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Sample records for mesh patient selection

  1. Selective laser vaporization of polypropylene sutures and mesh

    Burks, David; Rosenbury, Sarah B.; Kennelly, Michael J.; Fried, Nathaniel M.

    2012-02-01

    Complications from polypropylene mesh after surgery for female stress urinary incontinence (SUI) may require tedious surgical revision and removal of mesh materials with risk of damage to healthy adjacent tissue. This study explores selective laser vaporization of polypropylene suture/mesh materials commonly used in SUI. A compact, 7 Watt, 647-nm, red diode laser was operated with a radiant exposure of 81 J/cm2, pulse duration of 100 ms, and 1.0-mm-diameter laser spot. The 647-nm wavelength was selected because its absorption by water, hemoglobin, and other major tissue chromophores is low, while polypropylene absorption is high. Laser vaporization of ~200-μm-diameter polypropylene suture/mesh strands, in contact with fresh urinary tissue samples, ex vivo, was performed. Non-contact temperature mapping of the suture/mesh samples with a thermal camera was also conducted. Photoselective vaporization of polypropylene suture and mesh using a single laser pulse was achieved with peak temperatures of 180 and 232 °C, respectively. In control (safety) studies, direct laser irradiation of tissue alone resulted in only a 1 °C temperature increase. Selective laser vaporization of polypropylene suture/mesh materials is feasible without significant thermal damage to tissue. This technique may be useful for SUI procedures requiring surgical revision.

  2. Outcomes of Autologous Fascia Pubovaginal Sling for Patients with Transvaginal Mesh Related Complications Requiring Mesh Removal.

    McCoy, Olugbemisola; Vaughan, Taylor; Nickles, S Walker; Ashley, Matt; MacLachlan, Lara S; Ginsberg, David; Rovner, Eric

    2016-08-01

    We reviewed the outcomes of the autologous fascial pubovaginal sling as a salvage procedure for recurrent stress incontinence after intervention for polypropylene mesh erosion/exposure and/or bladder outlet obstruction in patients treated with prior transvaginal synthetic mesh for stress urinary incontinence. In a review of surgical databases at 2 institutions between January 2007 and June 2013 we identified 46 patients who underwent autologous fascial pubovaginal sling following removal of transvaginal synthetic mesh in simultaneous or staged fashion. This cohort of patients was evaluated for outcomes, including subjective and objective success, change in quality of life and complications between those who underwent staged vs concomitant synthetic mesh removal with autologous fascial pubovaginal sling placement. All 46 patients had received at least 1 prior mesh sling for incontinence and 8 (17%) had received prior transvaginal polypropylene mesh for pelvic organ prolapse repair. A total of 30 patients underwent concomitant mesh incision with or without partial excision and autologous sling placement while 16 underwent staged autologous sling placement. Mean followup was 16 months. Of the patients 22% required a mean of 1.8 subsequent interventions an average of 6.5 months after autologous sling placement with no difference in median quality of life at final followup. At last followup 42 of 46 patients (91%) and 35 of 46 (76%) had achieved objective and subjective success, respectively. There was no difference in subjective success between patients treated with a staged vs a concomitant approach (69% vs 80%, p = 0.48). Autologous fascial pubovaginal sling placement after synthetic mesh removal can be performed successfully in patients with stress urinary incontinence as a single or staged procedure. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Patient perception of transvaginal mesh and the media.

    Koski, Michelle Elaine; Chamberlain, Jennifer; Rosoff, James; Vaughan, Taylor; Kaufman, Melissa R; Winters, Jack C; Rovner, Eric S

    2014-09-01

    To assess the penetration of media-based information on transvaginal mesh (TVM) in our patient population and to determine whether exposure affects patient opinion. Since the 2011 Federal Drug Administration communication on TVM, many advertisements from legal practices have been directed toward patients. An 18-item survey was administered to female patients at 2 sites from August 2012 to April 2013. Patients presenting with new diagnoses of pelvic organ prolapse or stress urinary incontinence or patients who reported prior mesh surgery were excluded. Ninety-nine questionnaires were completed. Sixty-six of the patients (67%) were aware of TVM; and of these, 38 (58%) cited advertisements as the initial source of information. Only 12% were aware of the Food and Drug Administration's communication. Regarding opinion of TVM, 9% chose "it is a safe product," 9% "safety depends on factors related to patient," 4.5% "not a safe product," 1.5% "safety depends on the doctor," 68% "I don't know," and 4.5% marked 2 selections. Only 12% indicated knowing the difference in the use of TVM for pelvic organ prolapse vs stress urinary incontinence. When asked what influenced their opinion of TVM the most; responses were as follows: advertisement (33.3%), medical professional (22.7%), friends or family who underwent TVM procedure (12.1%), media article (6.1%), and "not sure" (25.8%). Advertisements of TVM lawsuits had a high penetration into our patient population but did not produce an overtly negative response in our sample. Clinicians should be aware of the impact of these advertisements on patient opinion and counsel patients accordingly with unbiased and scientifically accurate information. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Does Attorney Advertising Influence Patient Perceptions of Pelvic Mesh?

    Tippett, Elizabeth; King, Jesse; Lucent, Vincent; Ephraim, Sonya; Murphy, Miles; Taff, Eileen

    2018-01-01

    To measure the relative influence of attorney advertising on patient perceptions of pelvic mesh compared with a history of surgery and a first urology visit. A 52-item survey was administered to 170 female patients in 2 urology offices between 2014 and 2016. Multiple survey items were combined to form scales for benefit and risk perceptions of pelvic mesh, perceptions of the advertising, attitudes toward pelvic mesh, and knowledge of pelvic mesh and underlying medical conditions. Data were analyzed using hierarchical linear regression models. Exposure to attorney advertising was quite high; 88% reported seeing a mesh-related attorney advertisement in the last 6 months. Over half of patients reported seeing attorney advertisements more than once per week. A history of prior mesh implant surgery was the strongest predictor of benefit and risk perceptions of pelvic mesh. Exposure to attorney advertising was associated with higher risk perceptions but did not significantly affect perceptions of benefits. Past urologist visits increased perceptions of benefits but had no effect on risk perceptions. Attorney advertising appears to have some influence on risk perceptions, but personal experience and discussions with a urogynecologist or urologist also influence patient perceptions. Implications, limitations, and future research are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Are patient specific meshes required for EIT head imaging?

    Jehl, Markus; Aristovich, Kirill; Faulkner, Mayo; Holder, David

    2016-06-01

    Head imaging with electrical impedance tomography (EIT) is usually done with time-differential measurements, to reduce time-invariant modelling errors. Previous research suggested that more accurate head models improved image quality, but no thorough analysis has been done on the required accuracy. We propose a novel pipeline for creation of precise head meshes from magnetic resonance imaging and computed tomography scans, which was applied to four different heads. Voltages were simulated on all four heads for perturbations of different magnitude, haemorrhage and ischaemia, in five different positions and for three levels of instrumentation noise. Statistical analysis showed that reconstructions on the correct mesh were on average 25% better than on the other meshes. However, the stroke detection rates were not improved. We conclude that a generic head mesh is sufficient for monitoring patients for secondary strokes following head trauma.

  6. Sacral colpopexy versus transvaginal mesh colpopexy in obese patients.

    McDermott, Colleen D; Park, Jean; Terry, Colin L; Woodman, Patrick J; Hale, Douglass S

    2013-05-01

    Obesity can predispose women to pelvic organ prolapse and can also affect the success of pelvic organ prolapse surgery. The purpose of this study was to compare the postoperative anatomical outcomes following sacral colpopexy (SC) and transvaginal mesh colpopexy in a group of obese women with pelvic organ prolapse. We conducted a retrospective cohort study of obese women who underwent SC (n = 56) or transvaginal mesh colpopexy (n = 35). Follow-up ranged from 6 to 12 months. Preoperative, perioperative, and postoperative variables were compared using Student t, Mann-Whitney U, and Fisher exact tests, and by analysis of covariance. The women in the SC group had significantly higher mean apical vaginal measurements (P transvaginal mesh colpopexy group. There were no significant differences between the groups for other postoperative outcomes, including mesh erosion, recurrent prolapse symptoms, dyspareunia, and surgical satisfaction (P > 0.05). In these 91 obese patients with pelvic organ prolapse, SC resulted in better anatomical outcomes than transvaginal mesh colpopexy. However, the two procedures had similar outcomes with regard to recurrent symptoms and surgical satisfaction.

  7. Selectivity of commercial, larger mesh and square mesh trawl codends for deep water rose shrimp Parapenaeus longirostris (Lucas, 1846 in the Aegean Sea

    Hakan Kaykaç

    2009-09-01

    Full Text Available We investigated the differences between size selectivity of a commercial codend (40 mm diamond mesh – 40D, a larger mesh codend (48 mm diamond mesh – 48D, and a square mesh codend (40 mm square mesh – 40S for Parapenaeus longirostris in international waters of the Aegean Sea. Selectivity data were collected by using a covered codend method and analysed taking between-haul variation into account. The results indicate significant increases in L50 values in relation to an increase in mesh size and when the square mesh is used in the commercial trawl codend. The results demonstrate that the commercially used codend (40D is not selective enough for P. longirostris in terms of length at first maturity. Changing from a 40D to a 48D codend significantly improves selection, with an increase of about 15% in the L50 values (carapace length 14.5 mm for 40D and 16.6 mm for 48D. Similarly, 40 mm square mesh, which has recently been legislated for EU Mediterranean waters, showed a 12.4% higher mean L50 value (16.3 mm than 40 mm diamond mesh for this species. However, despite these improvements, the 48D and 40S codends still need further improvements to obtain higher selectivity closer to the length at first maturity (20 mm carapace length.

  8. Scalable power selection method for wireless mesh networks

    Olwal, TO

    2009-01-01

    Full Text Available This paper addresses the problem of a scalable dynamic power control (SDPC) for wireless mesh networks (WMNs) based on IEEE 802.11 standards. An SDPC model that accounts for architectural complexities witnessed in multiple radios and hops...

  9. Worlds largest particle physics laboratory selects Proxim Wireless Mesh

    2007-01-01

    "Proxim Wireless has announced that the European Organization for Nuclear Research (CERN), the world's largest particle physics laboratory and the birthplace of the World Wide Web, is using it's ORiNOCO AP-4000 mesh access points to extend the range of the laboratory's Wi-Fi network and to provide continuous monitoring of the lab's calorimeters" (1/2 page)

  10. Evaluation of mechanical properties in metal wire mesh supported selective catalytic reduction (SCR) catalyst structures

    Rajath, S.; Siddaraju, C.; Nandakishora, Y.; Roy, Sukumar

    2018-04-01

    The objective of this research is to evaluate certain specific mechanical properties of certain stainless steel wire mesh supported Selective catalytic reduction catalysts structures wherein the physical properties of the metal wire mesh and also its surface treatments played vital role thereby influencing the mechanical properties. As the adhesion between the stainless steel wire mesh and the catalyst material determines the bond strength and the erosion resistance of catalyst structures, surface modifications of the metal- wire mesh structure in order to facilitate the interface bonding is therefore very important to realize enhanced level of mechanical properties. One way to enhance such adhesion properties, the stainless steel wire mesh is treated with the various acids, i.e., chromic acid, phosphoric acid including certain mineral acids and combination of all those in various molar ratios that could generate surface active groups on metal surface that promotes good interface structure between the metal- wire mesh and metal oxide-based catalyst material and then the stainless steel wire mesh is dipped in the glass powder slurry containing some amount of organic binder. As a result of which the said catalyst material adheres to the metal-wire mesh surface more effectively that improves the erosion profile of supported catalysts structure including bond strength.

  11. Energy-aware path selection metric for IEEE 802.11s wireless mesh networking

    Mhlanga, MM

    2009-01-01

    Full Text Available The IEEE 802.11s working group has commenced activities, which would lead to the development of a standard for wireless mesh networks (WMNs). The draft of 802.11s introduces a new path selection metric called airtime link metric. However...

  12. Energy-aware path selection metric for IEEE 802.11s wireless mesh networking

    Mhlanga, MM

    2009-08-01

    Full Text Available The IEEE 802.11s working group has commenced activities, which would lead to the development of a standard for wireless mesh networks (WMNs). The draft of 802.11s introduces a new path selection metric called airtime link metric. However...

  13. Size selectivity of commercial (300 MC) and larger square mesh top ...

    In the present study, size selectivity of a commercial (300 MC) and a larger square mesh top panel (LSMTPC) codend for blue whiting (Micromesistius poutassou) were tested on a commercial trawl net in the international waters between Turkey and Greece. Trawling, performed during daylight was carried out at depths ...

  14. Selective separation of oil and water with mesh membranes by capillarity

    Yu, Yuanlie; Chen, Hua; Liu, Yun; Craig, Vincent S.J.; Lai, Zhiping

    2016-01-01

    The separation of oil and water from wastewater generated in the oil-production industries, as well as in frequent oil spillage events, is important in mitigating severe environmental and ecological damage. Additionally, a wide arrange of industrial processes require oils or fats to be removed from aqueous systems. The immiscibility of oil and water allows for the wettability of solid surfaces to be engineered to achieve the separation of oil and water through capillarity. Mesh membranes with extreme, selective wettability can efficiently remove oil or water from oil/water mixtures through a simple filtration process using gravity. A wide range of different types of mesh membranes have been successfully rendered with extreme wettability and applied to oil/water separation in the laboratory. These mesh materials have typically shown good durability, stability as well as reusability, which makes them promising candidates for an ever widening range of practical applications. © 2016 Elsevier B.V.

  15. Selective separation of oil and water with mesh membranes by capillarity

    Yu, Yuanlie

    2016-05-29

    The separation of oil and water from wastewater generated in the oil-production industries, as well as in frequent oil spillage events, is important in mitigating severe environmental and ecological damage. Additionally, a wide arrange of industrial processes require oils or fats to be removed from aqueous systems. The immiscibility of oil and water allows for the wettability of solid surfaces to be engineered to achieve the separation of oil and water through capillarity. Mesh membranes with extreme, selective wettability can efficiently remove oil or water from oil/water mixtures through a simple filtration process using gravity. A wide range of different types of mesh membranes have been successfully rendered with extreme wettability and applied to oil/water separation in the laboratory. These mesh materials have typically shown good durability, stability as well as reusability, which makes them promising candidates for an ever widening range of practical applications. © 2016 Elsevier B.V.

