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Sample records for managed penetrating subclavian

  1. Management Strategy for Patients With Chronic Subclavian Vein Thrombosis.

    Science.gov (United States)

    Keir, Graham; Marshall, M Blair

    2017-02-01

    We performed a systematic review to determine best practice for the management of patients with chronic or subacute subclavian vein thrombosis. This condition is best managed with surgical excision of the first rib followed by long-term anticoagulation. Interventional techniques aimed at restoring patency are ineffective beyond 2 weeks postthrombosis. Additional therapeutic options should be made based on the severity of symptoms as well as vein status. Patients with milder symptoms are given decompression surgery followed by anticoagulation whereas patients with more severe symptoms are considered for either a jugular vein transposition or saphenous patch based on the vein characteristics. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Subclavian artery dissection during diagnostic cardiac catheterization: the role of conservative management.

    Science.gov (United States)

    Frohwein, S; Ververis, J J; Marshall, J J

    1995-04-01

    Dissection of the subclavian artery during routine cardiac catheterization while obtaining cannulation to the left internal mammary artery is an unusual complication and to our knowledge has never been reported. Conservative management of this vascular injury can avoid the sequelae of high-risk surgical repairs made difficult by a complex operative exposure. We describe a case in which dissection of the left subclavian artery was treated conservatively with an excellent outcome.

  3. Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

    Directory of Open Access Journals (Sweden)

    Brian O'Leary

    2015-08-01

    Full Text Available Subclavian vein stenosis is a common, but usually asymptomatic, complication following cardiac device placement. In addition to reviewing the literature on incidence, pathogenesis and management options for this important clinical problem, we describe two cases of symptomatic subclavian vein occlusion following pacemaker/defibrillator placement and successful treatment with venoplasty and stenting.

  4. Contemporary management of civilian penetrating cervicothoracic arterial injuries.

    Science.gov (United States)

    Weinberg, Jordan A; Moore, Andrew H; Magnotti, Louis J; Teague, Rebecca J; Ward, Tyler A; Wasmund, Joshua B; Lamb, Elena M P; Schroeppel, Thomas J; Savage, Stephanie A; Minard, Gayle; Maish, George O; Croce, Martin A; Fabian, Timothy C

    2016-08-01

    The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care. Patients with penetrating injuries to the innominate, carotid, subclavian, or axillary arteries managed at a single civilian trauma center between 2000 and 2013 were categorized as the modern era (ME) cohort. The management strategies and outcomes pertaining to the ME group were compared to those of previously reported experience (PE) concerning injuries to the innominate, carotid, subclavian, or axillary arteries at the same institution from 1974 to 1988. Over the two eras, there were 202 patients: 110 in the ME group and 92 in the PE group. Most of the injuries in both groups were managed with primary repair (45% vs. 46%; p = 0.89). A similar proportion of injuries in each group was managed with anticoagulation alone (14% vs. 10%; p = 0.40). In the ME group, two cases were managed with temporary shunt placement, and endovascular stent placement was performed in 12 patients. Outcomes were similar between the groups (bivariate comparison): mortality (ME, 15% vs. PE, 14%; p = 0.76), amputation following subclavian or axillary artery injury (ME, 5% vs. PE, 4%; p = 0.58), and posttreatment stroke following carotid injury (ME, 2% vs. PE, 6%; p = 0.57). Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries. Therapeutic study, level V.

  5. Contemporary management of subclavian and axillary artery injuries-A Western Trauma Association multicenter review.

    Science.gov (United States)

    Waller, Christine J; Cogbill, Thomas H; Kallies, Kara J; Ramirez, Luis D; Cardenas, Justin M; Todd, S Rob; Chapman, Kayla J; Beckman, Marshall A; Sperry, Jason L; Anto, Vincent P; Eriksson, Evert A; Leon, Stuart M; Anand, Rahul J; Pearlstein, Maura; Capano-Wehrle, Lisa; Cothren Burlew, Clay; Fox, Charles J; Cullinane, Daniel C; Roberts, Jennifer C; Harrison, Paul B; Berg, Gina M; Haan, James M; Lightwine, Kelly

    2017-12-01

    Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability. A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant. Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients. The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for

  6. Penetrating abdominal injuries: management controversies

    Science.gov (United States)

    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

  7. Penetrating abdominal injuries: management controversies

    Directory of Open Access Journals (Sweden)

    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.

  8. Subclavian steal syndrome without subclavian stenosis

    Directory of Open Access Journals (Sweden)

    Matt Cwinn, MD

    2017-09-01

    Full Text Available Subclavian steal syndrome (SSS has been well described in the setting of subclavian stenosis. We describe an unusual case of SSS caused by a high-flow arteriovenous dialysis fistula in the absence of subclavian stenosis, provide a review of the literature, and propose that arteriovenous fistula-induced SSS is an underdiagnosed cause of syncope in this population of patients.

  9. 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

  10. Penetrating spinal injuries and their management

    Directory of Open Access Journals (Sweden)

    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.

  11. Partial subclavian steal syndrome in a congenitally anomalous subclavian artery

    International Nuclear Information System (INIS)

    Krnic, A.; Sucic, Z.; Vucic, N.; Krolo, I.

    2006-01-01

    Background. A subclavian steal syndrome results from the abnormal flow of blood due to the occlusion in the subclavian artery proximal to the origin of the vertebral artery. A case of a male patient with a partial subclavian steal syndrome is presented. Case report. The syndrome was caused by a stenotic lesion of an aberrant right subclavian artery (the so called lusorian artery). The partial subclavian steal was recognized using the duplex ultrasound which showed the to and fro pattern in the right vertebral artery. Angiography of the aortic arch revealed the arterial anomaly. In our case, duplex ultrasound was a crucial method in diagnosing the partial subclavian steal syndrome. However, in order to show the arterial anomaly, the final evaluation had to be performed using arteriography. Conclusions. The early recognized partial subclavian steal syndrome provides good understanding of patient's symptoms, successful follow up, and a variety of treatment options. (author)

  12. 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.

  13. 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] ...

  14. 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.

  15. 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...

  16. Carotid-subclavian bypass for subclavian steal syndrome following coarctation repair in infancy

    Directory of Open Access Journals (Sweden)

    Scott Chowning

    2012-01-01

    Full Text Available A 19 year old man presented with dizziness that was exacerbated while using left arm. On investigation, subclavian steal syndrome (SSS was diagnosed. He underwent left carotid to subclavian bypass with relief of symptoms. Subclavian steal syndrome, although rare, should be considered in the differential diagnosis in patients with the history of subclavian artery manipulation in the past in proper settings.

  17. 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 ...

  18. Subclavian steal syndrome: treatment by percutaneous transluminal angioplasty

    International Nuclear Information System (INIS)

    Abath, Carlos Gustavo Coutinho; Silva, Marcos Antonio Barbosa da; Brito, Norma Maria Tenorio; Marques, Silvio Romero; Santa Cruz, Rodolfo

    1995-01-01

    The subclavian steal syndrome is a rare vascular disease that can be managed by interventional radiology. It is presented the experience with three cases of this syndrome that underwent percutaneous transluminal angioplasty, and a brief literature review is done. Two patients remained asymptomatic 23 and 30 months, respectively, after the procedure. One patient presented with recurrent symptoms 12 months after the dilatation. Considering the low morbidity and good clinical and technical results, percutaneous transluminal angioplasty is the first choice in the subclavian steal syndrome treatment. (author). 9 refs., 3 figs

  19. Operative management of penetrating carotid artery injuries.

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    Reva, V A; Pronchenko, A A; Samokhvalov, I M

    2011-07-01

    To analyse management and outcomes of carotid artery (CA) injuries. Retrospective study of the patients in the combat operations in Chechnya (1999-2002) and in peacetime (2003-2009). A total of 46 patients with missile (27) and stab (19) wounds, who had common and internal CA injury, underwent an open surgery. Temporary shunts (TSs) were placed in eight patients with more severe injuries. Retrospective analysis of patients' data. CA ligation and CA repair were performed in 9 and 37 patients, respectively. Of the nine patients with CA ligation, five developed neurologic deficit; the remaining four patients died (100% of poor outcomes). Of the 37 patients with blood flow restoration, nine patients died and neurologic deficit persisted in two patients (30% of poor outcomes) (p < 0.05). Among patients with TS, three patients died and two had stable neurologic deficit (63% of poor results). Of the patients without TS, 10 patients died and five had neurologic disorders (56% of poor outcomes) (p = 0.53). CA repair is the method of choice in CA injury. TS use does not result in a decreased mortality rate or neurologic deficit reduction in patients with severe injuries. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  20. 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...

  1. 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

  2. Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries

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    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

  3. 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.

  4. Applications and complications of subclavian vein catheterization for hemodialysis

    International Nuclear Information System (INIS)

    Kamran, T.; Zaheer, K.; Khan, A.A.; Khalid, M.; Akhtar, M.S.

    2003-01-01

    Objective: To study the indications, complications and duration of 605 subclavian catheters inserted over a period of 4 years as venous access for the management of renal failure in local setup. Results: Among the patients who underwent subclavian vien catheterization, 75.2% patients were suffering from chronic renal failure and 24.7% patients were admitted for acute renal failure. Among chronic renal failure patients, 21.9% catheters had to be replaced due to various complications e.g. thrombosis, infection or kinking of the catheter. The subclavian catheters remained in place for a mean duration of 4 weeks. Early complications encountered were arterial puncture, inability to cannulate the innominate vein, hemo thorax, punctures of thoracic duct, hemo mediastinum, arrhythmias and pulmonary hematoma in 10.7%, 16.5%, 0.5%, 0.2%, 0.6% and 0.2% of patients respectively. Mortality attributed to the procedure occurred in 0.1 % cases. Delayed complications included early infection in 15% catheterizations while delayed infection occurred in 39 % cases. Conclusion: Percutaneous subclavian catheterization is valuable, relatively easy to learn and safe method with acceptable rate of complications for patients necessitating hemodialysis and no established permanent vascular access. (author)

  5. 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

  6. 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.)

  7. A Rare Entity: Traumatic Thoracic Aortic Injury in a Patient with Aberrant Right Subclavian Artery.

    Science.gov (United States)

    Patel, Hiten Mohanbhai; Banerjee, Shubhabrata; Bulsara, Shahzad; Sahu, Tapish; Sheorain, Virender K; Grover, Tarun; Parakh, Rajiv

    2017-05-01

    Aberrant right subclavian artery is an uncommon entity incidence ranging from 0.5 to 2.5%. Management of thoracic aortic injury in the presence of such anomalies can be a challenge. We present here a case of traumatic aortic injury, which was incidentally found to have an asymptomatic aberrant right subclavian artery. The patient was managed by an endovascular repair of thoracic aortic injury with an endograft and a right carotid to subclavian artery bypass as a hybrid procedure. A 40-year male patient was brought to the emergency in shock with an alleged history of road traffic accident an hour back. After initial resuscitation as per advance trauma life support protocol, imaging revealed thoracic aortic injury with aberrant right subclavian artery with multiple rib and bilateral humerus fracture. After primary stabilization of arm fractures, the patient was shifted to a hybrid operation room. As the aortic injury was within 10 mm of the origin of both subclavian arteries, it was decided to cover the origin of both subclavian arteries and land the endograft distal to the left carotid artery origin. Since there was a right dominant vertebral artery on imaging, right carotid to right subclavian artery bypass was done with expanded polytetrafluoroethylene graft to prevent posterior circulatory stroke along with thoracic endovascular aortic repair to seal the thoracic aortic injury. After endovascular repair of thoracic aortic injury, left subclavian artery perfusion was maintained through left vertebral artery; and hence, revascularization of left subclavian artery was deferred. After management of all fractures, the patient was discharged 3 weeks after the date of admission without any complications. At 6 months follow-up, patient was stable and images showed patent bypass graft and sealed aortic injury. In a trauma setting with multiple injuries, hybrid procedure with a thoracic endograft is associated with low mortality and morbidity; hence, it is the treatment

  8. Retroesophageal right subclavian artery: a case report and review of ...

    African Journals Online (AJOL)

    Retroesophageal right subclavian artery: a case report and review of the literature. Anthony Ocaya. Department ... the left subclavian artery, and the left common carotid artery. Adachi first .... Vol 2, New York: Harper & Row. 1968. 13. Tubbs SR ...

  9. 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.

  10. 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.

  11. Surgical treatment of massive bleeding of a right aberrant subclavian artery after oesophageal stent removal

    Directory of Open Access Journals (Sweden)

    Michael Raum

    2018-06-01

    Full Text Available We report a case of a 9-year-old female who required surgical treatment and resuscitation after severe transoesophageal bleeding of a right aberrant subclavian artery (RASA. Bleeding of this RASA was caused by a mechanical irritation due to an oesophageal stent. The stent was placed weeks before to dilate the oesophagus after accidental ingestion of a caustic agent. Although conservative management of benign oesophageal stenosis in children is highly recommended, there are still some major complications to be considered. To avoid erosion of aberrant subclavian artery vascular rings and slings, as described in several case reports, these vessels should be excluded by computed tomography (CT or magnetic resonance imaging (MRI scans before placement of oesophageal stents. This case suggests that management of caustic ingestion in children is still a major challenge in paediatric surgical departments. Keywords: Paediatric surgery, Chemical Burn, Oesophageal stenosis, Oesophageal stenting, Vascular abnormalities, Right aberrant subclavian artery

  12. Endo-aneurysmorrhaphy of a giant aneurysm of the subclavian vein

    Directory of Open Access Journals (Sweden)

    Ahmed Afifi

    2012-07-01

    Full Text Available Venous aneurysms are relatively rare anomalies which can affect different parts of the vascular system. Diagnosis and management of this condition could pose important problems. We here report a giant false aneurysm of the subclavian vein with emphasis on the thought process that determined the management strategy.

  13. 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

  14. Color doppler imaging of subclavian steal phenomenon

    International Nuclear Information System (INIS)

    Cho, Nari Ya; Chung, Tae Sub; Kim, Jai Keun

    1997-01-01

    To evaluate the characteristic color doppler imaging of vertebral artery flow in the subclavian steal phenomenon. The study group consisted of eight patients with reversed vertebral artery flow proved by color Doppler imaging. We classified this flow into two groups:(1) complete reversal;(2) partial reversal, as shown by Doppler velocity waveform. Vertebral angiography was performed in six of eight patients;color Doppler imaging and angiographic findings were compared. On color Doppler imaging, all eight cases with reversed vertebral artery flow showed no signal at the proximal subclavian or brachiocephalic artery. We confirmed shunting of six cases by performing angiography from the contralateral vertebral and basilar artery to the ipsilateral vertebral artery. On the Doppler spectrum, six cases showed complete reversal and two partial reversal. On angiography, one partial reversal case showed complete occlusion of the subclavian artery with abundant collateral circulation of muscular branches of the vertebral artery. On color Doppler imaging, a reversed vertebral artery suggests the subclavian steal phenomenon. In particular, partial reversal waveform may reflect collateral circulation

  15. 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)

  16. Validation of subclavian duplex velocity criteria to grade severity of subclavian artery stenosis.

    Science.gov (United States)

    Mousa, Albeir Y; Morkous, Ramez; Broce, Mike; Yacoub, Michael; Sticco, Andrew; Viradia, Ravi; Bates, Mark C; AbuRahma, Ali F

    2017-06-01

    Validation of subclavian duplex ultrasound velocity criteria (SDUS VC) to grade the severity of subclavian artery stenosis has not been established or systematically studied. Currently, there is a paucity of published literature and lack of practitioner consensus for how subclavian duplex velocity findings should be interpreted in patients with subclavian artery stenosis. The objective of the present study was to validate SDUS measurements using subclavian conventional or computed tomography angiogram (subclavian angiogram [SA])-derived measurements. Secondary objectives included measuring the correlation between SDUS peak systolic velocities and SA measurements, and to determine the optimal cutoff value for predicting significant stenosis (>70%). This is a retrospective review of all patients with suspected subclavian artery stenosis and a convenience sample of carotid artery patients who underwent SDUS and SA from May 1999 to July 2013. SA reference vessel and intralesion minimal lumen diameters were measured and compared with SDUS velocities obtained within 3 months of the imaging study. Percent stenosis was calculated using the North American Symptomatic Carotid Endarterectomy Trial method for detecting stenosis in a sufficiently large cohort. Receiver operating characteristic curves was generated for SDUS VC to predict >70% stenosis. Velocity cutoff points were determined with equal weighting of sensitivity and specificity. We examined 268 arteries for 177 patients. The majority of the arteries were for female patients (52.5%) with a mean age of 66.7 ± 11.1 years. Twenty-three arteries had retrograde vertebral artery flow and excluded from further analysis. For the remaining 245 arteries, the average peak systolic velocity was 212.6 ± 110.7 cm/s, with a range of 45-626 cm/s. Average stenosis was 25.8% ± 28.2%, with a range of 0% to 100%. Following receiver operating characteristic analysis, we found a cutoff value of >240 cm/s to be most predictive

  17. 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...

