-01

An analysis based on elastic rod theory is given for the early-time axisymmetric response of pointed penetrators. Results of measurements by laser interferometry of the back surface particle velocity of laboratory scale penetrators impacted by sandstone targets are presented. Values of the initial pressure on the penetrator tip are determined which give good agreement between the analytical and experimental results. These initial tip pressures are found to be approximated by the stress-particle velocity Hugoniot for the target material

Evaporation Limited Radial Capillary Penetration in Porous Media.

Science.gov (United States)

Liu, Mingchao; Wu, Jian; Gan, Yixiang; Hanaor, Dorian A H; Chen, C Q

2016-09-27

The capillary penetration of fluids in thin porous layers is of fundamental interest in nature and various industrial applications. When capillary flows occur in porous media, the extent of penetration is known to increase with the square root of time following the Lucas-Washburn law. In practice, volatile liquid evaporates at the surface of porous media, which restricts penetration to a limited region. In this work, on the basis of Darcy's law and mass conservation, a general theoretical model is developed for the evaporation-limited radial capillary penetration in porous media. The presented model predicts that evaporation decreases the rate of fluid penetration and limits it to a critical radius. Furthermore, we construct a unified phase diagram that describes the limited penetration in an annular porous medium, in which the boundaries of outward and inward liquid are predicted quantitatively. It is expected that the proposed theoretical model will advance the understanding of penetration dynamics in porous media and facilitate the design of engineered porous architectures.

PHACE association with intracranial, oropharyngeal hemangiomas, and an atypical patent ductus arteriosus arising from the tortuous left subclavian artery in a premature infant

Directory of Open Access Journals (Sweden)

Do-Hyun Kim

2012-01-01

Full Text Available PHACE association is a rare neurocutaneous condition in which facial hemangiomas associate with a spectrum of posterior fossa malformations, arterial cerebrovascular anomalies, cardiovascular anomalies, and eye anomalies. We reported a case of PHACE association in a premature infant showing facial, intracranial, and oropharyngeal hemangiomas with evidence of the Dandy-Walker variant and complicated cardiovascular anomalies, including a right-sided aortic arch and an atypical patent ductus arteriosus arising from a tortuous left subclavian artery. To our knowledge, intracranial hemangiomas are rare in PHACE association, and a concomitant oropharyngeal hemangioma has not been previously reported in the PHACE association literature. In infants presenting with large, plaque-like facial hemangiomas, it is important to conduct active cardiovascular and neurological evaluations. Special attention should be given to the laryngoscopic examination to search for additional hemangiomas in the airway.

Real-Time Penetrating Particle Analyzer (PAN)

Science.gov (United States)

Wu, X.; Ambrosi, G.; Bertucci, B.

2018-02-01

The PAN can measure penetrating particles with great precision to study energetic particles, solar activities, and the origin and propagation of cosmic rays. The real-time monitoring of penetrating particles is crucial for deep space human travel.

Development of penetrant materials from used oil

International Nuclear Information System (INIS)

Mohamad Pauzi Ismail; Azhar Azmi

2014-01-01

This paper described the results of experiment to produce penetrant for nondestructive testing using used engine oil. The used engine oil was obtained from motor vehicle. It was mixed with kerosene at several mix proportion. The penetrability of these mixing were measured and compared with the penetrant available on the market. The results of measurement were explained and discussed. (author)

Development of coring, consolidating, subterrene penetrators

International Nuclear Information System (INIS)

Murphy, H.D.; Neudecker, J.W.; Cort, G.E.; Turner, W.C.; McFarland, R.D.; Griggs, J.E.

1976-02-01

Coring penetrators offer two advantages over full face-melting penetrators, i.e., formation of larger boreholes with no increase in power and the production of glass-lined, structurally undisturbed cores which can be recovered with conventional core-retrieval systems. These cores are of significant value in geological exploratory drilling programs. The initial design details and fabrication features of a 114-mm-diam coring penetrator are discussed; significant factors for design optimization are also presented. Results of laboratory testing are reported and compared with performance predictions, and an initial field trial is described

Impact of managed care on cancer trial enrollment.

Science.gov (United States)

Gross, C P; Krumholz, H M

2005-06-01

To determine the relationship between managed care market activity and cancer trial enrollment. Trial participant data were obtained from the National Cancer Institute. Participants in cooperative group trials of breast, colorectal, lung, or prostate cancer during the years 1996 through 2001 were assigned to counties based on their zip code of residence. Linear regression was used to determine the relationship between county enrollment rate and two measures of county managed care activity (penetration and index of competition [IOC]), adjusting for other county characteristics. In bivariate analysis, there was a strong inverse correlation between trial enrollment rate and IOC (r = -0.23; P penetration, proportion uninsured, and other county characteristics. Counties in the lowest quartile of managed care penetration tended to have lower enrollment rates than the remaining counties (r = -0.05; P = .048), while counties in the second, third, and fourth quartiles of penetration all had similar enrollment rates to one another. Cancer trial enrollment rates were suboptimal across all counties, and counties with higher levels of managed care competition had significantly lower enrollment rates. The relationship between managed care penetration and trial enrollment was less consistent. Future efforts to enhance trial participation should address the potential negative influence of market factors.

Two methodologies for physical penetration testing using social engineering

NARCIS (Netherlands)

Dimkov, T.; van Cleeff, A.; Pieters, Wolter; Hartel, Pieter H.

2010-01-01

Penetration tests on IT systems are sometimes coupled with physical penetration tests and social engineering. In physical penetration tests where social engineering is allowed, the penetration tester directly interacts with the employees. These interactions are usually based on deception and if not

Increasing penetration of renewable and distributed electricity generation and the need for different network regulation

International Nuclear Information System (INIS)

Joode, J. de; Jansen, J.C.; Welle, A.J. van der; Scheepers, M.J.J.

2009-01-01

The amount of decentralised electricity generation (DG) connected to distribution networks increases across EU member states. This increasing penetration of DG units poses potential costs and benefits for distribution system operators (DSOs). These DSOs are regulated since the business of electricity distribution is considered to be a natural monopoly. This paper identifies the impact of increasing DG penetration on the DSO business under varying parameters (network characteristics, DG technologies, network management type) and argues that current distribution network regulation needs to be improved in order for DSOs to continue to facilitate the integration of DG in the network. Several possible adaptations are analysed.

Assessing the credibility of diverting through containment penetrations

International Nuclear Information System (INIS)

Cooley, J.N.; Swindle, D.W. Jr.

1980-01-01

A viable approach has been developed for identifying those containment penetrations in a nuclear fuel reprocessing plant which are credible diversion routes. The approach is based upon systematic engineering and design analyses and is applied to each type of penetration to determine which penetrations could be utilized to divert nuclear material from a reprocessing facility. The approach is described and the results of an application are discussed. In addition, the concept of credibility is developed and discussed. For a typical reprocessing plant design, the number of penetrations determined to be credible without process or piping modifications was approx. 16% of the penetrations originally identified

Quasi-relativistic effects in barrier-penetration processes

International Nuclear Information System (INIS)

Anchishkin, D.V.

1991-01-01

The problem of a particle tunneling through the potential barrier is solved within quasi-relativistic Schroedinger equation. It is shown that the subbarrier relativistic effects give a significant addition to penetration coefficient when some relations between parameters of the barrier and mass of a tunneling particle are satisfied. For instance an account of these effects for penetration of low energy π + -mesons through Coulomb barrier of the 298 U nuclei would give the increasing of penetration coefficient to 30 percent as compared to the nonrelativistic one. Also we give the criteria under which the contribution of the ''under barrier relativism'' to penetration coefficient becomes essential. 3 refs.; 6 figs. (author)

VISUAL INSPECTION OF WATER LEAKAGE FROM GROUND PENETRATING RADAR RADARGRAM

OpenAIRE

N. N. Halimshah; A. Yusup; Z. Mat Amin; M. D. Ghazalli

2015-01-01

Water loss in town and suburban is currently a significant issue which reflect the performance of water supply management in Malaysia. Consequently, water supply distribution system has to be maintained in order to prevent shortage of water supply in an area. Various techniques for detecting a mains water leaks are available but mostly are time-consuming, disruptive and expensive. In this paper, the potential of Ground Penetrating Radar (GPR) as a non-destructive method to correctly and effic...

Contemporary Management of Type B Aortic Dissection in the Endovascular Era.

Science.gov (United States)

Bannazadeh, Mohsen; Tadros, Rami O; McKinsey, James; Chander, Rajiv; Marin, Michael L; Faries, Peter L

2016-04-01

Aortic dissection (AD) is one of the most common catastrophic pathologies affecting the aorta. Anatomic classification is based on the origin of entry tear and its extension. Type A dissections originate in the ascending aorta, whereas the entry tear in Type B dissections starts distal to the left subclavian artery. The patients with aortic dissection who manifest complications such as rupture, malperfusion, aneurysmal degeneration, and intractable pain are classified as complicated AD. Risk factors for developing aortic dissection include age, male gender, and aortic wall structural abnormalities. The most common presenting symptom of acute aortic dissection is pain. Malperfusion occurs as a result of end-organ ischemia due to involvement of aortic branches from the dissecting process. This can happen in various locations causing mesenteric ischemia (mesenteric vessels), stroke (aortic arch vessels), renal failure (renal arteries), spinal ischemia, and limb ischemia (iliac or subclavian arteries). Aneurysmal degeneration is the most common complication of patients with chronic Type B dissection who are managed with medical therapy. Management of Type B aortic dissection (TBAD) remains controversial. Many groups recommend conservative therapy for newly diagnosed TBAD and reserve surgical management for patients who develop complications such as rupture, malperfusion, aneurysmal dilatation, and refractory pain. The mainstay of medical therapy includes antihypertensive medication to reduced ΔP/ ΔT by lowering blood pressure and heart rate. With the continued success of thoracic endovascular aortic repair (TEVAR), this procedure has been extended to treat TBAD in selected patients. The outcomes of TEVAR are promising, with early mortality rates from 10% to 20%. With promising results from these series, some groups recommend early TEVAR in uncomplicated TBAD to prevent future adverse events. The goals of endovascular treatment of TBAD are to cover the entry tear

Thyroid Emphysema Following Penetrating Neck Trauma

Directory of Open Access Journals (Sweden)

Demet Karadağ

2011-03-01

Full Text Available Although traumatic thyroid gland rupture or hemorrhage is usually seen in goitrous glands, injuries of the normal thyroid gland after neck trauma have rarely been described in the literature. We describe a 44-year-old man who presented with thyroid emphysema and subcutaneous emphysema (SCE that occurred after penetrating neck trauma. CT images showed complete resolution of thyroid emphysema and subcutaneous emphysema at follow-up examination. Neck injuries can be life threatening. After penetrating neck traumas, physicians should consider subtle esophageal or tracheal laceration. Thyroid emphysema can occur as the result of penetrating neck trauma. The mechanism of emphysema of the thyroid parenchyma can be explained by the thyroid gland’s presence in a single visceral compartment that encompasses the larynx, trachea and thyroid gland. We describe an unusual case of thyroid emphysema of a normal thyroid gland following a penetrating neck injury.

Technical note: subclavian artery misplacement of a 12F Shaldon catheter: percutaneous repair with a local closure device under temporary balloon tamponade; Technische Mitteilung: Entfernung eines fehlplatzierten 12F Shaldon Katheters aus der A. subclavia und Abdichtung mittels Verschlusssystem bei temporaerer Ballonblockade

Energy Technology Data Exchange (ETDEWEB)

Wildberger, J.E.; Katoh, M.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, RWTH Aachen (Germany); Fussen, R. [Anaesthesiologische Klinik, Medizinisches Zentrum Kreis Aachen GmbH (Germany)

2006-06-15

A case of subsequent percutaneous repair using a local closure device with a collagen block (VasoSeal {sup registered}) and temporary balloon tamponade after inadvertent subclavian artery misplacement of a 12F Shaldon catheter is reported. Balloon occlusion safely prevented displacement of collagen into the vascular lumen by occluding the 12F entry site. Furthermore, collagen-induced coagulation was facilitated. (orig.)

Crack growth rates in vessel head penetration materials

International Nuclear Information System (INIS)

Gomez Briceno, D.; Lapena, J.; Blazquez, F.

1994-01-01

The cracks detected in reactor vessel head penetrations in certain European plants have been attributed to Primary Water Stress Corrosion Cracking (PWSCC). The penetrations in question are made from Inconel 600. The susceptibility of this alloy to PWSCC has been widely studied in relation to use of this material for steam generator tubes. When the first reactor vessel head penetration cracks were detected, most of the available data on crack propagation rates were from test specimens made from steam generator tubes and tested under conditions that questioned the validity of these data for assessment of the evolution of cracks in penetrations. For this reason, the scope of the Spanish Research Project on the Inspection and Repair of PWR reactor vessel head penetrations included the acquisition of data on crack propagation rates in Inconel 600, representative of the materials used for vessel head penetrations. (authors). 1 fig., 2 tabs., 6 refs

How do Neoseiulus californicus (Acari: Phytoseiidae) females penetrate densely webbed spider mite nests?

Science.gov (United States)

Montserrat, M; de la Peña, F; Hormaza, J I; González-Fernández, J J

2008-02-01

The persea mite Oligonychus perseae is a pest of avocado trees that builds extremely dense webbed nests that protect them against natural enemies, including phytoseiid mites. Nests have one or two marginal entrances that are small and flattened. The predatory mite Neoseiulus californicus co-occurs with O. perseae in the avocado orchards of the south-east of Spain. Penetration inside nests through the entrances by this predator is thought to be hindered by its size and its globular-shaped body. However, in the field it has repeatedly been found inside nests that were clearly ripped. Perhaps penetration of the nests has been facilitated by nest wall ripping caused by some other species or by unfavourable abiotic factors. However, to assess whether N. californicus is also able to enter the nest of O. perseae by itself, we carried out laboratory experiments and made a short film. They show how this predator manages to overcome the webbed wall, and that it can penetrate and forage inside nests of O. perseae.

Tretinoin-based formulations - influence of concentration and vehicles on skin penetration

Directory of Open Access Journals (Sweden)

Edileia Bagatin

2015-03-01

Full Text Available Tretinoin is used in the management of acne and it is part of a gold standard treatment for photoaging. It has also been reported as an agent for superficial chemical peeling in highly concentrated formulations with few considerations about skin penetration. The aim of this study was to evaluate the influence of drug concentration and vehicles currently used on skin penetration of tretinoin. In vitro permeation tests were carried out using Franz diffusion cells fitted with porcine ear skin and 10% aqueous methanol in the receptor compartment. Formulations studied, cream or hydroalcoholic dispersion, containing 0.25%, 1% and 5% of tretinoin were placed in the donor compartment for six hours. Tretinoin concentration in skin layers was measured by high performance liquid chromatography. The largest amount of tretinoin from both vehicles was detected in stratum corneum with significant differences among the three concentrations. The hydroalcoholic dispersion was the best vehicle. Significant amounts of tretinoin were found even in deep layers of epidermis. The formulation with 0.25% tretinoin showed better results when considered the amount of tretinoin on skin in terms of percentage. Finally, skin penetration of tretinoin was influenced by vehicle and concentration of this drug used in formulation.

Penetration of Photovoltaics in Greece

OpenAIRE

Eugenia Giannini; Antonia Moropoulou; Zacharias Maroulis; Glykeria Siouti

2015-01-01

Recently, an interesting experiment was completed in Greece concerning photovoltaic penetration into the electricity production sector. Based on the relevant laws and in accordance to the related European directives, an explosive penetration process was completed in less than three years, resulting in a 7% share of photovoltaics in electricity production instead of the previous negligible share. The legislation was based on licensing simplification and generous feed-in-tariffs. This approach ...

Recursive Monte Carlo method for deep-penetration problems

International Nuclear Information System (INIS)

Goldstein, M.; Greenspan, E.

1980-01-01

The Recursive Monte Carlo (RMC) method developed for estimating importance function distributions in deep-penetration problems is described. Unique features of the method, including the ability to infer the importance function distribution pertaining to many detectors from, essentially, a single M.C. run and the ability to use the history tape created for a representative region to calculate the importance function in identical regions, are illustrated. The RMC method is applied to the solution of two realistic deep-penetration problems - a concrete shield problem and a Tokamak major penetration problem. It is found that the RMC method can provide the importance function distributions, required for importance sampling, with accuracy that is suitable for an efficient solution of the deep-penetration problems considered. The use of the RMC method improved, by one to three orders of magnitude, the solution efficiency of the two deep-penetration problems considered: a concrete shield problem and a Tokamak major penetration problem. 8 figures, 4 tables

penetrating abdominal trauma

African Journals Online (AJOL)

gender, mechanism of injury, injury severity scores (ISS), penetrating ... ileus, reduced pulmonary function and loss of muscle mass and function, all of .... pathophysiology and rehabilitation. ... quality of life after surgery for colorectal cancer.

A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries.

Science.gov (United States)

Yilmaz, Tugba H; Ndofor, Brown C; Smith, Martin D; Degiannis, Elias

2010-07-14

There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and pitfalls that will be encountered in penetrating trauma to the abdomen, will help the occasional trauma surgeons to avoid intraoperative errors and improve patient care. This manuscript provides a heuristic approach from surgeons working in a high volume penetrating trauma centers in South African. Some of the statements could be considered heretic by the "accepted" trauma literature. We believe that this heuristic ("rule of thumb" approach, that originating from "try and error" experience) can help surgical trainees or less experienced in penetrating trauma surgeons to improve their surgical decision making and technique, resulting in better patient outcome.

A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries

Directory of Open Access Journals (Sweden)

Smith Martin D

2010-07-01

Full Text Available Abstract There is a general decline in penetrating abdominal trauma throughout the western world. As a result of that, there is a significant loss of expertise in dealing with this type of injury particularly when the patient presents to theatre with physiological instability. A significant percentage of these patients will not be operated by a trauma surgeon but, by the "occasional trauma surgeon", who is usually trained as a general surgeon. Most general surgeons have a general knowledge of operating penetrating trauma, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide them with enough armamentaria to tackle the difficult case. In this scenario, their operative dexterity and knowledge cannot be compared to that of their trauma surgeon colleagues, something that is taken for granted in the trauma textbooks. Techniques that are considered basic and easy by the trauma surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and pitfalls that will be encountered in penetrating trauma to the abdomen, will help the occasional trauma surgeons to avoid intraoperative errors and improve patient care. This manuscript provides a heuristic approach from surgeons working in a high volume penetrating trauma centers in South African. Some of the statements could be considered heretic by the "accepted" trauma literature. We believe that this heuristic ("rule of thumb" approach, that originating from "try and error" experience can help surgical trainees or less experienced in penetrating trauma surgeons to improve their surgical decision making and technique, resulting in better patient outcome.

Characterization of nuclear reactor containment penetrations. Preliminary report

International Nuclear Information System (INIS)

Bump, T.R.; Seidensticker, R.W.; Shackelford, M.A.; Gambhir, V.K.; McLennan, G.L.

1984-06-01

This report summarizes the survey work conducted by Argonne National Laboratory on the design and details of major penetrations in 22 nuclear power plants. The survey includes all containment types and materials in current use. It also includes details of all types of penetrations (except for electrical penetration assemblies and valves) and the seals and gaskets used in them. The report provides a test matrix for testing major penetrations and for testing seals and gaskets in order to evaluate their leakage potential under severe accident conditions

40 CFR 1065.365 - Nonmethane cutter penetration fractions.

Science.gov (United States)

2010-07-01

... fractions. 1065.365 Section 1065.365 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Measurements § 1065.365 Nonmethane cutter penetration fractions. (a) Scope and frequency. If you use a FID... penetration fractions of methane, PFCH4, and ethane, PF C2H6. As detailed in this section, these penetration...

The penetration of aerosols through fine orifices

International Nuclear Information System (INIS)

Marshall, I.A.; Latham, L.J.; Ball, M.H.E.; Mitchell, J.P.

1991-07-01

A novel experimental technique has been extended to study the migration of gas-borne glass microspheres in the size range from about 1 to 15 μm volume equivalent diameter through orifices with bores and thicknesses in the range from 2 to 100 μm and 12.7 to 509 μm respectively. The penetration of these particles was significant with all orifices greater than 10 μm bore at a constant driving pressure of 100 kPa. However, few particles penetrated the 5 μm bore orifice, while virtually no particles penetrated the 2 μm bore orifice. Particle size distributions determined after penetration through the orifices were very similar to that of the upstream aerosol except when significant attenuation occurred. (author)

Temporary fire sealing of penetrations on TFTR

International Nuclear Information System (INIS)

Hondorp, H.L.

1981-02-01

The radiation shielding provided for TFTR for D-D and D-T operation will be penetrated by numerous electrical and mechanical services. Eventually, these penetrations will have to be sealed to provide the required fire resistance, tritium sealability, pressure integrity and radiation attenuation. For the initial hydrogen operation, however, fire sealing of the penetrations in the walls and floor is the primary concern. This report provides a discussion of the required and desirable properties of a temporary seal which can be used to seal these penetrations for the hydrogen operation and then subsequently be removed and replaced as required for the D-D and D-T operations. Several candidate designs are discussed and evaluated and recommendations are made for specific applications

Miniature Ground Penetrating Radar, CRUX GPR

Science.gov (United States)

Kim, Soon Sam; Carnes, Steven R.; Haldemann, Albert F.; Ulmer, Christopher T.; Ng, Eddie; Arcone, Steven A.

2006-01-01

Under NASA instrument development programs (PIDDP 2000-2002, MIPD 2003-2005, ESR and T, 2005) we have been developing miniature ground penetrating radars (GPR) for use in mapping subsurface stratigraphy from planetary rovers for Mars and lunar applications. The Mars GPR is for deeper penetration (up to 50 m depth) into the Martian subsurface at moderate resolution (0.5 m) for a geological characterization. As a part of the CRUX (Construction and Resource Utilization Explorer) instrument suite, the CRUX GPR is optimized for a lunar prospecting application. It will have shallower penetration (5 m depth) with higher resolution (10 cm) for construction operations including ISRU (in-situ resource utilization).

Building virtual pentesting labs for advanced penetration testing

CERN Document Server

Cardwell, Kevin

2014-01-01

Written in an easy-to-follow approach using hands-on examples, this book helps you create virtual environments for advanced penetration testing, enabling you to build a multi-layered architecture to include firewalls, IDS/IPS, web application firewalls, and endpoint protection, which is essential in the penetration testing world. If you are a penetration tester, security consultant, security test engineer, or analyst who wants to practice and perfect penetration testing skills by building virtual pen testing labs in varying industry scenarios, this is the book for you. This book is ideal if yo

Chronic Disease Prevalence and Medicare Advantage Market Penetration

Science.gov (United States)

Bernell, Stephanie Lazarus; Casim, Faizan M.; Wilmott, Jennifer; Pearson, Lindsey; Byler, Caitlin M.; Zhang, Zidong

2015-01-01

By March 2015, 30% of all Medicare beneficiaries were enrolled in Medicare Advantage (MA) plans. Research to date has not explored the impacts of MA market penetration on individual or population health outcomes. The primary objective of this study is to examine the relationships between MA market penetration and the beneficiary’s portfolio of cardiometabolic diagnoses. This study uses 2004 to 2008 Medical Expenditure Panel Survey (MEPS) Household Component data to construct an aggregate index that captures multiple diagnoses in one outcome measure (Chronic Disease Severity Index [CDSI]). The MEPS data for 8089 Medicare beneficiaries are merged with MA market penetration data from Centers for Medicare and Medicaid Services (CMS). Ordinary least squares regressions are run with SAS 9.3 to model the effects of MA market penetration on CDSI. The results suggest that each percentage increase in MA market penetration is associated with a greater than 2-point decline in CDSI (lower burden of cardiometabolic chronic disease). Spill-over effects may be driving improvements in the cardiometabolic health of beneficiary populations in counties with elevated levels of MA market penetration. PMID:28462266

Impact of HMO penetration and other environmental factors on hospital X-inefficiency.

Science.gov (United States)

Rosko, M D

2001-12-01

This study examined the impact of health maintenance organization (HMO) market penetration and other internal and external environmental factors on hospital X-inefficiency in a national sample (N = 1,966) of urban U.S. hospitals in 1997. Stochastic frontier analysis, a frontier regression technique, was used to measure X-inefficiency and estimate parameters of the correlates of X-inefficiency. Log-likelihood restriction tests were used to test a variety of assumptions about the empirical model that guided its selection. Average estimated X-inefficiency in study hospitals was 12.96 percent. Increases in managed care penetration, dependence on Medicare and Medicaid, membership in a multihospital system, and location in areas where competitive pressures and the pool of uncompensated care are greater were associated with less X-inefficiency. Not-for-profit ownership was associated with increased X-inefficiency.

Thermo-chemical Ice Penetrator for Icy Moons

Science.gov (United States)

Arenberg, J. W.; Lee, G.; Harpole, G.; Zamel, J.; Sen, B.; Ross, F.; Retherford, K. D.