  16. High throughput route selection in multi-rate wireless mesh networks

    WEI Yi-fei; GUO Xiang-li; SONG Mei; SONG Jun-de

    2008-01-01

    Most existing Ad-hoc routing protocols use the shortest path algorithm with a hop count metric to select paths. It is appropriate in single-rate wireless networks, but has a tendency to select paths containing long-distance links that have low data rates and reduced reliability in multi-rate networks. This article introduces a high throughput routing algorithm utilizing the multi-rate capability and some mesh characteristics in wireless fidelity (WiFi) mesh networks. It uses the medium access control (MAC) transmission time as the routing metric, which is estimated by the information passed up from the physical layer. When the proposed algorithm is adopted, the Ad-hoc on-demand distance vector (AODV) routing can be improved as high throughput AODV (HT-AODV). Simulation results show that HT-AODV is capable of establishing a route that has high data-rate, short end-to-end delay and great network throughput.

  17. Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications.

    Manonai, Jittima; Rostaminia, Ghazaleh; Denson, Lindsay; Shobeiri, S Abbas

    2016-03-01

    The objective of this study was to investigate the clinical and ultrasonographic findings of women who had three-dimensional endovaginal ultrasound (EVUS) for the management of vaginal mesh complications. This was a retrospective study of patients that had EVUS due to mesh complications at a tertiary care center. The clinical charts were reviewed. The stored 3D volumes were reviewed regarding mesh information by two examiners independently. The predictive value of physical examination for detection of vaginal mesh was calculated. Patient outcomes were reviewed. Seventy-nine patients presented to our center because of their, or their physicians' concern regarding mesh complications. Forty-one (51.9%) had vaginal/pelvic pain, and 51/62 (82.2%) of sexually active women experienced dyspareunia. According to ultrasonographic findings, mesh or sling was not demonstrated in six patients who believed they have had mesh/sling implantation. The positive predictive value for vaginal examination was 94.5% (95% CI: 84.9%-98.8%), negative predictive value was 12.5% (95% CI: 2.8%-32.4%), sensitivity was 72.2% (95% CI: 59.4%-81.2%), and specificity was 50.0% (95% CI: 12.4%-87.6%). Fifty-four patients were indicated for surgical treatment. Median postoperative review was 12 (range, 3-18) months and 38/53 (71.7%) patients were satisfied. The most common complaints of vaginal mesh complications were pain and dyspareunia. EVUS appeared to be helpful for assessing mesh presence, location, and extent including planning for surgical intervention. © 2015 Wiley Periodicals, Inc.

  18. Selective separation of oil and water with special wettability mesh membranes

    Liu, Defei

    2017-02-24

    Due to the different interfacial effects of oil and water, utilizing the special wettability of solid surfaces to design an oil and water separation process has been demonstrated to be an effective approach for oil/water separation. In this report, a simple process has been developed to fabricate special surface wettability mesh membranes. The carbon nanoparticles with diameters of 10 nm were first coated onto the surface of steel wires based on a candle soot coating process. These templates of carbon nanoparticles were then coated with a more stable layer of silica (SiO2) particles via a facile chemical vapor deposition route. After being modified by two separate methods, a superhydrophobic/superoleophilic membrane was obtained by the use of 1H,1H,2H,2H-perfluorooctyltrichlorosilane (PFOTS) and a oleophobic/superhydrophilic membrane was obtained by using poly(diallyldimethylammonium-perfluorooctanoate) (PDDA–PFO). Separation experiments show that these superhydrophobic/superoleophilic or oleophobic/superhydrophilic mesh membranes can be used to selectively separate oil/water with a high flux of more than 930 L m−2 h−1 and a collecting efficiency of over 97%. Furthermore, the repetitions of the separation experiments demonstrate that these superhydrophobic/superoleophilic or oleophobic/superhydrophilic mesh membranes are durable, stable and reusable, making them encouraging candidates for practical oil-polluted water treatment.

  19. An Approach for Patient-Specific Multi-domain Vascular Mesh Generation Featuring Spatially Varying Wall Thickness Modeling

    Raut, Samarth S.; Liu, Peng; Finol, Ender A.

    2015-01-01

    In this work, we present a computationally efficient image-derived volume mesh generation approach for vasculatures that implements spatially varying patient-specific wall thickness with a novel inward extrusion of the wall surface mesh. Multi-domain vascular meshes with arbitrary numbers, locations, and patterns of both iliac bifurcations and thrombi can be obtained without the need to specify features or landmark points as input. In addition, the mesh output is coordinate-frame independent ...

  20. Positive Contrast MRI Techniques for Visualization of Iron-Loaded Hernia Mesh Implants in Patients.

    Alexander Ciritsis

    Full Text Available In MRI, implants and devices can be delineated via susceptibility artefacts. To discriminate susceptibility voids from proton-free structures, different positive contrast techniques were implemented. The purpose of this study was to evaluate a pulse sequence-based positive contrast technique (PCSI and a post-processing susceptibility gradient mapping algorithm (SGM for visualization of iron loaded mesh implants in patients.Five patients with iron-loaded MR-visible inguinal hernia mesh implants were examined at 1.5 Tesla. A gradient echo sequence (GRE; parameters: TR: 8.3ms; TE: 4.3ms; NSA:2; FA:20°; FOV:350mm² and a PCSI sequence (parameters: TR: 25ms; TE: 4.6ms; NSA:4; FA:20°; FOV:350mm² with on-resonant proton suppression were performed. SGM maps were calculated using two algorithms. Image quality and mesh delineation were independently evaluated by three radiologists.On GRE, the iron-loaded meshes generated distinct susceptibility-induced signal voids. PCSI exhibited susceptibility differences including the meshes as hyperintense signals. SGM exhibited susceptibility differences with positive contrast. Visually, the different algorithms presented no significant differences. Overall, the diagnostic value was rated best in GRE whereas PCSI and SGM were barely "sufficient".Both "positive contrast" techniques depicted implanted meshes with hyperintense signal. SGM comes without additional acquisition time and can therefore be utilized in every patient.

  1. Effect of netting direction and number of meshes around on size selection in the codend for Baltic cod (Gadus morhua)

    Wienbeck, Harald; Herrmann, Bent; Moderhak, Waldemar

    2011-01-01

    We investigated experimentally the effect that turning the netting direction 90° (T90) and halving the number of meshes around in the circumference in a diamond mesh codend had on size selection of Baltic cod. The results generally agreed with predictions of a previous simulation-based study. Both...... modifications had a significant positive effect on the size selection of cod. The best selection results were obtained for a codend in which both factors were applied together. For that codend, very little between-haul variation in cod size selection was detected, especially compared to the reference codend...

  2. Selectivity of Standard, Narrow and Square Mesh Panel Trawl Codends for Hake (Merluccius merluccius) and Poor Cod (Trisopterus minutus capelanus)

    ÖZBİLGİN, Hüseyin; TOSUNOĞLU, Zafer; AYDIN, Celalettin; KAYKAÇ, Hakan; TOKAÇ, Adnan

    2005-01-01

    The selectivity of 3 trawl codends, (1) a commercially used standard codend, (2) a narrow codend (100 meshes on its circumference instead of 200) and (3) a square mesh top panel codend, was tested for hake (Merluccius merluccius) and poor cod (Trisopterus minutus capelanus) between 8 and 24 October 2003, in the Aegean Sea. Data were collected using the covered codend technique, and analysed by means of a logistic equation with the maximum likelihood method. The results show that the commer...

  3. Operation for recurrent cystocele with anterior colporrhaphy or non-absorbable mesh: patient reported outcomes

    Nüssler, Emil Karl; Greisen, Susanne; Kesmodel, Ulrik Schiøler

    2013-01-01

    Abstract INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare patient reported outcomes and complications after repair of recurrent anterior vaginal wall prolapse in routine health care settings using standard anterior colporrhaphy or non-absorbable mesh. METHODS: The study is based...... on prospective data from the Swedish National Register for Gynaecological Surgery. 286 women were operated on for recurrent anterior vaginal wall prolapse in 2008-2010; 157 women had an anterior colporrhaphy and 129 were operated on with a non-absorbable mesh. Pre-, and perioperative data were collected from...... (0.6 %) in the anterior colporrhaphy group (p = 0.58). The infection rate was higher after mesh (8.5 %) than after anterior colporrhaphy (2.5 %; OR 3.19 ; 1.07-14.25). CONCLUSION: Implantation of synthetic mesh during operation for recurrent cystocele more than doubled the cure rate, whereas...

  4. Evaluation of mesh morphing and mapping techniques in patient specific modeling of the human pelvis.

    Salo, Zoryana; Beek, Maarten; Whyne, Cari Marisa

    2013-01-01

    Robust generation of pelvic finite element models is necessary to understand the variation in mechanical behaviour resulting from differences in gender, aging, disease and injury. The objective of this study was to apply and evaluate mesh morphing and mapping techniques to facilitate the creation and structural analysis of specimen-specific finite element (FE) models of the pelvis. A specimen-specific pelvic FE model (source mesh) was generated following a traditional user-intensive meshing scheme. The source mesh was morphed onto a computed tomography scan generated target surface of a second pelvis using a landmarked-based approach, in which exterior source nodes were shifted to target surface vertices, while constrained along a normal. A second copy of the morphed model was further refined through mesh mapping, in which surface nodes of the initial morphed model were selected in patches and remapped onto the surfaces of the target model. Computed tomography intensity based material properties were assigned to each model. The source, target, morphed and mapped models were analyzed under axial compression using linear static FE analysis and their strain distributions evaluated. Morphing and mapping techniques were effectively applied to generate good quality geometrically complex specimen-specific pelvic FE models. Mapping significantly improved strain concurrence with the target pelvis FE model. Copyright © 2012 John Wiley & Sons, Ltd.

  5. Evaluation of mesh morphing and mapping techniques in patient specific modelling of the human pelvis.

    Salo, Zoryana; Beek, Maarten; Whyne, Cari Marisa

    2012-08-01

    Robust generation of pelvic finite element models is necessary to understand variation in mechanical behaviour resulting from differences in gender, aging, disease and injury. The objective of this study was to apply and evaluate mesh morphing and mapping techniques to facilitate the creation and structural analysis of specimen-specific finite element (FE) models of the pelvis. A specimen-specific pelvic FE model (source mesh) was generated following a traditional user-intensive meshing scheme. The source mesh was morphed onto a computed tomography scan generated target surface of a second pelvis using a landmarked-based approach, in which exterior source nodes were shifted to target surface vertices, while constrained along a normal. A second copy of the morphed model was further refined through mesh mapping, in which surface nodes of the initial morphed model were selected in patches and remapped onto the surfaces of the target model. Computed tomography intensity-based material properties were assigned to each model. The source, target, morphed and mapped models were analyzed under axial compression using linear static FE analysis, and their strain distributions were evaluated. Morphing and mapping techniques were effectively applied to generate good quality and geometrically complex specimen-specific pelvic FE models. Mapping significantly improved strain concurrence with the target pelvis FE model. Copyright © 2012 John Wiley & Sons, Ltd.

  6. Selective separation of oil and water with special wettability mesh membranes

    Liu, Defei; Yu, Yuanlie; Chen, Xin; Zheng, Yuying

    2017-01-01

    that these superhydrophobic/superoleophilic or oleophobic/superhydrophilic mesh membranes are durable, stable and reusable, making them encouraging candidates for practical oil-polluted water treatment.

  7. BIOLOGICAL AND SYNTHETIC MESH USE IN RECONSTRUCTIVE SURGERY IN PATIENTS WITH BREAST CANCER

    M. V. Ermoshchenkova

    2017-01-01

    Full Text Available Introduction. In recent years, considerable success has been achieved in complex and combined treatment of breast cancer (BC. Reconstructive plastic surgery plays an important role in the rehabilitation of patients with breast cancer and it is currently considered as the causal treatment of mental disorders caused by loss of femininity and integrity of one’s own body. One-step breast reconstruction for cancer treatment makes it possible to use supplementary materials — synthetic and biological implants that can replace muscle autografts and thereby reduce trauma, blood loss, operation time, and thereby help to avoid the defect of donor areas. The authors describe the state of the art at present and demonstrate the results of their own research.Materials and methods. The object of study was 38 of breast cancer cases and 1 case of multiple gelioma caused by silicone implant rupture. 44 operations have been completed: 21 — radical subcutaneous mastectomy, 1 — subcutaneous mastectomy, 17 — skin-sparing radical mastectomy with one-step reconstruction with mesh implant (12 — titanium, 16 — polyester, 11 — acellular dermal matrix Permacol, 5 — prophylactic contralateral subcutaneous mastectomy with one-step reconstruction with silicone implant and a mesh implant due to a mutation of the BRCA1 gene. The technique of operations and the results of studies have been described in detail.Results. In the late post-operational period, the implants were removed in 5 cases: in 2 patients due to the development of inflammation of ADM, 3 — in connection with the development of bedsores and diastasis of the skin in the wound area when synthetic implants were used. From the total number of patients in the group (n = 39 excellent cosmetic results were reported in 21 cases (54%, good — in 13 (33% and unsatisfactory — in 5 (13% cases due to the removal of the implants.Conclusions. Biological and synthetic materials are significantly important

  8. Theoretical study of the influence of twine thickness on haddock selectivity in diamond mesh cod-ends

    Herrmann, Bent; O'Neill, F.G.

    2006-01-01

    Using the cod-end simulation model PRESEMO, the influence of twine thickness on cod-end selectivity is investigated. The reduction of lateral mesh opening that arises as a result of both twine bending stiffness and the physical presence of the twine is considered. While it is shown that this lead...