  18. 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...

  19. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

    Directory of Open Access Journals (Sweden)

    Szkup Peter

    2006-05-01

    Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

  20. 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 ...

  1. 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.

  2. 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

  3. Doppler Ultrasonography in Suspected Subclavian Artery Obstruction and in Patient Monitoring after Subclavian Stenting

    International Nuclear Information System (INIS)

    Kablak-Ziembicka, Anna; Przewlocki, Tadeusz; Pieniazek, Piotr; Musialek, Piotr; Kozanecki, Artur; Stopa, Ireneusz; Zalewski, Jaroslaw; Tracz, Wieslawa

    2007-01-01

    Purpose. Subclavian or innominate artery (SIA) stenosis affects up to 5% of patients referred to coronary bypass grafting; it is symptomatic in less than half of these. This study aimed to assess the Doppler ultrasonography (DU) findings in SIA obstruction and patients' follow-up after percutaneous angioplasty (PTA). Methods. The study enrolled 118 patients (68 men, 50 women), aged 61.3 ± 8.7 years, with suspected SIA obstruction, in whom peak systolic velocity (PSV) in the SIA and subclavian steal grade were assessed on DU and verified by quantitative angiography (QA). Serial follow-up DU was performed in patients treated with PTA. Results. Grade I-III of subclavian steal from the vertebral artery (VA) was found in 89.8% of patients. In the remaining 10.2% only a PSV increase in the SIA was observed. QA confirmed the presence of SIA obstruction in all patients (stenosis grade: 80.9 ± 17.3%). In patients with one-sided SIA obstruction, the ultrasonographic steal grade correlated with the QA stenosis grade (p < 0.001, r = 0.648). Lack of subclavian steal was noted in the case of distal subclavian stenosis, VA obstruction, VA originating from the aortic arch, and bilateral SIA obstruction. Successful PTA was performed in 77 of 83 patients referred to that procedure. PSV was reduced from 4.4 ± 1.2 (2.2-6.5) m/sec to 1.34 ± 0.51 (0.5-2.5) m/sec and flow in the VA was normalized. During the mean follow-up time of 24.7 ± 15.6 months, there was a gradual increase in the in-stent PSV as well as gradual VA flow alterations, resulting in symptom recurrence. More than a twofold PSV increase, compared with the post-PTA values, was an indicator of restenosis in 11 of 12 patients. Conclusions. Careful DU evaluation enables the recognition of SIA obstruction in all patients. Ninety percent of them have subclavian steal correlating with the stenosis grade. Restenosis can be reliably detected with DU based on in-stent PSV and VA flow alterations

  4. 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

  5. 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...

  6. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Supraclavicular versus Infraclavicular Subclavian Vein Catheterization in Infants

    Directory of Open Access Journals (Sweden)

    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.

  9. 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.

  10. Right cervical aortic arch with aberrant left subclavian artery.

    Science.gov (United States)

    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.

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. Isolated Subclavian Vein Injury: A Rare and High Mortality Case

    Directory of Open Access Journals (Sweden)

    Sahin Iscan

    2013-01-01

    Full Text Available Isolated subclavian vein injuries are rarely seen without concomitant arterial injury, bone fracture, damage to brachial plexus, and thoracal traumas. Our case was brought to the emergency service 6 hours after he had been shot at the shoulder with a firearm. After detection of extravasation from the left axillary and subclavian vein on arteriographic and venographic examinations, he was operated on. An autogenous saphenous vein graft was interposed between subclavian and axillary veins. Cardiac arrest developed twice because of hypovolemia, which was resolved with medical therapy. Subclavian vein injuries have a more mortal course when compared with the injuries to the subclavian arteries. Its most important reason is excessive blood loss and air embolism because of delayed arrival to hospital. As is the case in all vascular injuries, angiography is the most important diagnostic examination. If the general health state of the patient permits, arteriography and venography should be performed in patients potentially exposed to vascular injuries. In patients with extreme blood loss and deteriorated health state, direct surgical exploration of the injury site, containment of the bleeding, and venous repair are life-saving approaches.

  16. 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

  17. 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.

  18. 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.

  19. 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.

  20. TrapEase inferior vena cava filter placement: use of the subclavian vein.

    Science.gov (United States)

    Stone, Patrick A; Aburahma, Ali F; Hass, Stephen M; Hofeldt, Matthew J; Zimmerman, William B; Deel, John T; Deluca, John A

    2004-01-01

    The purpose of this paper was to evaluate the safety and technical success of TrapEase inferior vena cava filter placement via the subclavian vein. As of yet, no reports in the literature have specifically investigated the use of the subclavian vein as a route for deploying TrapEase vena cava filters. Retrospective chart review was conducted of 135 patients with attempted TrapEase inferior vena cava filter placement over a 2-year period. In a majority of cases, the choice of subclavian vein approach was based primarily on surgeon preference. Other circumstances for subclavian vein deployment included cervical immobilization secondary to trauma, desire for concomitant placement of a subclavian long-term central venous access catheter, and patient body habitus limiting exposure to the internal jugular vein. One hundred and thirty-five filters were placed over this 2-year period. The internal jugular vein approach was used in 56 patients, the femoral vein approach in 39 patients, and the subclavian vein approach in 40 patients. Thirty-nine of the 40 TrapEase filter placements using the subclavian vein were successful. Twenty-six were deployed through the right subclavian vein and 14 through the left subclavian vein. The single failed subclavian deployment was due to the inability to pass the guidewire adequately into the inferior vena cava after successful cannulation of the right subclavian vein. The average deployment time for subclavian vein placement was 26 minutes when TrapEase filter placement was the only procedure performed. No insertional complications were encountered, specifically no pneumothoraces confirmed by chest radiography or fluoroscopy. The subclavian vein provides an alternative site of access for the TrapEase inferior vena cava filter. This route is comparable to other alternative methods evaluated both in average deployment time and complication occurrence. Furthermore, the subclavian vein route is valuable in patients with limited central access

  1. 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...

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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.)

  7. 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

  8. 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.

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

    Science.gov (United States)

    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.

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. 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.)

  16. 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.

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

    Science.gov (United States)

    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.

  18. 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)

  19. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

  3. 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.

  4. 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...

  5. [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...

  6. 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

  7. 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.

  8. 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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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...

  12. 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)

  13. 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.

  14. 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

  15. 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).

  16. 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.

  17. 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

  18. 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.

  19. 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)

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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)

  2. 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.

  3. 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.

  4. 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.

  5. 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

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

    Science.gov (United States)

    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.

  7. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma

    Directory of Open Access Journals (Sweden)

    Milanchi S

    2009-01-01

    Full Text Available Background: The role of video-assisted Thoracoscopic Surgery (VATS is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. Materials and Methods: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Results: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26 and the length of hospital stay was 20 days (range 3-58. There was no mortality. VATS was performed in an emergency (day 1-2, or in the early (day 2-7 or late (after day 7 phases of trauma. Conclusion: VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late, each with different indications.

  8. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma.

    Science.gov (United States)

    Milanchi, S; Makey, I; McKenna, R; Margulies, D R

    2009-01-01

    The role of video-assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26) and the length of hospital stay was 20 days (range 3-58). There was no mortality. VATS was performed in an emergency (day 1-2), or in the early (day 2-7) or late (after day 7) phases of trauma. VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late), each with different indications.

  9. The impact of demand side management strategies in the penetration of renewable electricity

    International Nuclear Information System (INIS)

    Pina, André; Silva, Carlos; Ferrão, Paulo

    2012-01-01

    High fuel costs, increasing energy security and concerns with reducing emissions have pushed governments to invest in the use of renewable energies for electricity generation. However, the intermittence of most renewable resources when renewable energy provides a significant share of the energy mix can create problems to electricity grids, which can be minimized by energy storage systems that are usually not available or expensive. An alternative solution consists on the use of demand side management strategies, which can have the double effect of reducing electricity consumption and allowing greater efficiency and flexibility in the grid management, namely by enabling a better match between supply and demand. This work analyzes the impact of demand side management strategies in the evolution of the electricity mix of Flores Island in the Azores archipelago which is characterized by high shares of renewable energy and therefore the introduction of more renewable energy sources makes it an interesting case study for testing innovative solutions. The electricity generation system is modeled in TIMES, a software which optimizes the investment and operation of wind and hydro plants until 2020 based on scenarios for demand growth, deployment of demand response technologies in the domestic sector and promotion of behavioral changes to eliminate standby power. The results show that demand side management strategies can lead to a significant delay in the investment on new generation capacity from renewable resources and improve the operation of the existing installed capacity. -- Highlights: ► Energy efficiency can help reduce the need for investment in more renewable energy. ► Dynamic demand helps increase the use of renewable energy in low demand periods. ► Around 40% of total consumption by domestic appliances is used as dynamic demand. ► The load of domestic appliances is mainly shifted to the 5:00 to 9:00 period.

  10. Refractory Hypotension as an Initial Presentation of Bilateral Subclavian Artery Stenosis

    Directory of Open Access Journals (Sweden)

    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.

  11. 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®.

  12. Bedside prediction of right subclavian venous catheter insertion length

    Directory of Open Access Journals (Sweden)

    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.

  13. 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...

  14. 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.

  15. Voltage management of distribution networks with high penetration of distributed photovoltaic generation sources

    Science.gov (United States)

    Alyami, Saeed

    Installation of photovoltaic (PV) units could lead to great challenges to the existing electrical systems. Issues such as voltage rise, protection coordination, islanding detection, harmonics, increased or changed short-circuit levels, etc., need to be carefully addressed before we can see a wide adoption of this environmentally friendly technology. Voltage rise or overvoltage issues are of particular importance to be addressed for deploying more PV systems to distribution networks. This dissertation proposes a comprehensive solution to deal with the voltage violations in distribution networks, from controlling PV power outputs and electricity consumption of smart appliances in real time to optimal placement of PVs at the planning stage. The dissertation is composed of three parts: the literature review, the work that has already been done and the future research tasks. An overview on renewable energy generation and its challenges are given in Chapter 1. The overall literature survey, motivation and the scope of study are also outlined in the chapter. Detailed literature reviews are given in the rest of chapters. The overvoltage and undervoltage phenomena in typical distribution networks with integration of PVs are further explained in Chapter 2. Possible approaches for voltage quality control are also discussed in this chapter, followed by the discussion on the importance of the load management for PHEVs and appliances and its benefits to electric utilities and end users. A new real power capping method is presented in Chapter 3 to prevent overvoltage by adaptively setting the power caps for PV inverters in real time. The proposed method can maintain voltage profiles below a pre-set upper limit while maximizing the PV generation and fairly distributing the real power curtailments among all the PV systems in the network. As a result, each of the PV systems in the network has equal opportunity to generate electricity and shares the responsibility of voltage

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

    Science.gov (United States)

    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.

  17. 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

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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)

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

    Science.gov (United States)

    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.

  4. 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)

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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 ...

  7. "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.

  8. 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

  9. "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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  13. 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

  14. 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.

  15. 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.

  16. 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...

  17. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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...

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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

  9. 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.

  10. 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

  11. 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.)

  12. Penetrating ureteral trauma

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    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.

  13. 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.

  14. 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.

  15. 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.

  16. Management of Extreme Ametropia after Penetrating Keratoplasty: A Series of Surgical Procedures for High Myopia and Astigmatism

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    Jorge E. Valdez-Garcia

    2014-08-01

    Full Text Available A series of surgical interventions - relaxing corneal incisions, intraocular lens, and intrastromal rings - were used to correct a case of extreme ametropia in a thin cornea after a penetrating keratoplasty in an 18-year-old patient who presented with a -10.25 -8.50 × 120 preoperative refraction and 20/200 best-corrected visual acuity (BCVA. After a series of surgical procedures, the patient's BCVA in his left eye improved to 20/30 with +0.50 -1.00 × 170, the slit lamp examination showed no significant findings, and the patient's visual complaints disappeared. At the 1-year follow-up, the BCVA was 20/25, without visual complaints. The process of individualizing the surgical procedure in the present case was employed in an outcome-based approach, that is, the next surgical procedure was defined after the surgery and postoperative evaluation. The patient did not present complications during the follow-up period of 2.5 years.

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

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    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.

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

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    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.

  19. Penetrating abdominal trauma.

    Science.gov (United States)

    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

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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.

  3. Application of Model Predictive Control for Active Load Management in a Distributed Power System with High Wind Penetration

    DEFF Research Database (Denmark)

    Zong, Yi; Kullmann, Daniel; Thavlov, Anders

    2012-01-01

    management. It also presents in detail how to implement a thermal model predictive controller (MPC) for the heaters' power consumption prediction in the PowerFlexHouse. It demonstrates that this MPC strategy can realize load shifting, and using good predictions in MPC-based control, a better matching...

  4. Surgical management of cutaneous infection caused by atypical mycobacteria after penetrating injury: the hidden dangers of horticulture.

    Science.gov (United States)

    Holland, J; Smith, C; Childs, P A; Holland, A J

    1997-02-01

    We identified two patients in a 12-month period who presented with cutaneous infection and secondary lymph node involvement from atypical mycobacterial infection after minor gardening injuries. One patient had a coinfection with Nocardia asteroides. Both patients required multiple surgical interventions, despite appropriate antibiotic therapy, before resolution of the disease. The course of the infection was characterized by chronic relapses with complete healing at 12 to 18 months after the original injury. The identification and management of this clinical problem are reviewed.

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

    OpenAIRE

    Jaramillo, Paula M.; Montoya, Jaime A.; Mejia, David A.; Pereira Warr, Salin

    2018-01-01

    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,...

  6. 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.

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

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    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.

  8. 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...

  9. 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,

  10. 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

  11. 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

  12. Airway Management in a Patient With Tracheal Disruption due to Penetrating Neck Trauma With Hollow Point Ammunition: A Case Report.

    Science.gov (United States)

    Johnson, Angela M; Hill, James L; Zagorski, Dave J; McClain, Joseph M; Maronian, Nicole C

    2018-05-01

    Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver. Subcutaneous emphysema had developed. The endotracheal tube was advanced into the right mainstem with adequate ventilation. Imaging illustrated tracheoesophageal injury. The patient was emergently explored. An intraluminal bullet was removed, lateral wall tracheal defect was repaired, and a tracheostomy was placed. The intubating provider should secure the airway by the method they are most comfortable, have high suspicion of airway injury, and prepare to manage airway disruption.

  13. 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.

  14. 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.

  15. 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.