2016-12-01

The ability to place sensors or to take samples below the ice surface enables a wide variety of potential scientific investigations. Penetrating an ice cap can be accomplished via a mechanical drill, laser drill, kinetic impactor, or heated penetrator. This poster reports on the development of technology for the latter most option, namely a self-heated probe driven by an exothermic chemical reaction: a Thermo-chemical ice penetrator (TChIP). Our penetrator design employs a eutectic mix of alkali metals that produce an exothermic reaction upon contact with an icy surface. This reaction increases once the ice starts melting, so no external power is required. This technology is inspired by a classified Cold-War era program developed at Northrop Grumman for the US Navy. Terrestrial demonstration of this technology took place in the Arctic; however, this device cannot be considered high TRL for application at the icy moons of the solar system due to the environmental differences between Earth's Arctic and the icy moons. These differences demand a TChIP design specific to these cold, low mass, airless worlds. It is expected that this model of TChIP performance will be complex, incorporating all of the forces on the penetrator, gravity, the thermo-chemistry at the interface between penetrator and ice, and multi-phase heat and mass transport, and hydrodynamics. Our initial efforts are aimed at the development of a validated set of tools and simulations to predict the performance of the penetrator for both the environment found on these icy moons and for a terrestrial environment. The purpose of the inclusion of the terrestrial environment is to aid in model validation. Once developed and validated, our models will allow us to design penetrators for a specific scientific application on a specific body. This poster discusses the range of scientific investigations that are enabled by TChIP. We also introduce the development plan to advance TChIP to the point where it can be

Penetration shielding applications of CYLSEC

International Nuclear Information System (INIS)

Dexheimer, D.T.; Hathaway, J.M.

1985-01-01

Evaluation of penetration and discontinuity shielding is necessary to meet 10CFR20 regulations for ensuring personnel exposures are as low as reasonably achievable (ALARA). Historically, those shielding evaluations have been done to some degree on all projects. However, many early plants used conservative methods due to lack of an economical computer code, resulting in costly penetration shielding programs. With the increased industry interest in cost effectively reducing personnel exposures to meet ALARA regulations and with the development of the CYLSEC gamma transport computer code at Bechtel, a comprehensive effort was initiated to reduce penetration and discontinuity shielding but still provide a prudent degree of protection for plant personnel from radiation streaming. This effort was more comprehensive than previous programs due to advances in shielding analysis technology and increased interest in controlling project costs while maintaining personnel exposures ALARA. Methodology and resulting cost savings are discussed

Development Of The Nuclear Optical Penetration

Science.gov (United States)

Inoue, K.; Koike, K.; Imada, Y.

1984-10-01

We have developed the nuclear optical penetration to be incorporated in the wall penetration of the shell to introduce a data transmission system using optical fibers into a nuclear power plant with a pressurized water reactor. Radiation-induced coloration in optical glass seriously affects transmission characteristics of optical fibers, whereas it has been revealed that the pure-silica core optical fiber without any dopant in the core has wide applicability in radiation fields thanks to its very low radiation-induced attenuation. The wall penetration of the shell should have airtightness and resistivity to heat, vibration, and pressure, let alone radiation, excellent enough to be invariable in data transmission efficiency even when subjected to severe environmental tests. The sealing modules of this newly developed nuclear optical penetration are hermetically sealed. The gap between the optical fiber rod (100 pm in core diameter and 5 mm in rod diameter) and stainless steel tube is sealed with lamingted glass layer. As the result of He gas leakage test, high airtightness of less than 10 cc/sec was achieved. No thermal deformation of the core was caused by sealing with laminated glass layer, nor was observed transmission loss. Then the sealiing modules were subjected to the irradiation test using 60 Co gamma ray exposure of 2 x 10 rads. Though silica glass layer supporting the fiber rod and sealing glass portion turned blackish purple, transparency of the fiber was not affected. Only less than 0.5 dB of connecting loss was observed at the connecting point with the optical fiber cable. The sealing modules were also found to have resistivity to vibration and pressure as excellent as that of existing nuclear electric penetrations. We expect the nuclear optical fiber penetration will be much effective in improving reliability of data transmission systems using optical fibers in radiation fields.

Theory of activated penetrant diffusion in viscous fluids and colloidal suspensions

International Nuclear Information System (INIS)

Zhang, Rui; Schweizer, Kenneth S.

2015-01-01

We heuristically formulate a microscopic, force level, self-consistent nonlinear Langevin equation theory for activated barrier hopping and non-hydrodynamic diffusion of a hard sphere penetrant in very dense hard sphere fluid matrices. Penetrant dynamics is controlled by a rich competition between force relaxation due to penetrant self-motion and collective matrix structural (alpha) relaxation. In the absence of penetrant-matrix attraction, three activated dynamical regimes are predicted as a function of penetrant-matrix size ratio which are physically distinguished by penetrant jump distance and the nature of matrix motion required to facilitate its hopping. The penetrant diffusion constant decreases the fastest with size ratio for relatively small penetrants where the matrix effectively acts as a vibrating amorphous solid. Increasing penetrant-matrix attraction strength reduces penetrant diffusivity due to physical bonding. For size ratios approaching unity, a distinct dynamical regime emerges associated with strong slaving of penetrant hopping to matrix structural relaxation. A crossover regime at intermediate penetrant-matrix size ratio connects the two limiting behaviors for hard penetrants, but essentially disappears if there are strong attractions with the matrix. Activated penetrant diffusivity decreases strongly with matrix volume fraction in a manner that intensifies as the size ratio increases. We propose and implement a quasi-universal approach for activated diffusion of a rigid atomic/molecular penetrant in a supercooled liquid based on a mapping between the hard sphere system and thermal liquids. Calculations for specific systems agree reasonably well with experiments over a wide range of temperature, covering more than 10 orders of magnitude of variation of the penetrant diffusion constant

Hacking and penetration testing with low power devices

CERN Document Server

Polstra, Philip

2014-01-01

Hacking and Penetration Testing with Low Power Devices shows you how to perform penetration tests using small, low-powered devices that are easily hidden and may be battery-powered. It shows how to use an army of devices, costing less than you might spend on a laptop, from distances of a mile or more. Hacking and Penetration Testing with Low Power Devices shows how to use devices running a version of The Deck, a full-featured penetration testing and forensics Linux distribution, and can run for days or weeks on batteries due to their low power consumption. Author Philip Polstra shows how to

Cracking in LWR RPV head penetrations. Working material. Proceedings of a specialists meeting

International Nuclear Information System (INIS)

1995-01-01

The IAEA Specialists' Meeting on Cracking in LWR RPV Head Penetrations was held at the ASTM Headquarters, Philadelphia, Pennsylvania, on May 2-4, 1995. It was attended by 39 participants from 12 countries. The meeting was held in the framework of the IAEA International Working Group on Life Management of Nuclear Power Plants (IWG-LMNPP) and was organized and sponsored by the Oak Ridge National Laboratory and the U.S. Nuclear Regulatory Commission. The purpose of the meeting was to review experience in the field for ensuring adequate performance of reactor pressure vessel (RPV) heads and penetrations. Presentations were aimed at achieving a better understanding of the behaviour of reactor component materials, providing guidance and recommendations to assure reliability and adequate performance, and proposing directions for further investigations. Refs, figs and tabs

Cracking in LWR RPV head penetrations. Working material. Proceedings of a specialists meeting

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-12-31

The IAEA Specialists` Meeting on Cracking in LWR RPV Head Penetrations was held at the ASTM Headquarters, Philadelphia, Pennsylvania, on May 2-4, 1995. It was attended by 39 participants from 12 countries. The meeting was held in the framework of the IAEA International Working Group on Life Management of Nuclear Power Plants (IWG-LMNPP) and was organized and sponsored by the Oak Ridge National Laboratory and the U.S. Nuclear Regulatory Commission. The purpose of the meeting was to review experience in the field for ensuring adequate performance of reactor pressure vessel (RPV) heads and penetrations. Presentations were aimed at achieving a better understanding of the behaviour of reactor component materials, providing guidance and recommendations to assure reliability and adequate performance, and proposing directions for further investigations. Refs, figs and tabs.

HMO penetration and the geographic mobility of practicing physicians.

Science.gov (United States)

Polsky, D; Kletke, P R; Wozniak, G D; Escarce, J J

2000-09-01

In this study, we assessed the influence of changes in health maintenance organization (HMO) penetration on the probability that established patient care physicians relocated their practices or left patient care altogether. For physicians who relocated their practices, we also assessed the impact of HMO penetration on their destination choices. We found that larger increases in HMO penetration decreased the probability that medical/surgical specialists in early career stayed in patient care in the same market, but had no impact on generalists, hospital-based specialists, or mid career medical/surgical specialists. We also found that physicians who relocated their practices were much more likely to choose destination markets with the same level of HMO penetration or lower HMO penetration compared with their origin markets than they were to choose destination markets with higher HMO penetration. The largely negligible impact of changes in HMO penetration on established physicians' decisions to relocate their practices or leave patient care is consistent with high relocation and switching costs. Relocating physicians' attraction to destination markets with the same level of HMO penetration as their origin markets suggests that, while physicians' styles of medical practice may adapt to changes in market conditions, learning new practice styles is costly.

Skin Penetration Enhancement by Natural Oils for Dihydroquercetin Delivery.

Science.gov (United States)

Čižinauskas, Vytis; Elie, Nicolas; Brunelle, Alain; Briedis, Vitalis

2017-09-12

Natural oils are commonly used in topical pharmaceutical formulations as emulsifiers, stabilizers or solubility enhancers. They are presented as safe and inert components, mainly used for formulation purposes. It is confirmed that natural oils can affect the skin penetration of various substances. Fatty acids are mainly responsible for this effect. Current understanding lacks reliable scientific data on penetration of natural oils into the skin and their skin penetration enhancement potential. In the current study, fatty acid content analysis was used to determine the principal fatty acids in soybean, olive, avocado, sea-buckthorn pulp, raspberry seed and coconut oils. Time of flight secondary ion mass spectrometry bioimaging was used to determine the distribution of these fatty acids in human skin ex vivo after application of the oils. Skin penetration enhancement ratios were determined for a perspective antioxidant compound dihydroquercetin. The results demonstrated skin penetration of fatty acids from all oils tested. Only soybean and olive oils significantly increased the skin distribution of dihydroquercetin and can be used as skin penetration enhancers. However, no correlation can be determined between the fatty acids' composition and skin penetration enhancement using currently available methodological approaches. This indicates that potential chemical penetration enhancement should be evaluated during formulation of topically applied products containing natural oils.

A Study on Factors Affecting Airborne LiDAR Penetration

Directory of Open Access Journals (Sweden)

Wei-Chen Hsu

2015-01-01

Full Text Available This study uses data from different periods, areas and parameters of airborne LiDAR (light detection and ranging surveys to understand the factors that influence airborne LiDAR penetration rate. A discussion is presented on the relationships between these factors and LiDAR penetration rate. The results show that the flight height above ground level (AGL does not have any relationship with the penetration rate. There are some factors that should have larger influence. For example, the laser is affected by a wet ground surface by reducing the number of return echoes. The field of view (FOV has a slightly negative correlation with the penetration rate, which indicates that the laser incidence angle close to zero should achieve the best penetration. The vegetation cover rate also shows a negative correlation with the penetration rate, thus bare ground and reduced vegetation in the aftermath of a typhoon also cause high penetration rate. More return echoes could be extracted from the full-waveform system, thereby effectively improving the penetration rate. This study shows that full-waveform LiDAR is an effective method for increasing the number of surface reflected echoes. This study suggests avoiding LiDAR survey employment directly following precipitation to prevent laser echo reduction.

Penetration Testing Professional Ethics: a conceptual model and taxonomy

Directory of Open Access Journals (Sweden)

Justin Pierce

2006-05-01

Full Text Available In an environment where commercial software is continually patched to correct security flaws, penetration testing can provide organisations with a realistic assessment of their security posture. Penetration testing uses the same principles as criminal hackers to penetrate corporate networks and thereby verify the presence of software vulnerabilities. Network administrators can use the results of a penetration test to correct flaws and improve overall security. The use of hacking techniques, however, raises several ethical questions that centre on the integrity of the tester to maintain professional distance and uphold the profession. This paper discusses the ethics of penetration testing and presents our conceptual model and revised taxonomy.

Chronic Disease Prevalence and Medicare Advantage Market Penetration

Directory of Open Access Journals (Sweden)

Steven W. Howard

2015-10-01

Full Text Available By March 2015, 30% of all Medicare beneficiaries were enrolled in Medicare Advantage (MA plans. Research to date has not explored the impacts of MA market penetration on individual or population health outcomes. The primary objective of this study is to examine the relationships between MA market penetration and the beneficiary’s portfolio of cardiometabolic diagnoses. This study uses 2004 to 2008 Medical Expenditure Panel Survey (MEPS Household Component data to construct an aggregate index that captures multiple diagnoses in one outcome measure (Chronic Disease Severity Index [CDSI]. The MEPS data for 8089 Medicare beneficiaries are merged with MA market penetration data from Centers for Medicare and Medicaid Services (CMS. Ordinary least squares regressions are run with SAS 9.3 to model the effects of MA market penetration on CDSI. The results suggest that each percentage increase in MA market penetration is associated with a greater than 2-point decline in CDSI (lower burden of cardiometabolic chronic disease. Spill-over effects may be driving improvements in the cardiometabolic health of beneficiary populations in counties with elevated levels of MA market penetration.

Radon penetration of concrete slab cracks, joints, pipe penetrations, and sealants

NARCIS (Netherlands)

Nielson, KK; Rogers, VC; Holt, RB; Pugh, TD; Grondzik, WA; deMeijer, RJ

1997-01-01

Radon movement through 12 test slabs with different cracks, pipe penetrations, cold joints, masonry blocks, sealants, and tensile stresses characterized the importance of these anomalous structural domains, Diffusive and advective radon transport were measured with steady-state air pressure

Sphere impact and penetration into wet sand

KAUST Repository

Marston, J. O.

2012-08-07

We present experimental results for the penetration of a solid sphere when released onto wet sand. We show, by measuring the final penetration depth, that the cohesion induced by the water can result in either a deeper or shallower penetration for a given release height compared to dry granular material. Thus the presence of water can either lubricate or stiffen the granular material. By assuming the shear rate is proportional to the impact velocity and using the depth-averaged stopping force in calculating the shear stress, we derive effective viscosities for the wet granular materials.

Sphere impact and penetration into wet sand

KAUST Repository

Marston, J. O.; Vakarelski, Ivan Uriev; Thoroddsen, Sigurdur T

2012-01-01

We present experimental results for the penetration of a solid sphere when released onto wet sand. We show, by measuring the final penetration depth, that the cohesion induced by the water can result in either a deeper or shallower penetration for a given release height compared to dry granular material. Thus the presence of water can either lubricate or stiffen the granular material. By assuming the shear rate is proportional to the impact velocity and using the depth-averaged stopping force in calculating the shear stress, we derive effective viscosities for the wet granular materials.

Penetrating eye injury in war.

Science.gov (United States)

Biehl, J W; Valdez, J; Hemady, R K; Steidl, S M; Bourke, D L

1999-11-01

The percentage of penetrating eye injuries in war has increased significantly in this century compared with the total number of combat injuries. With the increasing use of fragmentation weapons and possibly laser weapons on the battle-field in the future, the rate of eye injuries may exceed the 13% of the total military injuries found in Operations Desert Storm/Shield. During the Iran-Iraq War (1980-1988), eye injuries revealed that retained foreign bodies and posterior segment injuries have an improved prognosis in future military ophthalmic surgery as a result of modern diagnostic and treatment modalities. Compared with the increasing penetrating eye injuries on the battlefield, advances in ophthalmic surgery are insignificant. Eye armor, such as visors that flip up and down and protect the eyes from laser injury, needs to be developed. Similar eye protection is being developed in civilian sportswear. Penetrating eye injury in the civilian sector is becoming much closer to the military model and is now comparable for several reasons.

Neuroimaging in adult penetrating brain injury: a guide for radiographers

International Nuclear Information System (INIS)

Temple, Nikki; Donald, Cortny; Skora, Amanda; Reed, Warren

2015-01-01

Penetrating brain injuries (PBI) are a medical emergency, often resulting in complex damage and high mortality rates. Neuroimaging is essential to evaluate the location and extent of injuries, and to manage them accordingly. Currently, a myriad of imaging modalities are included in the diagnostic workup for adult PBI, including skull radiography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, with each modality providing their own particular benefits. This literature review explores the current modalities available for investigating PBI and aims to assist in decision making for the appropriate use of diagnostic imaging when presented with an adult PBI. Based on the current literature, the authors have developed an imaging pathway for adult penetrating brain injury that functions as both a learning tool and reference guide for radiographers and other health professionals. Currently, CT is recommended as the imaging modality of choice for the initial assessment of PBI patients, while MRI is important in the sub-acute setting where it aids prognosis prediction and rehabilitation planning, Additional follow-up imaging, such as angiography, should be dependent upon clinical findings

Neuroimaging in adult penetrating brain injury: a guide for radiographers

Energy Technology Data Exchange (ETDEWEB)

Temple, Nikki; Donald, Cortny; Skora, Amanda [Discipline of Medical Radiation Sciences, The University of Sydney, Lidcombe, New South Wales (Australia); Reed, Warren, E-mail: warren.reed@sydney.edu.au [Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, The University of Sydney, Lidcombe, New South Wales (Australia)

2015-06-15

Penetrating brain injuries (PBI) are a medical emergency, often resulting in complex damage and high mortality rates. Neuroimaging is essential to evaluate the location and extent of injuries, and to manage them accordingly. Currently, a myriad of imaging modalities are included in the diagnostic workup for adult PBI, including skull radiography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, with each modality providing their own particular benefits. This literature review explores the current modalities available for investigating PBI and aims to assist in decision making for the appropriate use of diagnostic imaging when presented with an adult PBI. Based on the current literature, the authors have developed an imaging pathway for adult penetrating brain injury that functions as both a learning tool and reference guide for radiographers and other health professionals. Currently, CT is recommended as the imaging modality of choice for the initial assessment of PBI patients, while MRI is important in the sub-acute setting where it aids prognosis prediction and rehabilitation planning, Additional follow-up imaging, such as angiography, should be dependent upon clinical findings.

Cracks on instrumentation penetrations in reactor vessel: a new challenge; Fissuration des penetrations de cuve: un nouveau defi

Energy Technology Data Exchange (ETDEWEB)

Anon

2004-02-01

In august 2003 NRC (nuclear regulatory commission) issued a warning concerning the deposits of boron acid that might accumulate on instrumental penetrations in the bottom of PWR vessels. These deposits were first detected on the David-Besse power plant and more recently on the unit 1 of South Texas Project (STP) during a refueling shutdown. STP contracted with the Areva company in order to perform inspections on all the 58 vessel penetrations of the unit 1 and to propose solutions. For that purpose the Areva company had to design a specific visual inspection tool that combined both ultra-sound method and Foucault current probing. The results of the inspection campaign on the unit 1 showed that only 2 penetration tubes were concerned with axial defects in their walls, that no circumferential defects were detected and that butt welds presented no cracks. The 2 incriminated penetration tubes were repaired: a section of both was replaced by an alloy-690 tube. (A.C.)

Penetration Testing dan Analisis Kemanan Web Paud Dikmas

OpenAIRE

Giffari, Abizar

2018-01-01

Sebuah instansi atau perusahaan tentunya mempunyai data penting yang tersimpan dalam sebuah sistem database yang kuat dan aman untuk menghindari ancaman pencurian data dari pihak luar. Untuk mengukur sejauh mana tingkat keamanan yang dibuat, diperlukan sebuah metode pengetesan yang disebut Penetration Testing. Penetration Testing memungkinkan kita untuk dapat menentukan sejauh mana tingkat keamanan sistem yang di test. Penetration Testing juga memungkinkan kita menyerang sistem layaknya attac...

Pipe Penetrating Radar: a New Tool for the Assessment of Critical Infrastructure

Science.gov (United States)

Ekes, C.; Neducz, B.

2012-04-01

This paper describes the development of Pipe Penetrating Radar (PPR), the underground in-pipe application of GPR, a non-destructive testing method that can detect defects and cavities within and outside mainline diameter (>18 in / 450mm) non-metallic (concrete, PVC, HDPE, etc.) underground pipes. The method uses two or more high frequency GPR antennae carried by a robot into underground pipes. The radar data is transmitted to the surface via fibre optic cable and is recorded together with the output from CCTV (and optionally sonar and laser). Proprietary software analyzes the data and pinpoints defects or cavities within and outside the pipe. Thus the testing can identify existing pipe and pipe bedding symptoms that can be addressed to prevent catastrophic failure due to sinkhole development and can provide useful information about the remaining service life of the pipe. The key innovative aspect is the unique ability to map pipe wall thickness and deterioration including cracks and voids outside the pipe, enabling accurate predictability of needed intervention or the timing of replacement. This reliable non-destructive testing method significantly impacts subsurface infrastructure condition based asset management by supplying previously unattainable measurable conditions. Keywords: pipe penetrating radar (PPR), ground penetrating radar (GPR), pipe inspection, concrete deterioration, municipal engineering

Steady flow rate to a partially penetrating well with seepage face in an unconfined aquifer

Science.gov (United States)

Behrooz-Koohenjani, Siavash; Samani, Nozar; Kompani-Zare, Mazda

2011-06-01

The flow rate to fully screened, partially penetrating wells in an unconfined aquifer is numerically simulated using MODFLOW 2000, taking into account the flow from the seepage face and decrease in saturated thickness of the aquifer towards the well. A simple three-step method is developed to find the top of the seepage face and hence the seepage-face length. The method is verified by comparing it with the results of previous predictive methods. The results show that the component of flow through the seepage face can supply a major portion of the total pumping rate. Variations in flow rate as a function of the penetration degree, elevation of the water level in the well and the distance to the far constant head boundary are investigated and expressed in terms of dimensionless curves and equations. These curves and equations can be used to design the degree of penetration for which the allowable steady pumping rate is attained for a given elevation of water level in the well. The designed degree of penetration or flow rate will assure the sustainability of the aquifer storage, and can be used as a management criterion for issuing drilling well permits by groundwater protection authorities.

Chemical Penetration Enhancers for Transdermal Drug Delivery ...

African Journals Online (AJOL)

for transdermal administration. The permeation of drug through skin can be enhanced by both chemical penetration enhancement and physical methods. In this review, we have discussed the chemical penetration enhancement technology for transdermal drug delivery as well as the probable mechanisms of action.

Containment penetration design and analysis by finite element methods

International Nuclear Information System (INIS)

Perry, R.F.; Rigamonti, G.; Dainora, J.

1975-01-01

Containment penetration designs which provide complete support to process piping containing high pressure and high temperature fluids and which do not employ cooling coils, require special provisions to sustain loadings associated with normal/abnormal conditions and to limit maximum temperature transmitted to the containment concrete wall. In order to accomodate piping loads and fluid temperatures within code and regulatory limitations, the containment penetration designs require careful analysis of two critical regions: 1) the portion of the penetration sleeve which is exposed to containment ambient conditions and 2) the portion of the penetration which connects the sleeve to process piping (flued head). Analytical models using finite element representation of process piping, penetration flued head, and exposed sleeve were employed to investigate the penetration assembly design. By application of flexible multi-step analyses, different penetration configurations were evaluated to determine the effects of key design parameters. Among the parameters studied were flued head angles with the process piping, sleeve length and wall thickness. Special designs employing fins welded to the sleeve to further lower the temperature at the concrete wall interface were also investigated and fin geometry effects reported. (Auth.)

Akon - A Penetrator for Europa

Science.gov (United States)

Jones, Geraint

2016-04-01

Jupiter's moon Europa is one of the most intriguing objects in our Solar System. This 2000km-wide body has a geologically young solid water ice crust that is believed to cover a global ocean of liquid water. The presence of this ocean, together with a source of heating through tidal forces, make Europa a conceivable location for extraterrestrial life. The science case for exploring all aspects of this icy world is compelling. NASA has selected the Europa Mission (formerly Europa Clipper) to study Europa in detail in the 2020s through multiple flybys, and ESA's JUICE mission will perform two flybys of the body in the 2030s. The US agency has extended to the European Space Agency an invitation to provide a contribution to their mission. European scientists interested in Europa science and exploration are currently organizing themselves, in the framework of a coordinated Europa M5 Inititative to study concurrently the main options for this ESA contribution, from a simple addition of individual instruments to the NASA spacecraft, to a lander to investigate Europa's surface in situ. A high speed lander - a penetrator - is by far the most promising technology to achieve this latter option within the anticipated mass constraints, and studies of such a hard lander, many funded by ESA, are now at an advanced level. An international team to formally propose an Europa penetrator to ESA in response to the anticipated ESA M5 call is growing. The working title of this proposal is Akon (Άκων), named after the highly accurate javelin gifted to Europa by Zeus in ancient Greek mythology. We present plans for the Akon penetrator, which would impact Europa's surface at several hundred metres per second, and travel up to several metres into the moon's subsurface. To achieve this, the penetrator would be delivered to the surface by a dedicated descent module, to be destroyed on impact following release of the penetrator above the surface. It is planned that the instruments to be

Vehicle effects on human stratum corneum absorption and skin penetration.