  9. Cost effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing permanent colostomy for rectal cancer.

    Lee, Lawrence; Saleem, Abdulaziz; Landry, Tara; Latimer, Eric; Chaudhury, Prosanto; Feldman, Liane S

    2014-01-01

    Parastomal hernia (PSH) is common after stoma formation. Studies have reported that mesh prophylaxis reduces PSH, but there are no cost-effectiveness data. Our objective was to determine the cost effectiveness of mesh prophylaxis vs no prophylaxis to prevent PSH in patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer. Using a cohort Markov model, we modeled the costs and effectiveness of mesh prophylaxis vs no prophylaxis at the index operation in a cohort of 60-year-old patients undergoing abdominoperineal resection for rectal cancer during a time horizon of 5 years. Costs were expressed in 2012 Canadian dollars (CAD$) and effectiveness in quality-adjusted life years. Deterministic and probabilistic sensitivity analyses were performed. In patients with stage I to III rectal cancer, prophylactic mesh was dominant (less costly and more effective) compared with no mesh. In patients with stage IV disease, mesh prophylaxis was associated with higher cost (CAD$495 more) and minimally increased effectiveness (0.05 additional quality-adjusted life years), resulting in an incremental cost-effectiveness ratio of CAD$10,818 per quality-adjusted life year. On sensitivity analyses, the decision was sensitive to the probability of mesh infection and the cost of the mesh, and method of diagnosing PSH. In patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer, mesh prophylaxis might be the less costly and more effective strategy compared with no mesh to prevent PSH in patients with stage I to III disease, and might be cost effective in patients with stage IV disease. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  10. The use of synthetic mesh in patients undergoing ventral hernia repair during colorectal resection: Risk of infection and recurrence

    Galal H. El-Gazzaz

    2012-10-01

    Conclusions: Use of non-absorbable mesh during colorectal resection should be very selective. Comorbidity, duration of follow-up, emergency operations, size of area covered and infection are independent factors associated with recurrence.

  11. 3D active shape models of human brain structures: application to patient-specific mesh generation

    Ravikumar, Nishant; Castro-Mateos, Isaac; Pozo, Jose M.; Frangi, Alejandro F.; Taylor, Zeike A.

    2015-03-01

    The use of biomechanics-based numerical simulations has attracted growing interest in recent years for computer-aided diagnosis and treatment planning. With this in mind, a method for automatic mesh generation of brain structures of interest, using statistical models of shape (SSM) and appearance (SAM), for personalised computational modelling is presented. SSMs are constructed as point distribution models (PDMs) while SAMs are trained using intensity profiles sampled from a training set of T1-weighted magnetic resonance images. The brain structures of interest are, the cortical surface (cerebrum, cerebellum & brainstem), lateral ventricles and falx-cerebri membrane. Two methods for establishing correspondences across the training set of shapes are investigated and compared (based on SSM quality): the Coherent Point Drift (CPD) point-set registration method and B-spline mesh-to-mesh registration method. The MNI-305 (Montreal Neurological Institute) average brain atlas is used to generate the template mesh, which is deformed and registered to each training case, to establish correspondence over the training set of shapes. 18 healthy patients' T1-weightedMRimages form the training set used to generate the SSM and SAM. Both model-training and model-fitting are performed over multiple brain structures simultaneously. Compactness and generalisation errors of the BSpline-SSM and CPD-SSM are evaluated and used to quantitatively compare the SSMs. Leave-one-out cross validation is used to evaluate SSM quality in terms of these measures. The mesh-based SSM is found to generalise better and is more compact, relative to the CPD-based SSM. Quality of the best-fit model instance from the trained SSMs, to test cases are evaluated using the Hausdorff distance (HD) and mean absolute surface distance (MASD) metrics.

  12. Understanding and predicting size selection in diamond-mesh cod ends for danish seining: A study based on sea trials and computer simulations

    Herrmann, Bent; Krag, Ludvig Ahm; Feekings, Jordan P.

    2016-01-01

    described by a double logistic selection curve, implying that two different size selection processes occur in the cod end. The double selection process could be explained by an additional selection process occurring through slack meshes. The results imply that the escapement of 46% and 34% of the larger...... Atlantic Cod and Haddock (those above 48 cm), respectively, would be through wide-open or slack meshes. Since these mesh states are only likely to be present in the latest stage of the fishing process (e.g., when the cod end is near the surface), a large fraction of the bigger fish probably escaped near...

  13. 3-year results of transvaginal cystocele repair with transobturator four-arm mesh: A prospective study of 105 patients

    Kdous, Moez; Zhioua, Fethi

    2014-01-01

    Objectives To evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles. Patients and methods In this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ?2 according to the Baden?Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh?, Aspide Medical, France). All surgical procedures were carried out by the same experien...

  14. Surface mesh to voxel data registration for patient-specific anatomical modeling

    de Oliveira, Júlia E. E.; Giessler, Paul; Keszei, András.; Herrler, Andreas; Deserno, Thomas M.

    2016-03-01

    Virtual Physiological Human (VPH) models are frequently used for training, planning, and performing medical procedures. The Regional Anaesthesia Simulator and Assistant (RASimAs) project has the goal of increasing the application and effectiveness of regional anesthesia (RA) by combining a simulator of ultrasound-guided and electrical nerve-stimulated RA procedures and a subject-specific assistance system through an integration of image processing, physiological models, subject-specific data, and virtual reality. Individualized models enrich the virtual training tools for learning and improving regional anaesthesia (RA) skills. Therefore, we suggest patient-specific VPH models that are composed by registering the general mesh-based models with patient voxel data-based recordings. Specifically, the pelvis region has been focused for the support of the femoral nerve block. The processing pipeline is composed of different freely available toolboxes such as MatLab, the open Simulation framework (SOFA), and MeshLab. The approach of Gilles is applied for mesh-to-voxel registration. Personalized VPH models include anatomical as well as mechanical properties of the tissues. Two commercial VPH models (Zygote and Anatomium) were used together with 34 MRI data sets. Results are presented for the skin surface and pelvic bones. Future work will extend the registration procedure to cope with all model tissue (i.e., skin, muscle, bone, vessel, nerve, fascia) in a one-step procedure and extrapolating the personalized models to body regions actually being out of the captured field of view.

  15. Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment

    Notten, K. J. B.; Essers, B. A.; Weemhoff, M.; Rutten, A. G. H.; Donners, J. J. A. E.; van Gestel, I.; Kruitwagen, R. F. M. P.; Roovers, J. P. W. R.; Dirksen, C. D.

    2015-01-01

    We investigated patients' preferences for anterior colporrhaphy or mesh surgery as surgical correction of anterior vaginal wall prolapse. Labelled discrete choice experiment. Three Dutch teaching hospitals. Women with anterior vaginal wall prolapse Pelvic Organ Prolapse Quantification stage 2 or

  16. Opfront: mesh

    2015-01-01

    Mesh generation and visualization software based on the CGAL library. Folder content: drawmesh Visualize slices of the mesh (surface/volumetric) as wireframe on top of an image (3D). drawsurf Visualize surfaces of the mesh (surface/volumetric). img2mesh Convert isosurface in image to volumetric m...... mesh (medit format). img2off Convert isosurface in image to surface mesh (off format). off2mesh Convert surface mesh (off format) to volumetric mesh (medit format). reduce Crop and resize 3D and stacks of images. data Example data to test the library on...

  17. Work in progress: a channel selection algorithm for a TVWS mesh network

    Zlobinsky, Natasha

    2016-09-01

    Full Text Available and routing for throughput optimization in multi-radio wireless mesh networks,” Proc. 11th Annu. Int. Conf. Mob. Comput. Netw. - MobiCom ’05, p. 58, 2005. [4] M. R. Rai, S. Vahid, and K. Moessner, “SINR based Topology Control for Multihop Wireless Networks...

  18. Energy optimization based path selection algorithm for IEEE 802.11s wireless mesh networks

    Mhlanga, MM

    2011-09-01

    Full Text Available It is everyone’s dream to have network connectivity anywhere at all times. This dream can only be realized provided there are feasible solutions that are put in place for the next generation of wireless works. Wireless Mesh Networks (WMNs...

  19. Gear selectivity of large-mesh nets and drumlines used to catch ...

    Catches of sharks and bycatch in large-mesh nets and baited drumlines used by the Queensland Shark Control Program were examined to determine the efficacy of both gear types and assess fishing strategies that minimise their impacts. There were few significant differences in the size of both sharks and bycatch in the ...

  20. Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size.

    Seker, D; Oztuna, D; Kulacoglu, H; Genc, Y; Akcil, M

    2013-04-01

    Small mesh size has been recognized as one of the factors responsible for recurrence after Lichtenstein hernia repair due to insufficient coverage or mesh shrinkage. The Lichtenstein Hernia Institute recommends a 7 × 15 cm mesh that can be trimmed up to 2 cm from the lateral side. We performed a systematic review to determine surgeons' mesh size preference for the Lichtenstein hernia repair and made a meta-analysis to determine the effect of mesh size, mesh type, and length of follow-up time on recurrence. Two medical databases, PubMed and ISI Web of Science, were systematically searched using the key word "Lichtenstein repair." All full text papers were selected. Publications mentioning mesh size were brought for further analysis. A mesh surface area of 90 cm(2) was accepted as the threshold for defining the mesh as small or large. Also, a subgroup analysis for recurrence pooled proportion according to the mesh size, mesh type, and follow-up period was done. In total, 514 papers were obtained. There were no prospective or retrospective clinical studies comparing mesh size and clinical outcome. A total of 141 papers were duplicated in both databases. As a result, 373 papers were obtained. The full text was available in over 95 % of papers. Only 41 (11.2 %) papers discussed mesh size. In 29 studies, a mesh larger than 90 cm(2) was used. The most frequently preferred commercial mesh size was 7.5 × 15 cm. No papers mentioned the size of the mesh after trimming. There was no information about the relationship between mesh size and patient BMI. The pooled proportion in recurrence for small meshes was 0.0019 (95 % confidence interval: 0.007-0.0036), favoring large meshes to decrease the chance of recurrence. Recurrence becomes more marked when follow-up period is longer than 1 year (p < 0.001). Heavy meshes also decreased recurrence (p = 0.015). This systematic review demonstrates that the size of the mesh used in Lichtenstein hernia repair is rarely

  1. A Tissue Relevance and Meshing Method for Computing Patient-Specific Anatomical Models in Endoscopic Sinus Surgery Simulation

    Audette, M. A.; Hertel, I.; Burgert, O.; Strauss, G.

    This paper presents on-going work on a method for determining which subvolumes of a patient-specific tissue map, extracted from CT data of the head, are relevant to simulating endoscopic sinus surgery of that individual, and for decomposing these relevant tissues into triangles and tetrahedra whose mesh size is well controlled. The overall goal is to limit the complexity of the real-time biomechanical interaction while ensuring the clinical relevance of the simulation. Relevant tissues are determined as the union of the pathology present in the patient, of critical tissues deemed to be near the intended surgical path or pathology, and of bone and soft tissue near the intended path, pathology or critical tissues. The processing of tissues, prior to meshing, is based on the Fast Marching method applied under various guises, in a conditional manner that is related to tissue classes. The meshing is based on an adaptation of a meshing method of ours, which combines the Marching Tetrahedra method and the discrete Simplex mesh surface model to produce a topologically faithful surface mesh with well controlled edge and face size as a first stage, and Almost-regular Tetrahedralization of the same prescribed mesh size as a last stage.

  2. Chronic pain after liechtenstein mesh repair for inguinla hernia a review of 114 patients

    Shah, S.F.; Hameed, S.; Aurakzai, J.K.; Chaudry, MA.

    2015-01-01

    Objective: To determine factors related to chronic persistent pain lasting more than 6 months after mesh repair for inguinal hernia. Methodology: This study included 114 patients who underwent elective inguinal hernioplasty at Department of General Surgery, Federal General Hospital, Islamabad, Pakistan from July 2012 to December 2014. All were followed upto end of six months. Postoperatively pain was recorded at second, seventh and fourteen day and at the end of six months on Visual Analogue Scale. Results: Chronic pain at six-month follow up was present in 37 (32.45%) patients. The incidence of factors responsible for chronic pain were pain before surgery in 22 (19.29%), early postoperative pain in 10 (8.77%) of patients, wound infection in 2 (1.75%), hematoma formation in 3 (2.63%), and seroma formation in 4 (3.508%) patients. Conclusion: Chronic pain after mesh repair for inguinal hernia causes significant morbidity. Early recognition and management of the factors prevents patient morbidity. (author)

  3. Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results

    Fischer, Tanja [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany); Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Klinikum Innenstadt, Munich (Germany); Ladurner, Roland; Mussack, Thomas [Ludwig-Maximilians-University Munich, Department of Surgery and Traumatology, Klinikum Innenstadt, Munich (Germany); Gangkofer, Alexander; Reiser, Maximilian; Lienemann, Andreas [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany)

    2007-12-15

    The aim of our study was to develop a method that allows the vizualiation and evaluation of implanted mesh in patients after incisional hernia repair with MRI. Furthermore, we assessed problems typically related with mesh implantation like adhesions and muscular atrophy. We enrolled 28 patients after incisional hernia repair. In 10 patients mesh implantation was done by laparoscopy (expanded polytetrafluoroethylene=ePTFE mesh) and in 18 by laparotomy (polypropylene mesh). Functional MRI was performed on a 1.5-T system in supine position. Sagittal and axial TrueFISP images of the entire abdomen were acquired with the patient repeatedly straining. Evaluation included: correct position and intact fixation of the mesh, furthermore visceral adhesions, recurrent hernia and atrophy of the rectus muscle. The ePTFE mesh was visible in all cases; the polypropylene mesh was not detectable. In seven of the ten ePTFE meshes the fixation was not intact; two recurrent hernias were detected. Twenty of 28 patients had intraabdominal adhesions. In 5 cases mobility of the abdominal wall was reduced, and 16 patients showed an atropy of the rectus muscle. Functional cine MRI is a suitable method for follow-up studies in patients after hernia repair. ePTFE meshes can be visualized directly, and typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed reliably. (orig.)

  4. Necrotising fasciitis after hysterectomy and concomitant transvaginal mesh repair in a patient with pelvic organ prolapse.

    Pushkar, Dmitry Y; Vasilchenko, Mikhail I; Kasyan, George R

    2013-10-01

    Necrotising fasciitis is a severe form of soft tissue infection. Herein, we present an unreported complication of the transvaginal repair of a pelvic organ prolapse (POP) with trocar-guided polypropylene mesh and a concomitant hysterectomy. A 61-year-old Caucasian female who had been using an intrauterine device (IUD) for 30 years presented with a stage 3 pelvic organ prolapse. A genital ultrasound examination confirmed the presence of an IUD, but found no endometrial abnormalities. The surgical management was limited to a transvaginal hysterectomy and simultaneous anterior vaginal wall repair augmented with trocar-guided mesh. A morphological examination of the removed uterus confirmed the presence of the intrauterine device and additionally found endometrial cancer (T1N0M0), which was not revealed during the preoperative ultrasound. Within 6 days of the surgery, she developed anaerobic bilateral necrotising fasciitis on both thighs. Non-clostridial streptococci were identified in the wound. After 18 days of intensive care, the patient died of fatal coagulopathy.