  16. Different Predictive Control Strategies for Active Load Management in Distributed Power Systems with High Penetration of Renewable Energy Sources

    DEFF Research Database (Denmark)

    Zong, Yi; Bindner, Henrik W.; Gehrke, Oliver

    2013-01-01

    In order to achieve a Danish energy supply based on 100% renewable energy from combinations of wind, biomass, wave and solar power in 2050 and to cover 50% of the Danish electricity consumption by wind power in 2020, it requires more renewable energy in buildings and industries (e.g. cold stores......, greenhouses, etc.), and to coordinate the management of large numbers of distributed energy resources with the smart grid solution. This paper presents different predictive control (Genetic Algorithm-based and Model Predictive Control-based) strategies that schedule controlled loads in the industrial...... and residential sectors, based on dynamic power price and weather forecast, considering users’ comfort settings to meet an optimization objective, such as maximum profit or minimum energy consumption. Some field tests were carried out on a facility for intelligent, active and distributed power systems, which...

  17. 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.

  18. 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.)

  19. 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.

  20. 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.

  1. [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.

  2. 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 ...

  3. 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.

  4. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Control of penetration zone GMAW

    Directory of Open Access Journals (Sweden)

    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

  11. 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

  12. 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.

  13. 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.)

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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 ...

  19. 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.)

  20. 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.

  1. 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

  2. High Penetration Photovoltaic Power Electronics and Energy Management Technology Research, Development and Demonstration: Cooperative Research and Development Final Report, CRADA Number CRD-13-517

    Energy Technology Data Exchange (ETDEWEB)

    Hudgins, Andrew P. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2018-01-25

    Advanced Energy Industries, Inc., will partner with DOE's National Renewable Energy Laboratory (NREL) to conduct research and development to demonstrate technologies that will increase the penetration of photovoltaic (PV) technologies for commercial and utility applications. Standard PV power control systems use simple control techniques that only provide real power to the grid. A focus of this partnership is to demonstrate how state of the art control and power electronic technologies can be combined to create a utility interactive control platform.

  3. 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

  4. 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)

  5. 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)

  6. 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.

  7. 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.

  8. Tumor penetrating peptides

    Directory of Open Access Journals (Sweden)

    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

  9. Penetrating chest injury: A miraculous life salvage

    Directory of Open Access Journals (Sweden)

    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.

  10. Intentional left subclavian artery coverage during thoracic endovascular aortic repair for traumatic aortic injury.

    Science.gov (United States)

    McBride, Cameron L; Dubose, Joseph J; Miller, Charles C; Perlick, Alexa P; Charlton-Ouw, Kristofer M; Estrera, Anthony L; Safi, Hazim J; Azizzadeh, Ali

    2015-01-01

    Thoracic endovascular aortic repair (TEVAR) is widely used for treatment of traumatic aortic injury (TAI). Stent graft coverage of the left subclavian artery (LSA) may be required in up to 40% of patients. We evaluated the long-term effects of intentional LSA coverage (LSAC) on symptoms and return to normal activity in TAI patients compared with a similarly treated group whose LSA was uncovered (LSAU). Patients were identified from a prospective institutional trauma registry between September 2005 and July 2012. TAI was confirmed using computed tomography angiography. The electronic medical records, angiograms, and computed tomography angiograms were reviewed in a retrospective fashion. In-person or telephone interviews were conducted using the SF-12v2 (Quality Metrics, Lincoln, RI) to assess quality of life. An additional questionnaire was used to assess specific LSA symptoms and the ability to return to normal activities. Data were analyzed by Spearman rank correlation and multiple linear and logistic regression analysis with appropriate transformations using SAS software (SAS Institute, Cary, NC). During the study period, 82 patients (57 men; mean age 40.5 ± 20 years, mean Injury Severity Score, 34 ± 10.0) underwent TEVAR for treatment of TAI. Among them, LSAC was used in 32 (39.5%) and LSAU in 50. A group of the LSAU patients (n = 22) served as matched controls in the analysis. We found no statistically significant difference in SF-12v2 physical health scores (ρ = -0.08; P = .62) between LSAC and LSAU patients. LSAC patients had slightly better mental health scores (ρ = 0.62; P = .037) than LSAU patients. LSAC patients did not have an increased likelihood of experiencing pain (ρ = -0.0056; P = .97), numbness (ρ = -0.12; P = .45), paresthesia (ρ = -0.11; P = .48), fatigue (ρ = -0.066; P = .69), or cramping (ρ = -0.12; P = .45). We found no difference between groups in the ability to return to activities. The mean follow-up time was 3.35 years. Six LSAC

  11. Pleural Drainage and its Role in Management of the Isolated Penetrating Chest Injuries During the War Time in Sarajevo, 1992.-1995.

    Directory of Open Access Journals (Sweden)

    Ademir Hadžismajlović

    2007-05-01

    Full Text Available Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4% wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6% patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84% wounded individuals, and with bullet 120 (25,16% wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13% patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44% patients. Chest tube inserting as preoperative measure (urgent thoracotomy was used in 79 (16,56% patients. There were 460 (96,44% healed patients. Death occurred in 17 (3,56% patients.

  12. Pleural drainage and its role in management of the isolated penetrating chest injuries during the war time in Sarajevo, 1992.-1995.

    Science.gov (United States)

    Hadzismajlović, Ademir; Pilav, Alen

    2007-05-01

    Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4%) wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6%) patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84%) wounded individuals, and with bullet 120 (25,16%) wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13%) patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44%) patients. Chest tube inserting as preoperative measure (urgent thoracotomy) was used in 79 (16,56%) patients. There were 460 (96,44%) healed patients. Death occurred in 17 (3,56%) patients.

  13. 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.

  14. 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

  15. Python penetration testing essentials

    CERN Document Server

    Mohit

    2015-01-01

    If you are a Python programmer or a security researcher who has basic knowledge of Python programming and want to learn about penetration testing with the help of Python, this book is ideal for you. Even if you are new to the field of ethical hacking, this book can help you find the vulnerabilities in your system so that you are ready to tackle any kind of attack or intrusion.

  16. 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.

  17. HMO penetration: has it hurt public hospitals?

    Science.gov (United States)

    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.

  18. 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,

  19. 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.

  20. 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)

  1. Study of Penetration Technology

    Science.gov (United States)

    1976-11-01

    srecimens fabricated at the AFATL, AISI-01 oil quenched bar stock was used. Three of the projectiles used in the Eglin penetration experiments are shown...in the Mathema- tical Laboratory at Eglin AFB, is essencially a fourth order Runge-Kutta numerical method for solving simultaneous differential...C9G. VEL. X-COMPo (M4/5): d!10. I oil 140. 107. 82. RmCC~kr’ED TIME OF MAXIftjM/MINIM94U COIL VOLTAGE tSI MAX 0040 A 55 *.03J04A 0 0 05ji6 .000634 MIN

  2. Deep penetration calculations

    International Nuclear Information System (INIS)

    Thompson, W.L.; Deutsch, O.L.; Booth, T.E.

    1980-04-01

    Several Monte Carlo techniques are compared in the transport of neutrons of different source energies through two different deep-penetration problems each with two parts. The first problem involves transmission through a 200-cm concrete slab. The second problem is a 90 0 bent pipe jacketed by concrete. In one case the pipe is void, and in the other it is filled with liquid sodium. Calculations are made with two different Los Alamos Monte Carlo codes: the continuous-energy code MCNP and the multigroup code MCMG

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

    International Nuclear Information System (INIS)

    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.

  4. Penetrating cardiothoracic war wounds.

    Science.gov (United States)

    Biocina, B; Sutlić, Z; Husedzinović, I; Rudez, I; Ugljen, R; Letica, D; Slobodnjak, Z; Karadza, J; Brida, V; Vladović-Relja, T; Jelić, I

    1997-03-01

    Penetrating cardiothoracic war wounds are very common among war casualties. Those injuries require prompt and specific treatment in an aim to decrease mortality and late morbidity. There are a few controversies about the best modality of treatment for such injuries, and there are not many large series of such patients in recent literature. We analysed a group of 259 patients with penetrating cardiothoracic war wounds admitted to our institutions between May 1991 and October 1992. There were 235 (90.7%) patients with thoracic wounds, 14 (5.4%) patients with cardiac, wounds and in 10 (3.7%) patients both heart and lungs were injured. The cause of injury was shrapnel in 174 patients (67%), bullets in 25 patients (9.7%), cluster bomb particles in 45 patients (17.3%) and other (blast etc.) in 15 patients (6%). Patients, 69, had concomitant injuries of various organs. The initial treatment in 164 operated patients was chest drainage in 76 (46.3%) patients, thoracotomy and suture of the lung in 71 (43.2%) patients, lobectomy in 12 (7.3%) patients and pneumonectomy in 5 (3%) patients. Complications include pleural empyema and/or lung abscess in 20 patients (8.4%), incomplete reexpansion of the lung in 10 patients (4.2%), osteomyelitis of the rib in 5 patients (2.1%) and bronchopleural fistula in 1 patient (0.4%). Secondary procedures were decortication in 12 patients, rib resection in 5 patients, lobectomy in 2 patients, pneumonectomy in 4 patients, reconstruction of the chest wall in 2 patients and closure of the bronchopleural fistula in 1 patient. The cardiac chamber involved was right ventricle in 12 patients, left ventricular in 6 patients, right atrium in 7 patients, left atrium in 3 patients, ascending aorta in 2 patients and 1 patient which involved descending aorta, right ventricle and coronary artery (left anterior descending) and inferior vena cava, respectively. The primary procedure was suture in 17 patients (in 10 patients with the additional suture of the

  5. Rainfall simulation experiments and Water Drop Penetration Time measurements shed light on the impact of water repellency on soils under organic farming management in Eastern Spain

    Science.gov (United States)

    Cerdà, Artemi; González, Óscar; León, Javier; Jordán, Antonio

    2015-04-01

    Water repellency is a well-know soil property since the research of professor Stefan Helmut Doerr recovered and powered the research developed by professor DeBano (Atanassova and Doerr, 2011; ; Jordán et al., 2011; Bodí et al., 2012; González Peñaloza et al., 2012 Bodí et al., 2013; García Moreno et al., 2013; Jordán et al., 2013; Badía-Villas et al., 2014; Jordán et al., 2013; Jiménez Morillo et al., 2015). However, little is known about the impact of water repellency in surface runoff generation, although usually is accepted that when more soil water repellent is a soil, higher will be the surface runoff discharge (Stoff et al., 2011; Madsen et al., 2011; León et al., 2013; Lozano et al., 2013; Mataix-Solera et al., 2013; Santos et al., 2015). And the impact of the water repellency and then the higher surface wash discharge can trigger high erosion rates (Kröpfl et al., 2013; Mandal and Sharda 2013; Zhao et al., 2013). However these relationships were not demonstrated as the most water repellent soils are the one with high organic contents, and those soils do not have soil losses, probably due to the high infiltration rates due to the macropore flow. Rainfall simulation experiments can shed light in the runoff generation mechanism as they can control the rainfall intensity (Bodí et al., 2012; Iserloh et al., 2012; Iserloh et al., 2013), and inform about the main mechanism of the soil erosion process Cerdà and Jurgensen, 2011; Daugherty et al., 2011; Podwojewski et al., 2011; Dunkerley, 2012; Garel et al., 2012; Jouquet et al., 2012; Kibet et al., 2013; Butzen et al., 2014; Ma et al., 2014; Martínez Murillo et al., 2013). To determine the relationship between surface runoff generated under simulated rainfall (Cerdà, 1988a; 1988b; Cerdà et al., 1998; Ziadat and Taimeh, 2013) with a small rainfall simulator (0.25 m2) and water repellency measurements with the Water Drop Penetration time methods were done (Bodí et al., 2012). The results show that

  6. 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

  7. Penetration of Recommended Procedures for Lung Cancer Staging and Management in the United States Over 10 Years: A Quality Research in Radiation Oncology Survey

    Energy Technology Data Exchange (ETDEWEB)

    Komaki, Ritsuko, E-mail: rkomaki@mdanderson.org [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Khalid, Najma [American College of Radiology, Philadelphia, Pennsylvania (United States); Langer, Corey J. [Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Kong, Feng-Ming [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Owen, Jean B.; Crozier, Cheryl L. [American College of Radiology, Philadelphia, Pennsylvania (United States); Wilson, J. Frank [Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Wei, Xiong [University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States)

    2013-03-15

    Purpose: To document the penetration of clinical trial results, practice guidelines, and appropriateness criteria into national practice, we compared the use of components of staging and treatment for lung cancer among patients treated in 2006-2007 with those used in patients treated in 1998-1999. Methods and Materials: Patient, staging work-up, and treatment characteristics were extracted from the process survey database of the Quality Research in Radiation Oncology (QRRO), consisting of records of 340 patients with locally advanced non-small cell lung cancer (LA-NSCLC) at 44 institutions and of 144 patients with limited-stage small cell lung cancer (LS-SCLC) at 39 institutions. Data were compared for patients treated in 2006-2007 versus those for patients treated in 1998-1999. Results: Use of all recommended procedures for staging and treatment was more common in 2006-2007. Specifically, disease was staged with brain imaging (magnetic resonance imaging or computed tomography) and whole-body imaging (positron emission tomography or bone scanning) in 66% of patients with LA-NSCLC in 2006-2007 (vs 42% in 1998-1999, P=.0001) and in 84% of patients with LS-SCLC in 2006-2007 (vs 58.3% in 1998-1999, P=.0011). Concurrent chemoradiation was used for 77% of LA-NSCLC patients (vs 45% in 1998-1999, P<.0001) and for 90% of LS-SCLC patients (vs 62.5% in 1998-1999, P<.0001). Use of the recommended radiation dose (59-74 Gy for NSCLC and 60-70 Gy as once-daily therapy for SCLC) did not change appreciably, being 88% for NSCLC in both periods and 51% (2006-2007) versus 43% (1998-1999) for SCLC. Twice-daily radiation for SCLC was used for 21% of patients in 2006-2007 versus 8% in 1998-1999. Finally, 49% of patients with LS-SCLC received prophylactic cranial irradiation (PCI) in 2006-2007 (vs 21% in 1998-1999). Conclusions: Although adherence to all quality indicators improved over time, brain imaging and recommended radiation doses for stage III NSCLC were used in <90% of cases. Use

  8. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  10. 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.

  11. An advanced control system for the optimal operation and management of medium size power systems with a large penetration from renewable power sources

    Energy Technology Data Exchange (ETDEWEB)

    Nogaret, E.; Stavrakakis, G.; Kariniotakis, G. [Ecole de Mines de Paris, Centre d`Energetique, Sophia-Antipolis (France)] [and others

    1997-10-01

    An advanced control system for the optimal operation and management of autonomous wind-diesel systems is presented. This system minimises the production costs through an on-line optimal scheduling of the power units, which takes into account the technical constraints of the diesel units, as well as short-term forecasts of the load and renewable resources. The power system security is maximised through on-line security assessment modules, which enable the power system to withstand sudden changes in the production of the renewable sources. The control system was evaluated using data from the island of Lemnos, where it has been installed and operated since January 1995. (Author)

  12. Perforation of a duodenal ulcer into a non-parasitic liver cyst: a rare case of a penetrate hole blockaded with conservative medical management.

    Science.gov (United States)

    Ono, Koichi; Takeda, Masaharu; Makihata, Eiichi; Okazaki, Junji; Nagai, Akira

    2014-01-01

    An 88-year-old Japanese woman was admitted to our hospital for abdominal pain with a raised inflammatory reaction. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) showed a duodenal ulcer punching a liver cyst. Since neither ascites nor free air were detected on CT and her family did not wish for aggressive medical treatment, the patient received clinical observation and conservative management. Antibiotic and proton-pump inhibitor therapy was effective, and she exhibited an uneventful recovery. A reexamination of EGD and CT confirmed that the fistulous tract between the liver cyst and duodenum was blockaded.

  13. 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.