Science.gov (United States)

Zhang, Alissa; Jung, Eui-Chang; Zhu, Hanjiang; Zou, Ying; Hui, Xiaoying; Maibach, Howard

2017-05-01

This study evaluated the effects of three vehicles-ethanol (EtOH), isopropyl alcohol (IPA), and isopropyl myristate (IPM)-on stratum corneum (SC) absorption and diffusion of the [ 14 C]-model compounds benzoic acid and butenafine hydrochloride to better understand the transport pathways of chemicals passing through and resident in SC. Following application of topical formulations to human dermatomed skin for 30 min, penetration flux was observed for 24 h post dosing, using an in vitro flow-through skin diffusion system. Skin absorption and penetration was compared to the chemical-SC (intact, delipidized, or SC lipid film) binding levels. A significant vehicle effect was observed for chemical skin penetration and SC absorption. IPA resulted in the greatest levels of intact SC/SC lipid absorption, skin penetration, and total skin absorption/penetration of benzoic acid, followed by IPM and EtOH, respectively. For intact SC absorption and total skin absorption/penetration of butenafine, the vehicle that demonstrated the highest level of sorption/penetration was EtOH, followed by IPA and IPM, respectively. The percent doses of butenafine that were absorbed in SC lipid film and penetrated through skin in 24 h were greatest for IPA, followed by EtOH and IPM, respectively. The vehicle effect was consistent between intact SC absorption and total chemical skin absorption and penetration, as well as SC lipid absorption and chemical penetration through skin, suggesting intercellular transport as a main pathway of skin penetration for model chemicals. These results suggest the potential to predict vehicle effects on skin permeability with simple SC absorption assays. As decontamination was applied 30 min after chemical exposure, significant vehicle effects on chemical SC partitioning and percutaneous penetration also suggest that skin decontamination efficiency is vehicle dependent, and an effective decontamination method should act on chemical solutes in the lipid domain.

Stylet penetration of Cacopsylla pyri; an electrical penetration graph (EPG) study

NARCIS (Netherlands)

Civolani, S.; Leis, M.; Grandi, G.; Garzo, E.; Pasqualini, E.; Musacchi, S.; Chicca, M.; Castaldelli, G.; Rossie, M.; Tjallingii, W.F.

2011-01-01

Detailed information on plant penetration activities by pear psylla Cacopsylla pyri L. (Hemiptera Psyllidae) is essential to study phytoplasma transmission of “Candidatus Phytoplasma pyri” responsible of pear decline disease (PD) and to trace and evaluate resistant traits in new pear tree selections

Spontaneous bilateral subclavian vein thrombosis in a 40-year-old man: A case report.

Science.gov (United States)

Huang, Chun-Yen; Wu, Yen-Hung; Yeh, I-Jeng; Chen, Yun-Yi; Kung, Fung-Ya

2018-04-01

Paget-Schroetter syndrome (PSS) is an uncommon condition that refers to primary (spontaneous) thrombosis of the deep veins that drain the upper extremities because of anatomical anomalies or repetitive strenuous arm activity. Bilateral spontaneous upper extremity deep-vein thrombosis (UEDVT) is an extremely rare phenomenon in adults, which may be misdiagnosed by physicians in acute settings. A 40-year-old man presented to our emergency department because of progressive left upper arm swelling for 1 day. He denied fever, chest pain, dyspnea, trauma, or any other systemic disease before. The swollen left arm also had no local heat or redness with normal radius pulsation. He was a laborer who lifted heavy objects. Blood examination included tests for complete blood count, renal function, liver function, blood coagulation profile, cardiac enzyme levels, and D-dimer level. Results showed that the white blood cell count, renal and liver functions, and cardiac enzyme levels were all within their normal ranges, except for the elevated D-dimer level (1.93 mg/L). Chest radiography and electrocardiography were performed with nonspecific findings. Subsequently, computed tomographic angiography was recommended for the suspected deep-vein thrombosis. The report showed venous thrombosis involving the bilateral subclavian and internal jugular veins. Heparin and enoxaparin were prescribed for this patient, with loading and maintenance doses. He was then admitted to our cardiovascular ward for further treatment. The patient was discharged 9 days later in a stable condition. Emergency physicians should consider the rare condition of UEDVT when a healthy patient presents with acute arm swelling. Patient history taking should be thorough, especially concerning the risk factors of secondary causes and possible frequent vigorous heavy lifting and overhead motion. Without secondary risk factors, primary upper deep-vein thrombosis might be suspected. Further laboratory tests and imaging

Prophylactic antibiotics for penetrating abdominal trauma.

Science.gov (United States)

Brand, Martin; Grieve, Andrew

2013-11-18

Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, with antibiotics first being used in World War II to combat septic complications associated with these injuries. This practice was marked with a reduction in sepsis-related mortality and morbidity. Whether prophylactic antibiotics are required in the prevention of infective complications following penetrating abdominal trauma is controversial, however, as no randomised placebo controlled trials have been published to date. There has also been debate about the timing of antibiotic prophylaxis. In 1972 Fullen noted a 7% to 11% post-surgical infection rate with pre-operative antibiotics, a 33% to 57% infection rate with intra-operative antibiotic administration and 30% to 70% infection rate with only post-operative antibiotic administration. Current guidelines state there is sufficient class I evidence to support the use of a single pre-operative broad spectrum antibiotic dose, with aerobic and anaerobic cover, and continuation (up to 24 hours) only in the event of a hollow viscus perforation found at exploratory laparotomy. To assess the benefits and harms of prophylactic antibiotics administered for penetrating abdominal injuries for the reduction of the incidence of septic complications, such as septicaemia, intra-abdominal abscesses and wound infections. Searches were not restricted by date, language or publication status. We searched the following electronic databases: the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2013, issue 12 of 12), MEDLINE (OvidSP), Embase (OvidSP), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S) and PubMed. Searches were last conducted in January 2013. All randomised controlled trials of antibiotic prophylaxis in patients with penetrating abdominal trauma versus no

Deformation analysis of shallow penetration in clay

Science.gov (United States)

Sagaseta, C.; Whittle, A. J.; Santagata, M.

1997-10-01

A new method of analysis is described for estimating the deformations and strains caused by shallow undrained penetration of piles and caissons in clay. The formulation combines previous analyses for steady, deep penetration, with methods used to compute soil deformations due to near-surface ground loss, and is referred to as the Shallow Strain Path Method (SSPM). Complete analytical solutions for the velocity and strain rates are given for a planar wall, an axisymmetric, closed-ended pile and unplugged, open-ended pile geometries. In these examples, the analyses consider a single source penetrating through the soil at a constant rate, generating a family of penetrometers with rounded tips, referred to as simple wall, pile and tube geometries. Soil deformations and strains are obtained by integrating the velocity and strain rates along the particle paths.The transition from shallow to deep penetration is analysed in detail. Shallow penetration causes heave at the ground surface, while settlements occur only in a thin veneer of material adjacent to the shaft and in a bulb-shaped region around the tip. The size of this region increases with the embedment depth. Deformations inside an open-ended pile/caisson are affected significantly by details of the simple tube wall geometry.

Air pollutant penetration through airflow leaks into buildings

Energy Technology Data Exchange (ETDEWEB)

Liu, De-Ling [Univ. of California, Berkeley, CA (United States)

2002-01-01

The penetration of ambient air pollutants into the indoor environment is of concern owing to several factors: (1) epidemiological studies have shown a strong association between ambient fine particulate pollution and elevated risk of human mortality; (2) people spend most of their time in indoor environments; and (3) most information about air pollutant concentration is only available from ambient routine monitoring networks. A good understanding of ambient air pollutant transport from source to receptor requires knowledge about pollutant penetration across building envelopes. Therefore, it is essential to gain insight into particle penetration in infiltrating air and the factors that affect it in order to assess human exposure more accurately, and to further prevent adverse human health effects from ambient particulate pollution. In this dissertation, the understanding of air pollutant infiltration across leaks in the building envelope was advanced by performing modeling predictions as well as experimental investigations. The modeling analyses quantified the extent of airborne particle and reactive gas (e.g., ozone) penetration through building cracks and wall cavities using engineering analysis that incorporates existing information on building leakage characteristics, knowledge of pollutant transport processes, as well as pollutant-surface interactions. Particle penetration is primarily governed by particle diameter and by the smallest dimension of the building cracks. Particles of 0.1-1 μm are predicted to have the highest penetration efficiency, nearly unity for crack heights of 0.25 mm or higher, assuming a pressure differential of 4 Pa or greater and a flow path length of 3 cm or less. Supermicron and ultrafine particles (less than 0.1 μm) are readily deposited on crack surfaces by means of gravitational settling and Brownian diffusion, respectively. The fraction of ozone penetration through building leaks could vary widely, depending significantly on its

[Special penetration needling for refractory peripheral facial paralysis].

Science.gov (United States)

Cao, Rongjuan; Qiu, Xiaohu; Xie, Xiaokun

2018-03-12

To observe the clinical effect difference between special penetration needling and conventional penetration needling for the refractory peripheral facial paralysis. A total of 97 patients with intractable facial paralysis were randomized into an observation group (49 cases and 2 dropping) and a control group (48 cases and 4 dropping). In the observation group, special penetration needling at an angle about 45° between the penetration needle and paralysis muscle bundle was used, Yangbai (GB 14) through Touwei (ST 8), Yangbai (GB 14) through Shangxing (GV 23), Sizhukong (TE 23) through Yuyao (EX-HN 4), Qianzhen (Extra) through Yingxiang (LI 20), mutual penetration between Yingxiang (LI 20) and Jiache (ST 6). Conventional penetration needling was applied in the control group, Yangbai (GB 14) through Yuyao (EX-HN 4), Cuanzhu (BL 2) through Yuyao (EX-HN 4), mutual penetration between Dicang (ST 4) and Jiache (ST 6), Qianzheng (Extra) through Dicang (ST 4), Sibai (ST 2) through Yingxiang (LI 20). Three groups of electroacupuncture (discontinuous wave, 1 Hz) with tolerance were connected respectively in the two groups, Yangbai (GB 14) and Sizhukong (TE 23), Yangbai (GB 14) and Qianzheng (Extra), Yingxiang (LI 20) and Jiache (ST 6) in the observation group, Yangbai (GB 14) and Cuanzhu (BL 2), Dicang (ST 4) and Jiache (ST 6), Qianzheng (Extra) and Sibai (ST 2) in the control group. TDP was applied in the two groups at the affected Yifeng (TE 17), Jiache (ST 6) and Qianzheng (Extra), which were around the ear. Perpendicular insertion was used at Yifeng (TE 17) at the affected side and Hegu (LI 4) at the healthy side and bilateral Zusanli (ST 36). The needles were retained for 30 min. The treatment was given for 3 courses, once a day and 10 days as a course, 5 days at the interval. House-Brackmann (H-B) facial nerve grading score was recorded before and after treatment. The clinical effects were compared. The H-B scores after treatment in the two groups were higher than

Opportunities for high wind energy penetration

DEFF Research Database (Denmark)

Tande, J.O.; Hansen, J.C.

1997-01-01

Wind power is today a mature technology, which at windy locations, is economically competitive to conventional power generation technologies. This and growing global environmental concerns have led governments to encourage and plan for wind energy development, a typical aim being 10% of electricity...... consumption. The successful operation of the three major power systems of Cape Verde, with a total wind energy penetration of about 15% since December 1994, demonstrates that power systems can be operated with high penetration of wind energy by adding simple control and monitoring systems only. Thorough...... analyses conclude that expanding to even above 15% wind energy penetration in the Cape Verde power systems is economical. Worldwide, numerous locations with favorable wind conditions and power systems similar to the Capeverdean provide good opportunities for installing wind farms and achieving high wind...

Current Understanding of Physicochemical Mechanisms for Cell Membrane Penetration of Arginine-rich Cell Penetrating Peptides: Role of Glycosaminoglycan Interactions.

Science.gov (United States)

Takechi-Haraya, Yuki; Saito, Hiroyuki

2018-01-01

Arginine-rich cell penetrating peptides (CPPs) are very promising drug carriers to deliver membrane-impermeable pharmaceuticals, such as siRNA, bioactive peptides and proteins. CPPs directly penetrate into cells across cell membranes via a spontaneous energy-independent process, in which CPPs appear to interact with acidic lipids in the outer leaflet of the cell membrane. However, acidic lipids represent only 10 to 20% of the total membrane lipid content and in mammalian cell membranes they are predominantly located in the inner leaflet. Alternatively, CPPs favorably bind in a charge density- dependent manner to negatively charged, sulfated glycosaminoglycans (GAGs), such as heparan sulfate and chondroitin sulfate, which are abundant on the cell surface and are involved in many biological functions. We have recently demonstrated that the interaction of CPPs with sulfated GAGs plays a critical role in their direct cell membrane penetration: the favorable enthalpy contribution drives the high-affinity binding of arginine-rich CPPs to sulfated GAGs, initiating an efficient cell membrane penetration. The favorable enthalpy gain is presumably mainly derived from a unique property of the guanidino group of arginine residues forming multidentate hydrogen bonding with sulfate and carboxylate groups in GAGs. Such interactions can be accompanied with charge neutralization of arginine-rich CPPs, promoting their partition into cell membranes. This review summarizes the current understanding of the physicochemical mechanism for lipid membrane penetration of CPPs, and discusses the role of the GAG interactions on the cell membrane penetration of CPPs. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

The penetration of aerosols through fine capillaries

International Nuclear Information System (INIS)

Mitchell, J.P.; Edwards, R.T.; Ball, M.H.E.

1989-10-01

A novel experimental technique has been developed to study the penetration of aerosol particles ranging from about 1 to 15 μm aerodynamic diameter through capillaries varying from 20 to 80 μm bore and from 10 to 50 mm in length. When the driving pressure was 100 kPa, the penetration of the airborne particles was considerably smaller than expected from a simple comparison of particle diameter with the bore of the capillary. Particle size distributions determined after penetration through the capillaries were in almost all cases similar to the particle size distribution of the aerosol at the capillary entrance. This lack of size-selectivity can be explained in terms of the capillary behaving as a conventional suction-based sampler from a near still (calm) air environment. The resulting particle penetration data are important in assessing the potential for the leakage of aerosols through seals in containers used to transport radioactive materials. (author)

Application of Uintah-MPM to shaped charge jet penetration of aluminum

International Nuclear Information System (INIS)

Burghardt, J; Leavy, B; Brannon, R; Guilkey, J; Xue, Z

2010-01-01

The capability of the generalized interpolation material point (GIMP) method in simulation of penetration events is investigated. A series of experiments was performed wherein a shaped charge jet penetrates into a stack of aluminum plates. Electronic switches were used to measure the penetration time history. Flash x-ray techniques were used to measure the density, length, radius and velocity of the shaped charge jet. Simulations of the penetration event were performed using the Uintah MPM/GIMP code with several different models of the shaped charge jet being used. The predicted penetration time history for each jet model is compared with the experimentally observed penetration history. It was found that the characteristics of the predicted penetration were dependent on the way that the jet data are translated to a discrete description. The discrete jet descriptions were modified such that the predicted penetration histories fell very close to the range of the experimental data. In comparing the various discrete jet descriptions it was found that the cumulative kinetic energy flux curve represents an important way of characterizing the penetration characteristics of the jet. The GIMP method was found to be well suited for simulation of high rate penetration events.

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands.

Science.gov (United States)

Heus, C; Mellema, J J; Giannakopoulos, G F; Zuidema, W P

2015-04-25

Most patients with penetrating chest injuries benefit from early treatment with chest tube drainage or surgery. Although penetrating chest injury is not uncommon, few descriptive studies are published, especially in Europe. The aim of this study was to review our experience and further improve our management of penetrating chest injuries in a level I trauma center in the Netherlands. All patients with penetrating chest injury between August 2004 and December 2012 were included. Demographics, mechanism of injury, physiological parameters, Injury Severity Scores (ISS), surgical and non-surgical treatment, length of intensive care unit (ICU) stay, length of hospital stay (LOS), complications and rate of mortality were collected. A total of 159 patients were analyzed. Patients included 116 (73 %) stab wounds and 34 (21 %) gunshot wounds. In 27 patients (17 %), cardiac injury was seen. The mean ISS was 12. Almost half of all patients (49 %) were treated with only chest tube drainage. Alternatively, surgical treatment was performed in 24 % of all cases. Anterolateral incision was most frequently used to gain access to the thoracic cavity. The mean LOS was 9 days. Among all patients, 17 % were admitted to the ICU with a mean stay of 3 days. In 18 (11 %) patients, one or more complications occurred. The 30-day mortality was 7.5 %. Patients presenting with penetrating chest injury are not uncommon in the Netherlands and can mostly be treated conservatively. In one-fourth of the patients, surgical treatment is performed. A structural and vigorous approach is needed for good clinical outcome.

Medicaid HMO penetration and its mix: did increased penetration affect physician participation in urban markets?

Science.gov (United States)

Adams, E Kathleen; Herring, Bradley

2008-02-01

To use changes in Medicaid health maintenance organization (HMO) penetration across markets over time to test for effects on the extent of Medicaid participation among physicians and to test for differences in the effects of increased use of commercial versus Medicaid-dominant plans within the market. The nationally representative Community Tracking Study's Physician Survey for three periods (1996-1997, 1998-1999, and 2000-2001) on 29,866 physicians combined with Centers for Medicare and Medicaid Services (CMS) and InterStudy data. Market-level estimates of Medicaid HMO penetration are used to test for (1) any participation in Medicaid and (2) the degree to which physicians have an "open" (i.e., nonlimited) practice accepting new Medicaid patients. Models account for physician, firm, and local characteristics, Medicaid relative payment levels adjusted for geographic variation in practice costs, and market-level fixed effects. There is a positive effect of increases in commercial Medicaid HMO penetration on the odds of accepting new Medicaid patients among all physicians, and in particular, among office-based physicians. In contrast, there is no effect, positive or negative, from expanding the penetration of Medicaid-dominant HMO plans within the market. Increases in cost-adjusted Medicaid fees, relative to Medicare levels, were associated with increases in the odds of participation and of physicians having an "open" Medicaid practice. Provider characteristics that consistently lower participation among all physicians include being older, board certified, a U.S. graduate and a solo practitioner. The effects of Medicaid HMO penetration on physician participation vary by the type of plan. If states are able to attract and retain commercial plans, participation by office-based physicians is likely to increase in a way that opens existing practices to more new Medicaid patients. Other policy variables that affect participation include the presence of a federally

Ground penetrating radar and microwave tomography for the safety management of a cultural heritage site: Miletos Ilyas Bey Mosque (Turkey)

International Nuclear Information System (INIS)

Kadioglu, Selma; Kadioglu, Yusuf Kagan; Catapano, Ilaria; Soldovieri, Francesco

2013-01-01

Detection and assessment of structural damage affecting foundation robustness is of significant relevance for the safety management of cultural heritage sites. In this framework, ground penetrating radar (GPR) is worth consideration owing to its capability of providing high resolution and detailed information about the inner status of a structure, without involving significant invasive actions and ensuring a fast survey. On the other hand, the effectiveness of a GPR diagnostic survey can be impaired by the low interpretability of the raw data radargrams; thus huge interest is currently focused on the development of advanced and application-oriented data processing strategies. In this paper, a data processing chain based on the combined use of the commercial REFLEXW program and a microwave tomography approach is presented. An assessment of the achievable imaging capabilities is provided by processing measurements collected during a survey at the Great Mosque of Ilyas Bey (Ilyas Bey Mosque), one of the most important cultural heritages in ancient Miletos-Iona in Söke-Aydin city (Turkey). (paper)

Analysis of the transient response and durability characteristics of a proton exchange membrane fuel cell with different micro-porous layer penetration thicknesses

International Nuclear Information System (INIS)

Cho, Junhyun; Park, Jaeman; Oh, Hwanyeong; Min, Kyoungdoug; Lee, Eunsook; Jyoung, Jy-Young

2013-01-01

Highlights: • The GDL which has a large MPL penetration showed a better transient response. • The transient response of the PEMFC was affected by the water balance of the GDL. • A large MPL penetration balanced the capillary pressure gradient through the GDL. • The carbon corrosion induced loss of the MPL penetration region. - Abstract: The optimal design of the gas diffusion layer (GDL) of proton exchange membrane fuel cells is crucial because it directly determines the mass transport mechanism of the reactants and products. In this study, the micro-porous layer (MPL) penetration thickness, which affects the pore size profile through the GDL, is varied as the design parameter of the GDL. The cell performance is investigated under various humidity conditions, and the water permeability characteristics are studied. In addition, the accelerated carbon corrosion stress test is conducted to determine the effect of MPL penetration on GDL degradation. GDLs with large MPL penetration thickness show better performance in the high-current–density region due to the enhanced management of water resulting from a balanced capillary pressure gradient. However, the loss of penetrated MPL parts is observed due to the low binding force between the MPL and the GDL substrate

Prevention of serious impurity penetration into water-steam circuits

International Nuclear Information System (INIS)

Burgmann, F.; Bursik, A.; Flunkert, F.; Nieder, R.

1977-01-01

In consequence of reports from several power Plants concerning heavy damages due to penetrations of impurities into the water-steam circuit, the VGB Sub-Committee 'Water Chemistry in Thermal Power Plants' has established a working group to check-up how serious impurity penetration can be avoided. The lecture describes possible danger points. Suitable technical arrangements for the avoidance of penetrations, and possibilities for monitoring will be discussed. Penetration of impurities cannot be avoided with absolute reliability, even when the recommended arrangements and usual monitoring are realized. Additional measures for the protection of water steam circuits will be suggested. (orig.) [de

Consistent constitutive modeling of metallic target penetration using empirical, analytical, and numerical penetration models

Directory of Open Access Journals (Sweden)

John (Jack P. Riegel III

2016-04-01

Full Text Available Historically, there has been little correlation between the material properties used in (1 empirical formulae, (2 analytical formulations, and (3 numerical models. The various regressions and models may each provide excellent agreement for the depth of penetration into semi-infinite targets. But the input parameters for the empirically based procedures may have little in common with either the analytical model or the numerical model. This paper builds on previous work by Riegel and Anderson (2014 to show how the Effective Flow Stress (EFS strength model, based on empirical data, can be used as the average flow stress in the analytical Walker–Anderson Penetration model (WAPEN (Anderson and Walker, 1991 and how the same value may be utilized as an effective von Mises yield strength in numerical hydrocode simulations to predict the depth of penetration for eroding projectiles at impact velocities in the mechanical response regime of the materials. The method has the benefit of allowing the three techniques (empirical, analytical, and numerical to work in tandem. The empirical method can be used for many shot line calculations, but more advanced analytical or numerical models can be employed when necessary to address specific geometries such as edge effects or layering that are not treated by the simpler methods. Developing complete constitutive relationships for a material can be costly. If the only concern is depth of penetration, such a level of detail may not be required. The effective flow stress can be determined from a small set of depth of penetration experiments in many cases, especially for long penetrators such as the L/D = 10 ones considered here, making it a very practical approach. In the process of performing this effort, the authors considered numerical simulations by other researchers based on the same set of experimental data that the authors used for their empirical and analytical assessment. The goals were to establish a

Penetration analysis of projectile with inclined concrete target

Directory of Open Access Journals (Sweden)

Kim S.B.

2015-01-01

Full Text Available This paper presents numerical analysis result of projectile penetration with concrete target. We applied dynamic material properties of 4340 steels, aluminium and explosive for projectile body. Dynamic material properties were measured with static tensile testing machine and Hopkinson pressure bar tests. Moreover, we used three concrete damage models included in LS-DYNA 3D, such as SOIL_CONCRETE, CSCM (cap model with smooth interaction and CONCRETE_DAMAGE (K&C concrete models. Strain rate effect for concrete material is important to predict the fracture deformation and shape of concrete, and penetration depth for projectiles. CONCRETE_DAMAGE model with strain rate effect also applied to penetration analysis. Analysis result with CSCM model shows good agreement with penetration experimental data. The projectile trace and fracture shapes of concrete target were compared with experimental data.

Penetration analysis of projectile with inclined concrete target

Science.gov (United States)

Kim, S. B.; Kim, H. W.; Yoo, Y. H.

2015-09-01

This paper presents numerical analysis result of projectile penetration with concrete target. We applied dynamic material properties of 4340 steels, aluminium and explosive for projectile body. Dynamic material properties were measured with static tensile testing machine and Hopkinson pressure bar tests. Moreover, we used three concrete damage models included in LS-DYNA 3D, such as SOIL_CONCRETE, CSCM (cap model with smooth interaction) and CONCRETE_DAMAGE (K&C concrete) models. Strain rate effect for concrete material is important to predict the fracture deformation and shape of concrete, and penetration depth for projectiles. CONCRETE_DAMAGE model with strain rate effect also applied to penetration analysis. Analysis result with CSCM model shows good agreement with penetration experimental data. The projectile trace and fracture shapes of concrete target were compared with experimental data.

Age-related percutaneous penetration part 1: skin factors.