  5. OPTIMASI OLSR ROUTING PROTOCOL PADA JARINGAN WIRELESS MESH DENGAN ADAPTIVE REFRESHING TIME INTERVAL DAN ENHANCE MULTI POINT RELAY SELECTING ALGORITHM

    Faosan Mapa

    2014-01-01

    Full Text Available Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Wireless Mesh Network (WMN adalah suatu konektivitas jaringan yang self-organized, self-configured dan multi-hop. Tujuan dari WMN adalah menawarkan pengguna suatu bentuk jaringan nirkabel yang dapat dengan mudah berkomunikasi dengan jaringan konvensional dengan kecepatan tinggi dan dengan cakupan yang lebih luas serta biaya awal yang minimal. Diperlukan suatu desain protokol routing yang efisien untuk WMN yang secara adaptif dapat mendukung mesh routers dan mesh clients. Dalam tulisan ini, diusulkan untuk mengoptimalkan protokol OLSR, yang merupakan protokol routing proaktif. Digunakan heuristik yang meningkatkan protokol OLSR melalui adaptive refreshing time interval dan memperbaiki metode MPR selecting algorithm. Suatu analisa dalam meningkatkan protokol OLSR melalui adaptive refreshing time interval dan memperbaiki algoritma pemilihan MPR menunjukkan kinerja yang signifikan dalam hal throughput jika dibandingkan dengan protokol OLSR yang asli. Akan tetapi, terdapat kenaikan dalam hal delay. Pada simulasi yang dilakukan dapat disimpulkan bahwa OLSR dapat dioptimalkan dengan memodifikasi pemilihan node MPR berdasarkan cost effective dan penyesuaian waktu interval refreshing hello message sesuai dengan keadaan

  6. An eFTD-VP framework for efficiently generating patient-specific anatomically detailed facial soft tissue FE mesh for craniomaxillofacial surgery simulation.

    Zhang, Xiaoyan; Kim, Daeseung; Shen, Shunyao; Yuan, Peng; Liu, Siting; Tang, Zhen; Zhang, Guangming; Zhou, Xiaobo; Gateno, Jaime; Liebschner, Michael A K; Xia, James J

    2018-04-01

    Accurate surgical planning and prediction of craniomaxillofacial surgery outcome requires simulation of soft tissue changes following osteotomy. This can only be achieved by using an anatomically detailed facial soft tissue model. The current state-of-the-art of model generation is not appropriate to clinical applications due to the time-intensive nature of manual segmentation and volumetric mesh generation. The conventional patient-specific finite element (FE) mesh generation methods are to deform a template FE mesh to match the shape of a patient based on registration. However, these methods commonly produce element distortion. Additionally, the mesh density for patients depends on that of the template model. It could not be adjusted to conduct mesh density sensitivity analysis. In this study, we propose a new framework of patient-specific facial soft tissue FE mesh generation. The goal of the developed method is to efficiently generate a high-quality patient-specific hexahedral FE mesh with adjustable mesh density while preserving the accuracy in anatomical structure correspondence. Our FE mesh is generated by eFace template deformation followed by volumetric parametrization. First, the patient-specific anatomically detailed facial soft tissue model (including skin, mucosa, and muscles) is generated by deforming an eFace template model. The adaptation of the eFace template model is achieved by using a hybrid landmark-based morphing and dense surface fitting approach followed by a thin-plate spline interpolation. Then, high-quality hexahedral mesh is constructed by using volumetric parameterization. The user can control the resolution of hexahedron mesh to best reflect clinicians' need. Our approach was validated using 30 patient models and 4 visible human datasets. The generated patient-specific FE mesh showed high surface matching accuracy, element quality, and internal structure matching accuracy. They can be directly and effectively used for clinical

  7. Orbital Reconstruction: Patient-Specific Orbital Floor Reconstruction Using a Mirroring Technique and a Customized Titanium Mesh.

    Tarsitano, Achille; Badiali, Giovanni; Pizzigallo, Angelo; Marchetti, Claudio

    2016-10-01

    Enophthalmos is a severe complication of primary reconstruction of orbital floor fractures. The goal of secondary reconstruction procedures is to restore symmetrical globe positions to recover function and aesthetics. The authors propose a new method of orbital floor reconstruction using a mirroring technique and a customized titanium mesh, printed using a direct metal laser-sintering method. This reconstructive protocol involves 4 steps: mirroring of the healthy orbit at the affected site, virtual design of a patient-specific orbital floor mesh, CAM procedures for direct laser-sintering of the customized titanium mesh, and surgical insertion of the device. Using a computed tomography data set, the normal, uninjured side of the craniofacial skeleton was reflected onto the contralateral injured side, and a reconstructive orbital floor mesh was designed virtually on the mirrored orbital bone surface. The solid-to-layer files of the mesh were then manufactured using direct metal laser sintering, which resolves the shaping and bending biases inherent in the indirect method. An intraoperative navigation system ensured accuracy of the entire procedure. Clinical outcomes were assessed using 3dMD photogrammetry and computed tomography data in 7 treated patients. The technique described here appears to be a viable method to correct complex orbital floor defects needing delayed reconstruction. This study represents the first step in the development of a wider experimental protocol for orbital floor reconstruction using computer-assisted design-computer-assisted manufacturing technology.

  8. Mesh Excision: Is Total Mesh Excision Necessary?

    Wolff, Gillian F; Winters, J Christian; Krlin, Ryan M

    2016-04-01

    Nearly 29% of women will undergo a secondary, repeat operation for pelvic organ prolapse (POP) symptom recurrence following a primary repair, as reported by Abbott et al. (Am J Obstet Gynecol 210:163.e1-163.e1, 2014). In efforts to decrease the rates of failure, graft materials have been utilized to augment transvaginal repairs. Following the success of using polypropylene mesh (PPM) for stress urinary incontinence (SUI), the use of PPM in the transvaginal repair of POP increased. However, in recent years, significant concerns have been raised about the safety of PPM mesh. Complications, some specific to mesh, such as exposures, erosion, dyspareunia, and pelvic pain, have been reported with increased frequency. In the current literature, there is not substantive evidence to suggest that PPM has intrinsic properties that warrant total mesh removal in the absence of complications. There are a number of complications that can occur after transvaginal mesh placement that do warrant surgical intervention after failure of conservative therapy. In aggregate, there are no high-quality controlled studies that clearly demonstrate that total mesh removal is consistently more likely to achieve pain reduction. In the cases of obstruction and erosion, it seems clear that definitive removal of the offending mesh is associated with resolution of symptoms in the majority of cases and reasonable practice. There are a number of complications that can occur with removal of mesh, and patients should be informed of this as they formulate a choice of treatment. We will review these considerations as we examine the clinical question of whether total versus partial removal of mesh is necessary for the resolution of complications following transvaginal mesh placement.

  9. Mesh Migration into the J-Pouch in a Patient with Post-Ulcerative Colitis Colectomy: A Case Report and Literature Review

    Asem Ghanim

    2017-01-01

    Full Text Available Mesh repair offers advantages like lower postsurgical pain and earlier return to work. Thus, it has become a widely used treatment option. Here, we present the first case report of a mesh migration into a J-pouch in a patient with history of ulcerative colitis who underwent total abdominal colectomy with J-pouch and ileoanal anastomosis and a subsequent laparoscopic ventral hernia repair with mesh.

  10. Modelling and simulation of size selectivity in diamond mesh trawl cod-ends

    Herrmann, Bent

    of the fishing gear. The cod-end is the rearmost part of a trawl where catch accumulates and in which most of the size selection is known to take place. To date, the main method used to assess the selectivity of trawl cod-ends has been to run sea trials followed by statistical analysis of the obtained......Within many fisheries there is a widespread discard of fish. Furthermore, there are several fisheries where fish are caught before reaching the optimal size, leading to an adverse exploitation of the resources. One way to achieve a more optimal exploitation is to improve the size selectivity...

  11. Antarctic krill; assessment of mesh size selectivity and escape mortality from trawls

    Krafft, Bjørn A.; Krag, Ludvig Ahm; Herrmann, Bent

    2015-01-01

    Marine AS. The project will examine krill escape mortality from the codend during a full scale field experiment, model size selectivity and escape mortality in codends including different designs and assess the size selectivity in the trawl body forward of the codend. Based on end results from the preceding...... examinations we will be able to predict size selectivity and escape mortality from the entire trawl body with the appurtenant mortality for different trawl designs......This working paper presents the aims and methodology for a three-year-project (commenced in 2015) assessing size selectivity and escape mortality of Antarctic krill from trawl nets. The project is widely based on acquired experiences from a completed study Net Escapement of Antarctic krill...

  12. Mesh erosion after abdominal sacrocolpopexy.

    Kohli, N; Walsh, P M; Roat, T W; Karram, M M

    1998-12-01

    To report our experience with erosion of permanent suture or mesh material after abdominal sacrocolpopexy. A retrospective chart review was performed to identify patients who underwent sacrocolpopexy by the same surgeon over 8 years. Demographic data, operative notes, hospital records, and office charts were reviewed after sacrocolpopexy. Patients with erosion of either suture or mesh were treated initially with conservative therapy followed by surgical intervention as required. Fifty-seven patients underwent sacrocolpopexy using synthetic mesh during the study period. The mean (range) postoperative follow-up was 19.9 (1.3-50) months. Seven patients (12%) had erosions after abdominal sacrocolpopexy with two suture erosions and five mesh erosions. Patients with suture erosion were asymptomatic compared with patients with mesh erosion, who presented with vaginal bleeding or discharge. The mean (+/-standard deviation) time to erosion was 14.0+/-7.7 (range 4-24) months. Both patients with suture erosion were treated conservatively with estrogen cream. All five patients with mesh erosion required transvaginal removal of the mesh. Mesh erosion can follow abdominal sacrocolpopexy over a long time, and usually presents as vaginal bleeding or discharge. Although patients with suture erosion can be managed successfully with conservative treatment, patients with mesh erosion require surgical intervention. Transvaginal removal of the mesh with vaginal advancement appears to be an effective treatment in patients failing conservative management.

  13. Improving the selectivity of beam trawls in The Netherlands: the effect of large mesh top panels on the catch rates of sole, plaice, cod and whiting

    Marlen, van B.

    2003-01-01

    This paper presents the results of experiments aimed to improve the selectivity of beam trawls in the North Sea for roundfish whilst minimizing losses on target flatfish. Large-meshed top panels were designed for the tickler chain type of beam trawls used in this fishery. The design process involved

  14. Socioemotional selectivity in cancer patients.

    Pinquart, Martin; Silbereisen, Rainer K

    2006-06-01

    This study analyzed the contact preferences of newly diagnosed cancer patients and healthy control group participants. In line with the theory of socioemotional selectivity, patients were more likely than control participants to prefer contact with familiar social partners, but this difference was stronger in younger and middle-aged patients than in older patients. Across a 6-month interval, patients' contact preferences changed according to the perceived success of therapy. For example, if therapy was perceived to be successful, patients showed an increasing interest in contacts with unfamiliar social partners. Results indicate that contact preferences are adapted to the perception of limited versus extended future lifetime. Copyright (c) 2006 APA, all rights reserved.

  15. Abdominal wall hernia repair with a composite ePTFE/polypropylene mesh: clinical outcome and quality of life in 152 patients

    Iversen, E; Lykke, Anna; Hensler, M

    2010-01-01

    No consensus has yet been reached regarding the optimal mesh for the repair of small ventral hernias. A composite polytetrafluoroethylene/polypropylene mesh (Ventralex(®)) is designed for this purpose, and this paper reports its use in a larger series of patients....

  16. 3-year results of transvaginal cystocele repair with transobturator four-arm mesh: A prospective study of 105 patients.

    Kdous, Moez; Zhioua, Fethi

    2014-12-01

    To evaluate the long-term efficacy and safety of transobturator four-arm mesh for treating cystoceles. In this prospective study, 105 patients had a cystocele corrected between January 2004 and December 2008. All patients had a symptomatic cystocele of stage ⩾2 according to the Baden-Walker halfway stratification. We used only the transobturator four-arm mesh kit (Surgimesh®, Aspide Medical, France). All surgical procedures were carried out by the same experienced surgeon. The patients' characteristics and surgical variables were recorded prospectively. The anatomical outcome, as measured by a physical examination and postoperative stratification of prolapse, and functional outcome, as assessed by a questionnaire derived from the French equivalents of the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire and the Pelvic Organ Prolapse-Urinary Incontinence-Sexual Questionnaire, were considered as the primary outcome measures. Peri- and postoperative complications constituted the secondary outcome measures. At 36 months after surgery the anatomical success rate (stage 0 or 1) was 93%. On a functional level, all the scores of quality of life and sexuality were improved. The overall satisfaction score (visual analogue scale) was 71.4%. There were no perioperative adverse events. Mesh erosion was reported in 7.6% and mesh retraction in 5.7% of the patients. If the guidelines and precautions are followed, vaginal prosthetic surgery for genitourinary prolapse has shown long-term benefits. It provides excellent results both anatomically and functionally. However, complications are not negligible and some are specific to prosthetic surgery.

  17. Surgical patient selection and counseling.

    Ziegelmann, Matt; Köhler, Tobias S; Bailey, George C; Miest, Tanner; Alom, Manaf; Trost, Landon

    2017-08-01

    The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of

  18. Reengineering of MeSH thesauri for term selection to optimize literature retrieval and knowledge reconstruction in support of stem cell research.