  14. Resistência à penetração em Neossolo Quartzarênico submetido a diferentes formas de manejo Resistance to penetration in Quartzarenic Neosol subjected to different forms of management

    Directory of Open Access Journals (Sweden)

    Idelfonso C. de Freitas

    2012-12-01

    Full Text Available A substituição das florestas nativas por agrossistemas provoca mudanças na estrutura do solo. O grau dessas alterações depende da intensidade do uso e do manejo do solo, condições climáticas locais e propriedades físicas e químicas do solo. O objetivo deste estudo foi avaliar a densidade do solo, resistência do solo à penetração e a matéria orgânica de um Neossolo Quartzarênico órtico em quatro sistemas de manejo: floresta nativa, agrofloresta, pasto e outra área recentemente convertida para uso agrícola. Em cada sistema avaliado sete perfis de solo foram coletados em julho de 2010 e Janeiro de 2011. A resistência do solo foi determinada com um penetrômetro de impacto, modelo Planasucar Stolf IAA, de 00-40 cm de profundidade. O teor de água do solo foi determinado de 00-20 e 20-40 cm de profundidade. A matéria orgânica e a densidade do solo foram determinadas de 00-05; 05-10; 10-20 e 20-40 cm. Entre os sistemas avaliados os menores valores de densidade e resistência do solo foram encontrados na agrofloresta e os maiores obtidos no pasto. Os resultados obtidos na área com uso agrícola de apenas um ano, foram semelhantes aos obtidos em mata nativa.The replacement of native forests for agrosystems causes changes in soil structure. The degree of these changes depends on the intensity of use and soil management, climatic conditions and soil physical and chemical properties. The aim of this study was to evaluate the soil bulk density (Bd, soil resistance to penetration and organic matter content of an Ortic Quartzarenic Neosol under four land use systems: native forest, agroforestry, pasture and other area recently converted to agricultural use. In each system seven soil profiles were selected and samples were collected in July 2010 and January 2011. The soil resistance to penetration was determined in 0-40 cm depth using an impact penetrometer, Planasucar Stolf IAA model. The water content in the soil layers was determined

  15. 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

  16. Feeder Voltage Regulation with High-Penetration PV Using Advanced Inverters and a Distribution Management System: A Duke Energy Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Palmintier, Bryan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Giraldez, Julieta [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gruchalla, Kenny [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gotseff, Peter [National Renewable Energy Lab. (NREL), Golden, CO (United States); Nagarajan, Adarsh [National Renewable Energy Lab. (NREL), Golden, CO (United States); Harris, Tom [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bugbee, Bruce [National Renewable Energy Lab. (NREL), Golden, CO (United States); Baggu, Murali [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gantz, Jesse [GE Grid Solutions, Fairfield, CT (United States); Boardman, Ethan [GE Grid Solutions, Fairfield, CT (United States)

    2016-11-01

    Duke Energy, Alstom Grid, and the National Renewable Energy Laboratory teamed up to better understand the impacts of solar photovoltaics (PV) on distribution system operations. The core goal of the project is to compare the operational - specifically, voltage regulation - impacts of three classes of PV inverter operations: 1.) Active power only (Baseline); 2.) Local inverter control (e.g., PF...not equal...1, Q(V), etc.); and 3.) Integrated volt-VAR control (centralized through the distribution management system). These comparisons were made using multiple approaches, each of which represents an important research-and-development effort on its own: a) Quasi-steady-state time-series modeling for approximately 1 year of operations using the Alstom eTerra (DOTS) system as a simulation engine, augmented by Python scripting for scenario and time-series control and using external models for an advanced inverter; b) Power-hardware-in-the-loop (PHIL) testing of a 500-kVA-class advanced inverter and traditional voltage regulating equipment. This PHIL testing used cosimulation to link full-scale feeder simulation using DOTS in real time to hardware testing; c) Advanced visualization to provide improved insights into time-series results and other PV operational impacts; and d) Cost-benefit analysis to compare the financial and business-model impacts of each integration approach.

  17. 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...

  18. 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 ...

  19. 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.

  20. 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.

  1. 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,

  2. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. Prediction of electric vehicle penetration.

    Science.gov (United States)

    2017-05-01

    The object of this report is to present the current market status of plug-in-electric : vehicles (PEVs) and to predict their future penetration within the world and U.S. : markets. The sales values for 2016 show a strong year of PEV sales both in the...

  10. 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.

  11. 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

  12. Import market penetration in services

    OpenAIRE

    Langhammer, Rolf J.

    1991-01-01

    The EC-1992 programme foresees the complete liberalization of trade in services among member countries. To what extent has import market penetration in the Community already begun in selected service industries? Which EC member countries have been the forerunners to date? The following paper uses a new data base released recently by EUROSTAT in an attempt to answer these and other related questions.

  13. [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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  16. 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

  17. 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.

  18. Assessing high wind energy penetration

    DEFF Research Database (Denmark)

    Tande, J.O.

    1995-01-01

    In order to convincingly promote installing wind power capacity as a substantial part of the energy supply system, a set of careful analyses must be undertaken. This paper applies a case study concentrated on assessing the cost/benefit of high wind energy penetration. The case study considers...... expanding the grid connected wind power capacity in Praia, the capital of Cape Verde. The currently installed 1 MW of wind power is estimated to supply close to 10% of the electric energy consumption in 1996. Increasing the wind energy penetration to a higher level is considered viable as the project...... with the existing wind power, supply over 30% of the electric consumption in 1996. Applying the recommended practices for estimating the cost of wind energy, the life-cycle cost of this 2.4 MW investment is estimated at a 7% discount rate and a 20 year lifetime to 0.26 DKK/kW h....

  19. Mobile Termination and Mobile Penetration

    OpenAIRE

    Hurkens, Sjaak; Jeon, Doh-Shin

    2009-01-01

    In this paper, we study how access pricing affects network competition when subscription demand is elastic and each network uses non-linear prices and can apply termination-based price discrimination. In the case of a fixed per minute termination charge, we find that a reduction of the termination charge below cost has two oppos- ing effects: it softens competition but helps to internalize network externalities. The former reduces mobile penetration while the latter boosts it. We find that fi...

  20. Mobile termination and mobile penetration

    OpenAIRE

    Hurkens, Sjaak

    2009-01-01

    In this paper, we study how access pricing affects network competition when subscription demand is elastic and each network uses non-linear prices and can apply termination-based price discrimination. In the case of a fixed per minute termination charge, we find that a reduction of the termination charge below cost has two opposing effects: it softens competition but helps to internalize network externalities. The former reduces mobile penetration while the latter boosts it. We find that firm...

  1. Fluorescent penetration crack testing method

    International Nuclear Information System (INIS)

    Roth, A.

    1979-01-01

    The same cleaning, penetration, washing, development and evaluation agents are used in this method as for known methods. In order to accelerate or shorten the testing, the drying process is performed only to optical dryness of the material surface by blowing on it with pressurized air, the development by simple pressing into or dusting of the material with the developer and the temperature of the washing water is selected within room temperature range. (RW) [de

  2. 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.

  3. 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.

  4. PETA: Methodology of Information Systems Security Penetration Testing

    Directory of Open Access Journals (Sweden)

    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.

  5. 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.

  6. 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

  7. 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...

  8. 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

  9. 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.

  10. 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.

  11. 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)

  12. 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.

  13. 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

  14. Penetration through the Skin Barrier

    DEFF Research Database (Denmark)

    Nielsen, Jesper Bo; Benfeldt, Eva; Holmgaard, Rikke

    2016-01-01

    The skin is a strong and flexible organ with barrier properties essential for maintaining homeostasis and thereby human life. Characterizing this barrier is the ability to prevent some chemicals from crossing the barrier while allowing others, including medicinal products, to pass at varying rates......-through diffusion cells) as well as in vivo methods (microdialysis and microperfusion). Then follows a discussion with examples of how different characteristics of the skin (age, site and integrity) and of the penetrants (size, solubility, ionization, logPow and vehicles) affect the kinetics of percutaneous...

  15. Penetration testing with Raspberry Pi

    CERN Document Server

    Muniz, Joseph

    2015-01-01

    If you are looking for a low budget, small form-factor remotely accessible hacking tool, then the concepts in this book are ideal for you. If you are a penetration tester who wants to save on travel costs by placing a low-cost node on a target network, you will save thousands by using the methods covered in this book. You do not have to be a skilled hacker or programmer to use this book. It will be beneficial to have some networking experience; however, it is not required to follow the concepts covered in this book.

  16. 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...

  17. 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.

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

    International Nuclear Information System (INIS)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  20. 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.

  1. Linguistic Intuitions and Cognitive Penetrability

    Directory of Open Access Journals (Sweden)

    Michael Devitt

    2014-12-01

    Full Text Available Metalinguistic intuitions play a very large evidential role in both linguistics and philosophy. Linguists think that these intuitions are products of underlying linguistic competence. I call this view “the voice of competence” (“VoC”. Although many philosophers seem to think that metalinguistic intuitions are a priori many may implicitly hold the more scientifically respectable VoC. According to VoC, I argue, these intuitions can be cognitively penetrated by the central processor. But, I have argued elsewhere, VoC is false. Instead, we should hold “the modest explanation” (“ME” according to which these intuitions are fairly unreflective empirical theory-laden central-processor responses to phenomena. On ME, no question of cognitive penetration arises. ME has great methodological significance for the study of language. Insofar as we rely on intuitions as evidence we should prefer those of linguists and philosophers because they are more expert. But, more importantly, we should be seeking other evidence in linguistic usage.

  2. 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.

  3. Cable Braid Electromagnetic Penetration Model.

    Energy Technology Data Exchange (ETDEWEB)

    Warne, Larry K. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Langston, William L. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Basilio, Lorena I. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Johnson, W. A. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States)

    2015-06-01

    The model for penetration of a wire braid is rigorously formulated. Integral formulas are developed from energy principles and reciprocity for both self and transfer immittances in terms of potentials for the fields. The detailed boundary value problem for the wire braid is also setup in a very efficient manner; the braid wires act as sources for the potentials in the form of a sequence of line multipoles with unknown coefficients that are determined by means of conditions arising from the wire surface boundary conditions. Approximations are introduced to relate the local properties of the braid wires to a simplified infinite periodic planar geometry. This is used in a simplified application of reciprocity to be able to treat nonuniform coaxial geometries including eccentric interior coaxial arrangements and an exterior ground plane.

  4. Bodily action penetrates affective perception

    Science.gov (United States)

    Rigutti, Sara; Gerbino, Walter

    2016-01-01

    Fantoni & Gerbino (2014) showed that subtle postural shifts associated with reaching can have a strong hedonic impact and affect how actors experience facial expressions of emotion. Using a novel Motor Action Mood Induction Procedure (MAMIP), they found consistent congruency effects in participants who performed a facial emotion identification task after a sequence of visually-guided reaches: a face perceived as neutral in a baseline condition appeared slightly happy after comfortable actions and slightly angry after uncomfortable actions. However, skeptics about the penetrability of perception (Zeimbekis & Raftopoulos, 2015) would consider such evidence insufficient to demonstrate that observer’s internal states induced by action comfort/discomfort affect perception in a top-down fashion. The action-modulated mood might have produced a back-end memory effect capable of affecting post-perceptual and decision processing, but not front-end perception. Here, we present evidence that performing a facial emotion detection (not identification) task after MAMIP exhibits systematic mood-congruent sensitivity changes, rather than response bias changes attributable to cognitive set shifts; i.e., we show that observer’s internal states induced by bodily action can modulate affective perception. The detection threshold for happiness was lower after fifty comfortable than uncomfortable reaches; while the detection threshold for anger was lower after fifty uncomfortable than comfortable reaches. Action valence induced an overall sensitivity improvement in detecting subtle variations of congruent facial expressions (happiness after positive comfortable actions, anger after negative uncomfortable actions), in the absence of significant response bias shifts. Notably, both comfortable and uncomfortable reaches impact sensitivity in an approximately symmetric way relative to a baseline inaction condition. All of these constitute compelling evidence of a genuine top-down effect on

  5. Bodily action penetrates affective perception

    Directory of Open Access Journals (Sweden)

    Carlo Fantoni

    2016-02-01

    Full Text Available Fantoni & Gerbino (2014 showed that subtle postural shifts associated with reaching can have a strong hedonic impact and affect how actors experience facial expressions of emotion. Using a novel Motor Action Mood Induction Procedure (MAMIP, they found consistent congruency effects in participants who performed a facial emotion identification task after a sequence of visually-guided reaches: a face perceived as neutral in a baseline condition appeared slightly happy after comfortable actions and slightly angry after uncomfortable actions. However, skeptics about the penetrability of perception (Zeimbekis & Raftopoulos, 2015 would consider such evidence insufficient to demonstrate that observer’s internal states induced by action comfort/discomfort affect perception in a top-down fashion. The action-modulated mood might have produced a back-end memory effect capable of affecting post-perceptual and decision processing, but not front-end perception. Here, we present evidence that performing a facial emotion detection (not identification task after MAMIP exhibits systematic mood-congruent sensitivity changes, rather than response bias changes attributable to cognitive set shifts; i.e., we show that observer’s internal states induced by bodily action can modulate affective perception. The detection threshold for happiness was lower after fifty comfortable than uncomfortable reaches; while the detection threshold for anger was lower after fifty uncomfortable than comfortable reaches. Action valence induced an overall sensitivity improvement in detecting subtle variations of congruent facial expressions (happiness after positive comfortable actions, anger after negative uncomfortable actions, in the absence of significant response bias shifts. Notably, both comfortable and uncomfortable reaches impact sensitivity in an approximately symmetric way relative to a baseline inaction condition. All of these constitute compelling evidence of a genuine top

  6. Assessing high wind energy penetration

    International Nuclear Information System (INIS)

    Tande, J.O.

    1995-01-01

    In order to convincingly promote installing wind power capacity as a substantial part of the energy supply system, a set of careful analyses must be undertaken. This paper applies a case study concentrated on assessing the cost/benefit of high wind energy penetration. The case study considers expanding the grid connected wind power capacity in Praia, the capital of Cape Verde. The currently installed 1 MW of wind power is estimated to supply close to 10% of the electric energy consumption in 1996. Increasing the wind energy penetration to a higher level is considered viable as the project settings are close to ideal, including a very capable national utility company, Electra, a conventional power supply system based on imported heavy fuel and gas oil, and favourable wind conditions with an estimated annual average of 9.3 m/s at the hub height of the wind turbines. With the applied case study assumptions, simulations with WINSYS over the lifetime of the assessed wind power investment show that investments up to 4.2 MW are economically viable. The economic optimum is found at 2.4 MW reaching an internal rate of return of almost 8% p.a. This 2.4 MW of wind power would, together with the existing wind power, supply over 30% of the electric consumption in 1996. Applying the recommended practices for estimating the cost of wind energy, the life-cycle cost of this 2.4 MW investment is estimated at a 7% discount rate and a 20 year lifetime to 0.26 DKK/kW h. (Author)

  7. 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.

  8. 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...

  9. 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 ...

  10. 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

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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...

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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.)

  2. 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.)

  3. 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

  4. 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.

  5. Transconjunctival penetration of mitomycin C

    Directory of Open Access Journals (Sweden)

    Velpandian T

    2008-01-01

    Full Text Available Aims: The study was performed to estimate transconjunctival penetration of mitomycin C (MMC to Tenon′s tissue following application over the intact conjunctiva before routine trabeculectomy. Settings and Design: Institution-based case series. Materials and Methods: In 41 eyes of 41 patients, MMC (0.4 mg/ml for 3 min was applied over the intact conjunctiva before beginning trabeculectomy. Tenon′s capsule directly beneath the site of application was excised during trabeculectomy and was homogenized, centrifuged and MMC concentrations were analyzed using high-performance liquid chromatography (HPLC. Statistical Analysis Used: Statistical analysis was performed using stata0 8.0 version software (STATA Corporation, Houston, TX, USA. In this study, P -values less than 0.05 were considered as statistically significant. Results: The average weight of the sample of Tenon′s tissue excised was 5.51 ± 4.42 mg (range: 0.9-17.1 and the average estimated MMC concentration found to be present in Tenon′s tissue using HPLC was 18.67 ± 32.36 x 10−6 moles/kg of the tissue (range: 0.38-197.05 x 10−6 . In 36 of the 41 patients (87.80%, the MMC concentration reached above 2 x 10−6 moles/kg of the tissue concentration required to inhibit human conjunctival fibroblasts. Conclusions: Mitomycin C does permeate into the subconjunctival tissue after supraconjunctival application for 3 min. Application of MMC over the conjunctiva may be a useful alternative to subconjunctival or subscleral application during routine trabeculectomy and as an adjunct for failing blebs.