Science.gov (United States)

Konda, S; Meier-Davis, S R; Cayme, B; Shudo, J; Maibach, H I

2012-05-01

Changes in the skin that occur in the elderly may put them at increased risk for altered percutaneous penetration from pharmacotherapy along with potential adverse effects. Skin factors that may have a role in age-related percutaneous penetration include blood flow, pH, skin thickness, hair and pore density, and the content and structure of proteins, glycosaminoglycans (GAGs), water, and lipids. Each factor is examined as a function of increasing age along with its potential impact on percutaneous penetration. Additionally, topical drugs that successfully overcome the barrier function of the skin can still fall victim to cutaneous metabolism, thereby producing metabolites that may have increased or decreased activity. This overview discusses the current data and highlights the importance of further studies to evaluate the impact of skin factors in age-related percutaneous penetration.

Numerical analysis of impact-penetration problems for nuclear reactor safety

International Nuclear Information System (INIS)

Dubois, J.J.; Chedmail, J.F.; Bianchini, J.C.

1977-01-01

This paper discusses the finite element and finite difference analysis of two impact penetration problems, namely a fuel cask drop on a foundation slab and a missile penetration into a reinforced concrete structure. For a realistic detailed analysis, advanced techniques were required in the following areas: reinforced concrete simulation; remeshing algorithms for penetration induced distortions; boundary condition. The fuel cask drop on a concrete slab generates complex elasto plastic waves which propagate towards the pool where tensile cracks might appear. The problem is analysed in two steps: calculation of the energy absorbed locally around the impacted area; calculation of the three dimensional wave propagation towards the pool. For the analysis of missile penetration problems, two examples are shown: a 3000 kg missile with a velocity of 132 m/s penetrates a 1.2 m thick concrete wall (PAM-GDYNS) and a 3600 kg missile with a velocity of 90 m/s (F.D. Program HEMP-ESI) penetrates a wall at a floor level. For the second case, the computed impact-penetration mechanism is

Water Penetration through a Superhydrophobic Mesh During a Drop Impact

Science.gov (United States)

Ryu, Seunggeol; Sen, Prosenjit; Nam, Youngsuk; Lee, Choongyeop

2017-01-01

When a water drop impacts a mesh having submillimeter pores, a part of the drop penetrates through the mesh if the impact velocity is sufficiently large. Here we show that different surface wettability, i.e., hydrophobicity and superhydrophobicity, leads to different water penetration dynamics on a mesh during drop impact. We show, despite the water repellence of a superhydrophobic surface, that water can penetrate a superhydrophobic mesh more easily (i.e., at a lower impact velocity) over a hydrophobic mesh via a penetration mechanism unique to a superhydrophobic mesh. On a superhydrophobic mesh, the water penetration can occur during the drop recoil stage, which appears at a lower impact velocity than the critical impact velocity for water penetration right upon impact. We propose that this unique water penetration on a superhydrophobic mesh can be attributed to the combination of the hydrodynamic focusing and the momentum transfer from the water drop when it is about to bounce off the surface, at which point the water drop retrieves most of its kinetic energy due to the negligible friction on superhydrophobic surfaces.

Topological properties of the limited penetrable horizontal visibility graph family

Science.gov (United States)

Wang, Minggang; Vilela, André L. M.; Du, Ruijin; Zhao, Longfeng; Dong, Gaogao; Tian, Lixin; Stanley, H. Eugene

2018-05-01

The limited penetrable horizontal visibility graph algorithm was recently introduced to map time series in complex networks. In this work, we extend this algorithm to create a directed-limited penetrable horizontal visibility graph and an image-limited penetrable horizontal visibility graph. We define two algorithms and provide theoretical results on the topological properties of these graphs associated with different types of real-value series. We perform several numerical simulations to check the accuracy of our theoretical results. Finally, we present an application of the directed-limited penetrable horizontal visibility graph to measure real-value time series irreversibility and an application of the image-limited penetrable horizontal visibility graph that discriminates noise from chaos. We also propose a method to measure the systematic risk using the image-limited penetrable horizontal visibility graph, and the empirical results show the effectiveness of our proposed algorithms.

Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head.

Science.gov (United States)

Turco, Lauren; Cornell, David L; Phillips, Bradley

2017-08-01

Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. PubMed was searched for query terms, and PRISMA guidelines were used. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded. Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had greater mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with greater rates of bihemispheric injuries. Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population. Copyright © 2017 Elsevier Inc. All rights reserved.

A new measure of the impact of managed care on healthcare markets.

Science.gov (United States)

Pawlson, L G; Moy, E M; Kim, J I; Griner, P F

2001-11-01

Most studies of managed care impact have used health maintenance organization (HMO) penetration or index of competition as the marker of managed care impact. However, little empirical evidence has been found to support the validity of these or other measures in current use. In addition, as managed care evolves to forms other than HMOs and managed care penetration in large metropolitan areas approaches 100% of commercially insured patients, the utility of the most commonly used measure, HMO penetration, will decrease still further. To provide a preliminary analysis of the use of premiums as a measure of market impact of managed care. Retrospective analysis (quartile, correlation, multiple-variable linear regression) of publicly available datasets. Labor market-adjusted HMO premiums from 3 publicly available sources, for the 56 largest metropolitan areas in the United States, were compared with penetration and index of competition as predictors of the dependent market variable, hospital bed-days per 1000 population. Health maintenance organization premiums in the Federal Employees Health Benefits Program emerged as the best predictor of HMO market impact. Average HMO premiums reported in the Interstudy database and for the Medicare+Choice program also outperformed penetration or index of competition in relating to several commonly available markers of competition such as bed-days per 1000. Premiums charged by HMOs are a useful measure of the impact of managed care on healthcare markets in large metropolitan areas.

Managed care market share and cesarean section rates in the United States: is there a link?

Science.gov (United States)

Hueston, W J; Sutton, A

2000-11-01

After peaking during the early 1980s, cesarean section rates in the United States have been falling for the last decade. At the same time, managed care enrollment has increased dramatically. This study examines whether managed care penetration in local markets is associated with lower cesarean section rates in those geographic area. A cross-sectional comparison of cesarean section rates and health maintenance organization (HMO) market penetration in 61 selected metropolitan areas in the United States was conducted. National birth certificate data for 1996 were used to calculate crude and race-adjusted cesarean section rates for residents in each area. No relationship between overall cesarean section rates in the metropolitan areas and managed care penetration was observed. Subanalyses of racial groups demonstrated the existence of a weak association between managed care penetration and cesarean section rates for white women (21.2% for the highest quartile of HMO penetration, compared with 19.1% for the lowest quartile; P = .03), but not for African-Americans or other minorities. Managed care penetration in a market may have an association with cesarean section rates for white women, but the strength of this relationship is small. Even if managed care delivery systems reduce cesarean section rates in their own populations, this change is likely to have only a small impact on overall cesarean rates. HMO penetration is unlikely to influence national cesarean section rates, nor does it appear to explain state variations in these rates.

Containment penetration design and analysis by finite element methods

International Nuclear Information System (INIS)

Perry, R.F.; Rigamonti, G.; Dainora, J.

1975-01-01

Containment penetration designs which provide complete support to process piping containing high pressure and high temperature fluids and which do not employ cooling coils, require special provisions to sustain loadings associated with normal/abnormal conditions and to limit maximum temperature transmitted to the containment concrete wall. In order to accommodate piping imposed loads and fluid temperatures within code and regulatory limitations, the containment penetration designs require careful analysis of two critical regions: the portion of the penetration sleeve which is exposed to containment ambient conditions and the portion of the penetration which connects the sleeve to process piping (flued head). The length and thickness of the sleeve must be designed to provide maximum heat dissipation to the atmosphere and minimum heat conduction through the sleeve to meet concrete temperature limitations. The sleeve must have the capability to transmit the postulated piping loads to concrete embedments in the containment shell. The penetration flued head design must be strong enough to transfer high mechanical loads and be flexible enough to accommodate the thermal stresses generated by the high temperature fluid. Analytical models using finite element representations of process piping, penetration flued head, and exposed sleeve were employed to investigate the penetration assembly design. By application of flexible multi-step analyses, different penetration configurations were evaluated to determine the effects of key design parameters. Among the parameters studied were flued head profiles, flued head angles with the process piping, sleeve length and wall thickness. Special designs employing fins welded to the sleeve to lower the temperature at the concrete wall interface were investigated and fin geometry effects reported

Network Penetration Testing and Research

Science.gov (United States)

Murphy, Brandon F.

2013-01-01

This paper will focus the on research and testing done on penetrating a network for security purposes. This research will provide the IT security office new methods of attacks across and against a company's network as well as introduce them to new platforms and software that can be used to better assist with protecting against such attacks. Throughout this paper testing and research has been done on two different Linux based operating systems, for attacking and compromising a Windows based host computer. Backtrack 5 and BlackBuntu (Linux based penetration testing operating systems) are two different "attacker'' computers that will attempt to plant viruses and or NASA USRP - Internship Final Report exploits on a host Windows 7 operating system, as well as try to retrieve information from the host. On each Linux OS (Backtrack 5 and BlackBuntu) there is penetration testing software which provides the necessary tools to create exploits that can compromise a windows system as well as other operating systems. This paper will focus on two main methods of deploying exploits 1 onto a host computer in order to retrieve information from a compromised system. One method of deployment for an exploit that was tested is known as a "social engineering" exploit. This type of method requires interaction from unsuspecting user. With this user interaction, a deployed exploit may allow a malicious user to gain access to the unsuspecting user's computer as well as the network that such computer is connected to. Due to more advance security setting and antivirus protection and detection, this method is easily identified and defended against. The second method of exploit deployment is the method mainly focused upon within this paper. This method required extensive research on the best way to compromise a security enabled protected network. Once a network has been compromised, then any and all devices connected to such network has the potential to be compromised as well. With a compromised

Assessment and outcome of 496 penetrating gastrointestinal warfare injuries.

Science.gov (United States)

Saghafinia, M; Nafissi, N; Motamedi, M R K; Motamedi, M H K; Hashemzade, M; Hayati, Z; Panahi, F

2010-03-01

The abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War (1980-88) to assess surgical outcomes. The medical records of 496 Iranian war victims suffering penetrating gastrointestinal (GI) injuries treated at first, second and third-line (tertiary) hospitals, a total of 19 centres, were reviewed. Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed. There were 496 patients; 145, 220 and 131 victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals (145 victims) had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality. Overall mortality from GI surgery was 3.6% (18 patients). Eleven patients (7.5%) whose first GI operation was performed at frontline hospitals and 7 patients (3.2%) who underwent their first surgical operation at second-line hospitals died. The most common reason for these deaths was complications relating to the gastrointestinal operation such as anastomotic leak. Six missed injuries were seen at the frontline and one at second line hospitals. There were no deaths at the 3rd line hospitals

CNS penetration of ART in HIV-infected children

NARCIS (Netherlands)

van den Hof, Malon; Blokhuis, Charlotte; Cohen, Sophie; Scherpbier, Henriette J.; Wit, Ferdinand W. N. M.; Pistorius, M. C. M.; Kootstra, Neeltje A.; Teunissen, Charlotte E.; Mathot, Ron A. A.; Pajkrt, Dasja

2018-01-01

Background: Paediatric data on CNS penetration of antiretroviral drugs are scarce. Objectives: To evaluate CNS penetration of antiretroviral drugs in HIV-infected children and explore associations with neurocognitive function. Patients and methods: Antiretroviral drug levels were measured in paired

Effects of soap-water wash on human epidermal penetration.

Science.gov (United States)

Zhu, Hanjiang; Jung, Eui-Chang; Phuong, Christina; Hui, Xiaoying; Maibach, Howard

2016-08-01

Skin decontamination is a primary interventional method used to decrease dermal absorption of hazardous contaminants, including chemical warfare agents, pesticides and industrial pollutants. Soap and water wash, the most common and readily available decontamination system, may enhance percutaneous absorption through the "wash-in effect." To understand better the effect of soap-water wash on percutaneous penetration, and provide insight to improving skin decontamination methods, in vitro human epidermal penetration rates of four C(14) -labeled model chemicals (hydroquinone, clonidine, benzoic acid and paraoxon) were assayed using flow-through diffusion cells. Stratum corneum (SC) absorption rates of these chemicals at various hydration levels (0-295% of the dry SC weights) were determined and compared with the results of the epidermal penetration study to clarify the effect of SC hydration on skin permeability. Results showed accelerated penetration curves of benzoic acid and paraoxon after surface wash at 30 min postdosing. Thirty minutes after washing (60 min postdosing), penetration rates of hydroquinone and benzoic acid decreased due to reduced amounts of chemical on the skin surface and in the SC. At the end of the experiment (90 min postdosing), a soap-water wash resulted in lower hydroquinone penetration, greater paraoxon penetration and similar levels of benzoic acid and clonidine penetration compared to penetration levels in the non-wash groups. The observed wash-in effect agrees with the enhancement effect of SC hydration on the SC chemical absorption rate. These results suggest SC hydration derived from surface wash to be one cause of the wash-in effect. Further, the occurrence of a wash-in effect is dependent on chemical identity and elapsed time between exposure and onset of decontamination. By reducing chemical residue quantity on skin surface and in the SC reservoir, the soap-water wash may decrease the total quantity of chemical absorbed in the

Elastic behavior of MFI-type zeolites: Compressibility of H-ZSM-5 in penetrating and non-penetrating media

International Nuclear Information System (INIS)

Quartieri, Simona; Montagna, Gabriele; Arletti, Rossella; Vezzalini, Giovanna

2011-01-01

The elastic behavior of H-ZSM-5 was investigated by in-situ synchrotron X-ray powder diffraction, using both silicone oil (s.o.) and (16:3:1) methanol:ethanol:water (m.e.w.) as 'non-penetrating' and 'penetrating' pressure transmitting media, respectively. From P amb to 6.2 GPa the volume reduction observed in s.o. is 16.6%. This testifies that H-ZSM-5 is one of the most flexible microporous materials up to now compressed in s.o. Volume reduction observed in m.e.w. up to 7.6 GPa is 14.6%. A strong increase in the total electron number of the extraframework system, due to the penetration of water/alcohol molecules in the pores, is observed in m.e.w. This effect is the largest up to now observed in zeolites undergoing this phenomenon without cell volume expansion. The higher compressibility in s.o. than in m.e.w. can be ascribed to the penetration of the extra-water/alcohol molecules, which stiffen the structure and contrast the channel deformations. - Graphical abstract: High-pressure behavior of H-ZSM-5 compressed in (16:3:1) methanol:ethanol:water: (a) projection of the structure along the [0 1 0] direction at P amb , 2 GPa and after pressure release to original ambient conditions (P amb (rev)), and (b) P-dependence of the extraframework content expressed as total number of electrons (gray square represents the number of the extraframework electrons at P amb after decompression). Highlights: → X-ray powder diffraction study of H-ZSM-5 compressibility. → H-ZSM-5 is one of the softest porous material compressed in silicon oil. → Penetration of additional water/alcohol molecules upon compression in m.e.w. → Extra molecules contribute to stiffen the structure and to contrast HP effects.

Analysis of 178 penetrating stomach and small bowel injuries.

Science.gov (United States)

Salim, Ali; Teixeira, Pedro G R; Inaba, Kenji; Brown, Carlos; Browder, Timothy; Demetriades, Demetrios

2008-03-01

Surgical site infections (SSIs), such as wound infection, fascial dehiscence, and intraabdominal abscess, commonly occur following penetrating abdominal trauma. However, most of the literature involves penetrating colon injuries. There are few reports describing complications following penetrating stomach and small bowel injuries. Based on the hypothesis that SSIs are commonly found following penetrating stomach and small bowel trauma, a prospective observational study was performed at an academic Level I trauma center from March 1, 2004 until August 31, 2006. The subjects were patients who had sustained a penetrating injury to the stomach or small bowel. Patients were followed for the development of an SSI, defined as wound infection, fascial dehiscence, or intraabdominal abscess. A total of 178 patients were admitted with penetrating stomach or small bowel injuries over the 29-month period. There were 121 (68%) gunshot injuries and 57 (32%) stab wounds. Associated intraabdominal injuries occurred in 74% of patients. Overall, SSIs occurred in 20% of cases. Risk factors for SSI included associated duodenal or colon injury, whereas time to operating room, blood loss, and type and duration of antibiotic use were not. When associated colon injuries were excluded, SSIs occurred in 16% of patients with gastric injuries and 13% of those with small bowel injuries. SSIs commonly follow penetrating stomach and small bowel trauma. Risk factors for SSI include associated duodenal or colon injury. Delay to operating room, blood loss, and type and length of antibiotic prophylaxis were not associated with an increased risk of SSI.

NRC Information Notice No. 93-25: Electrical penetration assembly degradation

International Nuclear Information System (INIS)

Grimes, B.K.

1993-01-01

In July 1987 and in October 1989, the licensee for the Trojan Nuclear Plant, the Portland and General Electric Company, reported problems with containment air leakage through its Bunker-Ramo electrical penetration assembly seals. In July and August 1991, the NRC inspected the use of containment electrical penetration assembly seals at Trojan and concluded that the licensee had not established an effective program for trending and evaluating electrical penetration assembly seal leakage. On October 28, 1991, while the plant was in a refueling outage, the licensee reported to the NRC that in the originally installed electrical penetration assemblies, the seal (polyurethane) and lubricant (Celvacen or Glycerin) materials were inappropriate for the application. The licensee concluded that these materials may cause seal degradation and that the seals may become degraded if subjected to design basis accident conditions for moisture or temperature. The licensee replaced the electrical penetration assembly seal with an environmentally qualified ethylene propylene rubber seal and added a silicone rubber backup O-ring to the outer face of each electrical penetration assembly module. The licensee subsequently replaced all the Bunker-Ramo electrical penetration assemblies with Conax assemblies

Penetration testing with Perl

CERN Document Server

Berdeaux, Douglas

2014-01-01

If you are an expert Perl programmer interested in penetration testing or information security, this guide is designed for you. However, it will also be helpful for you even if you have little or no Linux shell experience.

Standard practice for liquid penetrant examination for general industry

CERN Document Server

American Society for Testing and Materials. Philadelphia

2009-01-01

1.1 This practice covers procedures for penetrant examination of materials. Penetrant testing is a nondestructive testing method for detecting discontinuities that are open to the surface such as cracks, seams, laps, cold shuts, shrinkage, laminations, through leaks, or lack of fusion and is applicable to in-process, final, and maintenance testing. It can be effectively used in the examination of nonporous, metallic materials, ferrous and nonferrous metals, and of nonmetallic materials such as nonporous glazed or fully densified ceramics, as well as certain nonporous plastics, and glass. 1.2 This practice also provides a reference: 1.2.1 By which a liquid penetrant examination process recommended or required by individual organizations can be reviewed to ascertain its applicability and completeness. 1.2.2 For use in the preparation of process specifications and procedures dealing with the liquid penetrant testing of parts and materials. Agreement by the customer requesting penetrant inspection is strongly rec...

Evaporation and skin penetration characteristics of mosquito repellent formulations

International Nuclear Information System (INIS)

Reifenrath, W.G.; Hawkins, G.S.; Kurtz, M.S.

1989-01-01

Formulations of the mosquito repellent N,N-diethyl-3-methylbenzamide (deet) in combination with a variety of additives were developed to control repellent evaporation and percutaneous penetration. Deet was also formulated with the repellent dimethyl phthalate to study the interaction of the two compounds on the skin. The evaporation and penetration processes were evaluated on whole and split-thickness pig skin using radiolabeled repellents with an in vitro apparatus. Under essentially still air and air flow conditions, one of the deet formulations resulted in significantly reduced total evaporation and percutaneous penetration of deet as compared to unformulated repellent. When deet and dimethyl phthalate were combined, neither repellent affected the total amount of evaporation and penetration of the other compound. However, initial percutaneous penetration and evaporation rates were slightly less and decayed less rapidly than when both chemicals were tested separately at the same dose. These results indicated a degree of competition of the two compounds for the same avenues of loss

Integrated computation model of lithium-ion battery subject to nail penetration

International Nuclear Information System (INIS)

Liu, Binghe; Yin, Sha; Xu, Jun

2016-01-01

Highlights: • A coupling model to predict battery penetration process is established. • Penetration test is designed and validates the computational model. • Governing factors of the penetration induced short-circuit is discussed. • Critical safety battery design guidance is suggested. - Abstract: The nail penetration of lithium-ion batteries (LIBs) has become a standard battery safety evaluation method to mimic the potential penetration of a foreign object into LIB, which can lead to internal short circuit with catastrophic consequences, such as thermal runaway, fire, and explosion. To provide a safe, time-efficient, and cost-effective method for studying the nail penetration problem, an integrated computational method that considers the mechanical, electrochemical, and thermal behaviors of the jellyroll was developed using a coupled 3D mechanical model, a 1D battery model, and a short circuit model. The integrated model, along with the sub-models, was validated to agree reasonably well with experimental test data. In addition, a comprehensive quantitative analysis of governing factors, e.g., shapes, sizes, and displacements of nails, states of charge, and penetration speeds, was conducted. The proposed computational framework for LIB nail penetration was first introduced. This framework can provide an accurate prediction of the time history profile of battery voltage, temperature, and mechanical behavior. The factors that affected the behavior of the jellyroll under nail penetration were discussed systematically. Results provide a solid foundation for future in-depth studies on LIB nail penetration mechanisms and safety design.

Generic penetration in the retail antidepressant market.

Science.gov (United States)

Ventimiglia, Jeffrey; Kalali, Amir H

2010-06-01

In this article, we explore the accelerated penetration of generic antidepressants in the United States market following the availability of generic citalopram and sertraline. Analysis suggests that overall, generic penetration into the antidepressant market has grown from approximately 41 percent in January 2004 to over 73 percent in January 2010. Similar trends are uncovered when branded and generic prescriptions are analyzed by specialty.

Quantitative wood–adhesive penetration with X-ray computed tomography

Energy Technology Data Exchange (ETDEWEB)

Paris, Jesse L.; Kamke, Frederick A. (Oregon State U.); (Willamette Valley)

2015-09-01

Micro X-ray computed tomography (XCT) was used to analyze the 3D adhesive penetration behavior of different wood–adhesive bondlines. Three adhesives, a phenol formaldehyde (PF), a polymeric diphenylmethane diisocyanate (pMDI), and a hybrid polyvinyl acetate (PVA), all tagged with iodine for enhanced X-ray attenuation, were used to prepare single-bondline laminates in two softwoods, Douglas-fir and loblolly pine, and one hardwood, a hybrid polar. Adhesive penetration depth was measured with two separate calculations, and results were compared with 2D fluorescent micrographs. A total of 54 XCT scans were collected, representing six replicates of each treatment type; each replicate, however, consisted of approximately 1500 individual, cross-section slices stacked along the specimen length. As these adhesives were highly modified, the presented results do not indicate typical behavior for their broader adhesive classes. Still, clear penetration differences were observed between each adhesive type, and between wood species bonded with both the PF and pMDI adhesives. Furthermore, penetration results depended on the calculation method used. Two adhesive types with noticeably different resin distributions in the cured bondline, showed relatively similar penetration depths when calculated with a traditional effective penetration equation. However, when the same data was calculated with a weighted penetration calculation, which accounts for both adhesive area and depth, the results appeared to better represent the different distributions depicted in the photomicrographs and tomograms. Additionally, individual replicate comparisons showed variation due to specimen anatomy, not easily observed or interpreted from 2D images. Finally, 3D views of segmented 3D adhesive phases offered unique, in-situ views of the cured adhesive structures. In particular, voids formed by CO₂ bubbles generated during pMDI cure were clearly visible in penetrated columns of the solidified

WAPTT - Web Application Penetration Testing Tool

Directory of Open Access Journals (Sweden)

DURIC, Z.

2014-02-01

Full Text Available Web applications vulnerabilities allow attackers to perform malicious actions that range from gaining unauthorized account access to obtaining sensitive data. The number of reported web application vulnerabilities in last decade is increasing dramatically. The most of vulnerabilities result from improper input validation and sanitization. The most important of these vulnerabilities based on improper input validation and sanitization are: SQL injection (SQLI, Cross-Site Scripting (XSS and Buffer Overflow (BOF. In order to address these vulnerabilities we designed and developed the WAPTT (Web Application Penetration Testing Tool tool - web application penetration testing tool. Unlike other web application penetration testing tools, this tool is modular, and can be easily extended by end-user. In order to improve efficiency of SQLI vulnerability detection, WAPTT uses an efficient algorithm for page similarity detection. The proposed tool showed promising results as compared to six well-known web application scanners in detecting various web application vulnerabilities.

Penetrating power of resonant electromagnetic induction imaging

Directory of Open Access Journals (Sweden)

Roberta Guilizzoni

2016-09-01

Full Text Available The possibility of revealing the presence and identifying the nature of conductive targets is of central interest in many fields, including security, medicine, industry, archaeology and geophysics. In many applications, these targets are shielded by external materials and thus cannot be directly accessed. Hence, interrogation techniques are required that allow penetration through the shielding materials, in order for the target to be identified. Electromagnetic interrogation techniques represent a powerful solution to this challenge, as they enable penetration through conductive shields. In this work, we demonstrate the power of resonant electromagnetic induction imaging to penetrate through metallic shields (1.5-mm-thick and image targets (having conductivities σ ranging from 0.54 to 59.77 MSm−1 concealed behind them.