    Su, Yan; Andrews, James; Huang, Hong; Wang, Yue; Kong, Liangliang; Cannon, Peter; Xu, Ping

    2016-05-23

    PubMed is a widely used database for scientists to find biomedical-related literature. Due to the complexity of the selected research subject and its interdisciplinary nature, as well as the exponential growth in the number of disparate pieces of biomedical literature, it is an overwhelming challenge for scientists to define the right search strategies and quickly locate all related information. Specialized subsets and groupings of controlled vocabularies, such as Medical Subject Headings (MeSH), can enhance information retrieval in specialized domains, such as stem cell research. There is a need to develop effective search strategies and convenient solutions for knowledge organization in stem cell research. The understanding of the interrelationships between these MeSH terms also facilitates the building of knowledge organization systems in related subject fields. This study collected empirical data for MeSH-related terms from stem cell literature and developed a novel approach that uses both automation and expert-selection to create a set of terms that supports enhanced retrieval. The selected MeSH terms were reconstructed into a classified thesaurus that can guide researchers towards a successful search and knowledge organization of stem cell literature. First, 4253 MeSH terms were harvested from a sample of 5527 stem cell related research papers from the PubMed database. Next, unrelated terms were filtered out based on term frequency and specificity. Precision and recall measures were used to help identify additional valuable terms, which were mostly non-MeSH terms. The study identified 15 terms that specifically referred to stem cell research for information retrieval, which would yield a higher precision (97.7 %) and recall (94.4 %) rates in comparison to other approaches. In addition, 128 root MeSH terms were selected to conduct knowledge organization of stem cell research in categories of anatomy, disease, and others. This study presented a novel strategy

  19. Advanced 3D Mesh Manipulation in Stereolithographic Files and Post-Print Processing for the Manufacturing of Patient-Specific Vascular Flow Phantoms.

    O'Hara, Ryan P; Chand, Arpita; Vidiyala, Sowmya; Arechavala, Stacie M; Mitsouras, Dimitrios; Rudin, Stephen; Ionita, Ciprian N

    2016-02-27

    Complex vascular anatomies can cause the failure of image-guided endovascular procedures. 3D printed patient-specific vascular phantoms provide clinicians and medical device companies the ability to preemptively plan surgical treatments, test the likelihood of device success, and determine potential operative setbacks. This research aims to present advanced mesh manipulation techniques of stereolithographic (STL) files segmented from medical imaging and post-print surface optimization to match physiological vascular flow resistance. For phantom design, we developed three mesh manipulation techniques. The first method allows outlet 3D mesh manipulations to merge superfluous vessels into a single junction, decreasing the number of flow outlets and making it feasible to include smaller vessels. Next we introduced Boolean operations to eliminate the need to manually merge mesh layers and eliminate errors of mesh self-intersections that previously occurred. Finally we optimize support addition to preserve the patient anatomical geometry. For post-print surface optimization, we investigated various solutions and methods to remove support material and smooth the inner vessel surface. Solutions of chloroform, alcohol and sodium hydroxide were used to process various phantoms and hydraulic resistance was measured and compared with values reported in literature. The newly mesh manipulation methods decrease the phantom design time by 30 - 80% and allow for rapid development of accurate vascular models. We have created 3D printed vascular models with vessel diameters less than 0.5 mm. The methods presented in this work could lead to shorter design time for patient specific phantoms and better physiological simulations.

  20. Polypropylene mesh as an alternative option for uterine preservation in pelvic reconstruction in patients with uterine prolapse.

    Huang, Kuan-Hui; Chuang, Fei-Chi; Fu, Hung-Chun; Kung, Fu-Tsai

    2012-01-01

      The aim of this study was to evaluate the efficacy and safety of polypropylene mesh for uterine preservation during pelvic reconstruction in patients with severe uterine prolapse. The study included 67 women with severe uterine prolapse (pelvic organ prolapse quantification stage III/IV) who received transvaginal mesh reconstruction with uterine preservation. Surgery combined with a transobturator membrane sling procedure (tension-free vaginal tape-transobturator route) was performed in 54 patients. Among them, 18 had urodynamic stress incontinence, 30 had occult stress urinary incontinence, and six had mixed urinary incontinence. Objective assessments were carried out with the pelvic organ prolapse quantification staging system, urodynamic examination, and 1-h pad test. Evaluation of urinary and prolapse symptoms comprised the subjective assessment. The mean follow-up interval was 19.6 months (12-40 months). The objective cure rate for the treatment of uterine prolapse was 89.5%, and the objective cure rate for the treatment of urinary incontinence was more than 90%. Uterine preservation in pelvic reconstruction is technically feasible and the subjective and objective assessments imply that uterine preservation in pelvic reconstruction is an alternative option for indicated patients. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

  1. Coarse mesh code development

    Lieberoth, J.

    1975-06-15

    The numerical solution of the neutron diffusion equation plays a very important role in the analysis of nuclear reactors. A wide variety of numerical procedures has been proposed, at which most of the frequently used numerical methods are fundamentally based on the finite- difference approximation where the partial derivatives are approximated by the finite difference. For complex geometries, typical of the practical reactor problems, the computational accuracy of the finite-difference method is seriously affected by the size of the mesh width relative to the neutron diffusion length and by the heterogeneity of the medium. Thus, a very large number of mesh points are generally required to obtain a reasonably accurate approximate solution of the multi-dimensional diffusion equation. Since the computation time is approximately proportional to the number of mesh points, a detailed multidimensional analysis, based on the conventional finite-difference method, is still expensive even with modern large-scale computers. Accordingly, there is a strong incentive to develop alternatives that can reduce the number of mesh-points and still retain accuracy. One of the promising alternatives is the finite element method, which consists of the expansion of the neutron flux by piecewise polynomials. One of the advantages of this procedure is its flexibility in selecting the locations of the mesh points and the degree of the expansion polynomial. The small number of mesh points of the coarse grid enables to store the results of several of the least outer iterations and to calculate well extrapolated values of them by comfortable formalisms. This holds especially if only one energy distribution of fission neutrons is assumed for all fission processes in the reactor, because the whole information of an outer iteration is contained in a field of fission rates which has the size of all mesh points of the coarse grid.

  2. Surgical intervention after transvaginal Prolift mesh repair: retrospective single-center study including 524 patients with 3 years' median follow-up.

    de Landsheere, Laurent; Ismail, Sharif; Lucot, Jean-Philippe; Deken, Valérie; Foidart, Jean-Michel; Cosson, Michel

    2012-01-01

    The aim of this study was to explore the nature and rate of surgical intervention after transvaginal Prolift mesh repair for pelvic organ prolapse. This was a retrospective study of all patients who underwent Prolift mesh repair between January 2005 and January 2009. Patient data were obtained from medical records, and patients were telephoned to check if they had surgery in other hospitals. A total of 600 consecutive patients were identified. Of these, 524 patients (87.3%) were included in the study, with a median follow-up duration of 38 months (range, 15-63). Global reoperation rate was 11.6%. Indications of intervention were surgery for urinary incontinence (6.9%), mesh-related complications (3.6%), or prolapse recurrence (3%). The global reoperation rate after transvaginal Prolift mesh repair was 11.6%, with urinary incontinence surgery being the most common indication. Rates of mesh complications and prolapse recurrence are relatively low in an experienced team. Copyright © 2012 Mosby, Inc. All rights reserved.

  3. To mesh or not to mesh: a review of pelvic organ reconstructive surgery

    Dällenbach, Patrick

    2015-01-01

    Pelvic organ prolapse (POP) is a major health issue with a lifetime risk of undergoing at least one surgical intervention estimated at close to 10%. In the 1990s, the risk of reoperation after primary standard vaginal procedure was estimated to be as high as 30% to 50%. In order to reduce the risk of relapse, gynecological surgeons started to use mesh implants in pelvic organ reconstructive surgery with the emergence of new complications. Recent studies have nevertheless shown that the risk of POP recurrence requiring reoperation is lower than previously estimated, being closer to 10% rather than 30%. The development of mesh surgery – actively promoted by the marketing industry – was tremendous during the past decade, and preceded any studies supporting its benefit for our patients. Randomized trials comparing the use of mesh to native tissue repair in POP surgery have now shown better anatomical but similar functional outcomes, and meshes are associated with more complications, in particular for transvaginal mesh implants. POP is not a life-threatening condition, but a functional problem that impairs quality of life for women. The old adage “primum non nocere” is particularly appropriate when dealing with this condition which requires no treatment when asymptomatic. It is currently admitted that a certain degree of POP is physiological with aging when situated above the landmark of the hymen. Treatment should be individualized and the use of mesh needs to be selective and appropriate. Mesh implants are probably an important tool in pelvic reconstructive surgery, but the ideal implant has yet to be found. The indications for its use still require caution and discernment. This review explores the reasons behind the introduction of mesh augmentation in POP surgery, and aims to clarify the risks, benefits, and the recognized indications for its use. PMID:25848324

  4. Urogynecologic Surgical Mesh Implants

    ... procedures performed to treat pelvic floor disorders with surgical mesh: Transvaginal mesh to treat POP Transabdominal mesh to treat ... address safety risks Final Order for Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair Final Order for Effective ...

  5. Management of complications of mesh surgery.

    Lee, Dominic; Zimmern, Philippe E

    2015-07-01

    Transvaginal placements of synthetic mid-urethral slings and vaginal meshes have largely superseded traditional tissue repairs in the current era because of presumed efficacy and ease of implant with device 'kits'. The use of synthetic material has generated novel complications including mesh extrusion, pelvic and vaginal pain and mesh contraction. In this review, our aim is to discuss the management, surgical techniques and outcomes associated with mesh removal. Recent publications have seen an increase in presentation of these mesh-related complications, and reports from multiple tertiary centers have suggested that not all patients benefit from surgical intervention. Although the true incidence of mesh complications is unknown, recent publications can serve to guide physicians and inform patients of the surgical outcomes from mesh-related complications. In addition, the literature highlights the growing need for a registry to account for a more accurate reporting of these events and to counsel patients on the risk and benefits before proceeding with mesh surgeries.

  6. A Comparison of the Incidence of Early Postoperative Infections between Patients Using Synthetic Mesh and Those Undergoing Traditional Pelvic Reconstructive Surgical Procedures

    Jaromír Mašata

    2013-01-01

    Full Text Available New mesh-related complications such as erosion, etc., can result from abnormal postoperative healing due to surgical site infection. The aim of our study was to compare systemic inflammatory responses and the incidence of early infectious complications after reconstructive surgery using synthetic mesh and after traditional vaginal wall repair. In this prospective observational study 99 women with symptomatic pelvic organ prolapse were included; 55 women underwent traditional repair and 44 repair using mesh. After the procedure infectious complications were monitored. The patients who underwent reconstructive surgery using mesh material were more likely to have febrile morbidity in the postoperative period than the patients who had been treated with traditional repair (p=0.031; there was a higher incidence of combination febrile morbidity with elevated C-reactive protein (CRP > 50 mg/l; p=0.046, and a higher incidence of CRP increase over 30 mg/l; p=0.005. Reconstructive procedures using synthetic mesh are accompanied by a higher incidence of early post-operative infectious complications.

  7. To mesh or not to mesh: a review of pelvic organ reconstructive surgery

    Dällenbach P

    2015-04-01

    Full Text Available Patrick Dällenbach Department of Gynecology and Obstetrics, Division of Gynecology, Urogynecology Unit, Geneva University Hospitals, Geneva, Switzerland Abstract: Pelvic organ prolapse (POP is a major health issue with a lifetime risk of undergoing at least one surgical intervention estimated at close to 10%. In the 1990s, the risk of reoperation after primary standard vaginal procedure was estimated to be as high as 30% to 50%. In order to reduce the risk of relapse, gynecological surgeons started to use mesh implants in pelvic organ reconstructive surgery with the emergence of new complications. Recent studies have nevertheless shown that the risk of POP recurrence requiring reoperation is lower than previously estimated, being closer to 10% rather than 30%. The development of mesh surgery – actively promoted by the marketing industry – was tremendous during the past decade, and preceded any studies supporting its benefit for our patients. Randomized trials comparing the use of mesh to native tissue repair in POP surgery have now shown better anatomical but similar functional outcomes, and meshes are associated with more complications, in particular for transvaginal mesh implants. POP is not a life-threatening condition, but a functional problem that impairs quality of life for women. The old adage “primum non nocere” is particularly appropriate when dealing with this condition which requires no treatment when asymptomatic. It is currently admitted that a certain degree of POP is physiological with aging when situated above the landmark of the hymen. Treatment should be individualized and the use of mesh needs to be selective and appropriate. Mesh implants are probably an important tool in pelvic reconstructive surgery, but the ideal implant has yet to be found. The indications for its use still require caution and discernment. This review explores the reasons behind the introduction of mesh augmentation in POP surgery, and aims to

  8. From 4D Medical Images (CT, MRI, and Ultrasound to 4D Structured Mesh Models of the Left Ventricular Endocardium for Patient-Specific Simulations

    Federico Canè

    2018-01-01

    Full Text Available With cardiovascular disease (CVD remaining the primary cause of death worldwide, early detection of CVDs becomes essential. The intracardiac flow is an important component of ventricular function, motion kinetics, wash-out of ventricular chambers, and ventricular energetics. Coupling between Computational Fluid Dynamics (CFD simulations and medical images can play a fundamental role in terms of patient-specific diagnostic tools. From a technical perspective, CFD simulations with moving boundaries could easily lead to negative volumes errors and the sudden failure of the simulation. The generation of high-quality 4D meshes (3D in space + time with 1-to-1 vertex becomes essential to perform a CFD simulation with moving boundaries. In this context, we developed a semiautomatic morphing tool able to create 4D high-quality structured meshes starting from a segmented 4D dataset. To prove the versatility and efficiency, the method was tested on three different 4D datasets (Ultrasound, MRI, and CT by evaluating the quality and accuracy of the resulting 4D meshes. Furthermore, an estimation of some physiological quantities is accomplished for the 4D CT reconstruction. Future research will aim at extending the region of interest, further automation of the meshing algorithm, and generating structured hexahedral mesh models both for the blood and myocardial volume.

  9. Biologic meshes and synthetic meshes in cancer patients: a double-edged sword: differences in production of IL-6 and IL-12 caused by acellular dermal matrices in human immune cells.