  6. 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).

  7. 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

  8. 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.

  9. 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.

  10. 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...

  11. 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.

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

    Science.gov (United States)

    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

  13. 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)

  14. 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

  15. Identifying structural damage with ground penetrating radar

    CSIR Research Space (South Africa)

    Van Schoor, Abraham M

    2008-07-01

    Full Text Available Ground penetrating radar (GPR) and electrical resistance tomography (ERT) surveys were conducted in an urban environment in an attempt to identify the cause of severe structural damage to a historically significant residential property...

  16. 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.

  17. Kali Linux wireless penetration testing beginner's guide

    CERN Document Server

    Ramachandran, Vivek

    2015-01-01

    If you are a security professional, pentester, or anyone interested in getting to grips with wireless penetration testing, this is the book for you. Some familiarity with Kali Linux and wireless concepts is beneficial.

  18. Penetration testing protecting networks and systems

    CERN Document Server

    Henry, Kevin M

    2012-01-01

    This book is a preparation guide for the CPTE examination, yet is also a general reference for experienced penetration testers, ethical hackers, auditors, security personnel and anyone else involved in the security of an organization's computer systems.

  19. 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)

  20. 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.

  1. 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.

  2. 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.

  3. 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....

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. 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...

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.)

  15. 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)

  16. 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)

  17. 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

  18. Fractal measures in a deep penetration problem

    International Nuclear Information System (INIS)

    Murthy, K.P.N.; Indira, R.; John, T.M.

    1993-01-01

    In the Monte Carlo simulation of a deep penetration problem the parameter, say b in the importance function must be assigned a value b' such that variance is minimum. If b b' the sample mean is still not reliable; but the sample fluctuations would be small and misleading, though the actual fluctuations are quite large. This is because the distribution of transmission has a tail which becomes prominent when b > b'. Considering a model deep penetration problem, and employing exact enumeration techniques, it is shown that in the limit of large biasing the long tailed distribution to the transmission is multifractal. (author). 5 refs., 3 figs

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. Tree root mapping with ground penetrating radar

    CSIR Research Space (South Africa)

    Van Schoor, Abraham M

    2009-09-01

    Full Text Available In this paper, the application of ground penetrating radar (GPR) for the mapping of near surface tree roots is demonstrated. GPR enables tree roots to be mapped in a non-destructive and cost-effective manner and is therefore a useful prospecting...

  4. Penetration and haptenation of p-phenylenediamine

    NARCIS (Netherlands)

    Pot, Laura M.; Scheitza, Simone M.; Coenraads, Pieter-Jan; Bloemeke, Brunhilde; Blomeke, B.

    Although p-phenylenediamine (PPD) has been recognized as an extreme sensitizer for many years, the exact mechanism of sensitization has not been elucidated yet. Penetration and the ability to bind to proteins are the first two hurdles that an allergen has to overcome to be able to sensitize. This

  5. Mechanical behaviour of pressure vessel head penetrations

    International Nuclear Information System (INIS)

    Faidy, C.; Ternon, F.; Vagner, J.; Vaindirlis, M.

    1994-01-01

    After leaks on Bugey 3 penetrations EdF and Framatome have started a study on the stress corrosion phenomenon of Inconel 600. In this paper, limited to the mechanical aspect, we present an estimation of in service stresses, the experimental program on mockup for visualize the surface stress and the noxiousness of potential cracks. 5 figs., 6 tabs., 5 refs

  6. Standard Penetration Test and Relative Density

    Science.gov (United States)

    1971-02-01

    Se OPSeS Debido a que el agua subterranea granclemente influve la resistencia a suelo, se establecio una relacion empirica entre el nurmero de golpes...de laboratorio ejecutados con un penetr6metro est’tico pequeno. INTRODUCTION One of the main problems encountered in subsoil e’xploration is in situ

  7. Penetration of electronic beams in ionizing media

    International Nuclear Information System (INIS)

    Martiarena, M.L.; Zanete, D.H.; Garibotti, C.R.

    1988-01-01

    It is studied the penetration of an electron beam in an ionizable medium by means of a generalized kinetic equation. This equation is related to elastic collisions, processes of creation and destruction of particles. By integrating numerically the transport equation, it can be evaluated the relative effects of all the processes involved in the evolution of the system. (A.C.A.S.) [pt

  8. Penetration of amalgam constituents into dentine

    NARCIS (Netherlands)

    Scholtanus, Johannes D.; Ozcan, Mutlu; Huysmans, Marie-Charlotte D. N. J. M.

    Objectives: Amalgam restorations are replaced by adhesively placed composite resin restorations at an increasing rate. After the removal of amalgam dentine often shows marked dark discoloration that is attributed to the penetration of corrosion products from overlying amalgams. it is questioned

  9. Penetration of amalgam constituents into dentine.

    NARCIS (Netherlands)

    Scholtanus, J.D.; Ozcan, M.; Huysmans, M.C.D.N.J.M.

    2009-01-01

    OBJECTIVES: Amalgam restorations are replaced by adhesively placed composite resin restorations at an increasing rate. After the removal of amalgam dentine often shows marked dark discoloration that is attributed to the penetration of corrosion products from overlying amalgams. It is questioned

  10. Computed tomographic findings in penetrating peptic ulcer

    International Nuclear Information System (INIS)

    Madrazo, B.L.; Halpert, R.D.; Sandler, M.A.; Pearlberg, J.L.

    1984-01-01

    Four cases of peptic ulcer penetrating the head of the pancreas were diagnosed by computed tomography (CT). Findings common to 3 cases included (a) an ulcer crater, (b) a sinus tract, and (c) enlargement of the head of the pancreas. Unlike other modalities, the inherent spatial resolution of CT allows a convenient diagnosis of this important complication of peptic ulcer disease

  11. Reduced penetrance in human inherited disease

    African Journals Online (AJOL)

    Rabah M. Shawky

    2014-01-31

    Jan 31, 2014 ... tant role in cellular senescence, tumorigenesis and in several diseases including type ... between epigenetic DNA modifications and human life span has also been shown .... penetrance mutation that is age dependent especially when compared with the ..... on healthy aging and longevity. Immunity Aging ...

  12. An Experimental Model for Market Penetration.

    Science.gov (United States)

    Caren, William L.

    1987-01-01

    A plan for college market penetration that has been successful in increasing the applicant pool for one institution is outlined and discussed. It includes development of performance objectives, a schedule, a promotional plan, market survey, and promotional activities including alumni, media, and other community resources. (MSE)

  13. STYLET PENETRATION BEHAVIOURS OF FOUR Cicadulina ...

    African Journals Online (AJOL)

    ACSS

    Feeding from phloem cells, overall probing and probe mean (the average time per probe) were higher ... Key Words: Cicadulina spp., electrical penetration graph, MSV, Zea mays .... wire and alligator clip clamped to the stem of the .... á All measures are in minutes except for frequency of probing; - Main effect not significant.

  14. Percutaneous penetration studies for risk assessment

    DEFF Research Database (Denmark)

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

    2000-01-01

    experiences, literature data and guidelines already in existence. During the meetings of Percutaneous Penetration Subgroup they presented a number of short papers of up to date information on the key issues. The objective was to focus the existing knowledge and the gaps in the knowledge in the field...

  15. Penetration of albendazole sulphoxide into hydatid cysts.

    OpenAIRE

    Morris, D L; Chinnery, J B; Georgiou, G; Stamatakis, G; Golematis, B

    1987-01-01

    The penetration of albendazole sulphoxide, the principal metabolite of albendazole into hydatid cysts (E granulosus) was measured by means of in vitro animal and clinical studies. The drug freely diffuses across the parasitic membranes. Cyst/serum concentrations of 22% were achieved in patients, longer pre-operative therapy produced higher concentrations.

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

    Science.gov (United States)

    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.

  17. 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

  18. 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.)

  19. 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

  20. 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.

  1. 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

  2. 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

  3. 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 ...

  4. Containment penetration design criteria and implementation

    International Nuclear Information System (INIS)

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

    1975-01-01

    A rational design criteria is presented which serves as a basis for the design and analysis of containment piping penetrations. The criteria includes the effect of temperature as well as mechanical loads for the full range of plant conditions. With this criteria various penetration flued head designs have been compared and optimization achieved. Sleeve wall dimensions and containment loads have been determined without reference to piping configuration. An interaction theory which allows the implementation of the criteria for the determination of design loads and minimum sleeve wall thickness. The interaction theory developed applies to elastic-perfectly plastic cylinders (pipes and sleeves) and accounts for the simultaneous load resultants of transverse shear force, bending moment, torsional moment, and axial force in addition to internal pipe pressure. Application of the theory developed to the determination of sleeve thickness and containment design loads is presented in detail. (Auth.)

  5. Ureteric transection secondary to penetrating handlebar injury

    Directory of Open Access Journals (Sweden)

    K.P. Debbink

    2017-08-01

    Full Text Available Ureteric trauma is rare, occurring in <1% of all traumas. We present a unique case of a 13 year old female who sustained a penetrating abdominal injury from a bicycle handlebar. Upon initial examination there was herniation of bowel through the abdominal wound, so exploratory laparotomy was performed. A serosal injury of the colon and bleeding mesenteric veins were encountered; the retroperitoneum was not explored at that time. Postoperative course was remarkable for a doubling of the serum creatinine, increasing abdominal distention and pain. Computed tomography on postoperative day five demonstrated a large amount of intra-abdominal fluid. The patient was taken for re-exploration. The left ureter was found to be completely transected. It was repaired over a double-J stent. This case demonstrates the need for a high index of suspicion in the diagnosis of ureteric injury. Keywords: Ureter, Bicycle, Handlebar, Penetrating

  6. Corrosion and protection of uranium alloy penetrators

    International Nuclear Information System (INIS)

    Weirick, L.J.; Johnson, H.R.; Dini, J.W.

    1975-06-01

    Penetrators made from either a U--3/4 percent Ti alloy or a U--3/4 percent Mo--3/4 percent Zr--3/4 percent Nb--1/2 percent Ti alloy (''Quad'') corrode mildly in moist air, significantly in moist nitrogen, and severely in salt fog. Adequate protection was provided in moist air and nitrogen by coating with electroplated nickel, electroplated nickel and zinc with a chromate finish, and galvanized zinc with a chromate finish. In salt fog, electroplated nickel offered only temporary protection whereas galvanized zinc and electroplated nickel-zinc provided long-lasting protection. The resistance of uncoated penetrators was affected variously by dissimilar metal couplings. Aluminum protected the Quad alloy and adversely affected the U--3/4 percent Ti alloy, whereas steel enhanced localized corrosion in both. (U.S.)

  7. Eddy current testing with high penetration

    International Nuclear Information System (INIS)

    Becker, R.; Kroening, M.

    1999-01-01

    The low-frequency eddy current testing method is used when penetration into very deep layers is required. The achievable penetration depth is determined among other parameters by the lowest testing frequency that can be realised together with the eddy current sensor. When using inductive sensors, the measuring effect declines proportional to the lowering frequency (induction effect). Further reduction of testing frequency requires other types of sensors, as e.g. the GMR (Giant Magnetic Resistance), which achieves a constant measuring sensitivity down to the steady field. The multi-frequency eddy current testing method MFEC 3 of IZFP described here can be operated using three different scanning frequencies at a time. Two variants of eddy current probes are used in this case. Both have an inductive winding at their emitters, of the type of a measuring probe. The receiver end is either also an inductive winding, or a magnetic field-responsive resistance (GMR). (orig./CB) [de

  8. Large scale wind power penetration in Denmark

    DEFF Research Database (Denmark)

    Karnøe, Peter

    2013-01-01

    he Danish electricity generating system prepared to adopt nuclear power in the 1970s, yet has become the world's front runner in wind power with a national plan for 50% wind power penetration by 2020. This paper deploys a sociotechnical perspective to explain the historical transformation...... of "networks of power" via the interactions of politics, the techno-physics of electrons, and the market setting. The Danish case is about how an assemblage of new agencies has reorganized and reshaped society by building a new sociotechnical network. This has rendered developments highly unpredictable...... and highly experimental. The transformation process can be followed through the way successive technical engineering reports have represented the challenges associated with the penetration of wind power. The iteration shows how novel technical phenomena emerge and are assimilated, and how new engineering...

  9. Suicide bomb attack causing penetrating craniocerebral injury

    Directory of Open Access Journals (Sweden)

    Hussain Manzar

    2013-02-01

    Full Text Available 【Abstract】Penetrating cerebral injuries caused by foreign bodies are rare in civilian neurosurgical trauma, al-though there are various reports of blast or gunshot inju-ries in warfare due to multiple foreign bodies like pellets and nails. In our case, a 30-year-old man presented to neurosur-gery clinic with signs and symptoms of right-sided weak-ness after suicide bomb attack. The skull X-ray showed a single intracranial nail. Small craniotomy was done and the nail was removed with caution to avoid injury to surround-ing normal brain tissue. At 6 months’ follow-up his right-sided power improved to against gravity. Key words: Head injury, penetrating; Bombs; Nails

  10. 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.)

  11. Standardization of penetrating radiation testing system

    International Nuclear Information System (INIS)

    Wiley, P.A.; Aronson, H.L.

    1979-01-01

    Standardization is provided to control system gain of a penetrating radiation testing system by periodically inspecting a reference object in the same manner as the product samples so as to generate a stabilization signal which is compared to a reference signal. The difference, if any, between the stabilization signal and the reference signal is integrated and the integrated signal is used to correct the gain of the system

  12. Market penetration of new energy technologies

    Energy Technology Data Exchange (ETDEWEB)

    Packey, D.J.

    1993-02-01

    This report examines the characteristics, advantages, disadvantages, and, for some, the mathematical formulas of forecasting methods that can be used to forecast the market penetration of renewable energy technologies. Among the methods studied are subjective estimation, market surveys, historical analogy models, cost models, diffusion models, time-series models, and econometric models. Some of these forecasting methods are more effective than others at different developmental stages of new technologies.

  13. Intrauterine Devices Penetrated and Migrated: CT Findings

    International Nuclear Information System (INIS)

    Mejia Restrepo, Jorge; Lopez, Juan Esteban; Aldana Sepulveda, Natalia; Ruiz Zabaleta, Tania; Mazzaro Mauricio

    2011-01-01

    Intrauterine devices have been used for over 40 years, and they constitute the most widely accepted method of contraception among women because of the low rates of complications and low cost. Although uncommon, with the growing use of multidetector CT penetrated and migrated intrauterine devices have become a more common incidental finding. In some cases, intrauterine devices migrate to adjacent viscera, in particular the bladder and bowel and may give rise to symptoms. Consequently tomographic localization and characterization are essential for treatment planning.

  14. Models of fast-electron penetration

    International Nuclear Information System (INIS)

    Perry, D.J.; Raisis, S.K.

    1994-01-01

    We introduce multiple scattering models of charged-particle penetration which are based on the previous analyses of Yang and Perry. Our development removes the main limitations of the Fermi-Eyges approach while retaining its considerable potential as a theory which is useful for applied work. We illustrate key predictions with sample calculations that are of particular interest in therapeutic applications, 5-20 MeV electrons incident on water. 8 refs., 5 figs

  15. Thyroid Emphysema Following Penetrating Neck Trauma

    OpenAIRE

    Karadağ, Demet; Doner, Egemen; Adapınar, Baki

    2014-01-01

    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 pene...

  16. 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.

  17. 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.

  18. 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

  19. Spanish RPV head penetrations. Regulatory status

    International Nuclear Information System (INIS)

    Figueras, J.M.; Colino, J.R.