Simple Amides of Oleanolic Acid as Effective Penetration Enhancers

Science.gov (United States)

Bednarczyk-Cwynar, Barbara; Partyka, Danuta; Zaprutko, Lucjusz

2015-01-01

Transdermal transport is now becoming one of the most convenient and safe pathways for drug delivery. In some cases it is necessary to use skin penetration enhancers in order to allow for the transdermal transport of drugs that are otherwise insufficiently skin-permeable. A series of oleanolic acid amides as potential transdermal penetration enhancers was formed by multistep synthesis and the synthesis of all newly prepared compounds is presented. The synthetized amides of oleanolic acid were tested for their in vitro penetration promoter activity. The above activity was evaluated by means of using the Fürst method. The relationships between the chemical structure of the studied compounds and penetration activity are presented. PMID:26010090

Simple amides of oleanolic acid as effective penetration enhancers.

Science.gov (United States)

Bednarczyk-Cwynar, Barbara; Partyka, Danuta; Zaprutko, Lucjusz

2015-01-01

Transdermal transport is now becoming one of the most convenient and safe pathways for drug delivery. In some cases it is necessary to use skin penetration enhancers in order to allow for the transdermal transport of drugs that are otherwise insufficiently skin-permeable. A series of oleanolic acid amides as potential transdermal penetration enhancers was formed by multistep synthesis and the synthesis of all newly prepared compounds is presented. The synthetized amides of oleanolic acid were tested for their in vitro penetration promoter activity. The above activity was evaluated by means of using the Fürst method. The relationships between the chemical structure of the studied compounds and penetration activity are presented.

Safety considerations of laser related penetration in LCTR central power stations

International Nuclear Information System (INIS)

Botts, T.E.; Chan, C.K.; Ullman, A.Z.

1976-01-01

The following topics are briefly described: (1) requirements for optical penetration performance, (2) failure sequences in LCTR optical penetrations, (3) thermal stress in optical penetrations, and (4) nonlinear optical effects

Sternotomy or drainage for a hemopericardium after penetrating trauma: a randomized controlled trial.

Science.gov (United States)

Nicol, Andrew J; Navsaria, Pradeep H; Hommes, Martijn; Ball, Chad G; Edu, Sorin; Kahn, Delawir

2014-03-01

To determine if stable patients with a hemopericardium detected after penetrating chest trauma can be safely managed with pericardial drainage alone. The current international practice is to perform a sternotomy and cardiac repair if a hemopericardium is detected after penetrating chest trauma. The experience in Cape Town, South Africa, on performing a mandatory sternotomy in hemodynamically stable patients was that a sternotomy was unnecessary and the cardiac injury, if present, had sealed. A single-center parallel-group randomized controlled study was completed. All hemodynamically stable patients with a hemopericardium confirmed at subxiphoid pericardial window (SPW), and no active bleeding, were randomized. The primary outcome measure was survival to discharge from hospital. Secondary outcomes were complications and postoperative hospital stay. Fifty-five patients were randomized to sternotomy and 56 to pericardial drainage and wash-out only. Fifty-one of the 55 patients (93%) randomized to sternotomy had either no cardiac injury or a tangential injury. There were only 4 patients with penetrating wounds to the endocardium and all had sealed. There was 1 death postoperatively among the 111 patients (0.9%) and this was in the sternotomy group. The mean intensive care unit (ICU) stay for a sternotomy was 2.04 days (range, 0-25 days) compared with 0.25 days (range, 0-2) for the drainage (P drainage group (95% CI: 0.8-2.7). Total hospital stay was significantly shorter in the SPW group (P drainage is effective and safe in the stable patient with a hemopericardium after penetrating chest trauma, with no increase in mortality and a shorter ICU and hospital stay. (ClinicalTrials.gov Identifier: NCT00823160).

Importance Of Penetration Testing For Legacy Operating System

Directory of Open Access Journals (Sweden)

Poorvi Bhatt

2017-12-01

Full Text Available Penetration testing is very important technique to find vulnerabilities in commercial networks. There are various techniques for ethical hacking via penetration testing. This report explains a white hat hacker approach of penetration testing. I have performed this test on private network where three PCs are connected through LAN via switch and without firewall. This network is not connected with Internet. All the PCs have windows operating system. The attacker host has windows server 2003 with Service Pack1 second host has windows XP with Service Pack 2 and third host has windows 2000 with service pack 4.

Magnetic field penetration into superconductors with sharp edges

International Nuclear Information System (INIS)

Zhilichev, Yuriy N.

2003-01-01

The magnetic field and surface currents induced within a superconductor are calculated assuming the field penetrates in it near sharp corners. Rounding the corners is used to keep the field less than a critical value. Analytical formulas for a corner radius are given for a wire of the rectangular cross-section and a cylinder in the external magnetic field. A boundary integral method is used to calculate the boundary of the Meissner domain when the external field penetrates deep into the superconductor. The effect of degree of penetration on the magnetic moment of superconducting cylinders and wires is discussed

Estimating residual life of alloy 600 RPV penetrations

International Nuclear Information System (INIS)

Hunt, E.S.; White, G.A.; Pathania, R.; Arey, M.L.; Whitaker, D.E.

1996-01-01

Primary water stress corrosion cracking (PWSCC) of Alloy 600 penetrations PWR in reactor pressure vessel (RPV) heads has become a significant economic concern worldwide. PWSCC of these penetrations has led to extended maintenance outages, expensive inspections and repairs, and in some cases, replacement of the entire vessel head. This paper describes methodology developed to predict the remaining life of Alloy 600 penetrations in reactor vessel heads. Predictions of remaining life are an important input to planning models used by utilities to select a strategy for responding to the PWSCC issue at the lowest life cycle cost with an acceptably low risk of leakage. The remaining life of RPV penetrations is determined using the results of inspections of penetrations and statistical methods to predict future degradation. The analysis takes into account the effects of material properties, welding residual stresses, and operating temperature on PWSCC initiation and growth. The probability of developing cracks of various depths is assessed using Monte Carlo methods which provide for uncertainties in the input assumptions. For plants which have not yet performed inspections, remaining life predictions are based on inspection results from similar plants which have performed inspections with corrections made for known differences in design details, material properties and operating conditions

Dynamic hole closure behind a deep ocean sediment penetrator

International Nuclear Information System (INIS)

Dzwilewski, P.T.; Karnes, C.H.

1982-01-01

A freefall or boosted penetrator is one concept being considered to dispose of nuclear waste in the deep ocean seabed. For this technique to be acceptable, the sediment must be an effective barrier to the migration of radioactive nuclides, which means that the hole behind the advancing penetrator must close. One mechanism which can cause the hole to close immediately behind the penetrator is the reduction in water pressure in the wake as water tries to follow the penetrator into the sediment. An approximate solution to this complex problem is presented which analyzes the deformation of the sediment with a nonlinear, large displacement and strain, Lagrangian finite-difference computer code (STEALTH). The water was treated by Bernoulli's Principle for flow in a pipe resulting in a pressure boundary condition applied to the sediment surface along the path after passage of the penetrator. Two one-dimensional and eight two-dimensional calculations were performed with various penetrator velocities (15, 30, and 60 m/s) and sediment shear strengths. In two of the calculations, the dynamic pressure reduction was neglected to see if geostatic stresses alone would close the hole. The results of this study showed that geostatic stresses alone would not close the hole but the dynamic pressure reduction would. The largest uncertainty in the analysis was the pressure conditions in the water behind the penetrator in which frictionless, steady-state flow, in a uniform diameter pipe was assumed. A more sophisticated and realistic pressure condition has been formulated and will be implemented in the computer code in the near future

Replica scale modelling of long rod tank penetrators

NARCIS (Netherlands)

Diederen, A.M.; Hoeneveld, J.C.

2001-01-01

Experiments and simulations have been conducted using scale size tungsten alloy penetrators at ordnance velocity against an oblique plate array consisting of an inert sandwich and a base armour. The penetrators are made from 2 types of tungsten alloy with different tensile strength. Two scale sizes

The Impact of IPv6 on Penetration Testing

NARCIS (Netherlands)

Ottow, Christiaan; van Vliet, Frank; de Boer, Pieter-Tjerk; Pras, Aiko

In this paper we discuss the impact the use of IPv6 has on remote penetration testing of servers and web applications. Several modifications to the penetration testing process are proposed to accommodate IPv6. Among these modifications are ways of performing fragmentation attacks, host discovery and

Conditions for plasmoid penetration across abrupt magnetic barriers

International Nuclear Information System (INIS)

Brenning, Nils; Hurtig, Tomas; Raadu, Michael A.

2005-01-01

The penetration of plasma clouds, or plasmoids, across abrupt magnetic barriers (of the scale less than a few ion gyro radii, using the plasmoid directed velocity) is studied. The insight gained earlier, from detailed experimental and computer simulation investigations of a case study, is generalized into other parameter regimes. It is concluded for what parameters a plasmoid should be expected to penetrate the magnetic barrier through self-polarization, penetrate through magnetic expulsion, or be rejected from the barrier. The scaling parameters are n e , v 0 , B perpendicular , m i , T i , and the width w of the plasmoid. The scaling is based on a model for strongly driven, nonlinear magnetic field diffusion into a plasma which is a generalization of the earlier laboratory findings. The results are applied to experiments earlier reported in the literature, and also to the proposed application of impulsive penetration of plasmoids from the solar wind into the Earth's magnetosphere

HMO penetration and physicians' earnings.

Science.gov (United States)

Hadley, J; Mitchell, J M

1999-11-01

The goal of this study is to estimate whether cross-sectional variations in enrollment in health maintenance organizations (HMOs) affected physicians' earnings and hourly income in 1990. Using data from a nationally representative sample of 4,577 younger physicians (penetration is endogenous and used the instrumental variables approach to obtain unbiased estimates. HMO penetration had a negative and statistically significant impact on physicians earnings in 1990. A doubling of the average level of HMO penetration in the market is estimated to reduce annual earnings by 7% to 10.7%, and hourly earnings by approximately 6% to 9%. It appears that HMOs were successful in reducing physicians' annual and per hour earnings in 1990, presumably through a combination of fewer visits and lower payment rates for people covered by HMOs. Although these results cannot be generalized to all physicians, the experience of a younger cohort of physicians may still be a good indicator of the future effects of HMOs because younger physicians may be more susceptible to market forces than older and more established physicians. Moreover, these results may be somewhat conservative because they reflect market behavior in 1990, several years before the rapid growth and more aggressive market behavior of HMOs in recent years.

Hybrid treatment of penetrating aortic ulcer

International Nuclear Information System (INIS)

Lara, Juan Antonio Herrero; Martins-Romeo, Daniela de Araujo; Escudero, Carlos Caparros; Falcon, Maria del Carmen Prieto; Batista, Vinicius Bianchi; Vazquez, Rosa Maria Lepe

2015-01-01

Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease. (author)

Hybrid treatment of penetrating aortic ulcer

Energy Technology Data Exchange (ETDEWEB)

Lara, Juan Antonio Herrero; Martins-Romeo, Daniela de Araujo; Escudero, Carlos Caparros; Falcon, Maria del Carmen Prieto; Batista, Vinicius Bianchi, E-mail: jaherrero5@hotmail.com [Unidade de Gestao Clinica (UGC) de Diagnostico por Imagem - Hosppital Universitario Virgen Macarena, Sevilha (Spain); Vazquez, Rosa Maria Lepe [Unit of Radiodiagnosis - Hospital Nuestra Senora de la Merced, Osuna, Sevilha (Spain)

2015-05-15

Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease. (author)

Methane penetration in DIII-D ELMing H-mode plasmas

International Nuclear Information System (INIS)

West, W.P.; Lasnier, C.J.; Whyte, D.G.; Isler, R.C.; Evans, T.E.; Jackson, G.L.; Rudakov, D.; Wade, M.R.; Strachan, J.

2003-01-01

Carbon penetration into the core plasma during midplane and divertor methane puffing has been measured for DIII-D ELMing H-mode plasmas. The methane puffs are adjusted to a measurable signal, but global plasma parameters are only weakly affected (line average density, e > increases by E , drops by 6+ density profiles in the core measured as a function of time using charge exchange recombination spectroscopy. The methane penetration factor is defined as the difference in the core content with the puff on and puff off, divided by the carbon confinement time and the methane puffing rate. In ELMing H-mode discharges with ion ∇B drift direction into the X-point, increasing the line averaged density from 5 to 8x10 19 m -3 dropped the penetration factor from 6.6% to 4.6% for main chamber puffing. The penetration factor for divertor puffing was below the detection limit (<1%). Changing the ion ∇B drift to away from the X-point decreased the penetration factor by more than a factor of five for main chamber puffing

Double ionization chamber survey meter for the separate measurement of penetrating and non-penetrating dose

International Nuclear Information System (INIS)

Lucas, A.C.

1987-01-01

The full capabilities of an advanced 8-bit microprocessor have been utilized in construction of a wide range, multiplexing survey meter based on dual electrometers and ionization chambers. The ionization chambers are constructed of modular conducting and non-conducting parts in such a way that the angular dependence for measurement of beta radiation is controlled by design. Display functions for the high range instrument include logarithmic or linear analog display, digital display of rate or dose, SI or English units, optionally for either total, penetrating, or non-penetrating dose. The instrument is presently configured to operate in the range 0.1 R/hr to 50,000 R/hr in support of the requirements of Regulatory Guide 19.7

Videofluoroscopic Predictors of Penetration-Aspiration in Parkinson's Disease Patients.

Science.gov (United States)

Argolo, Natalie; Sampaio, Marília; Pinho, Patrícia; Melo, Ailton; Nóbrega, Ana Caline

2015-12-01

Parkinson's disease (PD) patients show a high prevalence of swallowing disorders and tracheal aspiration of food. The videofluoroscopic study of swallowing (VFSS) allows clinicians to visualize the visuoperceptual and temporal parameters associated with swallowing disorders in an attempt to predict aspiration risk. However, this subject remains understudied in PD populations. Our aim was to identify the predictors of penetration-aspiration in PD patients using the VFSS. Consecutive patients were evaluated using VFSS with different consistencies and volumes of food. A speech-language pathologist measured the type of intra-oral bolus organization, loss of bolus control, bolus location at the initiation of the pharyngeal swallow, the presence of multiple swallows, piecemeal deglutition, bolus residue in the pharyngeal recesses and temporal measures. Scores ≥3 on the penetration-aspiration scale (PAS) indicated the occurrence of penetration-aspiration. Using logistic marginal regression, we found that residue in the vallecula, residue in the upper esophageal sphincter and piecemeal deglutition were associated with penetration-aspiration (odds ratio (OR) = 4.09, 2.87 and 3.83; P = 0.0040, 0.0071 and 0.0009, respectively). Penetration/aspiration occurred only with fluids (both of thin and thick consistency), and no significant differences were observed between fluid types or food volumes. The mechanisms underlying dysphagia and penetration/aspiration in PD patients and indications for further studies are discussed.

Electric vehicles in Danish power system with large penetration of wind power

DEFF Research Database (Denmark)

Yang, Lihui; Xu, Zhao; Østergaard, Jacob

2011-01-01

Electric vehicles (EVs) provide a unique opportunity for reducing the CO2 emissions from the transport sector. At the same time, EVs have the potential to play an important role in the economical and reliable operation of an electricity system with high penetration of renewable energy. An analysi......). The managing structure of V2G adopting virtual power plant (VPP) technology is proposed. © 2011 State Grid Electric Power Research Institute Press....... is made of the potential for using EVs in Denmark, and the benefits of the electric power system with high wind power generation by intelligent charging and discharging of EVs are enumerated. Based on the analysis, important technological gaps are identified, and the corresponding research and development...... initiatives of the recently established EDISON program are described. Moreover, the latest development of the EDISON program is treated, that is, EDISON as a research consortium to design a new model for the Danish power system with high penetration of wind power and EVs with vehicle to grid (V2G...

Penetrating Cardiac and Hepatic Injury; Polytrauma of a Child After Bombing

Directory of Open Access Journals (Sweden)

Baris Akca

2013-10-01

Full Text Available After a bombing attack, patients were brought into hospital suffering from a combination of injuries caused by the blast, penetrating injuries and burns which as a case of polytrauma. In penetrating thoracoabdominal injuries due to bombing possibility of cardiac injury should be kept in mind. Penetrating cardiac injuries in children are rare but has a high mortality and morbidity. In some cases there may be difficulty in diagnosis of penetrating cardiac injury. In this case we want to share the diagnosis, treatment and follow-up processes of penetrating cardiac and hepatic injury with burns of a politrauma child due to bombing.

Wireless Network Penetration Testing and Security Auditing

Directory of Open Access Journals (Sweden)

Wang Shao-Long

2016-01-01

Full Text Available IEEE802.11 wireless wireless networks have security issues that are vulnerable to a variety of attacks. Due to using radio to transport data, attackers can bypass firewalls, sniff sensitive information, intercept packets and send malicious packets. Security auditing and penetration testing is expected to ensure wireless networks security. The contributions of this work are analyzed the vulnerability and types of attacks pertaining to IEEE 802.11 WLAN, performed well known attacks in a laboratory environment to conduct penetration tests to confirm whether our wireless network is hackable or not. WAIDPS is configured as auditing tool to view wireless attacks, such as WEP/WPA/WPA2 cracking, rouge access points, denial of service attack. WAIDPS is designed to detect wireless intrusion with additional features. Penetration testing and auditing will mitigate the risk and threatening to protect WALN.

Characteristics of rain penetration through a gravity ventilator used for natural ventilation.

Science.gov (United States)

Kim, Taehyeung; Lee, Dong Ho; Ahn, Kwangseog; Ha, Hyunchul; Park, Heechang; Piao, Cheng Xu; Li, Xiaoyu; Seo, Jeoungyoon

2008-01-01

Gravity ventilators rely simply on air buoyancy to extract air and are widely used to exhaust air contaminants and heat from workplaces using minimal energy. They are designed to maximize the exhaust flow rate, but the rain penetration sometimes causes malfunctioning. In this study, the characteristics of rain penetration through a ventilator were examined as a preliminary study to develop a ventilator with the maximum exhaust capacity while minimizing rain penetration. A model ventilator was built and exposed to artificial rain and wind. The paths, intensities and amounts of penetration through the ventilator were observed and measured in qualitative and quantitative fashions. In the first phase, the pathways and intensities of rain penetration were visually observed. In the second phase, the amounts of rain penetration were quantitatively measured under the different configurations of ventilator components that were installed based on the information obtained in the first-phase experiment. The effects of wind speed, grill direction, rain drainage width, outer wall height, neck height and leaning angle of the outer wall from the vertical position were analyzed. Wind speed significantly affected rain penetration. Under the low crosswind conditions, the rain penetration intensities were under the limit of detection. Under the high crosswind conditions, grill direction and neck height were the most significant factors in reducing rain penetration. The installation of rain drainage was also important in reducing rain penetration. The experimental results suggest that, with proper configurations of its components, a gravity ventilator can be used for natural ventilation without significant rain penetration problems.

The influence of distributed generation penetration levels on energy markets

International Nuclear Information System (INIS)

Vahl, Fabrício Peter; Rüther, Ricardo; Casarotto Filho, Nelson

2013-01-01

Planning of national energy policies brings new dilemmas with the introduction of distributed generators (DG). Economic theory suggests that a perfectly competitive market would lead to efficient pricing. In the absence of competition, regulators play a fundamental role in attracting reasonably priced finance in order to maintain, refurbish and increase the infrastructure and provide services at a reasonable cost. Energy market price equilibrium is mainly dependent on suppliers, generators, energy sources and demand, represented by conventional utility grid users. Its behavior is similar to that of other commodities. As generation becomes less centralized with the increasing economic viability of renewable energy sources, new suppliers are being connected to the grid. Such evolution means the transition from a monopolistic market to a broader and more open environment, with an increasing number of competitors. We make use of variational inequalities to model a hypothetical DG market in different scenarios, from monopoly, to oligopoly, to open market. Such an approach enables different equilibrium outcomes due to different DG penetration levels. Based on these findings, we argue that energy policies for such markets must be developed according to each specific stage of the grid's lifecycle. We show how energy policies and market regulations may affect such a transition, which may be catastrophic if not managed properly, and which is dependent on the energy mix. -- Highlights: •DG affects energy markets depending on technologies, penetration and infrastructure. •Energy prices vary when the market moves from centralized to several suppliers. •Variational inequalities are presented to simulate a market under such transitions. •The increase of DG penetration level may present different energy prices variation. •If technical and political issues of smart grids are not improved, markets may crash

Percutaneous penetration of 3H-Huangbai extracts and H3-berberine

International Nuclear Information System (INIS)

Jin Xipeng; Yu Xiaozhong; Zhang Nianbao; Kuang Jianwen

1992-01-01

The percutaneous penetration of 3 H-huangbai extracts and 3 H-berberine through excised guinea pig and human shins was studied using the static diffusion cell technique. The data were treated with mathematical model of skin absorption. The results showed that huangbai extracts and berberine could penetrate the guinea pig and human skins at (above) dose of 8.38 μg/cm 2 and 14.32 μg/cm 2 , respectively. The amount and rate of penetration increased linearly with the time of exposure and dose. The permeability of berberine through guinea pig and human skins in two vehicles (water and glycol) was lower than that of huangbai extracts. When Huangbai extracts and berberine were applied in glycol solution, the vehicle greatly enhanced the penetration of the two penetrant. The lag time of two penetrant through human skin was longer than that through guinea pig skin

Barbs facilitate the helical penetration of honeybee (Apis mellifera ligustica) stingers.

Science.gov (United States)

Wu, Jianing; Yan, Shaoze; Zhao, Jieliang; Ye, Yuying

2014-01-01

The stinger is a very small and efficient device that allows honeybees to perform two main physiological activities: repelling enemies and laying eggs for reproduction. In this study, we explored the specific characteristics of stinger penetration, where we focused on its movements and the effects of it microstructure. The stingers of Italian honeybees (Apis mellifera ligustica) were grouped and fixed onto four types of cubic substrates, before pressing into different substrates. The morphological characteristics of the stinger cross-sections were analyzed before and after penetration by microscopy. Our findings suggest that the honeybee stinger undergoes helical and clockwise rotation during penetration. We also found that the helical penetration of the stinger is associated directly with the spiral distribution of the barbs, thereby confirming that stinger penetration involves an advanced microstructure rather than a simple needle-like apparatus. These results provide new insights into the mechanism of honeybee stinger penetration.

Conducting network penetration and espionage in a global environment

CERN Document Server

Middleton, Bruce

2014-01-01

When it's all said and done, penetration testing remains the most effective way to identify security vulnerabilities in computer networks. Conducting Network Penetration and Espionage in a Global Environment provides detailed guidance on how to perform effective penetration testing of computer networks-using free, open source, and commercially available tools, including Backtrack, Metasploit, Wireshark, Nmap, Netcat, and Nessus. It also considers exploits and other programs using Python, PERL, BASH, PHP, Ruby, and Windows PowerShell.The book taps into Bruce Middleton's decades of experience wi

The Effect and Mechanism of Transdermal Penetration Enhancement of Fu's Cupping Therapy: New Physical Penetration Technology for Transdermal Administration with Traditional Chinese Medicine (TCM) Characteristics.

Science.gov (United States)

Xie, Wei-Jie; Zhang, Yong-Ping; Xu, Jian; Sun, Xiao-Bo; Yang, Fang-Fang

2017-03-27

In this paper, a new type of physical penetration technology for transdermal administration with traditional Chinese medicine (TCM) characteristics is presented. Fu's cupping therapy (FCT), was established and studied using in vitro and in vivo experiments and the penetration effect and mechanism of FCT physical penetration technology was preliminarily discussed. With 1-(4-chlorobenzoyl)-5-methoxy-2-methylindole-3-ylacetic acid (indomethacin, IM) as a model drug, the establishment of high, medium, and low references was completed for the chemical permeation system via in vitro transdermal tests. Furthermore, using chemical penetration enhancers (CPEs) and iontophoresis as references, the percutaneous penetration effect of FCT for IM patches was evaluated using seven species of in vitro diffusion kinetics models and in vitro drug distribution; the IM quantitative analysis method in vivo was established using ultra-performance liquid chromatography-tandem mass spectrometry technology (UPLC-MS/MS), and pharmacokinetic parameters: area under the zero and first moment curves from 0 to last time t (AUC 0-t , AUMC 0-t ), area under the zero and first moment curves from 0 to infinity (AUC 0-∞ , AUMC 0-∞ ), maximum plasma concentration (C max ) and mean residence time (MRT), were used as indicators to evaluate the percutaneous penetration effect of FCT in vivo. Additionally, we used the 3 K factorial design to study the joint synergistic penetration effect on FCT and chemical penetration enhancers. Through scanning electron microscopy (SEM) and transmission electron microscope (TEM) imaging, micro- and ultrastructural changes on the surface of the stratum corneum (SC) were observed to explore the FCT penetration mechanism. In vitro and in vivo skin permeation experiments revealed that both the total cumulative percutaneous amount and in vivo percutaneous absorption amount of IM using FCT were greater than the amount using CPEs and iontophoresis. Firstly, compared with

Field Test Evaluation of Effect on Cone Resistance Caused by Change in Penetration Rate

DEFF Research Database (Denmark)

Poulsen, Rikke; Nielsen, Benjaminn Nordahl; Ibsen, Lars Bo

2012-01-01

in the laboratory. A change in the measured cone resistance occurs by lowering the penetration rate. This is caused by the changes in drainage conditions. Compared to the normal penetration rate of 20 mm/s, this paper illustrates that lowering the penetration rate leads to an increase in the cone resistance from 1......This paper presents how a change in cone penetration rate affects the measured cone resistance during cone penetration testing in silty soils. Regardless of soil, type the standard rate of penetration is 20 mm/s and it is generally accepted that undrained penetration occurs in clay while drained...... penetration occurs in sand. In intermediate soils such as silty soils, the standard cone penetration rate may result in drainage conditions varying from undrained to partially or fully drained conditions. Field cone penetrations tests have been conducted with different penetration rates on a test site...