    Karsten, Maria Margarete; Enders, Sabine; Knabl, Julia; Kirn, Verena; Düwell, Peter; Rack, Brigitte; Blohmer, Jens-Uwe; Mayr, Doris; Dian, Darius

    2018-05-01

    In 2005, Breuing et al. first described the use of acellular dermal matrices (ADMs) in breast cancer patients. ADMs are assumed to be safe to use in an oncologic setting, but data from controlled studies are still needed. Here, we investigate the effects of ADMs on the production of interleukin (IL)-6 and IL-12, key regulators of immune suppression and activation. Strattice (ST), CollaMend (CM), and Biodesign (BD) biologic meshes and TiLoop, a synthetic mesh (TL), were used in this study. We isolated myeloid dendritic cells (MDCs), untouched plasmacytoid dendritic cells (pDCs), naïve B cells, and CD8+ T cells and co-cultured these cells with either the biologic meshes or TL. As positive controls, we used CpG ODN 2216 or lipopolysaccharide (LPS). The cytokine concentrations of IL-12p70 and IL-6 were determined after 7 days using sandwich ELISA sets. There were highly significant differences between the ADMs and TL in terms of their ability to stimulate immunologic responses. IL-6 expression was significantly increased in B cells (p = 0.0006131) and T cells (p = 0.00418) when comparing TL and ADMs. We also identified significant differences in IL-12 production by B cells (p = 0.0166) and T cells (p = 0.003636) when comparing TL and ADMs. Despite the assumed lack of an immunological response to ADMs, in our experimental study, human immune cells reacted with significantly different cytokine profiles. These findings may have implications for the potential activation or suppression of effector cells in cancer patients and could explain some of the post clinical post surgical signs of ADMS like skin rush and seroma.

  10. Policy based Agents in Wireless Body Sensor Mesh Networks for Patient Health Monitoring

    Kevin Miller; Suresh Sankaranarayanan

    2009-01-01

    There is presently considerable research interest in using wireless and mobile technologies in patient health monitoring particularly in hospitals and nursing homes. For health monitoring,, an intelligent agent based hierarchical architecture has already been published by one of the authors of this paper. Also, the technique of monitoring and notifying the health of patients using an intelligent agent, to the concerned hospital personnel, has also been proposed. We now present the details of ...

  11. Mersiline mesh in premaxillary augmentation.

    Foda, Hossam M T

    2005-01-01

    Premaxillary retrusion may distort the aesthetic appearance of the columella, lip, and nasal tip. This defect is characteristically seen in, but not limited to, patients with cleft lip nasal deformity. This study investigated 60 patients presenting with premaxillary deficiencies in which Mersiline mesh was used to augment the premaxilla. All the cases had surgery using the external rhinoplasty technique. Two methods of augmentation with Mersiline mesh were used: the Mersiline roll technique, for the cases with central symmetric deficiencies, and the Mersiline packing technique, for the cases with asymmetric deficiencies. Premaxillary augmentation with Mersiline mesh proved to be simple technically, easy to perform, and not associated with any complications. Periodic follow-up evaluation for a mean period of 32 months (range, 12-98 months) showed that an adequate degree of premaxillary augmentation was maintained with no clinically detectable resorption of the mesh implant.

  12. Laparoscopic posterior mesh rectopexy for rectal prolapse is a safe procedure in older patients

    Dyrberg, D L; Nordentoft, T; Rosenstock, S

    2015-01-01

    to 1 June 2012, 81 laparoscopic posterior rectopexies were done. Male-to-female ratio was 4:77, median age 73 [57-80.5] years and median ASA Grade 2. Conversion to open surgery was done in 6.2%, the median operating time was 82 min [66 - 102] and median length of hospital stay was 2 days [2-5.7]. Minor...... and major complications were seen in 5.3% and 14.8%, respectively. The 30-day mortality rate was 1.2%. Constipation or incontinence improved or disappeared in 65.2% and 74.4%, respectively. The cumulated recurrence rate was 11.1% after a median observation time of 2 years. CONCLUSION: Laparoscopic posterior...... rectopexy is a safe and well-tolerated procedure in older patients and can be done with acceptable complications and recurrence rates and short hospital stays. Laparoscopic posterior rectopexy seems to improve bowel function in many patients....

  13. Comparing selectivity of a standard and turned mesh T90 codend during towing and haul-back

    Madsen, Niels; Herrmann, Bent; Frandsen, Rikke

    2012-01-01

    In this study, we compared the size selectivity of a T90 codend (netting turned by 90 degrees) with that of a standard codend made of similar netting. Sea trials were conducted in a Norway lobster directed fishery in the Kattegat- Skagerrak area, where there is a need for improved selectivity...... fewer Norway lobster both below and above the legal minimum landing size (40 mm, cephalothorax length), thereby causing a reduction of commercial catch. The difference was mainly due to a significantly higher escape rate during towing for the T90 codend. For plaice below minimum landing size (27 cm...

  14. Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain

    Bischoff, J M; Enghuus, Casper Nørskov; Werner, M U

    2013-01-01

    PURPOSE: Persistent inguinal pain, influencing daily activities, is seen in about 5 % of patients following inguinal herniorrhaphy. Surgical treatment of patients with persistent postherniorrhaphy pain has been associated with pain relief and improvement in functional status. However, the detailed...... and functional ability when comparing preoperative and postoperative assessments. RESULTS: Pain intensities (average, maximum, and during activity) were significantly lower at all time points during follow-up compared to preoperative values (p ...

  15. Postoperative pain outcomes after transvaginal mesh revision.

    Danford, Jill M; Osborn, David J; Reynolds, W Stuart; Biller, Daniel H; Dmochowski, Roger R

    2015-01-01

    Although the current literature discusses mesh complications including pain, as well as suggesting different techniques for removing mesh, there is little literature regarding pain outcomes after surgical removal or revision. The purpose of this study is to determine if surgical removal or revision of vaginal mesh improves patient's subjective complaints of pelvic pain associated with original placement of mesh. After obtaining approval from the Vanderbilt University Medical Center Institutional Review Board, a retrospective review of female patients with pain secondary to previous mesh placement who underwent excision or revision of vaginal mesh from January 2000 to August 2012 was performed. Patient age, relevant medical history including menopause status, previous hysterectomy, smoking status, and presence of diabetes, fibromyalgia, interstitial cystitis, and chronic pelvic pain, was obtained. Patients' postoperative pain complaints were assessed. Of the 481 patients who underwent surgery for mesh revision, removal or urethrolysis, 233 patients met our inclusion criteria. One hundred and sixty-nine patients (73 %) reported that their pain improved, 19 (8 %) reported that their pain worsened, and 45 (19 %) reported that their pain remained unchanged after surgery. Prior history of chronic pelvic pain was associated with increased risk of failure of the procedure to relieve pain (OR 0.28, 95 % CI 0.12-0.64, p = 0.003). Excision or revision of vaginal mesh appears to be effective in improving patients' pain symptoms most of the time. Patients with a history of chronic pelvic pain are at an increased risk of no improvement or of worsening pain.

  16. Mesh versus non-mesh repair of ventral abdominal hernias

    Jawaid, M.A.; Talpur, A.H.

    2008-01-01

    To investigate the relative effectiveness of mesh and suture repair of ventral abdominal hernias in terms of clinical outcome, quality of life and rate of recurrence in both the techniques. This is a retrospective descriptive analysis of 236 patients with mesh and non-mesh repair of primary ventral hernias performed between January 2000 to December 2004 at Surgery Department, Liaquat University of Medical and Health Sciences, Jamshoro. The record sheets of the patients were analyzed and data retrieved to compare the results of both techniques for short-term and long-term results. The data retrieved is statistically analyzed on SPSS version 11. There were 43 (18.22%) males and 193 (81.77%) females with a mean age of 51.79 years and a range of 59 (81-22). Para-umbilical hernia was the commonest of ventral hernia and accounted for 49.8% (n=118) of the total study population followed by incisional hernia comprising 24% (n=57) of the total number. There was a significant difference in the recurrent rate at 3 years interval with 23/101 (22.77%) recurrences in suture-repaired subjects compared to 10/135 (7.40%) in mesh repair group. Chronic pain lasting up to 1-2 years was noted in 14 patients with suture repair. Wound infection is comparatively more common (8.14%) in mesh group. The other variables such as operative and postoperative complications, total hospital stay and quality of life is also discussed. Mesh repair of ventral hernia is much superior to non-mesh suture repair in terms of recurrence and overall outcome. (author)

  17. Laparoscopic mesh explantation and drainage of sacral abscess remote from transvaginal excision of exposed sacral colpopexy mesh.

    Roth, Ted M; Reight, Ian

    2012-07-01

    Sacral colpopexy may be complicated by mesh exposure, and the surgical treatment of mesh exposure typically results in minor postoperative morbidity and few delayed complications. A 75-year-old woman presented 7 years after a laparoscopic sacral colpopexy, with Mersilene mesh, with an apical mesh exposure. She underwent an uncomplicated transvaginal excision and was asymptomatic until 8 months later when she presented with vaginal drainage and a sacral abscess. This was successfully treated with laparoscopic enterolysis, drainage of the abscess, and explantation of the remaining mesh. Incomplete excision of exposed colpopexy mesh can lead to ascending infection and sacral abscess. Laparoscopic drainage and mesh removal may be considered in these patients.

  18. Retrospective analysis of a VACM (vacuum-assisted closure and mesh-mediated fascial traction treatment manual for temporary abdominal wall closure – results of 58 consecutive patients

    Beltzer, Christian

    2016-07-01

    Full Text Available Introduction: The optimal treatment concept for temporary abdominal closure (TAC in critically ill visceral surgery patients with open abdomen (OA continues to be unclear. The VACM (vacuum-assisted closure and mesh-mediated fascial traction therapy seems to permit higher delayed primary fascial closure rates (FCR than other TAC procedures. Material and methods: Patients of our clinic (n=58 who were treated by application of a VAC/VACM treatment manual in the period from 2005 to 2008 were retrospectively analysed. Results: The overall FCR of all patients was 48.3% (95% confidence interval: 34.95–61.78. An FCR of 61.3% was achieved in patients who had a vicryl mesh implanted at the fascial level (VACM therapy in the course of treatment. Mortality among patients treated with VACM therapy was 45.2% (95% CI: 27.32–63.97.Conclusions: The results of our own study confirm the results of previous studies which showed an acceptable FCR among non-trauma patients who were treated with VACM therapy. VACM therapy currently appears to be the treatment regime of choice for patients with OA requiring TAC.

  19. Comparison of computed tomography based parametric and patient-specific finite element models of the healthy and metastatic spine using a mesh-morphing algorithm.

    O'Reilly, Meaghan Anne; Whyne, Cari Marisa

    2008-08-01

    A comparative analysis of parametric and patient-specific finite element (FE) modeling of spinal motion segments. To develop patient-specific FE models of spinal motion segments using mesh-morphing methods applied to a parametric FE model. To compare strain and displacement patterns in parametric and morphed models for both healthy and metastatically involved vertebrae. Parametric FE models may be limited in their ability to fully represent patient-specific geometries and material property distributions. Generation of multiple patient-specific FE models has been limited because of computational expense. Morphing methods have been successfully used to generate multiple specimen-specific FE models of caudal rat vertebrae. FE models of a healthy and a metastatic T6-T8 spinal motion segment were analyzed with and without patient-specific material properties. Parametric and morphed models were compared using a landmark-based morphing algorithm. Morphing of the parametric FE model and including patient-specific material properties both had a strong impact on magnitudes and patterns of vertebral strain and displacement. Small but important geometric differences can be represented through morphing of parametric FE models. The mesh-morphing algorithm developed provides a rapid method for generating patient-specific FE models of spinal motion segments.

  20. Effects of electromagnetic fields from mobile phones on depression and anxiety after titanium mesh cranioplasty among patients with traumatic brain injury.

    Zhu, Yongjian; Jin, Wen; Liu, Hui; Peng, Deqing; Ding, Zheyuan; Tang, Zhuxiao; Zhu, Liangliang; Yu, Yunxian

    2016-01-01

    To explore the effects of radiofrequency-electromagnetic fields (RF-EMFs) from mobile phones on depression and anxiety after titanium mesh cranioplasty among patients with traumatic brain injury (TBI). Two hundred and twenty patients with TBI and titanium mesh cranioplasty who were hospitalized from 2008-2012 were recruited in this study. From November-December 2012, the relevant information was surveyed including socio-demographic characteristics, lifestyle variables, injury-related information, RF-EMF exposure of mobile phone, Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS). Associations of RF-EMFs exposure after titanium mesh cranioplasty with SAS and SDS were respectively estimated by multivariable linear regression models. The patients with long durations of mobile phone use (β = -6.6, p = 0.002), long individual call duration (β = -5.3, p = 0.012), more daily calls (β = -3.6, p = 0.027), invariably answer call immediately (β = -3.9, p = 0.022) and high comprehensive exposure level (β = -4.8, p = 0.003) had a lower score of depression compared with those without a mobile phone. Moreover, an ipsilateral and contralateral answering phone enhanced the protective effect on depression. Individuals with a long duration of mobile phone use had a lower score of anxiety (β = -4.2, p = 0.008), while those with a bilateral answering phone had higher anxiety (β = 3.9, p = 0.012) in comparison to those without a mobile phone. RF-EMFs after cranioplasty were significantly associated with the lower risk of depression and anxiety status among patients with TBI. Chronic and frequent RF-EMFs exposure may improve psychiatric disorders among patients with TBI.

  1. Recurrence and Pain after Mesh Repair of Inguinal Hernias

    Abstract. Background: Surgery for inguinal hernias has ... repair. Methods: The study was conducted on all inguinal hernia patients operated between 1st. October ... bilateral (1.6%). Only 101 .... Open Mesh Versus Laparoscopic Mesh. Repair ...