    1995-01-01

    The paper presents the actual status of inspection results on the Spanish PWR RPV CRD head penetrations (CRDH's), after two years of a whole program of inspections in all affected plants. Actual situation of penetrations pertaining to ALMARAZ 1 and 2, ASCO 1 and 2 and VANDELLOS 2 NPP's show any damage in those CRDH's inspected in 1993 and 1994 (roughly 20 out of 65 CRDH's at each unit). The paper presents a summary of CRDH characteristics, inspection methods and results obtained in each plant. TRILLO NPP has a different CRDH design (KWU-SIEMENS type) and for that reason is not considered an affected plant nor has conducted any inspection up to now. JOSE CABRERA (ZORITA) NPP has shown extensive damage, both in the lower side (weldment to the vessel) and in the upper free span area, near bimetallic weldment to SS 304, in active and nonactive penetrations and also in the vent nozzle. The paper comments extensively on the CRDH materials general data, root-cause analysis and structural analysis of degraded zones, inspection results, repair actions and other additional actions applied up to now. Finally, the paper deals with the regulatory actions taken by CSN on this topic, both for those NPP's actually non affected by the IGSCC phenomenon in the RPV CRDH's and for the specific safety case of ZORITA NPP. (author)

  20. 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.

  1. Penetration in bimodal, polydisperse granular material

    KAUST Repository

    Kouraytem, Nadia; Thoroddsen, Sigurdur T; Marston, J. O.

    2016-01-01

    We investigate the impact penetration of spheres into granular media which are compositions of two discrete size ranges, thus creating a polydisperse bimodal material. We examine the penetration depth as a function of the composition (volume fractions of the respective sizes) and impact speed. Penetration depths were found to vary between delta = 0.5D(0) and delta = 7D(0), which, for mono-modal media only, could be correlated in terms of the total drop height, H = h + delta, as in previous studies, by incorporating correction factors for the packing fraction. Bimodal data can only be collapsed by deriving a critical packing fraction for each mass fraction. The data for the mixed grains exhibit a surprising lubricating effect, which was most significant when the finest grains [d(s) similar to O(30) mu m] were added to the larger particles [d(l) similar to O(200 - 500) mu m], with a size ratio, epsilon = d(l)/d(s), larger than 3 and mass fractions over 25%, despite the increased packing fraction. We postulate that the small grains get between the large grains and reduce their intergrain friction, only when their mass fraction is sufficiently large to prevent them from simply rattling in the voids between the large particles. This is supported by our experimental observations of the largest lubrication effect produced by adding small glass beads to a bed of large sand particles with rough surfaces.

  2. Penetrating chest wound of the foetus

    Directory of Open Access Journals (Sweden)

    Albert Wandaogo

    2016-01-01

    Full Text Available Traumas of the foetus caused by stabbings are rare but actually life-threatening for both the foetus and the mother. We report a case of penetrating chest wound on a baby taken from the obstetrics unit to the paediatric surgical department. His mother was assaulted by his father, a mentally sick person with no appropriate follow-up. The foetus did not show any sign of vital distress. Surgical exploration of the wound has revealed a section of the 10 th rib, a laceration of the pleura and a tearing of the diaphragm. A phrenorraphy and a pleural drainage were performed. The new-born and its mother were released from hospital after 5 days and the clinical control and X-ray checks 6 months later showed nothing abnormal. We insisted a medical, psychiatric follow-up be initiated for the father. As regards pregnant women with penetrating wounds, the mortality rate of the foetus is 80%. The odds are good for our newborn due to the mild injuries and good professional collaboration of the medical staff. Penetrating transuterine wounds of the foetus can be very serious. The health care needed should include many fields due to the mother and the foetus′ lesions extreme polymorphism. In our case, it could have prevented by a good psychiatric followed up of the offender.

  3. Penetration in bimodal, polydisperse granular material

    KAUST Repository

    Kouraytem, N.

    2016-11-07

    We investigate the impact penetration of spheres into granular media which are compositions of two discrete size ranges, thus creating a polydisperse bimodal material. We examine the penetration depth as a function of the composition (volume fractions of the respective sizes) and impact speed. Penetration depths were found to vary between delta = 0.5D(0) and delta = 7D(0), which, for mono-modal media only, could be correlated in terms of the total drop height, H = h + delta, as in previous studies, by incorporating correction factors for the packing fraction. Bimodal data can only be collapsed by deriving a critical packing fraction for each mass fraction. The data for the mixed grains exhibit a surprising lubricating effect, which was most significant when the finest grains [d(s) similar to O(30) mu m] were added to the larger particles [d(l) similar to O(200 - 500) mu m], with a size ratio, epsilon = d(l)/d(s), larger than 3 and mass fractions over 25%, despite the increased packing fraction. We postulate that the small grains get between the large grains and reduce their intergrain friction, only when their mass fraction is sufficiently large to prevent them from simply rattling in the voids between the large particles. This is supported by our experimental observations of the largest lubrication effect produced by adding small glass beads to a bed of large sand particles with rough surfaces.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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...

  9. 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...

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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)

  15. 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

  16. Conservative approach in the management of isolated penetrating ...

    African Journals Online (AJOL)

    Magdy A. Sorour

    2012-10-06

    Oct 6, 2012 ... fixed position, which makes it prone to injury. It is the ... injuries due to low velocity projectiles there is an absence of ... M.A. Sorour et al. ... transfusion with a fall in hemoglobin and hematocrit. .... at a single level 1 trauma center were reviewed as regards, ... Hepatic trauma: risk factors influencing outcome.

  17. 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.

  18. 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

  19. Market penetration scenarios for fuel cell vehicles

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, C.E.; James, B.D.; Lomax, F.D. Jr. [Directed Technologies, Inc., Arlington, VA (United States)

    1997-12-31

    Fuel cell vehicles may create the first mass market for hydrogen as an energy carrier. Directed Technologies, Inc., working with the US Department of Energy hydrogen systems analysis team, has developed a time-dependent computer market penetration model. This model estimates the number of fuel cell vehicles that would be purchased over time as a function of their cost and the cost of hydrogen relative to the costs of competing vehicles and fuels. The model then calculates the return on investment for fuel cell vehicle manufacturers and hydrogen fuel suppliers. The model also projects the benefit/cost ratio for government--the ratio of societal benefits such as reduced oil consumption, reduced urban air pollution and reduced greenhouse gas emissions to the government cost for assisting the development of hydrogen energy and fuel cell vehicle technologies. The purpose of this model is to assist industry and government in choosing the best investment strategies to achieve significant return on investment and to maximize benefit/cost ratios. The model can illustrate trends and highlight the sensitivity of market penetration to various parameters such as fuel cell efficiency, cost, weight, and hydrogen cost. It can also illustrate the potential benefits of successful R and D and early demonstration projects. Results will be shown comparing the market penetration and return on investment estimates for direct hydrogen fuel cell vehicles compared to fuel cell vehicles with onboard fuel processors including methanol steam reformers and gasoline partial oxidation systems. Other alternative fueled vehicles including natural gas hybrids, direct injection diesels and hydrogen-powered internal combustion hybrid vehicles will also be analyzed.

  20. Simulating barrier penetration during combat. Technical report

    International Nuclear Information System (INIS)

    De Laquil, P. III.

    1980-04-01

    A computer program, BARS, simulates combat between an adversary group attempting to hijack special nuclear material and escort personnel attempting to protect it. BARS is designed to investigate how various combat strategies and levels of performance affect the time required to penetrate barriers (armor, deterrent systems, etc.) against forcible entry. A Monte Carlo code, BARS uses a game theoretic approach to allocate the attacking and defending forces. Combat suppression is simulated using a stochastic state-transition model for the behavior of individuals under combat stress. The BARS program was developed as part of the overall combat modelling effort of the transportation safeguards program

  1. A medium energy neutron deep penetration experiment

    International Nuclear Information System (INIS)

    Amian, W.; Cloth, P.; Druecke, V.; Filges, D.; Paul, N.; Schaal, H.

    1986-11-01

    A deep penetration experiment conducted at the Los Alamos WNR facility's Spallation Neutron Target is compared with calculations using intra-nuclear-cascade and S N -transport codes installed at KFA-IRE. In the experiment medium energy reactions induced by neutrons between 15 MeV and about 150 MeV inside a quasi infinite slab of iron have been measured using copper foil monitors. Details of the experimental procedure and the theoretical methods are described. A comparison of absolute reaction rates for both experimentally and theoretically derived reactions is given. The present knowledge of the corresponding monitor reaction cross sections is discussed. (orig.)

  2. Income Inequality and Transnational Corporate Penetration

    Directory of Open Access Journals (Sweden)

    Linda Beer

    2015-08-01

    Full Text Available This study examines whether the positive association between national income inequality and transnational corporate penetration found previously by Bornschier and Chase-Dunn (1985 and others circa the late 1960s still holds for the mid-l980s. Both methodological and theoretical problems of earlier studies are discussed and solutions are offered. Economic development, political-institutional and regional variables are also included inthe analyses. While further research is warranted, the results provide support for a World-System/Dependency perspective in understanding income inequality cross-nationally.

  3. Premium Efficiency Motors And Market Penetration Policy

    Energy Technology Data Exchange (ETDEWEB)

    Benhaddadi, Mohamed; Olivier, Guy

    2010-09-15

    This paper illustrates the induced enormous energy saving potential, permitted by using high-efficiency motors. Furthermore, the most important barriers to larger high-efficiency motors utilization are identified, and some incentives recommendations are given to overcome identified impediments. The authors consider that there is a strong case to enhance incentives policies for larger market penetration. The US Energy Policy Act and the Canadian Energy Efficient Act have lead to North American leadership on motor efficiency implementation. North America is not on the leading edge for energy saving and conservation. Motor efficiency is an exception that should be at least maintained.

  4. Hacking with Kali practical penetration testing techniques

    CERN Document Server

    Broad, James

    2013-01-01

    Hacking with Kali introduces you the most current distribution of the de facto standard tool for Linux pen testing. Starting with use of the Kali live CD and progressing through installation on hard drives, thumb drives and SD cards, author James Broad walks you through creating a custom version of the Kali live distribution. You'll learn how to configure networking components, storage devices and system services such as DHCP and web services. Once you're familiar with the basic components of the software, you'll learn how to use Kali through the phases of the penetration testing lifecycle

  5. Penetration of relativistic heavy ions through matter

    International Nuclear Information System (INIS)

    Scheidenberger, C.; Geissel, H.

    1997-07-01

    New heavy-ion accelerators covering the relativistic and ultra-relativistic energy regime allow to study atomic collisions with bare and few-electron projectiles. High-resolution magnetic spectrometers are used for precise stopping-power and energy-loss straggling measurements. Refined theories beyond the Born approximation have been developed and are confirmed by experiments. This paper summarizes the large progress in the understanding of relativistic heavy-ion penetration through matter, which has been achieved in the last few years. (orig.)

  6. Penetrating the markets: biomass and commercial distribution

    International Nuclear Information System (INIS)

    Schmidl, J.

    1999-01-01

    Although biomass accounts for a significant proportion of renewable energy in Europe, its market penetration could be increased if certain barriers can be surmounted. Some of those barriers are identified and suggestions made as to how they may be overcome through improved 'distribution' in various sectors. To integrate biomass into the electricity distribution system, the commercial distribution of liquid biofuels, and in the commercial distribution of biomass in the heat sector, certain rewards and penalties could be introduced and these are discussed. The low temperature heat market is seen as very important for the further development of bioenergy in Europe. (UK)

  7. Neutron streaming studies along JET shielding penetrations

    Science.gov (United States)

    Stamatelatos, Ion E.; Vasilopoulou, Theodora; Batistoni, Paola; Obryk, Barbara; Popovichev, Sergey; Naish, Jonathan

    2017-09-01

    Neutronic benchmark experiments are carried out at JET aiming to assess the neutronic codes and data used in ITER analysis. Among other activities, experiments are performed in order to validate neutron streaming simulations along long penetrations in the JET shielding configuration. In this work, neutron streaming calculations along the JET personnel entrance maze are presented. Simulations were performed using the MCNP code for Deuterium-Deuterium and Deuterium- Tritium plasma sources. The results of the simulations were compared against experimental data obtained using thermoluminescence detectors and activation foils.

  8. Market penetration of natural gas in Europe

    International Nuclear Information System (INIS)

    Haas, R.; Wirl, F.

    1992-01-01

    The strategy of restricting natural gas to noble uses (directive of EEC and endorsed by the IEA) impeded gas expansion despite substantial upward revisions in the assessment of available resources. However, increasing environmental concern slowly but gradually undermines this strategy because natural gas serves as a substitute for costly abatement. This article discusses the prospect of future natural gas consumption considering economic and ecological facts as well as strategic and political considerations. In fact, we argue that inconsistent political interventions first seriously lowered gas penetration but now favor its use

  9. Kali Linux assuring security by penetration testing

    CERN Document Server

    Ali, Shakeel; Allen, Lee

    2014-01-01

    Written as an interactive tutorial, this book covers the core of Kali Linux with real-world examples and step-by-step instructions to provide professional guidelines and recommendations for you. The book is designed in a simple and intuitive manner that allows you to explore the whole Kali Linux testing process or study parts of it individually.If you are an IT security professional who has a basic knowledge of Unix/Linux operating systems, including an awareness of information security factors, and want to use Kali Linux for penetration testing, then this book is for you.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Ultraviolet and visible light penetration of epidermis

    International Nuclear Information System (INIS)

    Eggset, G.; Kavli, G.; Volden, G.; Krokan, H.

    1984-01-01

    Light penetration in untanned skin and skin tanned with UVB (middlewave ultraviolet light) or PUVA (Psoralen photochemotherapy) was compared. Transmission at different wavelengths was measured through sheets of intact epidermis isolated by a suction blister technique. Thick epidermis was collected from a newly formed palmar friction bulla. For these studies a monochromator was used and the range of wavelengths examined was 280-700 nm. The transmission was considerably lower in tanned skin and the difference was most pronounced in the UV range. In the UVB range (290-320 nm), transmission was 13-43% for untanned epidermis, 8-12% for UVB tanned and slightly lower for PUVA tanned epidermis. At wavelengths below 325 nm only a few per cent of light penetrate through thick palmar epidermis. Both UVB and PUVA induce increased melanin content and thickening of the epidermis. Our results indicate that melanin is the most efficient protection against UVA while thickening of epidermis may be as important as the increased melanin content for the protection of living basal cells against the harmful UVB rays. (Auth)

  12. Penetrating eye injuries from writing instruments

    Directory of Open Access Journals (Sweden)

    Kelly SP

    2011-12-01

    Full Text Available Simon P Kelly, Graham MB ReevesThe Royal Bolton Hospital, Bolton, UKPurpose: To consider the potential for ocular injury from writing implements by presenting four such cases, and to consider the incidence of such eye injuries from analysis of a national trauma database.Methods: The Home and Leisure Accident Surveillance System was searched for records of eye injuries from writing instruments to provide UK estimates of such injuries. Four patients with ocular penetrating injury from pens or pencils (especially when caused by children, and examined by the authors, are described which illustrate mechanisms of injury.Results: It is estimated that around 748 ocular pen injuries and 892 ocular pencil injuries of undetermined severity occurred annually in the UK during the database surveillance period 2000–2002. No eye injuries from swords, including toy swords and fencing foils, were reported.Conclusion: Ocular perforation sometimes occur from writing instruments that are thrown in the community, especially by children. Implications for policy and prevention are discussed. Non-specialists should have a low threshold for referring patients with eye injuries if suspicious of ocular penetration, even where caused by everyday objects, such as writing instruments.Keywords: eye injury, eye, children, mechanism, writing instruments, prevention

  13. High-Penetration Photovoltaic Planning Methodologies

    Energy Technology Data Exchange (ETDEWEB)

    Gao, David Wenzhong [Alternative Power Innovations, LLC, Broomfield, CO (United States); Muljadi, Eduard [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tian, Tian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, Mackay [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2017-02-24

    The main objective of this report is to provide an overview of select U.S. utility methodologies for performing high-penetration photovoltaic (HPPV) system planning and impact studies. This report covers the Federal Energy Regulatory Commission's orders related to photovoltaic (PV) power system interconnection, particularly the interconnection processes for the Large Generation Interconnection Procedures and Small Generation Interconnection Procedures. In addition, it includes U.S. state interconnection standards and procedures. The procedures used by these regulatory bodies consider the impacts of HPPV power plants on the networks. Technical interconnection requirements for HPPV voltage regulation include aspects of power monitoring, grounding, synchronization, connection to the overall distribution system, back-feeds, disconnecting means, abnormal operating conditions, and power quality. This report provides a summary of mitigation strategies to minimize the impact of HPPV. Recommendations and revisions to the standards may take place as the penetration level of renewables on the grid increases and new technologies develop in future years.