An explosive acoustic telemetry system for seabed penetrators

Energy Technology Data Exchange (ETDEWEB)

Hauser, G.C.; Hickerson, J.

1988-04-01

This report discusses the design and past applications of an explosive acoustic telemetry system (EATS) for gathering and transmitting data from seabed penetrators. The system was first fielded in 1982 and has since been used to measure penetrator performance on three other occasions. Descriptions are given of the mechanical hardware, system electronics, and software.

Operational experience of extreme wind penetrations

Energy Technology Data Exchange (ETDEWEB)

Estanqueiro, Ana [INETI/LNEG - National Laboratory for Energy and Geology, Lisbon (Portugal); Mateus, Carlos B. [Instituto de Meteorologia, Lisboa (Portugal); Pestana, Rui [Redes Energeticas Nacionais (REN), Lisboa (Portugal)

2010-07-01

This paper reports the operational experience from the Portuguese Power System during the 2009/2010 winter months when record wind penerations were observed: the instantaneous wind power penetration peaked at 70% of consumption during no-load periods and the wind energy accounted for more than 50% of the energy consumed for a large period. The regulation measures taken by the TSO are presented in the paper, together with the additional reserves operated for added system security. Information on the overall power system behavior under such extreme long-term wind power penetrations will also be addressed. (org.)

Generic Penetration of the SSRI Market.

Science.gov (United States)

Cascade, Elisa F; Kalali, Amir H

2008-04-01

In this article, we investigate the penetration of generic selective serotonin reuptake inhibitors (SSRIs) in the US market and the implications for patient out-of-pocket expense. The data suggest that generic penetration into the SSRI market has grown from approximately nine percent in 2000, the year that the patent for Prozac((R)) expired, to 72 percent in 2007. For December, 2007, the difference in patient out-of-pocket expense for branded vs. generic agents was, on average, $55.42 for patients paying by cash (i.e., they had no prescription drug insurance) and $22.39 for patients with insurance coverage.

Penetrating ocular trauma from trampoline spring.

Science.gov (United States)

Spokes, David; Siddiqui, Salina; Vize, Colin

2010-02-01

The case is presented of a 12-year old boy who sustained severe penetrating ocular trauma while playing on a domestic trampoline. A main spring broke under tension and the hook had struck the eye at high velocity and penetrated the sclera. Primary repair was undertaken but on review it became apparent the eye could not be salvaged. Evisceration was carried out and an orbital implant was placed. Post-operative cosmesis is acceptable. This type of injury has not been reported before. Adult supervision of children on trampolines is recommended to minimise the chance of serious injury.

Fire barrier penetration seals in nuclear power plants

International Nuclear Information System (INIS)

Bajwa, C.S.; West, K.S.

1996-07-01

NNPs are divided into separated fire areas by fire-rated structural barriers. Fire-rated penetration seals are installed to seal certain openings in these barriers, in order to provide reasonable assurance that a fire will be confined to the area where it started. The staff of the Fire Protection Engineering Section, Office of Nuclear Reactor Regulation, US NRC, conducted a comprehensive technical assessment of penetration seals to address reports of potential problems, to determine if there were any problems of safety significance, and to determine if NRC requirements, review guidance, and inspection procedures are adequate. It was concluded that the general condition of penetration seal programs in industry is satisfactory, and that the actions taken in 1988 and 1994 had increased industry awareness of potential problems and resulted in more thorough surveillances, maintenance, and corrective actions. These previous staff actions, together with continued licensee upkeep of existing penetration seal programs and continued NRC inspections, are adequate to maintain public health and safety. Several minor revisions to the NRC fire protection regulation and review guidance are recommended

Determining Hermeticity of Electron Devices by Dye Penetration

CERN Document Server

American Society for Testing and Materials. Philadelphia

1972-01-01

1.1 These practices cover procedures that will normally detect and locate the sites of gross leaks in electron devices. 1.2 These procedures are suitable for use on selected parts during receiving inspection or to verify and locate leakage sites for production control. They are not quantitative; no indication of leak size can be inferred from the test. 1.3 These procedures are most suitable for use on transparent glass-encased devices; all methods are applicable to transparent parts with an internal cavity. Method A, Penetrant-Capillary, is also applicable to parts, such as terminals, end seals or base assemblies, without an internal cavity, and Method C, Penetrant-Pressure Followed by Vacuum, can be used on opaque parts with an internal cavity. Method B, Penetrant-Pressure, can also be used on opaque parts with an internal cavity if the part is opened after dye penetration and before inspection. Parts that have an internal cavity may either contain gas (such as air, nitrogen, nitrogen-helium mixture, etc.) o...

Orientation dependence of deformation and penetration behavior of tungsten single-crystal rods

International Nuclear Information System (INIS)

Bruchey, W.J.; Horwath, E.J.; Kingman, P.W.

1991-01-01

This paper reports on the performance of tungsten single crystals as kinetic energy penetrator materials that was investigated in a high length-to-diameter (L/D) rod geometry at sub-scale (1/4 geometric scale). The [111]. [110], and [100] crystal orientations were tested in this 74-g LD = 15 geometry penetrator (6.90-mm diameter x 102.5-mm length). Several 93% tungsten alloy and uranium 3/4 titanium rod geometries were also tested to baseline expected performance of typical penetrator material/geometry combinations. Performance was determined for semi-infinite penetration into RHA steel and finite penetration into 76.20-mm RHA steel. Of the orientation tested, the [100] orientation provided the best ballistic results, with superior performance to mass and geometric equivalent 93% tungsten alloy rods. The [100] orientation also provided similar performance to geometric equivalent uranium 3/4 titanium rods. Favorable slip/cleavage during the compressive loading of the penetration process to allow penetrator material flow without large scale plastic deformation, and final shear localization at a favorable angle for easy material flow away from the penetration interface, contribute to the [100] orientation crystals' excellent performance. The net result was less energy expenditure during penetrator flow and, therefore, more energy for deformation of RHA

Assessing the effect of increased managed care on hospitals.

Science.gov (United States)

Mowll, C A

1998-01-01

This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

UO2/magnetite concrete interaction and penetration study

International Nuclear Information System (INIS)

Farhadieh, R.; Purviance, R.; Carlson, N.

1983-01-01

The concrete structure represents a line of defense in safety assessment of containment integrity and possible minimization of radiological releases following a reactor accident. The penetration study of hot UO 2 particles into limestone concrete and basalt concrete highlighted some major differences between the two concretes. These included penetration rate, melting and dissolution phenomena, released gases, pressurization of the UO 2 chamber, and characteristics of post-test concrete. The present study focuses on the phenomena associated with core debris interaction with and penetration into magnetite type concrete. The real material experiment was carried out with UO 2 particles and magnetite concrete in a test apparatus similar to the one utilized in the UO 2 /limestone experiment

Variance reduction methods applied to deep-penetration problems

International Nuclear Information System (INIS)

Cramer, S.N.

1984-01-01

All deep-penetration Monte Carlo calculations require variance reduction methods. Before beginning with a detailed approach to these methods, several general comments concerning deep-penetration calculations by Monte Carlo, the associated variance reduction, and the similarities and differences of these with regard to non-deep-penetration problems will be addressed. The experienced practitioner of Monte Carlo methods will easily find exceptions to any of these generalities, but it is felt that these comments will aid the novice in understanding some of the basic ideas and nomenclature. Also, from a practical point of view, the discussions and developments presented are oriented toward use of the computer codes which are presented in segments of this Monte Carlo course

A Study of Crystalline Mechanism of Penetration Sealer Materials.

Science.gov (United States)

Teng, Li-Wei; Huang, Ran; Chen, Jie; Cheng, An; Hsu, Hui-Mi

2014-01-14

It is quite common to dispense a topping material like crystalline penetration sealer materials (CPSM) onto the surface of a plastic substance such as concrete to extend its service life span by surface protections from outside breakthrough. The CPSM can penetrate into the existing pores or possible cracks in such a way that it may form crystals to block the potential paths which provide breakthrough for any unknown materials. This study investigated the crystalline mechanism formed in the part of concrete penetrated by the CPSM. We analyzed the chemical composites, in order to identify the mechanism of CPSM and to evaluate the penetrated depth. As shown in the results, SEM observes the acicular-structured crystals filling capillary pores for mortar substrate of the internal microstructure beneath the concrete surface; meanwhile, XRD and FT-IR showed the main hydration products of CPSM to be C-S-H gel and CaCO₃. Besides, MIP also shows CPSM with the ability to clog capillary pores of mortar substrate; thus, it reduces porosity, and appears to benefit in sealing pores or cracks. The depth of CPSM penetration capability indicated by TGA shows 0-10 mm of sealer layer beneath the concrete surface.

Penetration, Post-penetration Development, and Reproduction of Meloidogyne incognita on Cucumis melo var. texanus.

Science.gov (United States)

Faske, T R

2013-03-01

Cucumis melo var. texanus, a wild melon commonly found in the southern United States and two accessions, Burleson Co. and MX 1230, expressed resistance to Meloidogyne incognita in preliminary experiments. To characterize the mechanism of resistance, we evaluated root penetration, post-penetration development, reproduction, and emigration of M. incognita on these two accessions of C. melo var. texanus. Additionally, we evaluated 22 accessions of C. melo var. texanus for their reaction against M. incognita in a greenhouse experiment. Fewer (P ≤ 0.05) J2 penetrated the root system of C. melo var. texanus accessions (Burleson Co. and MX 1230) and C. metuliferus (PI 482452) (resistant control), 7 days after inoculation (DAI) than in C. melo 'Hales Best Jumbo' (susceptible control). A delayed (P ≤ 0.05) rate of nematode development was observed at 7, 14, and 21 DAI that contributed to lower (P ≤ 0.05) egg production on both accessions and C. metuliferus compared with C. melo. Though J2 emigration was observed on all Cucumis genotypes a higher (P ≤ 0.05) rate of J2 emigration was observed from 3 to 6 DAI on accession Burleson Co. and C. metuliferus than on C. melo. The 22 accessions of C. melo var. texanus varied relative to their reaction to M. incognita with eight supporting similar levels of nematode reproduction to that of C. metuliferus. Cucumis melo var. texanus may be a useful source of resistance against root-knot nematode in melon.

Spatiotemporal Dynamics of Soil Penetration Resistance of Recultivated Soil

Directory of Open Access Journals (Sweden)

Zadorozhnaya Galina

2018-03-01

Full Text Available This article examines changes in the spatial distribution of soil penetration resistance in ordinary chernozem (Calcic Chernozem and in the recultivated soil in 2012 and 2014. The measurements were carried out in the field using an Eijkelkamp penetrometer on a regular grid. The depth of measurement was 50 cm, the interval was 5 cm. The indices of variation of soil penetration resistance in space and time have been determined. The degree of spatial dependence of soil penetration resistance has been determined layer by layer. The nature of temporal dynamics of soil penetration resistance of chernozem and technical soil has been described. A significant positive relationship of the structure of chernozem in the two years of the research has been shown. Significant correlations between the data of different years in the technical soil were found to be mostly negative.

Lateral Tension-Induced Penetration of Particles into a Liposome

Directory of Open Access Journals (Sweden)

Kazuki Shigyou

2017-07-01

Full Text Available It is important that we understand the mechanism of the penetration of particles into a living cell to achieve advances in bionanotechnology, such as for treatment, visualization within a cell, and genetic modification. Although there have been many studies on the application of functional particles to cells, the basic mechanism of penetration across a biological membrane is still poorly understood. Here we used a model membrane system to demonstrate that lateral membrane tension drives particle penetration across a lipid bilayer. After the application of osmotic pressure, fully wrapped particles on a liposome surface were found to enter the liposome. We discuss the mechanism of the tension-induced penetration in terms of narrow constriction of the membrane at the neck part. The present findings are expected to provide insight into the application of particles to biological systems.

Antibody tumor penetration

Science.gov (United States)

Thurber, Greg M.; Schmidt, Michael M.; Wittrup, K. Dane

2009-01-01

Antibodies have proven to be effective agents in cancer imaging and therapy. One of the major challenges still facing the field is the heterogeneous distribution of these agents in tumors when administered systemically. Large regions of untargeted cells can therefore escape therapy and potentially select for more resistant cells. We present here a summary of theoretical and experimental approaches to analyze and improve antibody penetration in tumor tissue. PMID:18541331

The Current Status of the Japanese Penetrator Mission: LUNAR-A

Science.gov (United States)

Tanaka, S.; Shiraishi, H.; Fujimura, A.; Hayakawa, H.

The scientific objective of the LUNAR-A, Japanese Penetrator Mission, is to explore the lunar interior by seismic and heat-flow experiments. Two penetrators containing two seismometers (horizontal and vertical components) and heat-flow probes will be deployed from a spacecraft onto the lunar surface, one on the nearside and the other on the farside of the moon. The final impact velocity of the penetrator will be about 300m/sec; it will encounter a shock of about 8000 G at impact on the lunar surface. According to numerous experimental impact tests using model penetrators and a lunar regolith analog target, each penetrator is predicted to penetrate to a depth of 1 to 3 m. The data obtained by the penetrators will be transmitted to the earth station via the LUNAR-A mother spacecraft orbiting at an altitude of about 200 km. The penetrator is a missile-shaped instrument carrier, which is about 14cm in diameter, 75cm in length, and about 14kg in weight without attitude control system. It contains a two-component seismometer and heat flow probes together with other supporting instruments such as a tilt meter and an accelerometer. The seismic observations are expected to provide key data on the size of the lunar core, as well as data on deep lunar mantle structure. The heat flow measurements at two penetrator deployment sites will also provide important data on the thermal structure and bulk concentrations of heat-generating elements in the Moon. These data will provide much stronger geophysical constraints on the origin and evolution of the Moon than has been obtained so far. The LUNAR-A spacecraft was supposed to be launched in the summer of 2004, but it was postponed due to the necessity of a replacement of the valves used in the RCS propulsion system of the spacecraft, following a recall issued by the manufacturer who found a malfunction of similar valves. Then, the technological review boards by ISAS and JAXA recommended that both the more robustness of the

Produtividade de culturas e resistência à penetração de Argissolo Vermelho sob diferentes manejos Yield of crops and soil resistance to penetration of the Alfisol under different management

Directory of Open Access Journals (Sweden)

Cláudia Liane Rodrigues de Lima

2010-01-01

Full Text Available O objetivo deste trabalho foi avaliar a relação entre parâmetros de plantas de soja e feijão e a resistência do solo à penetração de Argissolo Vermelho distrófico arênico sob semeadura direta e convencional. Em experimento implantado em 1989 em semeadura direta, foram aplicadas diferentes passadas de máquina de 10 Mg e realizados diferentes preparos do solo em delineamento inteiramente casualizado. Foram quantificados o índice de velocidade de emergência, o índice de área foliar, a altura e a produtividade de grãos de soja e de feijão e a resistência do solo à penetração. O índice de área foliar, a altura e a produtividade do feijão são influenciados pela resistência do solo à penetração em 46, 51 e 59%, respectivamente, enquanto 55% da variação da altura da soja é explicada pela resistência à penetração. Indica-se um valor crítico de resistência à penetração de aproximadamente 1,7 e 1,9 MPa no que se refere ao crescimento e à produtividade de grãos de feijão e de soja, respectivamente.The objective of this work was to evaluate the relationship among soybean and bean plant parameters and soil resistance to penetration of an Alfisol under no-tillage and conventional systems. In an experiment deployed under no-tillage in 1989, different wheel tracks of a 10-Mg machine were applied and different soil management systems were used in completely randomized design. Emergence speed index, foliar area index, height and yield of soybean and bean crops and soil resistance to penetration were quantified. The influence of soil resistance to penetration in foliar area index, height and productivity of beans is of 46, 51 and 59% respectively, whereas 55% of the height variation in soybean is explained by soil resistance to penetration. The critical value of soil resistance to penetration indicated for bean and soybean growth and yield is of approximately 1.7 and 1.9 MPa respectively.

Ink Penetration of Uncoated Inkjet Paper and Impact on Printing Quality

Directory of Open Access Journals (Sweden)

Ren'ai Li

2015-10-01

Full Text Available This study investigated ink penetration through imaging technology, first by gray and contour mapping and then calculating the ink penetration depth by programing. Next, a series of further analyses were carried out, including average ink permeability, ink distributions, and printability of different uncoated inkjet paper with different parameters. The impact on ink penetration of the microstructure and hydrophilicity of the uncoated paper was also studied. The experimental results indicated that paper specimens with sizing agent were resistant to the ink, resulting in a slow and shallow ink penetration. Paper containing filler had a more hydrophilic surface and porous structure, leading to a faster and deeper ink penetration. However, the calendering operation could make the paper structure more compact and reduce the porosity and penetration depth. When an appropriate combination of sizing agent, filler content, and the calendering process was utilized, a more stable hue could be produced with improvements in optical density, saturation, and color.

Barbs facilitate the helical penetration of honeybee (Apis mellifera ligustica stingers.

Directory of Open Access Journals (Sweden)

Jianing Wu

Full Text Available The stinger is a very small and efficient device that allows honeybees to perform two main physiological activities: repelling enemies and laying eggs for reproduction. In this study, we explored the specific characteristics of stinger penetration, where we focused on its movements and the effects of it microstructure. The stingers of Italian honeybees (Apis mellifera ligustica were grouped and fixed onto four types of cubic substrates, before pressing into different substrates. The morphological characteristics of the stinger cross-sections were analyzed before and after penetration by microscopy. Our findings suggest that the honeybee stinger undergoes helical and clockwise rotation during penetration. We also found that the helical penetration of the stinger is associated directly with the spiral distribution of the barbs, thereby confirming that stinger penetration involves an advanced microstructure rather than a simple needle-like apparatus. These results provide new insights into the mechanism of honeybee stinger penetration.

A state of the art on penetration failure estimation under external vessel cooling

International Nuclear Information System (INIS)

Min, B. T.; Park, R. J.; Kang, K. H.; Cho, Y. R.; Kim, J. W.; Kim, S. B.; Park, S. Y.; Lee, K. Y.

2000-04-01

A state of the art on penetration failure was reviewed and analyzed to establish the direction of the experimental program in the KNGR and to decide the test section design. The interaction between the corium and the reactor vessel and the corium behavior in the lower plenum of the reactor vessel were analyzed to investigate the penetration effect on severe accident progression, and the TMI-2 accident was investigated in the point of penetration failure. Theoretical model and experiment results on penetration failure under the severe accident were investigated and reviewed to establish the direction of the experimental program on the estimation of the penetration failure in the KNGR. These results were compared with the TMI-2 results. The existing test facilities on penetration failure were investigated and reviewed to decide the test section design. It can be said from the state of the art review that penetration in the lower plenum of the reactor vessel is a week point in the reactor vessel failure under the severe accident, but the reactor vessel may not be failed by penetration failure in condition with the coolant supply to the penetration. Since the penetration is different with reactor types and there is no study on estimation of the penetration welding, it is necessary to investigate failure or not of the penetration in condition with external vessel cooling to maintain the reactor vessel integrity in KNGR. In the present experimental program on the integrity estimation of the KNGR penetration, the aluminum oxide melt by thermite reaction and the test section with one penetration of the real size and real material were selected. The melt mass, the pressure of the system, and the vessel geometry were selected as an experimental parameter. (author)

Penetration and fusion of phospholipid vesicles by lysozyme

International Nuclear Information System (INIS)

Kim, J.; Kim, H.

1989-01-01

The lysozyme-induced fusion of phosphatidylserine/phosphatidylethanolamine vesicles as studied at a wide range of pH is found to correlate well with the binding of this protein to the vesicles. An identical 6000 molecular weight segment of lysozyme at the N-terminal region is found to be protected from tryptic digestion when initially incubated with vesicles at several pH values. Only this segment is labeled by dansyl chloride, which is partitioned into the bilayer. These results suggest the penetration of one segment of lysozyme into the bilayer. Photoactivated labeling of the membrane-penetrating segment of lysozyme with 3-(trifluoromethyl)-3-([ 125 I]iodophenyl)diazirine ([ 125 I]TID) and subsequent identification of the labeled residues by Edman degradation and gamma-ray counting indicate that four amino acids from the N-terminal are located outside the hydrophobic core of the bilayer. Although treatment of the membrane-embedded segment with aminopeptidase failed to cleave any amino acids from the N-terminal, it appears that a loop of lysozyme segment near the N-terminal penetrates into the bilayer at acidic pH. A helical wheel diagram shows that the labeling is done mainly on one surface of the alpha-helix. The penetration kinetics as studied by time-dependent [ 125 I]TID labeling coincide with the fusion kinetics, strongly suggesting that the penetration of the lysozyme segment into the vesicles is the cause of the fusion

Penetration and fusion of phospholipid vesicles by lysozyme

Energy Technology Data Exchange (ETDEWEB)

Kim, J.; Kim, H. (Korea Advanced Institute of Science and Technology, Seoul)

1989-10-01

The lysozyme-induced fusion of phosphatidylserine/phosphatidylethanolamine vesicles as studied at a wide range of pH is found to correlate well with the binding of this protein to the vesicles. An identical 6000 molecular weight segment of lysozyme at the N-terminal region is found to be protected from tryptic digestion when initially incubated with vesicles at several pH values. Only this segment is labeled by dansyl chloride, which is partitioned into the bilayer. These results suggest the penetration of one segment of lysozyme into the bilayer. Photoactivated labeling of the membrane-penetrating segment of lysozyme with 3-(trifluoromethyl)-3-(({sup 125}I)iodophenyl)diazirine (({sup 125}I)TID) and subsequent identification of the labeled residues by Edman degradation and gamma-ray counting indicate that four amino acids from the N-terminal are located outside the hydrophobic core of the bilayer. Although treatment of the membrane-embedded segment with aminopeptidase failed to cleave any amino acids from the N-terminal, it appears that a loop of lysozyme segment near the N-terminal penetrates into the bilayer at acidic pH. A helical wheel diagram shows that the labeling is done mainly on one surface of the alpha-helix. The penetration kinetics as studied by time-dependent ({sup 125}I)TID labeling coincide with the fusion kinetics, strongly suggesting that the penetration of the lysozyme segment into the vesicles is the cause of the fusion.

Effect of Drainage Conditions on Cone Penetration Testing in Silty Soils

DEFF Research Database (Denmark)

Poulsen, Rikke; Nielsen, Benjaminn Nordahl; Ibsen, Lars Bo

2011-01-01

This paper discusses the challenges that occur when performing Cone Penetration Tests (CPT) in silty soil due to changes in drainage conditions. In this paper, CPT results from various papers and researchers are collected and interpreted. Results from cone penetrations tests with various penetrat......This paper discusses the challenges that occur when performing Cone Penetration Tests (CPT) in silty soil due to changes in drainage conditions. In this paper, CPT results from various papers and researchers are collected and interpreted. Results from cone penetrations tests with various...

Effects of magnetic shear on current penetration in a tokamak

International Nuclear Information System (INIS)

Zhang Pengyun; Wang Long

2001-01-01

The penetrations of the parallel and perpendicular components of plasma currents are interrelated to each other due to the existence of magnetic shear in a tokamak configuration. Effects of the shear on the penetration of Fourier components of toroidal plasma current are analysed in a cylindrical column model. The current penetration is obviously strengthened by the shear for a bell-bike conductivity profile and low safety factor and low aspect ratio

Europa Kinetic Ice Penetrator (EKIP)

Data.gov (United States)

National Aeronautics and Space Administration — The goal of the proposed work is to validate an initial design for a Europa penetrator that can withstand the high g load associated with the expected hypervelocity...

In vitro penetration of bleaching agents into the pulp chamber

DEFF Research Database (Denmark)

Benetti, Ana Raquel; Valera, M C; Mancini, M N G

2004-01-01

To investigate pulp chamber penetration of bleaching agents in teeth following restorative procedures.......To investigate pulp chamber penetration of bleaching agents in teeth following restorative procedures....

Orientation dependence of deformation and penetration behavior of tungsten single crystal rods

International Nuclear Information System (INIS)

Bruchey, W.J. Jr.; Horwath, E.J.; Kingman, P.W.