  2. Transrectal Mesh Erosion Requiring Bowel Resection.

    Kemp, Marta Maria; Slim, Karem; Rabischong, Benoît; Bourdel, Nicolas; Canis, Michel; Botchorishvili, Revaz

    To report a case of a transrectal mesh erosion as complication of laparoscopic promontofixation with mesh repair, necessitating bowel resection and subsequent surgical interventions. Sacrocolpopexy has become a standard procedure for vaginal vault prolapse [1], and the laparoscopic approach has gained popularity owing to more rapid recovery and less morbidity [2,3]. Mesh erosion is a well-known complication of surgical treatment for prolapse as reported in several negative evaluations, including a report from the US Food and Drug Administration in 2011 [4]. Mesh complications are more common after surgeries via the vaginal approach [5]; nonetheless, the incidence of vaginal mesh erosion after laparoscopic procedures is as high as 9% [6]. The incidence of transrectal mesh exposure after laparoscopic ventral rectopexy is roughly 1% [7]. The diagnosis may be delayed because of its rarity and variable presentation. In addition, polyester meshes, such as the mesh used in this case, carry a higher risk of exposure [8]. A 57-year-old woman experiencing genital prolapse, with the cervix classified as +3 according to the Pelvic Organ Prolapse Quantification system, underwent laparoscopic standard sacrocolpopexy using polyester mesh. Subtotal hysterectomy and bilateral adnexectomy were performed concomitantly. A 3-year follow-up consultation demonstrated no signs or symptoms of erosion of any type. At 7 years after the surgery, however, the patient presented with rectal discharge, diagnosed as infectious rectocolitis with the isolation of Clostridium difficile. She underwent a total of 5 repair surgeries in a period of 4 months, including transrectal resection of exposed mesh, laparoscopic ablation of mesh with digestive resection, exploratory laparoscopy with abscess drainage, and exploratory laparoscopy with ablation of residual mesh and transverse colostomy. She recovered well after the last intervention, exhibiting no signs of vaginal or rectal fistula and no recurrence

  3. Anisotropic evaluation of synthetic surgical meshes.

    Saberski, E R; Orenstein, S B; Novitsky, Y W

    2011-02-01

    The material properties of meshes used in hernia repair contribute to the overall mechanical behavior of the repair. The anisotropic potential of synthetic meshes, representing a difference in material properties (e.g., elasticity) in different material axes, is not well defined to date. Haphazard orientation of anisotropic mesh material can contribute to inconsistent surgical outcomes. We aimed to characterize and compare anisotropic properties of commonly used synthetic meshes. Six different polypropylene (Trelex(®), ProLite™, Ultrapro™), polyester (Parietex™), and PTFE-based (Dualmesh(®), Infinit) synthetic meshes were selected. Longitudinal and transverse axes were defined for each mesh, and samples were cut in each axis orientation. Samples underwent uniaxial tensile testing, from which the elastic modulus (E) in each axis was determined. The degree of anisotropy (λ) was calculated as a logarithmic expression of the ratio between the elastic modulus in each axis. Five of six meshes displayed significant anisotropic behavior. Ultrapro™ and Infinit exhibited approximately 12- and 20-fold differences between perpendicular axes, respectively. Trelex(®), ProLite™, and Parietex™ were 2.3-2.4 times. Dualmesh(®) was the least anisotropic mesh, without marked difference between the axes. Anisotropy of synthetic meshes has been underappreciated. In this study, we found striking differences between elastic properties of perpendicular axes for most commonly used synthetic meshes. Indiscriminate orientation of anisotropic mesh may adversely affect hernia repairs. Proper labeling of all implants by manufacturers should be mandatory. Understanding the specific anisotropic behavior of synthetic meshes should allow surgeons to employ rational implant orientation to maximize outcomes of hernia repair.

  4. Laparoscopic Pelvic Floor Repair Using Polypropylene Mesh

    Shih-Shien Weng

    2008-09-01

    Conclusion: Laparoscopic pelvic floor repair using a single piece of polypropylene mesh combined with uterosacral ligament suspension appears to be a feasible procedure for the treatment of advanced vaginal vault prolapse and enterocele. Fewer mesh erosions and postoperative pain syndromes were seen in patients who had no previous pelvic floor reconstructive surgery.

  5. Mesh-graft urethroplasty: a case report

    田中, 敏博; 滝川, 浩; 香川, 征; 長江, 浩朗

    1987-01-01

    We used a meshed free-foreskin transplant in a two-stage procedure for reconstruction of the extended stricture of urethra after direct vision urethrotomy. The results were excellent. Mesh-graft urethroplasty is a useful method for patients with extended strictures of the urethra or recurrent strictures after several operations.

  6. The Role of Chronic Mesh Infection in Delayed-Onset Vaginal Mesh Complications or Recurrent Urinary Tract Infections: Results From Explanted Mesh Cultures.

    Mellano, Erin M; Nakamura, Leah Y; Choi, Judy M; Kang, Diana C; Grisales, Tamara; Raz, Shlomo; Rodriguez, Larissa V

    2016-01-01

    Vaginal mesh complications necessitating excision are increasingly prevalent. We aim to study whether subclinical chronically infected mesh contributes to the development of delayed-onset mesh complications or recurrent urinary tract infections (UTIs). Women undergoing mesh removal from August 2013 through May 2014 were identified by surgical code for vaginal mesh removal. Only women undergoing removal of anti-incontinence mesh were included. Exclusion criteria included any women undergoing simultaneous prolapse mesh removal. We abstracted preoperative and postoperative information from the medical record and compared mesh culture results from patients with and without mesh extrusion, de novo recurrent UTIs, and delayed-onset pain. One hundred seven women with only anti-incontinence mesh removed were included in the analysis. Onset of complications after mesh placement was within the first 6 months in 70 (65%) of 107 and delayed (≥6 months) in 37 (35%) of 107. A positive culture from the explanted mesh was obtained from 82 (77%) of 107 patients, and 40 (37%) of 107 were positive with potential pathogens. There were no significant differences in culture results when comparing patients with delayed-onset versus immediate pain, extrusion with no extrusion, and de novo recurrent UTIs with no infections. In this large cohort of patients with mesh removed for a diverse array of complications, cultures of the explanted vaginal mesh demonstrate frequent low-density bacterial colonization. We found no differences in culture results from women with delayed-onset pain versus acute pain, vaginal mesh extrusions versus no extrusions, or recurrent UTIs using standard culture methods. Chronic prosthetic infections in other areas of medicine are associated with bacterial biofilms, which are resistant to typical culture techniques. Further studies using culture-independent methods are needed to investigate the potential role of chronic bacterial infections in delayed vaginal mesh

  7. Isotope selection for patients undergoing prostate brachytherapy

    Cha, Christine M.; Potters, Louis; Ashley, Richard; Freeman, Katherine; Wang Xiaohong; Waldbaum, Robert; Leibel, Steven

    1999-01-01

    Purpose: Ultrasound-guided trans perineal interstitial permanent prostate brachytherapy (TIPPB) is generally performed with either 103 Pd or 125 I. The use of 125 I for low Gleason score tumors and 103 Pd for higher Gleason scores has been suggested based on isotope dose rate and cell doubling time observed in in vitro studies. While many centers follow these isotope selection criteria, other centers have elected to use only a single isotope, regardless of Gleason score. No clinical data have been published comparing these isotopes. This study was undertaken to compare outcomes between 125 I and 103 Pd in a matched pair analysis for patients undergoing prostate brachytherapy. Methods and Materials: Six hundred forty-eight consecutively treated patients with clinically confined prostate cancer underwent TIPPB between June 1992 and February 1997. Five hundred thirty-two patients underwent TIPPB alone, whereas 116 received pelvic external beam irradiation and TIPPB. Ninety-three patients received androgen deprivation therapy prior to TIPPB. The prescribed doses for TIPPB were 160 Gy for 125 I (pre-TG43) and 120 Gy for 103 Pd. Patients treated with combination therapy received 41.4 or 45 Gy (1.8 Gy/fraction) external beam irradiation followed by a 3- to 5-week break and then received either a 120-Gy 125 I or a 90-Gy 103 Pd implant. Until November 1994, all patients underwent an 125 I implant after which the isotope selection was based on either Gleason score (Gleason score 2-5: 125 I; Gleason 5-8: 103 Pd) or isotope availability. A matched pair analysis was performed to assess any difference between isotopes. Two hundred twenty-two patients were matched according to Gleason score, prostate-specific antigen (PSA), and stage. PSA relapse-free survival (PSA-RFS) was calculated based on the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Group definition of failure. Kaplan-Meier actuarial survival curves were compared to assess differences in

  8. Early experience with mesh excision for adverse outcomes after transvaginal mesh placement using prolapse kits.

    Ridgeway, Beri; Walters, Mark D; Paraiso, Marie Fidela R; Barber, Matthew D; McAchran, Sarah E; Goldman, Howard B; Jelovsek, J Eric

    2008-12-01

    The purpose of this study was to determine the complications, treatments, and outcomes in patients choosing to undergo removal of mesh previously placed with a mesh procedural kit. This was a retrospective review of all patients who underwent surgical removal of transvaginal mesh for mesh-related complications during a 3-year period at Cleveland Clinic. At last follow-up, patients reported degree of pain, level of improvement, sexual activity, and continued symptoms. Nineteen patients underwent removal of mesh during the study period. Indications for removal included chronic pain (6/19), dyspareunia (6/19), recurrent pelvic organ prolapse (8/19), mesh erosion (12/19), and vesicovaginal fistula (3/19), with most patients (16/19) citing more than 1 reason. There were few complications related to the mesh removal. Most patients reported significant relief of symptoms. Mesh removal can be technically difficult but appears to be safe with few complications and high relief of symptoms, although some symptoms can persist.

  9. Seeking new surgical predictors of mesh exposure after transvaginal mesh repair.

    Wu, Pei-Ying; Chang, Chih-Hung; Shen, Meng-Ru; Chou, Cheng-Yang; Yang, Yi-Ching; Huang, Yu-Fang

    2016-10-01

    The purpose of this study was to explore new preventable risk factors for mesh exposure. A retrospective review of 92 consecutive patients treated with transvaginal mesh (TVM) in the urogynecological unit of our university hospital. An analysis of perioperative predictors was conducted in patients after vaginal repairs using a type 1 mesh. Mesh complications were recorded according to International Urogynecological Association (IUGA) definitions. Mesh-exposure-free durations were calculated by using the Kaplan-Meier method and compared between different closure techniques using log-rank test. Hazard ratios (HR) of predictors for mesh exposure were estimated by univariate and multivariate analyses using Cox proportional hazards regression models. The median surveillance interval was 24.1 months. Two late occurrences were found beyond 1 year post operation. No statistically significant correlation was observed between mesh exposure and concomitant hysterectomy. Exposure risks were significantly higher in patients with interrupted whole-layer closure in univariate analysis. In the multivariate analysis, hematoma [HR 5.42, 95 % confidence interval (CI) 1.26-23.35, P = 0.024), Prolift mesh (HR 5.52, 95 % CI 1.15-26.53, P = 0.033), and interrupted whole-layer closure (HR 7.02, 95 % CI 1.62-30.53, P = 0.009) were the strongest predictors of mesh exposure. Findings indicate the risks of mesh exposure and reoperation may be prevented by avoiding hematoma, large amount of mesh, or interrupted whole-layer closure in TVM surgeries. If these risk factors are prevented, hysterectomy may not be a relative contraindication for TVM use. We also provide evidence regarding mesh exposure and the necessity for more than 1 year of follow-up and preoperative counselling.

  10. [CLINICAL EVALUATION OF THE NEW ANTISEPTIC MESHES].

    Gogoladze, M; Kiladze, M; Chkhikvadze, T; Jiqia, D

    2016-12-01

    Improving the results of hernia treatment and prevention of complications became a goal of our research which included two parts - experimental and clinical. Histomorphological and bacteriological researches showed that the best result out of the 3 control groups was received in case of covering implant "Coladerm"+ with chlorhexidine. Based on the experiment results working process continued in clinics in order to test and introduce new "coladerm"+ chlorhexidine covered poliprophilene meshes into practice. For clinical illustration there were 60 patients introduced to the research who had hernioplasty procedures by different nets: I group - standard meshes+"coladerm"+chlorhexidine, 35 patients; II group - standard meshes +"coladerm", 15 patients; III group - standard meshes, 10 patients. Assessment of the wound and echo-control was done post-surgery on the 8th, 30th and 90th days. This clinical research based on the experimental results once again showed the best anti-microbe features of new antiseptic polymeric biocomposite meshes (standard meshes+"coladerm"+chlorhexidine); timely termination of regeneration and reparation processes without any post-surgery suppurative complications. We hope that new antiseptic polymeric biocomposite meshes presented by us will be successfully used in surgical practice of hernia treatment based on and supported by expermental-clinical research.

  11. Surgical management of lower urinary mesh perforation after mid-urethral polypropylene mesh sling: mesh excision, urinary tract reconstruction and concomitant pubovaginal sling with autologous rectus fascia.

    Shah, Ketul; Nikolavsky, Dmitriy; Gilsdorf, Daniel; Flynn, Brian J

    2013-12-01

    We present our management of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling using a novel combination of surgical techniques including total or near total mesh excision, urinary tract reconstruction, and concomitant pubovaginal sling with autologous rectus fascia in a single operation. We retrospectively reviewed the medical records of 189 patients undergoing transvaginal removal of polypropylene mesh from the lower urinary tract or vagina. The focus of this study is 21 patients with LUT mesh perforation after mid-urethral polypropylene mesh sling. We excluded patients with LUT mesh perforation from prolapse kits (n = 4) or sutures (n = 11), or mesh that was removed because of isolated vaginal wall exposure without concomitant LUT perforation (n = 164). Twenty-one patients underwent surgical removal of mesh through a transvaginal approach or combined transvaginal/abdominal approaches. The location of the perforation was the urethra in 14 and the bladder in 7. The mean follow-up was 22 months. There were no major intraoperative complications. All patients had complete resolution of the mesh complication and the primary symptom. Of the patients with urethral perforation, continence was achieved in 10 out of 14 (71.5 %). Of the patients with bladder perforation, continence was achieved in all 7. Total or near total removal of lower urinary tract (LUT) mesh perforation after mid-urethral polypropylene mesh sling can completely resolve LUT mesh perforation in a single operation. A concomitant pubovaginal sling can be safely performed in efforts to treat existing SUI or avoid future surgery for SUI.