  14. Coulomb explosion of large penetrating molecular clusters

    International Nuclear Information System (INIS)

    Wegner, H.E.; Thieberger, P.

    1981-01-01

    The main purpose of these Coulomb explosion measurements is to determine what kind of structure these and other complex molecules may have and also to determine what other special phenomena may come into play as these complex molecules pass through matter. Although the first preliminary measurements involving the Coulomb explosion of these molecules was reported at this workshop last year, the results are briefly summarized before going on to the more recent measurements obtained with a completely new kind of detector system. This new image intensifier detector system, coupled with a microcomputer, has proven to be a valuable tool in the study of the Coulomb explosion of complex molecules that penetrate matter. In the future, with some additional improvements in the system, and much better statistics for most of the molecules studied to date, it is expected that much new information will be gained about the structure of many kinds of complex molecular ions including the special effects that may be encountered when these fast molecular ions penetrate matter

  15. Penetration of magnetic fields into plasmas

    International Nuclear Information System (INIS)

    Bengtson, R.D.

    1976-01-01

    A pulsed plasma experiment was constructed to study the penetration of a fast-rising magnetic pulse into an initially unmagnetized, weakly ionized plasma of density 10 11 to 10 13 cm -3 . Magnetic probe data was analyzed using a magnetohydrodynamic approach to obtain detailed information about the dynamics of the penetration mechanism. In particular it is possible to obtain the local resistivity and thus the collision frequency from this data. These collision frequencies compare favorably with theoretical estimates of turbulent collision frequencies. The data indicates that sufficient energy is absorbed to heat the bulk of the plasma to temeratures in excess of 1 keV. A differential rotation of a collisionless theta-pinch column during implosion has been observed and explained by a model in which the driving mechanism is the off-diagonal element p/sub r theta/ of the pressure tensor. Rotational motion was detected by directional probes and spectroscopic techniques. Experimental data were modeled by a one-dimensional hybrid code which included ionization and charge exchange of protons with neutral H atoms

  16. Mass transfer from penetrations in waste containers

    International Nuclear Information System (INIS)

    Pescatore, C.; Sastre, C.

    1987-01-01

    Recent studies have indicated that localized corrosion of a relatively small area of a waste container may impair the containment function to such an extent that larger releases may be possible than from the bare waste form. This would take place when a large number of holes coexist on the container while their concentration fields do not interact significantly with each other. After performing a steady state analysis of the release from a hole, it is shown that much fewer independent holes can coexist on a container surface than previously estimated. The calculated radionuclide release from multiple independent holes must be changed accordingly. Previous analyses did not proceed to a correct application of the linear superposition principle. This resulted in unacceptable physical conclusions and undue strain on the performance assessment necessary for a container licensing procedure. The paper also analyzes the steady state release from penetrations of finite length and whose concentration fields interact with one another. The predicted release from these penetrations is lower than the previously calculated release from holes of zero thickness. It is concluded here that the steady-state release from multiple holes on a waste container can not exceed the release from the bare waste form and that multiple perforations need not be a serious liability to container performance. 8 refs., 3 figs., 1 tab

  17. 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

  18. 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.

  19. 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

  20. Civil engineering applications of ground penetrating radar

    CERN Document Server

    Pajewski, Lara

    2015-01-01

    This book, based on Transport and Urban Development COST Action TU1208, presents the most advanced applications of ground penetrating radar (GPR) in a civil engineering context, with documentation of instrumentation, methods, and results. It explains clearly how GPR can be employed for the surveying of critical transport infrastructure, such as roads, pavements, bridges, and tunnels, and for the sensing and mapping of underground utilities and voids. Detailed attention is also devoted to use of GPR in the inspection of geological structures and of construction materials and structures, including reinforced concrete, steel reinforcing bars, and pre/post-tensioned stressing ducts. Advanced methods for solution of electromagnetic scattering problems and new data processing techniques are also presented. Readers will come to appreciate that GPR is a safe, advanced, nondestructive, and noninvasive imaging technique that can be effectively used for the inspection of composite structures and the performance of diagn...

  1. Cephalic Tetanus from Penetrating Orbital Wound

    Directory of Open Access Journals (Sweden)

    Eloïse Guyennet

    2009-01-01

    Full Text Available Tetanus is a neurologic disorder caused by tetanospasmin, a protein toxin elaborated by Clostridium tetani. Cephalic tetanus is a localized form of the disease causing trismus and dysfunction of cranial nerves. We report the case of a man who presented with facial trauma, complete ophthalmoplegia, exophthalmos, areactive mydriasis, and periorbital hematoma. An orbital CT revealed air bubbles in the right orbital apex. The patient was given a tetanus toxoid booster and antibiotherapy. After extraction of a wooden foreign body, the patient developed right facial nerve palsy, disorders of swallowing, contralateral III cranial nerve palsy, and trismus. Only one case of cephalic tetanus from penetrating orbital wound has been reported in literature 20 years ago. When a patient presents with an orbital wound with ophthalmoplegia and signs of anaerobic infection, cephalic tetanus should be ruled out.

  2. Penetration enhancer: monoethylether of diethylene glycol

    International Nuclear Information System (INIS)

    Koprda, V.; Kassai, Z.; Bohacik, L.; Bezek, S.; Hadcrafft, J.; Falson-Rieg, F.

    1999-01-01

    The monoethylether of diethylene glycol (Transcutol), an excellent solubilising agent, has been suggested as a penetration enhancer compatible with trans-dermal drug delivery systems. Using the abdominal skin of 5 day old rats and Franz-type diffusion cells the following topics were studied in this contribution: (1) Flux of Transcutol, labelled with [Ethyl- 14 C]-ether, across an intact skin model, (2) Changes in properties of the skin barrier after stripping with adhesive tape, and (3) Changes in flux of Transcutol when mixed with different co-solvents. The flux from pure solvent in donor compartment reached around 50 μg cm -2 hr -1 across the intact skin horny layer, whilst after 12 strips the flux increased about 200 times. In the presence of propylene glycol dipelargonate, the flux over 2 mg cm -2 hr -1 across non stripped skin was achieved. (authors)

  3. Penetrating Stab Wound of the Right Ventricle

    Directory of Open Access Journals (Sweden)

    Onursal Buğra

    2010-04-01

    Full Text Available 18 years old male patient was admitted to our emergency unit with a penetrating stab wound to the right ventricle. A stab wound to the right ventricle was found to be 3 cm in diameter. The bleeding was controlled by insertion of a Foley catheter and inflation of the balloon. The stab wound had transected distal acute marginal side ofthe right coronary artery. A successful repair was performed with the use of a foley catheter and application of the Medtronic Octopus Tissue Stabilization System. The wound was closed with pledgeted mattress sutures. The distal acute marginal side of the right coronary artery was ligated. In this presentation, the surgical intervention method was reported and followed by a discussion of emergency surgical procedures of the heart.

  4. Automatic control of oscillatory penetration apparatus

    Science.gov (United States)

    Lucon, Peter A

    2015-01-06

    A system and method for controlling an oscillatory penetration apparatus. An embodiment is a system and method for controlling a sonic drill having a displacement and an operating range and operating at a phase difference, said sonic drill comprising a push-pull piston and eccentrics, said method comprising: operating the push-pull piston at an initial push-pull force while the eccentrics are operated at a plurality of different operating frequencies within the operating range of the sonic drill and measuring the displacement at each operating frequency; determining an efficient operating frequency for the material being drilled and operating the eccentrics at said efficient operating frequency; determining the phase difference at which the sonic drill is operating; and if the phase difference is not substantially equal to minus ninety degrees, operating the push-pull piston at another push-pull force.

  5. Fluorescent Penetrant INSPECTION—CLEANING Study Update

    Science.gov (United States)

    Eisenmann, D.; Brasche, L.

    2009-03-01

    Fluorescent penetrant inspection (FPI) is widely used in the aviation industry and other industries for surface-breaking crack detection. As with all inspection methods, adherence to the process parameters is critical to the successful detection of defects. There is variety of lubricants and surface coatings used in the aviation industry which must be removed prior to FPI. Before the FPI process begins, components are cleaned using a variety of cleaning methods which are selected based on the alloy and the soil types which must be removed. It is also important that the cleaning process not adversely affect the FPI process. From the first three phases of this project it has been found that a hot water rinse can aid in the detection process when using this nondestructive method.

  6. Market penetration of energy supply technologies

    Science.gov (United States)

    Condap, R. J.

    1980-03-01

    Techniques to incorporate the concepts of profit-induced growth and risk aversion into policy-oriented optimization models of the domestic energy sector are examined. After reviewing the pertinent market penetration literature, simple mathematical programs in which the introduction of new energy technologies is constrained primarily by the reinvestment of profits are formulated. The main results involve the convergence behavior of technology production levels under various assumptions about the form of the energy demand function. Next, profitability growth constraints are embedded in a full-scale model of U.S. energy-economy interactions. A rapidly convergent algorithm is developed to utilize optimal shadow prices in the computation of profitability for individual technologies. Allowance is made for additional policy variables such as government funding and taxation. The result is an optimal deployment schedule for current and future energy technologies which is consistent with the sector's ability to finance capacity expansion.

  7. Convective penetration in a young sun

    Science.gov (United States)

    Pratt, Jane; Baraffe, Isabelle; Goffrey, Tom; MUSIC developers group

    2018-01-01

    To interpret the high-quality data produced from recent space-missions it is necessary to study convection under realistic stellar conditions. We describe the multi-dimensional, time implicit, fully compressible, hydrodynamic, implicit large eddy simulation code MUSIC. We use MUSIC to study convection during an early stage in the evolution of our sun where the convection zone covers approximately half of the solar radius. This model of the young sun possesses a realistic stratification in density, temperature, and luminosity. We approach convection in a stellar context using extreme value theory and derive a new model for convective penetration, targeted for one-dimensional stellar evolution calculations. This model provides a scenario that can explain the observed lithium abundance in the sun and in solar-like stars at a range of ages.

  8. 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.

  9. Forestry applications of ground-penetrating radar

    Energy Technology Data Exchange (ETDEWEB)

    Lorenzo, H.; Perez-Gracia, V.; Novo, A.; Armesto, J.

    2010-07-01

    Ground-penetrating radar (GPR) is a geophysical and close-range remote sensing technique based on the use of radar pulses to obtain cross-section images of underground features. This method is characterized by the transmission of an electromagnetic short length pulse (1-2 ns), presenting a centre frequency ranging from 10 MHz to 2.5 GHz. The principles of GPR operation are based on the ability of low frequency radar waves to penetrate into a non-conductive medium, usually subsoil, but also walls, concrete or wood. Those waves are detected after suffering a reflection in electromagnetic discontinuities of the propagation medium. Therefore, this is a suitable method to study changes in those physical properties, and also to characterize different mediums and the reflective targets providing information about their physical properties. The aim of this work is to describe and demonstrate different applications of GPR in forestry, showing the obtained results together with their interpretation. Firstly, in this paper, it is illustrated how GPR is able to map shallow bedrock, subsoil stratigraphy and also to estimate shallow water table depth. Secondly, different tree trunks as well as dry timber are analyzed, evaluating the different radar data obtained in each particular case, and observing differences in their electromagnetic properties related to the GPR response. Finally, several measurements were taken in order to analyze the use of GPR to detect tree root systems using polarimetric techniques, being possible to detect medium and big size roots, together with groups of small roots. (Author) 39 refs.

  10. 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.

  11. 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

  12. 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.

  13. 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

  14. 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...

  15. 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...

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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)

  1. 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.

  2. 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

  3. 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

  4. 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.

  5. Ground Penetrating Radar Technologies in Ukraine

    Science.gov (United States)

    Pochanin, Gennadiy P.; Masalov, Sergey A.

    2014-05-01

    Transient electromagnetic fields are of great interest in Ukraine. The following topics are studied by research teams, with high-level achievements all over the world: (i) Ultra-Wide Band/Short-pulse radar techniques (IRE and LLC "Transient Technologies", for more information please visit http://applied.ire.kharkov.ua/radar%20systems_their%20components%20and%20relevant%20technologies_e.html and http://viy.ua); (ii) Ground Penetrating Radar (GPR) with stepped frequency sounding signals (IRE); (iii) Continuous-Wave (CW) radar with phase-shift keying signals (IRE); and (iv) Radio-wave interference investigation (Scientific and Technical Centre of The Subsurface Investigation, http://geophysics.ua). GPR applications are mainly in search works, for example GPR is often used to search for treasures. It is also used to identify leaks and diffusion of petroleum in soil, in storage areas, as well as for fault location of pipelines. Furthermore, GPR is used for the localization of underground utilities and for diagnostics of the technical state of hydro dams. Deeper GPR probing was performed to identify landslides in Crimea. Rescue radar with CW signal was designed in IRE to search for living people trapped under the rubble of collapsed buildings. The fourth version of this radar has been recently created, showing higher stability and noise immunity. Radio-wave interference investigation allows studying the soil down to tens of meters. It is possible to identify areas with increased conductivity (moisture) of the soil. LLC "Transient Technologies" is currently working with Shevchenko Kyiv University on a cooperation program in which the construction of a test site is one of the planned tasks. In the framework of this program, a GPR with a 300 MHz antenna was handed to the geological Faculty of the University. Employees of "Transient Technologies" held introductory lectures with a practical demonstration for students majoring in geophysics. The authors participated to GPR

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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...

  13. 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

  14. 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...

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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...

  20. 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 ...

  1. Penetration of asbestos fibers in respirator filters

    International Nuclear Information System (INIS)

    Cheng, Yung-Sung; Pearson, S.D.; Rohrbacher, K.D.; Yeh, Hsu-Chi.

    1994-01-01

    Currently, the health risks associated with asbestos have restricted its use and created a growing asbestos abatement industry with a need for respirator filters that are effective for worker protection. The main purpose of this project is to determine the influence of fiber size, electrostatic charge, and flow rate on the penetration of asbestos fibers in respirator filter cartridges. The study includes four types of filters each tested at two flow rates: the AO-R57A, a dual cartridge HEPA filter tested at 16 and 42.5 L/min; the MSA-S, a dust and mist filter tested at 16 and 42.5 L/min; the MSA-A power filter tested at 32 and 85 L/min; and the 3M-8710, a low-efficiency disposable face mask filter tested at 32 and 85 L/min. The three types of asbestos fibers used (amosite, crocidolite, and chrysotile) ranged in length from 0.04-0.5 μm and in aspect ratio (ratio of length to diameter) from 3 to 60. The fibers were used in both charged and neutralized forms. The results from amosite fibers are reported here

  2. Investigating hydrocarbon contamination using ground penetrating radar

    International Nuclear Information System (INIS)

    Roest, P.B. van der; Brasser, D.J.S.; Wagebaert, A.P.J.; Stam, P.H.