1991-01-01

This paper reports on deformation and flow at a target/penetrator interface that occurs under conditions of high hydrostatic pressure and associated heat generation. To further elucidate the role of material structure in the penetration process, oriented single crystals of tungsten have been launched into steel targets and the residual penetrators recovered and analyzed. Both the penetration depth and the deformation characteristics were strongly influenced by the crystallographic orientation. Deformation modes for the left-angle 100 right-angle rod, which exhibited the best performance, appeared to involve considerable localized slip/cleavage and relatively less plastic working; the residual penetrator was extensively cracked and the eroded penetrator material was extruded in a smooth tube lined with an oriented array of discrete particle exhibiting cleavage fractures. Deformation appeared to be much less localized and to involve more extensive plastic working in the left-angle 011 right-angle rod, which exhibited the poorest penetration, while the left-angle 111 right-angle behaved in an intermediate fashion

Penetration of stimuli of fish skin for Acanthostomum brauni cercariae.

Science.gov (United States)

Ostrowski de Nuñez, M; Haas, W

1991-02-01

The cercaria of Acanthostomum brauni penetrates the skin of its fish host in response to a combination of two chemical signals from the fish skin surface: free fatty acids and a macro-molecular mucus component. The latter seems to be a protein, as the penetration-stimulating activity of fish skin surface mucus is eliminated by digestion with proteinase, but not by digestion with glycosidases, nor by a removal of glycosaminoglycans. These penetration-stimulating host signals differ from the glycoproteins that stimulate the attachment of A. brauni cercariae to the host and also from the macromolecular fish host signals which have been found to stimulate the attachment and penetration by Opisthorchis viverrini cercariae.

Experience with managing liver trauma in southeastern Nigeria.

Science.gov (United States)

Chianakwana, Gu; Umeh, Ku; Chianakwana, Jo

2011-04-01

All over the world, liver trauma occurs as a result of blunt or penetrating abdominal injury. To review the management, morbidity and mortality of liver trauma in our resource-deprived centre, and to see how we can improve these outcomes, our poor facilities notwithstanding. This is a descriptive epidemiology. Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Patients who were treated for liver trauma in our centre between 2004 and 2010 were reviewed for aetiology of injury, management, morbidity and mortality. Of the 162 patients who were treated for liver trauma during the period, only 156 patients were recruited into the study. One hundred and nineteen (119) were males and 37 were females. Majority were blunt injuries while others were penetrating injuries. The blunt injuries were usually solitary, affecting only the liver whereas the penetrating injuries occasionally involved both the liver and some other organ(s). The commonest cause of blunt injuries was road traffic accident followed by fall from height. The commonest cause of penetrating injury was gunshot wound, followed by stab wound. Morbidity and mortality following liver trauma can be reduced by applying prompt and appropriate management modalities within the ambit of available resources. However, outcome will improve if adequate facilities are available.

Impact of adult atopic dermatitis on topical drug penetration

DEFF Research Database (Denmark)

Garcia Ortiz, Patricia; Hansen, Steen H; Shah, Vinod P

2009-01-01

Appropriate methodologies for the determination of drug penetration in diseased skin have not yet been established. The aim of this study was to determine the cutaneous penetration of a metronidazole cream formulation in atopic dermatitis, employing dermal microdialysis and tape strip sampling...

Radiation shielding techniques and applications. 4. Two-Phase Monte Carlo Approach to Photon Streaming Through Three-Legged Penetrations

International Nuclear Information System (INIS)

White, Travis; Hack, Joe; Nathan, Steve; Barnett, Marvin

2001-01-01

Westinghouse Safety Management Solutions (Westinghouse SMS) has been tasked with providing radiological engineering design support for the new Commercial Light Water Reactor Tritium Extraction Facility (CLWR-TEF) being constructed at the Savannah River Site. The Remote Handling Building (RHB) of the CLWR-TEF will act as the receiving facility for irradiated targets used in the production of tritium for the U.S. Department of Energy (DOE). Because of the high dose rates, approaching 50 000 rads/h (500 Gy/h) from the irradiated target bundles, significant attention has been made to shielding structures within the facility. One aspect of the design that has undergone intense review is the issue of the penetrations through the shield walls of the RHB, which includes heating, ventilation, and air-conditioning ductwork; cylindrical piping penetrations; floor drains; and conduit penetrations. The 'DOE Design Considerations Handbook' suggests that 'straight-line penetration of shield walls should be avoided to prevent radiation streaming', which is a prudent suggestion in this case considering the strength of the source. Therefore, a three-legged penetration approach was adopted for each type of penetration. To incorporate the three-legged penetration approach into the design, certain parameters had to be determined and confirmed as adequate. The main parameter to be determined was a minimum required offset length of the middle leg of the penetration. Additional parameters to be determined were supplemental photon shielding to be added to the interior of the wall to compensate for the void in the concrete created by the penetration, and the minimum necessary overlap dimensions of the supplemental shielding. Further, in cases where the minimum middle-leg offset was not practical, additional shielding requirements were determined for supplemental shielding added to the entrance or exit of the penetration to attenuate radiation scattering down the penetration. Analytical

Measurements of current penetration during PDX discharge start-up

International Nuclear Information System (INIS)

Meyerhofer, D.D.; Goldston, R.J.; Kaita, R.; Cavallo, A.; Grek, B.; Johnson, D.; McCune, D.C.; McGuire, K.; White, R.B.

1984-11-01

The current penetration phase of PDX discharges is examined. The Fast Ion Diagnostic Experiment has been used to measure the temporal evolution of the central q (r/a < 0.4), and to show the effect of magnetic perturbations on fast ions. During plasma current penetration, a series of magnetic perturbations was observed in the plasma. If the current was rising rapidly, the perturbations were accompanied by increases in β/sub theta/ + l/sub i//2 and decreases in the loop voltage, suggesting a rapid penetration of the plasma current. When the plasma current was rising slowly, a series of minor disruptions occurred. These were accompanied by decreases in β/sub theta/ + l/sub i//2 and the loop voltage, and increases in the plasma current. During this phase, current penetration may be enhanced by the change in the resistivity profile which accompanies the disruption

Endodontic sealers: Intratubular penetration and permeability to Enterococcus faecalis

Directory of Open Access Journals (Sweden)

Bortolini Maria Cecilia

2010-01-01

Full Text Available Aim : Evaluate in vitro the intratubular penetration and permeability of endodontic sealers in teeth contaminated with Enterococcus faecalis. Materials and Methods : Human canines were filled with AHPlus ® , Endo CPM-sealer ® or EndoRez ® sealers. To evaluate permeability, the coronary portion of each tooth was contaminated with E. faecalis, then the apical portion was immersed in brain heart infusion (BHI broth, and medium turbidity was observed for thirty days. Scanning electron microscope (SEM was used to evaluate the intratubular penetration of each sealer at the cervical, middle, and apical thirds of the tooth. Results : Only one tooth from the Endo CPM-sealer ® group presented broth contamination. EndoRez ® showed increased intratubular penetration compared to AHPlus ® and Endo CPM-sealer ® . Conclusions : Endo CPM-sealer ® showed greater permeability to E. faecalis and EndoRez ® showed increased intratubular penetration.

Roentgenologic image of penetrating duodenal bulb ulcer

International Nuclear Information System (INIS)

Strunin, A.E.

1986-01-01

When studying a series of aimed roentgenograms in patients with peptic ulcer a gas bubble of irregular spherical configuration or two-layer niche were determined near the bulb medial contour. Gas bubble was from 0.5-0.7 to 3.5 cm in diameter. In such cases penetrating ulcers were determined in operations. Along with other signs gas bubble symptom, sometimes two-layer signs may be used for timely and exact roentgenological diagnosis of penetrating duodenal bulb ulcer in peptic ulcer disease

Study on penetration-induced initiation of energetic fragment

Science.gov (United States)

Qiao, Xiangxin; Xu, Heyang

2017-09-01

In order to investigate penetration-induced initiation of energetic fragment penetrating target, PTFE/Al (mass ratio 73.5/26.5) pressed and sintered into a Ф8mm × 8mm cylinder. To form energetic fragment, the cylinder was put into a closed container made by 35CrMnSiA. The container is 12mm long, 2mm thick. Energetic fragments were launched by a 14.5mm ballistic gun with a series of velocities and the penetrate process was simulated by AUTODYN-3D. The results show that the stress peak of energetic material exceed the initiation threshold, and energetic material will deflagrate, when energetic fragments impact velocity more than 800 m/s. The research results can provide reference for designs of energetic warhead.

A case of an intrahepatic fish bone penetration

International Nuclear Information System (INIS)

Tsuboi, Kazuhiko; Nakajima, Yoshiro; Yamamoto, Shunji; Nagao, Masatoshi; Nishimura, Kazumasa.

1981-01-01

A 56-year-old man was admitted to our hospital because of epigastric discomfort, appetite loss and body weight loss. A gallstone, signs of chronic inflammation and CEA-Z: 12.5 ng/ml were found. Abdominal CT scan revealed an intrahepatic low density nodule and an intra-and-extrahepatic high-dense, needle-like foreign body. By laparotomy a fish bone penetrating into the left lateral segment of the liver from the anterior wall of the prepyloric region of the stomach was found. Cholecystectomy was performed. The penetrating fish bone was withdrawn from the liver easily. The Postoperative course was smooth. The possibility of the definitive preoperative diagnosis of the intestinal fish bone penetration by abdominal CT scan was suggested. (author)

Penetrating cardiac injury by wire thrown from a lawn mower.

Science.gov (United States)

Rubio, P A; Reul, G J

1979-01-01

The first successful surgically treated case of penetrating heart injury, specifically the right ventricle, caused by a fragment of coat hanger wire thrown by a lawn mower, is reported. Though traumatic heart injuries are rare, this case represents accurate surgical management and judgment, especially in the preoperative phase which resulted in early operating and excellent postoperative results. It is our feeling that if the patient can be transferred safely to the operating room the mortality rate is considerably lowered; however, emergency room thoracotomy, which will undoubtedly result in a greater survival rate from these spectacular injuries, should be performed in the emergency center if cardiac activity ceases or the patient's condition deteriorates considerably.

Interpretation of Cone Penetration Testing in Silty Soils Conducted under Partially Drained Conditions

DEFF Research Database (Denmark)

Holmsgaard, Rikke; Nielsen, Benjaminn Nordahl; Ibsen, Lars Bo

2016-01-01

The standard penetration rate used in cone penetration tests (CPTs) is 20 mm=s, regardless of soil type, which yields fully drained penetration in sand and fully undrained penetration in clay. However, for silty soils that represent an intermediate grain size composition and unique characteristic...

Microstructural observations on the terminal penetration of long rod projectile

OpenAIRE

Krushna Kumbhar; P. Ponguru Senthil; A.K. Gogia

2017-01-01

Present study focuses on the terminal penetration of tungsten heavy alloy (WHA) long rod penetrator impacted against armour steel at an impact velocity of 1600 m/s. The residual penetrator and armour steel target recovered after the ballistic test have been characterized using optical microscope, scanning electron microscope (SEM) and electron probe micro analyzer (EPMA). Metallurgical changes in target steel and WHA remnant have been analysed. Large shear stresses and shear localization have...

Two methodologies for physical penetration testing using social engineering

NARCIS (Netherlands)

Dimkov, T.; Pieters, Wolter; Hartel, Pieter H.

2009-01-01

During a penetration test on the physical security of an organization, if social engineering is used, the penetration tester directly interacts with the employees. These interactions are usually based on deception and if not done properly can upset the employees, violate their privacy or damage

Penetration of varnishes into demineralized root dentine in vitro

NARCIS (Netherlands)

Arends, J; Duschner, H; Ruben, JL

1997-01-01

In this paper the penetration of three different varnishes employed in caries prevention (Duraphat(R), Fluor Protector(R) and Cervitec(R)) into demineralized dentine is quantified using confocal laser scanning microscopy. The results show that the varnish penetration into lesions about 85 mu m in

High-pressure-induced water penetration into 3-isopropylmalate dehydrogenase

International Nuclear Information System (INIS)

Nagae, Takayuki; Kawamura, Takashi; Chavas, Leonard M. G.; Niwa, Ken; Hasegawa, Masashi; Kato, Chiaki; Watanabe, Nobuhisa

2012-01-01

Structures of 3-isopropylmalate dehydrogenase were determined at pressures ranging from 0.1 to 650 MPa. Comparison of these structures gives a detailed picture of the swelling of a cavity at the dimer interface and the generation of a new cleft on the molecular surface, which are accompanied by water penetration. Hydrostatic pressure induces structural changes in proteins, including denaturation, the mechanism of which has been attributed to water penetration into the protein interior. In this study, structures of 3-isopropylmalate dehydrogenase (IPMDH) from Shewanella oneidensis MR-1 were determined at about 2 Å resolution under pressures ranging from 0.1 to 650 MPa using a diamond anvil cell (DAC). Although most of the protein cavities are monotonically compressed as the pressure increases, the volume of one particular cavity at the dimer interface increases at pressures over 340 MPa. In parallel with this volume increase, water penetration into the cavity could be observed at pressures over 410 MPa. In addition, the generation of a new cleft on the molecular surface accompanied by water penetration could also be observed at pressures over 580 MPa. These water-penetration phenomena are considered to be initial steps in the pressure-denaturation process of IPMDH

A Study of Crystalline Mechanism of Penetration Sealer Materials

Directory of Open Access Journals (Sweden)

Li-Wei Teng

2014-01-01

Full Text Available It is quite common to dispense a topping material like crystalline penetration sealer materials (CPSM onto the surface of a plastic substance such as concrete to extend its service life span by surface protections from outside breakthrough. The CPSM can penetrate into the existing pores or possible cracks in such a way that it may form crystals to block the potential paths which provide breakthrough for any unknown materials. This study investigated the crystalline mechanism formed in the part of concrete penetrated by the CPSM. We analyzed the chemical composites, in order to identify the mechanism of CPSM and to evaluate the penetrated depth. As shown in the results, SEM observes the acicular-structured crystals filling capillary pores for mortar substrate of the internal microstructure beneath the concrete surface; meanwhile, XRD and FT-IR showed the main hydration products of CPSM to be C-S-H gel and CaCO3. Besides, MIP also shows CPSM with the ability to clog capillary pores of mortar substrate; thus, it reduces porosity, and appears to benefit in sealing pores or cracks. The depth of CPSM penetration capability indicated by TGA shows 0–10 mm of sealer layer beneath the concrete surface.

The Expanding Role of Managed Care in the Medicaid Program

Science.gov (United States)

Caswell, Kyle J.; Long, Sharon K.

2015-01-01

States increasingly use managed care for Medicaid enrollees, yet evidence of its impact on health care outcomes is mixed. This research studies county-level Medicaid managed care (MMC) penetration and health care outcomes among nonelderly disabled and nondisabled enrollees. Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and health care outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals. PMID:25882616

Study of the disorder by means of the superconducting penetration depth

International Nuclear Information System (INIS)

Arce, R.D.

1982-11-01

Measurements of the weak magnetic field penetration depth in the amorphous superconducting systems Lasub(1-x) Msub(x), being M = Cu, Al, Ga and Au, and in the Zr 70 Cu 30 system are presented. Measurements of the sample geometrical factors and the flux expulsion between the lowest temperature reached and the critical temperature, allows the determination of zero temperature penetration depth. The measurement of the flux expulsion as a function of temperature is used to determine the temperature dependence of penetration depth, used to evaluate the temperature dependence superconducting gap. The magnetization measurements have been made using an rf-SQUID. The evolution of the penetration depth with annealing is studied in the La 70 Cu 30 and Zr 70 Cu 30 systems. Measurements of the electrical resistivity and the critical temperature are used to verify the Gorkov equations in these materials. The variation of the penetration depth with annealing suggests that a metallurgical phase separation occurs within the submicrometer range. Penetration depth measurement is a tool to detect this type of phase separation in high kappa materials. (M.E.L.) [es

Market penetration of ethanol

International Nuclear Information System (INIS)

Szulczyk, Kenneth R.; McCarl, Bruce A.; Cornforth, Gerald

2010-01-01

This research examines in detail the technology and economics of substituting ethanol for gasoline. This endeavor examines three issues. First, the benefits of ethanol/gasoline blends are examined, and then the technical problems of large-scale implementation of ethanol. Second, ethanol production possibilities are examined in detail from a variety of feedstocks and technologies. The feedstocks are the starch/sugar crops and crop residues, while the technologies are corn wet mill, dry grind, and lignocellulosic fermentation. Examining in detail the production possibilities allows the researchers to identity the extent of technological change, production costs, byproducts, and GHG emissions. Finally, a U.S. agricultural model, FASOMGHG, is updated which predicts the market penetration of ethanol given technological progress, variety of technologies and feedstocks, market interactions, energy prices, and GHG prices. FASOMGHG has several interesting results. First, gasoline prices have a small expansionary impact on the U.S. ethanol industry. Both agricultural producers' income and cost both increase with higher energy prices. If wholesale gasoline is $4 per gallon, the predicted ethanol market penetration attains 53% of U.S. gasoline consumption in 2030. Second, the corn wet mill remains an important industry for ethanol production, because this industry also produces corn oil, which could be converted to biodiesel. Third, GHG prices expand the ethanol industry. However, the GHG price expands the corn wet mill, but has an ambiguous impact on lignocellulosic ethanol. Feedstocks for lignocellulosic fermentation can also be burned with coal to generate electricity. Both industries are quite GHG efficient. Finally, U.S. government subsidies on biofuels have an expansionary impact on ethanol production, but may only increase market penetration by an additional 1% in 2030, which is approximately 6 billion gallons. (author)

Retroperitoneal aortic hemorrhage caused by penetration of an endovascular stent-graft anchoring barb.

Science.gov (United States)

Twine, Christopher P; Winterbottom, Andrew; Shaida, Nadeem; Boyle, Jonathan R

2013-08-01

To report a rare case of acute intraoperative retroperitoneal hemorrhage secondary to aortic penetration by the suprarenal anchoring barb on a stent-graft. A 75-year-old patient on dual antiplatelet therapy for coronary stents and low-molecular-weight heparin for atrial thrombus underwent elective endovascular repair of a 6.7-cm infrarenal abdominal aortic aneurysm. A device with suprarenal fixation and metal anchoring barbs was implanted, and a molding balloon was used that at no time covered the proximal bare metal stents or barbs. In recovery, the patient became tachycardic and hypotensive. After resuscitation, imaging identified an anterior barb penetrating the aortic wall, causing the acute retroperitoneal hemorrhage. A decision to treat conservatively rather than resort to open surgery was difficult but ultimately influenced by the patients' high risk for open surgery. The patient was treated by aggressive reversal of heparin and platelet transfusion, and the bleed settled spontaneously. Major surgery and subsequent morbidity may be avoided by medical management of what would appear to be a surgical problem.

Review of Power System Stability with High Wind Power Penetration

DEFF Research Database (Denmark)

Hu, Rui; Hu, Weihao; Chen, Zhe

2015-01-01

analyzing methods and stability improvement approaches. With increasing wind power penetration, system balancing and the reduced inertia may cause a big threaten for stable operation of power systems. To mitigate or eliminate the wind impacts for high wind penetration systems, although the practical......This paper presents an overview of researches on power system stability with high wind power penetration including analyzing methods and improvement approaches. Power system stability issues can be classified diversely according to different considerations. Each classified issue has special...... and reliable choices currently are the strong outside connections or sufficient reserve capacity constructions, many novel theories and approaches are invented to investigate the stability issues, looking forward to an extra-high penetration or totally renewable resource based power systems. These analyzing...

Microstructural observations on the terminal penetration of long rod projectile

Directory of Open Access Journals (Sweden)

Krushna Kumbhar

2017-12-01

Full Text Available Present study focuses on the terminal penetration of tungsten heavy alloy (WHA long rod penetrator impacted against armour steel at an impact velocity of 1600 m/s. The residual penetrator and armour steel target recovered after the ballistic test have been characterized using optical microscope, scanning electron microscope (SEM and electron probe micro analyzer (EPMA. Metallurgical changes in target steel and WHA remnant have been analysed. Large shear stresses and shear localization have resulted in local failure and formation of erosion products. Severe plastic deformation acts as precursor for formation of adiabatic shear band (ASB induced cracks in target steel. Recovered WHA penetrator remnant also exhibits severe plastic deformation forming localized shear bands, ASB induced cracks and shock induced cracks.

Gastroscopic treatment of gastric band penetrating the gastric wall

DEFF Research Database (Denmark)

Jess, Per; Fonnest, G

1999-01-01

Gastric wall penetration of a gastric band after operation for morbid obesity is a well known late complication. The treatment is usually reoperation. In this case report we show that a band penetrating the gastric wall can be successfully treated by gastroscopic operation. This technique is more...

46 CFR 174.225 - Hull penetrations and shell connections.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Hull penetrations and shell connections. 174.225 Section 174.225 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) SUBDIVISION AND STABILITY... § 174.225 Hull penetrations and shell connections. Each overboard discharge and shell connection except...

Penetrating abdominal injury cases admitted in University of Benin ...

African Journals Online (AJOL)

The incidence of penetrating abdominal injuries especially through gunshot injuries is on the increase and is a major cause of morbidity and mortality in our community. Control measures and ways of reducing morbidity and mortality are suggested. Keywords: penetrating abdominal injuries, gun shot injuries. Annals of ...

Net load forecasting for high renewable energy penetration grids

International Nuclear Information System (INIS)

Kaur, Amanpreet; Nonnenmacher, Lukas; Coimbra, Carlos F.M.

2016-01-01

We discuss methods for net load forecasting and their significance for operation and management of power grids with high renewable energy penetration. Net load forecasting is an enabling technology for the integration of microgrid fleets with the macrogrid. Net load represents the load that is traded between the grids (microgrid and utility grid). It is important for resource allocation and electricity market participation at the point of common coupling between the interconnected grids. We compare two inherently different approaches: additive and integrated net load forecast models. The proposed methodologies are validated on a microgrid with 33% annual renewable energy (solar) penetration. A heuristics based solar forecasting technique is proposed, achieving skill of 24.20%. The integrated solar and load forecasting model outperforms the additive model by 10.69% and the uncertainty range for the additive model is larger than the integrated model by 2.2%. Thus, for grid applications an integrated forecast model is recommended. We find that the net load forecast errors and the solar forecasting errors are cointegrated with a common stochastic drift. This is useful for future planning and modeling because the solar energy time-series allows to infer important features of the net load time-series, such as expected variability and uncertainty. - Highlights: • Net load forecasting methods for grids with renewable energy generation are discussed. • Integrated solar and load forecasting outperforms the additive model by 10.69%. • Net load forecasting reduces the uncertainty between the interconnected grids.

Optimal Operation and Management for Smart Grid Subsumed High Penetration of Renewable Energy, Electric Vehicle, and Battery Energy Storage System

Science.gov (United States)

Shigenobu, Ryuto; Noorzad, Ahmad Samim; Muarapaz, Cirio; Yona, Atsushi; Senjyu, Tomonobu

2016-04-01

Distributed generators (DG) and renewable energy sources have been attracting special attention in distribution systems in all over the world. Renewable energies, such as photovoltaic (PV) and wind turbine generators are considered as green energy. However, a large amount of DG penetration causes voltage deviation beyond the statutory range and reverse power flow at interconnection points in the distribution system. If excessive voltage deviation occurs, consumer's electric devices might break and reverse power flow will also has a negative impact on the transmission system. Thus, mass interconnections of DGs has an adverse effect on both of the utility and the customer. Therefore, reactive power control method is proposed previous research by using inverters attached DGs for prevent voltage deviations. Moreover, battery energy storage system (BESS) is also proposed for resolve reverse power flow. In addition, it is possible to supply high quality power for managing DGs and BESSs. Therefore, this paper proposes a method to maintain voltage, active power, and reactive power flow at interconnection points by using cooperative controlled of PVs, house BESSs, EVs, large BESSs, and existing voltage control devices. This paper not only protect distribution system, but also attain distribution loss reduction and effectivity management of control devices. Therefore mentioned control objectives are formulated as an optimization problem that is solved by using the Particle Swarm Optimization (PSO) algorithm. Modified scheduling method is proposed in order to improve convergence probability of scheduling scheme. The effectiveness of the proposed method is verified by case studies results and by using numerical simulations in MATLAB®.

Penetration of ASM 981 in canine skin: a comparative study.

Science.gov (United States)

Gutzwiller, Meret E Ricklin; Reist, Martin; Persohn, Elke; Peel, John E; Roosje, Petra J

2006-01-01

ASM 981 has been developed for topical treatment of inflammatory skin diseases. It specifically inhibits the production and release of pro-inflammatory cytokines. We measured the skin penetration of ASM 981 in canine skin and compared penetration in living and frozen skin. To make penetration of ASM 981 visible in dog skin, tritium labelled ASM 981 was applied to a living dog and to defrosted skin of the same dog. Using qualitative autoradiography the radioactive molecules were detected in the lumen of the hair follicles until the infundibulum, around the superficial parts of the hair follicles and into a depth of the dermis of 200 to 500 microm. Activity could not be found in deeper parts of the hair follicles, the dermis or in the sebaceous glands. Penetration of ASM 981 is low in canine skin and is only equally spread in the upper third of the dermis 24 hours after application. Penetration in frozen skin takes even longer than in living canine skin but shows the same distribution.

Modeling Flood Insurance Penetration in the European Non-Life Market: An Overview

Science.gov (United States)

Mohan, P.; Thomson, M.-K.; Das, A.

2012-04-01

Non-life property insurance plays a significant role in assessing and managing economic risk. Understanding the exposure, or property at risk, helps insurers and reinsurers to better categorize and manage their portfolios. However, the nature of the flood peril, in particular adverse selection, has led to a complex system of different insurance covers and policies across Europe owing to its public and private distinctions based on premiums provided as ex ante or ex post, socio-economic characterization and various compensation schemes. To model this significant level of complexity within the European flood insurance market requires not only extensive data research, close understanding of insurance companies and associations as well as historic flood events, but also careful evaluation of the flood hazard in terms of return periods and flood extents, and the economic/ financial background of the geographies involved. This abstract explores different approaches for modeling the flood insurance penetration rates in Europe depending on the information available and complexity involved. For countries which have either a regulated market with mandatory or high penetration rate, as for example found in the UK, France and Switzerland, or indeed countries with negligible insurance cover such as Luxembourg, assumptions about the penetration rates can be made at country level. However, in countries with a private insurance market, the picture becomes inherently more complex. For example in both Austria and Germany, flood insurance is generally restricted, associated with high costs to the insured or not available at all in high risk areas. In order to better manage flood risk, the Austria and German government agencies produced the risk classification systems HORA and ZÜRS, respectively, which categorize risk into four risk zones based on the exceedance probability of a flood occurrence. Except for regions that have preserved mandatory flood inclusion from past policies

Technology for a Thermo-chemical Ice Penetrator for Icy Moons

Science.gov (United States)

Arenberg, Jonathan; Harpole, George; Zamel, James; Sen, Bashwar; Lee, Greg; Ross, Floyd; Retherford, Kurt D.

2016-10-01

The ability to place sensors or to take samples below the ice surface enables a wide variety of potential scientific investigations. Penetrating an ice cap can be accomplished via a mechanical drill, laser drill, kinetic impactor, or heated penetrator. This poster reports on the development of technology for the latter most option, namely a self-heated probe driven by an exothermic chemical reaction: a Thermo-chemical ice penetrator (TChIP). Our penetrator design employs a eutectic mix of alkali metals that produce an exothermic reaction upon contact with an icy surface. This reaction increases once the ice starts melting, so no external power is required. This technology is inspired by a classified Cold-War era program developed at Northrop Grumman for the US Navy. Terrestrial demonstration of this technology took place in the Arctic; however, this device cannot be considered high TRL for application at the icy moons of the solar system due to the environmental differences between Earth's Arctic and the icy moons. These differences demand a TChIP design specific to these cold, low mass, airless worlds. It is expected that this model of TChIP performance will be complex, incorporating all of the forces on the penetrator, gravity, the thermo-chemistry at the interface between penetrator and ice, and multi-phase heat and mass transport, and hydrodynamics. Our initial efforts are aimed at the development of a validated set of tools and simulations to predict the performance of the penetrator for both the environment found on these icy moons and for a terrestrial environment. The purpose of the inclusion of the terrestrial environment is to aid in model validation. Once developed and validated, our models will allow us to design penetrators for a specific scientific application on a specific body. This poster discusses the range of scientific investigations that are enabled by TChIP. We also introduce the development plan to advance TChIP to the point where it can be

Industrial Penetration and Internet Intensity

NARCIS (Netherlands)

C-L. Chang (Chia-Lin); M.J. McAleer (Michael); Y-C. Wu (Yu-Chieh)

2016-01-01

textabstractThis paper investigates the effect of industrial penetration and internet intensity for Taiwan manufacturing firms, and analyses whether the relationships are substitutes or complements. The sample observations are based on 153,081 manufacturing plants, and covers 26 two-digit industry

Flux penetration in a ferromagnetic/superconducting bilayer

Energy Technology Data Exchange (ETDEWEB)

Adamus, Z.; Cieplak, M.Z.; Abal' Oshev, A. [Polish Acad Sci, Inst Phys, PL-02668 Warsaw, (Poland); Konczykowski, M. [CEA/DSM/DRECAM, Laboratoire des Solides Irradies, F-91191 Gif Sur Yvette, (France); Konczykowski, M. [Ecole Polytech, CNRS - UMR 7642, F-91128 Palaiseau, (France); Cheng, X.M.; Zhu, L.Y.; Chien, C.L. [Johns Hopkins Univ, Dept Phys and Astron, Baltimore, MD 21218 (United States)

2007-07-01

An array of miniature Hall sensors is used to study the magnetic flux penetration in a ferromagnetic/superconducting bilayer consisting of Nb as a superconducting layer and Co/Pt multilayer with perpendicular magnetic anisotropy as a ferromagnetic layer, separated by an amorphous Si layer to avoid the proximity effect. It is found that the magnetic domains in the ferromagnetic layer create a large edge barrier in the superconducting layer which delays flux penetration. The smooth flux profiles observed in the absence of magnetic pinning change into terraced profiles in the presence of domains. (authors)

Generic penetration in the retail atypical antipsychotic market.

Science.gov (United States)

Lenderts, Susan; Kalali, Amir H; Buckley, Peter

2010-03-01

In this article, we explore the penetration of generic atypical antipsychotics in the United States market before and after the availability of generic risperidone in July 2008. Analysis suggests that, overall, generic penetration into the atypical antipsychotic market has grown from approximately three percent in January 2008 to more than 25 percent in December 2009. Similar trends are uncovered when branded and generic prescriptions are analyzed by specialty.

Penetration of charged particles through ordered isotropic matter

International Nuclear Information System (INIS)

Sigmund, P.

1977-01-01

A brief summary of some new results on fluctuation phenomena in particle penetration is presented. The results include collision statistics, positive and negative correlations and a framework for the treatment of cumulative effects in particle penetration. Incorporation of projectile and target states in the description and energy-loss straggling are discussed. Small-angle multiple scattering is considered and a comment made on ionic charge states. (B.R.H.)

Effects of renewables penetration on the security of Portuguese electricity supply

International Nuclear Information System (INIS)

Gouveia, João Pedro; Dias, Luís; Martins, Inês; Seixas, Júlia

2014-01-01

Highlights: • We assess the importance of the electricity sector in energy security in Portugal. • We compare energy security indicators for 2004 and 2011. • Strong wind penetration has an important role on the country energy security. • Infrastructure is the weaker component in electricity sector supply chain. - Abstract: The increase of renewables in power sector, together with the increase of their electricity share in final energy consumption, is changing our perception about energy security with diverse and contradictory statements. The Portuguese security of electricity supply is analyzed in this study by comparing selected indicators for 2 years before and after the high increase of onshore wind since 2005. Our goal is to find how the security of electricity supply was impacted by the penetration of renewables, taking a supply chain approach. Our analysis highlights that the penetration of renewables has decreased the energy dependence of the power sector by more than 20% between 2004 and 2011, while risks related to the concentration of natural gas suppliers and to the still-high share of fossil fuels suffering from price volatility are discussed. We observed a significant improvement in power interconnections with Spain, as well as an increase of the de-rated generation capacity margin, allowing proper management of renewable power intermittency if necessary, thereby improving power security. Although the share of intermittent renewables almost quadrupled in total installed capacity between those years, the indicators reveal an improvement in the quality of transport and distribution when delivering electricity to end-users. Although electricity prices increased, mainly due to taxes, the lack of energy efficiency is an aspect deserving improvement to alleviate the pressure on electricity security, mainly at high peak demands

Evaluation of nicotinamide microemulsion on the skin penetration enhancement.

Science.gov (United States)

Boonme, Prapaporn; Boonthongchuay, Chalida; Wongpoowarak, Wibul; Amnuaikit, Thanaporn

2016-01-01

This study purposed to evaluate a microemulsion containing nicotinamide for its characteristics, stability, and skin penetration and retention comparing with a solution of nicotinamide in 2:1 mixture of water and isopropyl alcohol (IPA). The microemulsion system was composed of 1:1 mixture of Span80 and Tween80 as a surfactant mixture, isopropyl palmitate (IPP) as an oil phase, and 2:1 mixture of water and IPA as an aqueous phase. Nicotinamide microemulsion was prepared by dissolving the active in the aqueous phase before simply mixing with the other components. It was determined for its characteristics and stability under various conditions. The skin penetration and retention studies of nicotinamide microemulsion and solution were performed by modified Franz diffusion cells, using newborn pig skin as the membrane. The results showed that nicotinamide microemulsion could be obtained as clear yellowish liquid, was water-in-oil (w/o) type, possessed Newtonian flow, and exhibited physicochemical stability when kept at 4 °C and room temperature (≈30 ± 2 °C) during 3 months. From the skin penetration data, the microemulsion could enhance the skin penetration of nicotinamide comparing with the solution. Additionally, nicotinamide microemulsion could provide much higher amount of skin retention than that of skin penetration, resulting in suitability for a cosmeceutical product.

Penetration of sub-micron aerosol droplets in composite cylindrical filtration elements

International Nuclear Information System (INIS)

Geurts, Bernard J.; Pratte, Pascal; Stolz, Steffen; Stabbert, Regina; Poux, Valerie; Nordlund, Markus; Winkelmann, Christoph

2011-01-01

Advection-diffusion transport of aerosol droplets in composite cylindrical filtration elements is analyzed and compared to experimental data. The penetration, characterizing the fraction of droplets that passes through the pores of a filtration element, is quantified for a range of flow rates. The advection-diffusion transport in a laminar Poiseuille flow is treated numerically for slender pores using a finite difference approach in cylindrical coordinates. The algebraic dependence of the penetration on the Peclet number as predicted theoretically, is confirmed by experimental findings at a variety of aspect ratios of the cylindrical pores. The effective penetration associated with a composite filtration element consisting of a set of parallel cylindrical pores is derived. The overall penetration of heterogeneous composite filtration elements shows an algebraic dependence to the fourth power on the radii of the individual pores that are contained. This gives rise to strong variations in the overall penetration in cases with uneven distributions of pore sizes, highly favoring filtration by the larger pores. The overall penetration is computed for a number of basic geometries, providing a point of reference for filtration design and experimental verification.

Deep penetration of light into biotissue

Science.gov (United States)

Bearden, Edward D.; Wilson, James D.; Zharov, Vladimir P.; Lowery, Curtis L.

2001-07-01

The results of a study of deep (several centimeters) light penetration into biological tissue are presented in order to estimate its significance to potentially photosensitive structures and processes including the fetal eyes. In order to accomplish this goal, samples of various tissues (fat, muscle, and uterus) from surgical patients and autopsies were examined with a double integrating sphere arrangement to determine their optical properties. The results were implemented in a Monte Carlo modeling program. Next, optical fiber probes were inserted into the uterus and abdominal wall of patients undergoing laparoscopic procedures. The fibers were couples to a photomultiplier tube with intervening filters allowing measurements of light penetration at various wavelengths. To determine the feasibility of stimulation in utero, a xenon lamp and waveguide were used to transilluminate the abdomen of several labor patients. Light in the range of 630 to 670 nm where the eye sensitivity and penetration depth are well matched, will likely provide the best chance of visual stimulation. Fetal heart rate, fetal movement, and fetal magnetoencephalography (SQUID) and electroencephalography (EEG) were observed in different studies to determine if stimulation has occurred. Since internal organs and the fetus are completely dark adapted, the amount of light required to simulate in our opinion could be on the order of 10(superscript -8 Watts.

Tratamento endovascular de lesões arteriais traumáticas Endovascular management of traumatic arterial injuries

Directory of Open Access Journals (Sweden)

Ruy Fernandes e Fernandes

2011-03-01

. Todos os procedimentos foram realizados com sucesso. Não se verificou mortalidade. No doente com RAS houve necessidade de cirurgia de descorticação pulmonar esquerda, por hematoma organizado, e o doente com FAV foi submetido com sucesso a nova embolização com coils por recorrência precoce de hematúria. Conclusão: O tratamento endovascular é, em casos seleccionados, uma alternativa válida e menos invasiva de lesões traumáticas complexas em regiões anatómicas de difícil acesso e morbi-mortalidade cirúrgica elevada.Introduction: Traumatic vascular injuries are present in less than 10% of patients with multi-organ trauma and, in western countries, the incidence of iatrogenic vascular lesions has been increasing. Conventional surgery in the approach of these lesions usually requires extended surgical exposure, presents increased technical challenges and has high morbidity and mortality. Recently, several authors have described the successful management of traumatic injuries with endovascular techniques with diminished surgical risk. Endovascular surgery has also been increasingly applied in management of chronic traumatic injuries like chronic post-traumatic thoracic aneurysms with significant improved outcomes. The authors present clinical cases with several acute and chronic traumatic vascular injuries treated with endovascular techniques, Clinical reports: Seven patients (21-77 years with traumatic vascular injuries were treated. Four patients presented acute injuries: 1 case of traumatic aortic injury in a patient with multi-organ trauma after automobile crash; 1 case of iatrogenic subclavian artery rupture after inadvertent subclavian artery catheterization during attempted venous central access ; 1 case of iatrogenic renal artery rupture during renal angioplasty and stenting; 1 case of iatrogenic intra-renal arterio-venous fistula (AVF after laparoscopic resection of a renal tumour. Three patients presented with chronic post-traumatic thoracic aneurysms

The epidemiology, evaluation, and management of stingray injuries.

Science.gov (United States)

Diaz, James H

2007-01-01

A descriptive analysis and review of the world's salient scientific literature on stingray injuries was conducted in light of recent high-profile cases of fatal and near-fatal thoracic stingray injuries to guide clinicians in evaluating and managing stingray injuries. Data was extracted from observational and longitudinal studies over the period, 1950-2006, to permit (1) a stratification of stingray injuries as bites, penetrating lacerations with and without envenoming, and combinations of deeply penetrating and envenoming wounds; and (2) an assessment of new management strategies for thoracoabdominal penetrating trauma and non-healing, necrotic stingray wounds. Unlike their Chondrichthyes classmates, the sharks, stingrays are docile and non-aggressive; and will not attack with their spined tails, unless provoked. Although some occupations are predisposed to stingray injuries, most stingray injuries can be avoided by observing seafloors and adopting simple practices when wading, swimming, diving, or fishing in temperate oceans and some tropical freshwater river systems. All stingray injuries should be managed initially with wound irrigation to dislodge retained spine fragments and envenoming tissues and warm water immersion to inactivate heat-labile toxins.

Penetration tests to study the mechanical tribological properties of chisel type knife

Science.gov (United States)

Vlăduţoiu, L.; Chişiu, G.; Andrei, T.; Predescu, A.; Muraru, C.; Vlăduţ, V.

2017-02-01

The goal of this study was to analyze the behaviour of chisel knife type penetration in a certain type of sand. A series of penetration tests were carried out with chisel knife type, the answer to penetration depending mainly on nature, shape, size of knife and operating parameters such as speed, depth and working conditions. Tests were conducted in work conditions with wet sand and dry sand and determined force of resistance to penetration of the chisel knife type to a certain depth.

Penetrating pancreatico-duodenal injuries: a 2-year experience at cmh peshawar

International Nuclear Information System (INIS)

Bashir, R.A.; Qasmi, S.A.; Waqas, A.

2012-01-01

Objective: To outline the various treatment options and outcomes in penetrating pancreatico-duodenal injuries with emphasis on the operative decision making strategies. Study Design: Descriptive study. Place and Duration of Study: Department of Surgery at Combined Military Hospital Peshawar, from 1st June 2008 to 30th May 2010. Patients and Methods: All combat casualties with penetrating pancreaticoduodenal injuries (PPDI) received in 'Emergency reception' of Combined Military Hospital, Peshawar were included. Data was taken from the patients medical charts and by personal evaluation and entered in a proforma. The variables used were age, sex, cause of the injury, haemo-dynamic status, conscious level, intensive care treatment duration, time to initial exploration, associated injury, grade of pancreatic injury according to Penetrating Abdominal Trauma Index (PATI) scoring system, grade of duodenal injury (according to PATI scoring system), total PATI score, operative repair, total hospital stay, morbidity, and mortality. Results: Twenty three patients having either or both of PPDI were included in the study out of 196 combat casualities. No case was excluded on basis of presence of associated injury. Mean age was 29.26 years (SD+-6.489) with only one (4.3%) case of female gender, the rest were male patients or soldiers. Nineteen (82.6%) cases had primary mechanism/cause of injury being splinters from Improvised Explosive Devices (IEDs) or bomb blasts; while 4 (17.4%) cases had Gunshot Wounds. Eighteen (78.3%) patients were haemo-dynamically stable on arrival while 5 (21.7%) patients were unstable. Mean duration of stay in hospital was 10.6 days, with a range of 1-19 days (cases with high PATI score and un-stable haemodynamic status died with-in 24 hrs). Most cases of pancreatico-duodenal injury were of mild severity i.e. grade-1 or 2 and we encountered no case of grade-5 PPDI. Most commonly occurring associated injury was to small gut. Overall mortality was 6 (26

Persistent enhancement of bacterial motility increases tumor penetration.

Science.gov (United States)

Thornlow, Dana N; Brackett, Emily L; Gigas, Jonathan M; Van Dessel, Nele; Forbes, Neil S

2015-11-01

Motile bacteria can overcome the transport limitations that hinder many cancer therapies. Active bacteria can penetrate through tissue to deliver treatment to resistant tumor regions. Bacterial therapy has had limited success, however, because this motility is heterogeneous, and within a population many individuals are non-motile. In human trials, heterogeneity led to poor dispersion and incomplete tumor colonization. To address these problems, a swarm-plate selection method was developed to increase swimming velocity. Video microscopy was used to measure the velocity distribution of selected bacteria and a microfluidic tumor-on-a-chip device was used to measure penetration through tumor cell masses. Selection on swarm plates increased average velocity fourfold, from 4.9 to 18.7 μm/s (P < 0.05) and decreased the number of non-motile individuals from 51% to 3% (P < 0.05). The selected phenotype was both robust and stable. Repeating the selection process consistently increased velocity and eliminated non-motile individuals. When selected strains were cryopreserved and subcultured for 30.1 doublings, the high-motility phenotype was preserved. In the microfluidic device, selected Salmonella penetrated deeper into cell masses than unselected controls. By 10 h after inoculation, control bacteria accumulated in the front 30% of cell masses, closest to the flow channel. In contrast, selected Salmonella accumulated in the back 30% of cell masses, farthest from the channel. Selection increased the average penetration distance from 150 to 400 μm (P < 0.05). This technique provides a simple and rapid method to generate high-motility Salmonella that has increased penetration and potential for greater tumor dispersion and clinical efficacy. © 2015 Wiley Periodicals, Inc.

Measurement of Skin Permeation/Penetration of Nanoparticles for Their Safety Evaluation

OpenAIRE

木村, 恵理子; 河野, 雄一郎; 藤堂, 浩明; 五十嵐, 良明; 杉林, 堅次

2012-01-01

The aim of the present study was to quantitatively evaluate the skin permeation/penetration of nanomaterials and to consider their penetration pathway through skin. Firstly, penetration/permeation of a model fluorescent nanoparticle, Fluoresbrite?, was determined through intact rat skin and several damaged skins. Fluoresbrite? permeated through only needle-punctured skin. The permeation profiles of soluble high molecular compounds, fluorescein isothiocyanate-dextrans (FITC-dextrans, FDs), wit...

The Effect of Bacteria Penetration on Chalk Permeability

DEFF Research Database (Denmark)

Halim, Amalia Yunita; Shapiro, Alexander; Nielsen, Sidsel Marie

number of B. licheniformis was detected on the effluent compared with P. putida. However, in the experiment with B. licheniformis mainly spores were detected in the effluent. The core permeability decreased rapidly during injection of bacteria and a starvation period of 12 days did not allow......Bacteria selective plugging is one of the mechanisms through which microorganisms can be applied for enhanced oil recovery. Bacteria can plug the water-bearing zones of a reservoir, thus altering the flow paths and improving sweep efficiency. It is known that the bacteria can penetrate deeply...... into reservoirs, however, a complete understanding of the penetration behavior of bacteria is lacking, especially in chalk formations where the pore throat sizes are almost comparable with the sizes of bacteria vegetative cells. This study investigates the penetration of bacteria into chalk. Two bacteria types...

Mechanism of long-range penetration of low-energy ions in botanic samples

International Nuclear Information System (INIS)

Liu Feng; Wang Yugang; Xue Jianming; Wang Sixue; Du Guanghua; Yan Sha; Zhao Weijiang

2002-01-01

The authors present experimental evidence to reveal the mechanism of long-range penetration of low-energy ions in botanic samples. In the 100 keV Ar + ion transmission measurement, the result confirmed that low-energy ions could penetrate at least 60 μm thick kidney bean slices with the probability of about 1.0 x 10 -5 . The energy spectrum of 1 MeV He + ions penetrating botanic samples has shown that there is a peak of the count of ions with little energy loss. The probability of the low-energy ions penetrating the botanic sample is almost the same as that of the high-energy ions penetrating the same samples with little energy loss. The results indicate that there are some micro-regions with mass thickness less than the projectile range of low-energy ions in the botanic samples and they result in the long-range penetration of low-energy ions in botanic samples

Capillaric penetration of etchant solution into swift heavy ion-irradiated silicone rubber

International Nuclear Information System (INIS)

Fink, D.; Mueller, M.

2000-01-01

There is growing evidence that etchants penetrate into latent ion tracks in polymers from the very beginning, i.e., even during the so-called 'incubation time' when no visible etchant attack is observed. The model of capillaric penetration of viscous liquids into sponge-like matter agrees with experimental values both in their parametric dependence as in the absolute values. Our experiments are based on LiOH etching of both pristine and swift heavy ion-irradiated silicone rubber foils. About five times more etchant penetrates into irradiated than into pristine silicone rubber. The overall etchant penetration is highest in tracks parallel to the surface normal, and decreases with increasing ion track tilt angle towards the surface normal. The etchant penetration into the tracks proceeds relatively slowly with an effective viscosity comparable to that of heavy machine oil. When swelling starts to predominate, the maximum etchant penetration depth comes to saturation, with the total etchant uptake even decreasing

Vena Cava Filter Retrieval with Aorto-Iliac Arterial Strut Penetration.

Science.gov (United States)

Holly, Brian P; Gaba, Ron C; Lessne, Mark L; Lewandowski, Robert J; Ryu, Robert K; Desai, Kush R; Sing, Ronald F

2018-05-03

To evaluate the safety and technical success of inferior vena cava (IVC) filter retrieval in the setting of aorto-iliac arterial strut penetration. IVC filter registries from six large United States IVC filter retrieval practices were retrospectively reviewed to identify patients who underwent IVC filter retrieval in the setting of filter strut penetration into the adjacent aorta or iliac artery. Patient demographics, implant duration, indication for placement, IVC filter type, retrieval technique and technical success, adverse events, and post procedural clinical outcomes were identified. Arterial penetration was determined based on pre-procedure CT imaging in all cases. The IVC filter retrieval technique used was at the discretion of the operating physician. Seventeen patients from six US centers who underwent retrieval of an IVC filter with at least one strut penetrating either the aorta or iliac artery were identified. Retrieval technical success rate was 100% (17/17), without any major adverse events. Post-retrieval follow-up ranging from 10 days to 2 years (mean 4.6 months) was available in 12/17 (71%) patients; no delayed adverse events were encountered. Findings from this series suggest that chronically indwelling IVC filters with aorto-iliac arterial strut penetration may be safely retrieved.

Pulsed lower-hybrid wave penetration in reactor plasmas

International Nuclear Information System (INIS)

Cohen, R.H.; Bonoli, P.T.; Porkolab, M.; Rognlien, T.D.

1989-01-01

Providing lower-hybrid power in short, intense (GW) pulses allows enhanced wave penetration in reactor-grade plasmas. We examine nonlinear absorption, ray propagation, and parametric instability of the intense pulses. We find that simultaneously achieving good penetration while avoiding parametric instabilities is possible, but imposes restrictions on the peak power density, pulse duration, and/or r.f. spot shape. In particular, power launched in narrow strips, elongated along the field direction, is desired

Chronic Disease Prevalence and Medicare Advantage Market Penetration

OpenAIRE

Steven W. Howard; Stephanie Lazarus Bernell; Faizan M. Casim; Jennifer Wilmott; Lindsey Pearson; Caitlin M. Byler; Zidong Zhang

2015-01-01

By March 2015, 30% of all Medicare beneficiaries were enrolled in Medicare Advantage (MA) plans. Research to date has not explored the impacts of MA market penetration on individual or population health outcomes. The primary objective of this study is to examine the relationships between MA market penetration and the beneficiary?s portfolio of cardiometabolic diagnoses. This study uses 2004 to 2008 Medical Expenditure Panel Survey (MEPS) Household Component data to construct an aggregate inde...