    1996-01-01

    The increasing costs of remediating contaminated sites has stimulated research for cost reducing techniques in soil investigation and clean-up techniques. Under the traditional approach soil borings and groundwater wells are used to investigate contaminated soil. These are useful tools to determine the amount and characteristics of the contamination, but they are inefficient and costly in providing information on the location and extent of contamination as they only give information on one point. This often leads to uncertainty in estimating clean-up costs or, even worse, to unsuccessful clean-ups. MAP Environmental Research has developed a technology using Ground Penetrating Radar (GPR) in combination with in-house developed software to locate and define the extent of hydrocarbon contamination. With this technology, the quality of site investigation is increased while costs are reduced. Since 1994 MAP has been improving its technology and has applied it to over 100 projects, which all have been checked afterwards by conventional drilling. This paper gives some general characteristics of the method and presents a case study. The emphasis of this paper lies on the practical application of GPR to hydrocarbon contamination detection

  3. Penetrative convection at high Rayleigh numbers

    Science.gov (United States)

    Toppaladoddi, Srikanth; Wettlaufer, John S.

    2018-04-01

    We study penetrative convection of a fluid confined between two horizontal plates, the temperatures of which are such that a temperature of maximum density lies between them. The range of Rayleigh numbers studied is Ra=[0.01 ,4 ]106,108 and the Prandtl numbers are Pr=1 and 11.6. An evolution equation for the growth of the convecting region is obtained through an integral energy balance. We identify a new nondimensional parameter, Λ , which is the ratio of temperature difference between the stable and unstable regions of the flow; larger values of Λ denote increased stability of the upper stable layer. We study the effects of Λ on the flow field using well-resolved lattice Boltzmann simulations and show that the characteristics of the flow depend sensitively upon it. For the range Λ = , we find that for a fixed Ra the Nusselt number, Nu, increases with decreasing Λ . We also investigate the effects of Λ on the vertical variation of convective heat flux and the Brunt-Väisälä frequency. Our results clearly indicate that in the limit Λ →0 the problem reduces to that of the classical Rayleigh-Bénard convection.

  4. Spontaneous wound dehiscence after penetrating keratoplasty

    Directory of Open Access Journals (Sweden)

    Alireza Foroutan

    2014-10-01

    Full Text Available Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-year-old Caucasian woman presented to our cornea clinic with spontaneous wound dehiscence after her third penetrating keratoplasty (PKP which was performed three years ago. An Ahmed glaucoma valve (New World Medical, Ranchos Cucamonga, CA was inserted ten months after the third PKP, which successfully controlled intraocular pressure (IOP. At the examination, the last sutures were removed eight months ago and she was using flourometholone 0.1 % (Sina Darou, Tehran, Iran with a dose of once a day. There was one quadrant of wound dehiscence from 8 to 11 o`clock associated with anterior wound gape and severe corneal edema. Resuturing was performed for the patient. At the one month examination, the corneal edema was resolved and best corrected visual acuity was 20/200 mainly due to previous glaucomatous optic neuropathy. Caution about the prolonged use of corticosteroids is necessary. Topical immunosuppressives could be a promising choice in this field.

  5. Adsorption of polymer chains at penetrable interfaces

    International Nuclear Information System (INIS)

    Gerasimchuk, I. V.; Sommer, J.-U.; Gerasimchuk, V. S.

    2011-01-01

    We investigate the problem of adsorption (localization) of polymer chains in the system of two penetrable interfaces within the mean-field approximation. The saturation of the polymer system in the limit case of zero bulk concentration is studied. We find the exact solution of this mean-field polymer adsorption problem that opens the possibility to treat various localization problems for polymer chains in such environments using appropriate boundary conditions. The exact solution is controlled by a single scaling variable that describes the coupling between the interfaces due to the polymer chains. We obtain a nonmonotonic behavior of the amount of adsorbed polymers as a function of the distance between the interfaces. This leads to a high-energy and a low-energy phase for the double layer with respect to the amount of polymers localized. At the saturation point, we find the total energy of the system and determine the force acting between the interfaces to be strictly attractive and to monotonically decay to zero when the interface distance increases.

  6. Interpretation of the lime column penetration test

    International Nuclear Information System (INIS)

    Liyanapathirana, D S; Kelly, R B

    2010-01-01

    Dry soil mix (DSM) columns are used to reduce the settlement and to improve the stability of embankments constructed on soft clays. During construction the shear strength of the columns needs to be confirmed for compliance with technical assumptions. A specialized blade shaped penetrometer known as the lime column probe, has been developed for testing DSM columns. This test can be carried out as a pull out resistance test (PORT) or a push in resistance test (PIRT). The test is considered to be more representative of average column shear strength than methods that test only a limited area of the column. Both PORT and PIRT tests require empirical correlations of measured resistance to an absolute measure of shear strength, in a similar manner to the cone penetration test. In this paper, finite element method is used to assess the probe factor, N, for the PORT test. Due to the large soil deformations around the probe, an Arbitrary Lagrangian Eulerian (ALE) based finite element formulation has been used. Variation of N with rigidity index and the friction at the probe-soil interface are investigated to establish a range for the probe factor.

  7. Penetration of tritium into the Tropical Pacific

    International Nuclear Information System (INIS)

    Fine, R.A.; Peterson, W.H.; Ostlund, H.G.

    1987-01-01

    The persistence of subsurface tritium maxima coincident with the Equatorial Currents is used to show that advection along isopycnals by the mean wind-driven circulation is the dominant process in the at most 14-year time scale for the penetration of high northern latitude water to the equator (above 26.2 sigma-theta). Ventilation of the equatorial Pacific thermocline from the north contrasts sharply with the equatorial Atlantic thermocline which is ventilated from the south. The most striking manifestation of the North Pacific circulation is evidenced by a tritium maximum and salinity minimum at the equator between 145 0 and 125 0 W located above 25.6 sigma-theta. It shows that regardless of time of sampling the easter/central equator has received the highest latitude water, probably as a consequence of recirculation by the Equatorial Currents. Between the same meridians there is a tritium maximum on and north of the equator at the surface, which is interpreted as an expression of upwelling. Its coincidence with the cool tongue (Wyrtki) provides direct evidence that the upwelling process plays a dominant role in its maintenance on a decadal time scale

  8. 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...

  9. 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

  10. Manual and automatic flight control during severe turbulence penetration

    Science.gov (United States)

    Johnston, D. E.; Klein, R. H.; Hoh, R. H.

    1976-01-01

    An analytical and experimental investigation of possible contributing factors in jet aircraft turbulence upsets was conducted. Major contributing factors identified included autopilot and display deficiencies, the large aircraft inertia and associated long response time, and excessive pilot workload. An integrated flight and thrust energy management director system was synthesized. The system was incorporated in a moving-base simulation and evaluated using highly experienced airline pilots. The evaluation included comparison of pilot workload and flight performance during severe turbulence penetration utilizing four control/display concepts: manual control with conventional full panel display, conventional autopilot (A/P-A) with conventional full panel display, improved autopilot (A/P-B) with conventional full panel display plus thrust director display, and longitudinal flight director with conventional full panel display plus thrust director display. Simulation results show improved performance, reduced pilot workload, and a pilot preference for the autopilot system controlling to the flight director command and manual control of thrust following the trim thrust director.

  11. Visual Inspection of Water Leakage from Ground Penetrating Radar Radargram

    Science.gov (United States)

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

    2015-10-01

    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 efficiently detect mains water leaks has been examined. Several experiments were designed and conducted to prove that GPR can be used as tool for water leakage detection. These include instrument validation test and soil compaction test to clarify the maximum dry density (MDD) of soil and simulation studies on water leakage at a test bed consisting of PVC pipe burying in sand to a depth of 40 cm. Data from GPR detection are processed using the Reflex 2D software. Identification of water leakage was visually inspected from the anomalies in the radargram based on GPR reflection coefficients. The results have ascertained the capability and effectiveness of the GPR in detecting water leakage which could help avoiding difficulties with other leak detection methods.

  12. VISUAL INSPECTION OF WATER LEAKAGE FROM GROUND PENETRATING RADAR RADARGRAM

    Directory of Open Access Journals (Sweden)

    N. N. Halimshah

    2015-10-01

    Full Text Available 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 efficiently detect mains water leaks has been examined. Several experiments were designed and conducted to prove that GPR can be used as tool for water leakage detection. These include instrument validation test and soil compaction test to clarify the maximum dry density (MDD of soil and simulation studies on water leakage at a test bed consisting of PVC pipe burying in sand to a depth of 40 cm. Data from GPR detection are processed using the Reflex 2D software. Identification of water leakage was visually inspected from the anomalies in the radargram based on GPR reflection coefficients. The results have ascertained the capability and effectiveness of the GPR in detecting water leakage which could help avoiding difficulties with other leak detection methods.

  13. 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

  14. [Penetrant injuries of colon--our experience].

    Science.gov (United States)

    Lazović, R; Krivokapić, Z; Dobricanin, V

    2010-01-01

    In attemption to determine the place of primary repair in management of colon injuries, an open, non randomized clinical study was performed. Retrospective (RS) group of 62 patients according to exclusion criteria by Stone (S/F) and Flint (F1) was managed by one or two stage surgical procedure. Prospective (PR) group of 34 patients was managed using one stage repair non-selectively: two stage procedures were performed in 3 cases of advanced peritonitis and multi-segmental lacerations with impaired circulation of colon. In RS group 36 patients were managed by primary repair and in PR group, 31 were managed by primary repair. Both groups were of similar age/sex. Indexes of trauma severity were similar (TS, ISS, PATI). The latent time was shorter in PR group. Associated injuries to other body regions and abdominal organs were similar in both groups. S/F criteria and Flint grading in both (RS vs. PR) groups were similar. Comparison of attempted and successful primary repairs justifies the more liberal use of primary repair in early management of colon injuries.

  15. 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.

  16. 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

  17. Market penetration of biodiesel and ethanol

    Science.gov (United States)

    Szulczyk, Kenneth Ray

    This dissertation examines the influence that economic and technological factors have on the penetration of biodiesel and ethanol into the transportation fuels market. This dissertation focuses on four aspects. The first involves the influence of fossil fuel prices, because biofuels are substitutes and have to compete in price. The second involves biofuel manufacturing technology, principally the feedstock-to-biofuel conversion rates, and the biofuel manufacturing costs. The third involves prices for greenhouse gas offsets. The fourth involves the agricultural commodity markets for feedstocks, and biofuel byproducts. This dissertation uses the Forest and Agricultural Sector Optimization Model-Greenhouse Gas (FASOM-GHG) to quantitatively examine these issues and calculates equilibrium prices and quantities, given market interactions, fossil fuel prices, carbon dioxide equivalent prices, government biofuel subsidies, technological improvement, and crop yield gains. The results indicate that for the ranges studied, gasoline prices have a major impact on aggregate ethanol production but only at low prices. At higher prices, one runs into a capacity constraint that limits expansion on the capacity of ethanol production. Aggregate biodiesel production is highly responsive to gasoline prices and increases over time. (Diesel fuel price is proportional to the gasoline price). Carbon dioxide equivalent prices expand the biodiesel industry, but have no impact on ethanol aggregate production when gasoline prices are high again because of refinery capacity expansion. Improvement of crop yields shows a similar pattern, expanding ethanol production when the gasoline price is low and expanding biodiesel. Technological improvement, where biorefinery production costs decrease over time, had minimal impact on aggregate ethanol and biodiesel production. Finally, U.S. government subsidies have a large expansionary impact on aggregate biodiesel production. Finally, U.S. government

  18. Severe accident testing of electrical penetration assemblies

    International Nuclear Information System (INIS)

    Clauss, D.B.

    1989-11-01

    This report describes the results of tests conducted on three different designs of full-size electrical penetration assemblies (EPAs) that are used in the containment buildings of nuclear power plants. The objective of the tests was to evaluate the behavior of the EPAs under simulated severe accident conditions using steam at elevated temperature and pressure. Leakage, temperature, and cable insulation resistance were monitored throughout the tests. Nuclear-qualified EPAs were produced from D. G. O'Brien, Westinghouse, and Conax. Severe-accident-sequence analysis was used to generate the severe accident conditions (SAC) for a large dry pressurized-water reactor (PWR), a boiling-water reactor (BWR) Mark I drywell, and a BWR Mark III wetwell. Based on a survey conducted by Sandia, each EPA was matched with the severe accident conditions for a specific reactor type. This included the type of containment that a particular EPA design was used in most frequently. Thus, the D. G. O'Brien EPA was chosen for the PWR SAC test, the Westinghouse was chosen for the Mark III test, and the Conax was chosen for the Mark I test. The EPAs were radiation and thermal aged to simulate the effects of a 40-year service life and loss-of-coolant accident (LOCA) before the SAC tests were conducted. The design, test preparations, conduct of the severe accident test, experimental results, posttest observations, and conclusions about the integrity and electrical performance of each EPA tested in this program are described in this report. In general, the leak integrity of the EPAs tested in this program was not compromised by severe accident loads. However, there was significant degradation in the insulation resistance of the cables, which could affect the electrical performance of equipment and devices inside containment at some point during the progression of a severe accident. 10 refs., 165 figs., 16 tabs

  19. 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.

  20. 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.)

  1. 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.

  2. 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.

  3. 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.

  4. 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

    Directory of Open Access Journals (Sweden)

    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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. 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

  14. Estimating Penetration Resistance in Agricultural Soils of Ardabil Plain Using Artificial Neural Network and Regression Methods

    Directory of Open Access Journals (Sweden)

    Gholam Reza Sheykhzadeh

    2017-02-01

    Full Text Available Introduction: Penetration resistance is one of the criteria for evaluating soil compaction. It correlates with several soil properties such as vehicle trafficability, resistance to root penetration, seedling emergence, and soil compaction by farm machinery. Direct measurement of penetration resistance is time consuming and difficult because of high temporal and spatial variability. Therefore, many different regressions and artificial neural network pedotransfer functions have been proposed to estimate penetration resistance from readily available soil variables such as particle size distribution, bulk density (Db and gravimetric water content (θm. The lands of Ardabil Province are one of the main production regions of potato in Iran, thus, obtaining the soil penetration resistance in these regions help with the management of potato production. The objective of this research was to derive pedotransfer functions by using regression and artificial neural network to predict penetration resistance from some soil variations in the agricultural soils of Ardabil plain and to compare the performance of artificial neural network with regression models. Materials and methods: Disturbed and undisturbed soil samples (n= 105 were systematically taken from 0-10 cm soil depth with nearly 3000 m distance in the agricultural lands of the Ardabil plain ((lat 38°15' to 38°40' N, long 48°16' to 48°61' E. The contents of sand, silt and clay (hydrometer method, CaCO3 (titration method, bulk density (cylinder method, particle density (Dp (pychnometer method, organic carbon (wet oxidation method, total porosity(calculating from Db and Dp, saturated (θs and field soil water (θf using the gravimetric method were measured in the laboratory. Mean geometric diameter (dg and standard deviation (σg of soil particles were computed using the percentages of sand, silt and clay. Penetration resistance was measured in situ using cone penetrometer (analog model at 10

  15. 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

  16. Analysis of the Noneroding Penetration of Tungsten Alloy Long Rods into Aluminum Targets

    National Research Council Canada - National Science Library

    Segletes, Steven

    2003-01-01

    .... the eroding-penetration regimes. Conventional one-dimensional penetration analysis reveals that the noneroding datum is wholly consistent with the notion of treating the rod as if it penetrated in a rigid-body fashion, possessing...

  17. Long term pavement performance computed parameter : frost penetration

    Science.gov (United States)

    2008-11-01

    As the pavement design process moves toward mechanistic-empirical techniques, knowledge of seasonal changes in pavement structural characteristics becomes critical. Specifically, frost penetration information is necessary for determining the effect o...

  18. 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.

  19. colour-flow ultrasound in the detection of penetrating vascular

    African Journals Online (AJOL)

    VASCULAR INJURIES OF THE NECK. Peter Corr ... in patients with penetrating neck injuries. 5 IIfr Mal ... study of the aortic arch, carotid and vertebral artery was performed as .... that may require endovascular treatment, for example vertebral.

  20. 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.