  12. Whipple procedure: patient selection and special considerations

    Tan-Tam C

    2016-07-01

    Full Text Available Clara Tan-Tam,1 Maja Segedi,2 Stephen W Chung2 1Department of Surgery, Bassett Healthcare, Columbia University, Cooperstown, New York, NY, USA; 2Department of Hepatobiliary and Pancreatic Surgery and Liver Transplant, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada Abstract: At the inception of pancreatic surgery by Dr Whipple in 1930s, the mortality and morbidity risk was more than 20%. With further understanding of disease processes and improvements in pancreas resection techniques, the mortality risk has decreased to less than 5%. Age and chronic illnesses are no longer a contraindication to surgical treatment. Life expectancy and quality of life at a later age have improved, making older patients more likely to receive pancreatic surgery , thereby also putting emphasis on operative patient selection to minimize complications. This review summarizes the benign and malignant illnesses that are treated with pancreas operations, and innovations and improvements in pancreatic surgery and perioperative care, and describes the careful selection process for patients who would benefit from an operation. These indications are not reserved only to Whipple operation, but to pancreatectomies as well.Keywords: pancreaticoduodenectomy, mortality, morbidity, cancer, trauma, pancreatitis

  13. Alveolar Ridge Reconstruction with Titanium Meshes and Simultaneous Implant Placement: A Retrospective, Multicenter Clinical Study

    Raquel Zita Gomes

    2016-01-01

    Full Text Available Objective. To evaluate horizontal bone gain and implant survival and complication rates in patients treated with titanium meshes placed simultaneously with dental implants and fixed over them. Methods. Twenty-five patients treated with 40 implants and simultaneous guided bone regeneration with titanium meshes (i–Gen®, MegaGen, Gyeongbuk, Republic of Korea were selected for inclusion in the present retrospective multicenter study. Primary outcomes were horizontal bone gain and implant survival; secondary outcomes were biological and prosthetic complications. Results. After the removal of titanium meshes, the CBCT evaluation revealed a mean horizontal bone gain of 3.67 mm (±0.89. The most frequent complications were mild postoperative edema (12/25 patients: 48% and discomfort after surgery (10/25 patients: 40%; these complications were resolved within one week. Titanium mesh exposure occurred in 6 patients (6/25 : 24%: one of these suffered partial loss of the graft and another experienced complete graft loss and implant failure. An implant survival rate of 97.5% (implant-based and a peri-implant marginal bone loss of 0.43 mm (±0.15 were recorded after 1 year. Conclusions. The horizontal ridge reconstruction with titanium meshes placed simultaneously with dental implants achieved predictable satisfactory results. Prospective randomized controlled trials on a larger sample of patients are required to validate these positive outcomes.

  14. Mesh Optimization for Ground Vehicle Aerodynamics

    Adrian Gaylard; Essam F Abo-Serie; Nor Elyana Ahmad

    2010-01-01

    Mesh optimization strategy for estimating accurate drag of a ground vehicle is proposed based on examining the effect of different mesh parameters.  The optimized mesh parameters were selected using design of experiment (DOE) method to be able to work in a...

  15. Liver Transplantation: Evolving Patient Selection Criteria

    Andy S Yu

    2001-01-01

    Full Text Available The widespread recognition of the success of liver transplantation as a treatment for most types of acute and chronic liver failure has led to increased referrals for transplantation in the setting of a relatively fixed supply of cadaver donor organs. These events have led to a marked lengthening of the waiting time for liver transplantation, resulting in increased deaths of those on the waiting list and sicker patients undergoing transplantation. Nearly 5000 liver transplantations were performed in the United States in 2000, while the waiting list grew to over 17,000 patients. The mounting disparity between the number of liver transplant candidates and the limited supply of donor organs has led to reassessment of the selection and listing criteria for liver transplantation, as well as revision of organ allocation and distribution policies for cadaver livers. The development of minimal listing criteria for patients with chronic liver disease based on a specific definition for decompensation of cirrhosis has facilitated the more uniform listing of patients at individual centres across the United States. The United Network for Organ Sharing, under pressure from transplant professionals, patient advocacy groups and the federal government, has continuously revised allocation and distribution policies based on the ethical principles of justice for the individual patient versus optimal utility of the limited organ supply available annually. Beginning in 2002, it is likely that the Model for End-stage Liver Disease (MELD score will be implemented to determine disease severity and direct donor organs to the sickest patients rather than to those with the longest waiting times.

  16. Hernia Surgical Mesh Implants

    ... knitted mesh or non-knitted sheet forms. The synthetic materials used can be absorbable, non-absorbable or a combination of absorbable and non-absorbable materials. Animal-derived mesh are made of animal tissue, such as intestine or skin, that has been processed and disinfected to be ...

  17. Transvaginal mesh procedures for pelvic organ prolapse.

    Walter, Jens-Erik

    2011-02-01

    To provide an update on transvaginal mesh procedures, newly available minimally invasive surgical techniques for pelvic floor repair. The discussion is limited to minimally invasive transvaginal mesh procedures. PubMed and Medline were searched for articles published in English, using the key words "pelvic organ prolapse," transvaginal mesh," and "minimally invasive surgery." Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis, and articles were incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1). Counselling for the surgical treatment of pelvic organ prolapse should consider all benefits, harms, and costs of the surgical procedure, with particular emphasis on the use of mesh. 1. Patients should be counselled that transvaginal mesh procedures are considered novel techniques for pelvic floor repair that demonstrate high rates of anatomical cure in uncontrolled short-term case series. (II-2B) 2. Patients should be informed of the range of success rates until stronger evidence of superiority is published. (II-2B) 3. Training specific to transvaginal mesh procedures should be undertaken before procedures are performed. (III-C) 4. Patients should undergo thorough preoperative counselling regarding (a) the potential serious adverse sequelae of transvaginal mesh repairs, including mesh exposure, pain, and dyspareunia; and (b) the limited data available

  18. Trends in internet search activity, media coverage, and patient-centered health information after the FDA safety communications on surgical mesh for pelvic organ prolapse.

    Stone, Benjamin V; Forde, James C; Levit, Valerie B; Lee, Richard K; Te, Alexis E; Chughtai, Bilal

    2016-11-01

    In July 2011, the US Food and Drug Administration (FDA) issued a safety communication regarding serious complications associated with surgical mesh for pelvic organ prolapse, prompting increased media and public attention. This study sought to analyze internet search activity and news article volume after this FDA warning and to evaluate the quality of websites providing patient-centered information. Google Trends™ was utilized to evaluate search engine trends for the term "pelvic organ prolapse" and associated terms between 1 January 2004 and 31 December 2014. Google News™ was utilized to quantify the number of news articles annually under the term "pelvic organ prolapse." The search results for the term "pelvic organ prolapse" were assessed for quality using the Health On the Net Foundation (HON) certification. There was a significant increase in search activity from 37.42 in 2010 to 57.75 in 2011, at the time of the FDA communication (p = 0.021). No other annual interval had a statistically significant increase in search activity. The single highest monthly search activity, given the value of 100, was August 2011, immediately following the July 2011 notification, with the next highest value being 98 in July 2011. Linear regression analysis of news articles per year since the FDA communication revealed r 2  = 0.88, with a coefficient of 186. Quality assessment demonstrated that 42 % of websites were HON-certified, with .gov sites providing the highest quality information. Although the 2011 FDA safety communication on surgical mesh was associated with increased public and media attention, the quality of relevant health information on the internet remains of poor quality. Future quality assurance measures may be critical in enabling patients to play active roles in their own healthcare.

  19. Biological Mesh Implants for Abdominal Hernia Repair: US Food and Drug Administration Approval Process and Systematic Review of Its Efficacy.

    Huerta, Sergio; Varshney, Anubodh; Patel, Prachi M; Mayo, Helen G; Livingston, Edward H

    2016-04-01

    Expensive biological mesh materials are increasingly used to reinforce abdominal wall hernia repairs. The clinical and cost benefit of these materials are unknown. To review the published evidence on the use of biological mesh materials and to examine the US Food and Drug Administration (FDA) approval history for these devices. Search of multiple electronic databases (Ovid, MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Cochrane National Health Service Economic Evaluation Database) to identify articles published between 1948 and June 30, 2015, on the use of biological mesh materials used to reinforce abdominal wall hernia repair. Keywords searched included surgical mesh, abdominal hernia, recurrence, infection, fistula, bioprosthesis, biocompatible materials, absorbable implants, dermis, and collagen. The FDA online database for 510(k) clearances was reviewed for all commercially available biological mesh materials. The median national price for mesh materials was established by a benchmarking query through several Integrated Delivery Network and Group Purchasing Organization tools. Of 274 screened articles, 20 met the search criteria. Most were case series that reported results of convenience samples of patients at single institutions with a variety of clinical problems. Only 3 of the 20 were comparative studies. There were no randomized clinical trials. In total, outcomes for 1033 patients were described. Studies varied widely in follow-up time, operative technique, meshes used, and patient selection criteria. Reported outcomes and clinical outcomes, such as fistula formation and infection, were inconsistently reported across studies. Conflicts of interest were not reported in 16 of the 20 studies. Recurrence rates ranged from 0% to 80%. All biological mesh devices were approved by the FDA based on substantial equivalence to a group of nonbiological predicate

  20. Oral, intestinal, and skin bacteria in ventral hernia mesh implants

    Odd Langbach

    2016-07-01

    Full Text Available Background: In ventral hernia surgery, mesh implants are used to reduce recurrence. Infection after mesh implantation can be a problem and rates around 6–10% have been reported. Bacterial colonization of mesh implants in patients without clinical signs of infection has not been thoroughly investigated. Molecular techniques have proven effective in demonstrating bacterial diversity in various environments and are able to identify bacteria on a gene-specific level. Objective: The purpose of this study was to detect bacterial biofilm in mesh implants, analyze its bacterial diversity, and look for possible resemblance with bacterial biofilm from the periodontal pocket. Methods: Thirty patients referred to our hospital for recurrence after former ventral hernia mesh repair, were examined for periodontitis in advance of new surgical hernia repair. Oral examination included periapical radiographs, periodontal probing, and subgingival plaque collection. A piece of mesh (1×1 cm from the abdominal wall was harvested during the new surgical hernia repair and analyzed for bacteria by PCR and 16S rRNA gene sequencing. From patients with positive PCR mesh samples, subgingival plaque samples were analyzed with the same techniques. Results: A great variety of taxa were detected in 20 (66.7% mesh samples, including typical oral commensals and periodontopathogens, enterics, and skin bacteria. Mesh and periodontal bacteria were further analyzed for similarity in 16S rRNA gene sequences. In 17 sequences, the level of resemblance between mesh and subgingival bacterial colonization was 98–100% suggesting, but not proving, a transfer of oral bacteria to the mesh. Conclusion: The results show great bacterial diversity on mesh implants from the anterior abdominal wall including oral commensals and periodontopathogens. Mesh can be reached by bacteria in several ways including hematogenous spread from an oral site. However, other sites such as gut and skin may also

  1. Prolapse Recurrence after Transvaginal Mesh Removal.

    Rawlings, Tanner; Lavelle, Rebecca S; Coskun, Burhan; Alhalabi, Feras; Zimmern, Philippe E

    2015-11-01

    We determined the rate of pelvic organ prolapse recurrence after transvaginal mesh removal. Following institutional review board approval a longitudinally collected database of women undergoing transvaginal mesh removal for complications after transvaginal mesh placement with at least 1 year minimum followup was queried for pelvic organ prolapse recurrence. Recurrent prolapse was defined as greater than stage 1 on examination or the need for reoperation at the site of transvaginal mesh removal. Outcome measures were based on POP-Q (Pelvic Organ Prolapse Quantification System) at the last visit. Patients were grouped into 3 groups, including group 1--recurrent prolapse in the same compartment as transvaginal mesh removal, 2--persistent prolapse and 3--prolapse in a compartment different than transvaginal mesh removal. Of 73 women 52 met study inclusion criteria from 2007 to 2013, including 73% who presented with multiple indications for transvaginal mesh removal. The mean interval between insertion and removal was 45 months (range 10 to 165). Overall mean followup after transvaginal mesh removal was 30 months (range 12 to 84). In group 1 (recurrent prolapse) the rate was 15% (6 of 40 patients). Four women underwent surgery for recurrent prolapse at a mean 7 of months (range 5 to 10). Two patients elected observation. The rate of persistent prolapse (group 2) was 23% (12 of 52 patients). Three women underwent prolapse reoperation at a mean of 10 months (range 8 to 12). In group 3 (de novo/different compartment prolapse) the rate was 6% (3 of 52 patients). One woman underwent surgical repair at 52 months. At a mean 2.5-year followup 62% of patients (32 of 52) did not have recurrent or persistent prolapse after transvaginal mesh removal and 85% (44 of 52) did not undergo any further procedure for prolapse. Specifically for pelvic organ prolapse in the same compartment as transvaginal mesh removal 12% of patients had recurrence, of whom 8% underwent prolapse repair

  2. Geometrically Consistent Mesh Modification

    Bonito, A.

    2010-01-01

    A new paradigm of adaptivity is to execute refinement, coarsening, and smoothing of meshes on manifolds with incomplete information about their geometry and yet preserve position and curvature accuracy. We refer to this collectively as geometrically consistent (GC) mesh modification. We discuss the concept of discrete GC, show the failure of naive approaches, and propose and analyze a simple algorithm that is GC and accuracy preserving. © 2010 Society for Industrial and Applied Mathematics.

  3. MeSH Now: automatic MeSH indexing at PubMed scale via learning to rank.

    Mao, Yuqing; Lu, Zhiyong

    2017-04-17

    MeSH indexing is the task of assigning relevant MeSH terms based on a manual reading of scholarly publications by human indexers. The task is highly important for improving literature retrieval and many other scientific investigations in biomedical research. Unfortunately, given its manual nature, the process of MeSH indexing is both time-consuming (new articles are not immediately indexed until 2 or 3 months later) and costly (approximately ten dollars per article). In response, automatic indexing by computers has been previously proposed and attempted but remains challenging. In order to advance the state of the art in automatic MeSH indexing, a community-wide shared task called BioASQ was recently organized. We propose MeSH Now, an integrated approach that first uses multiple strategies to generate a combined list of candidate MeSH terms for a target article. Through a novel learning-to-rank framework, MeSH Now then ranks the list of candidate terms based on their relevance to the target article. Finally, MeSH Now selects the highest-ranked MeSH terms via a post-processing module. We assessed MeSH Now on two separate benchmarking datasets using traditional precision, recall and F 1 -score metrics. In both evaluations, MeSH Now consistently achieved over 0.60 in F-score, ranging from 0.610 to 0.612. Furthermore, additional experiments show that MeSH Now can be optimized by parallel computing in order to process MEDLINE documents on a large scale. We conclude that MeSH Now is a robust approach with state-of-the-art performance for automatic MeSH indexing and that MeSH Now is capable of processing PubMed scale documents within a reasonable time frame. http://www.ncbi.nlm.nih.gov/CBBresearch/Lu/Demo/MeSHNow/ .

  4. Management of complications arising from transvaginal mesh kit procedures: a tertiary referral center's experience.

    Hurtado, Eric A; Appell, Rodney A

    2009-01-01

    This case series' purpose is to review a referral center's experience with complications from mesh kits. A chart review of 12 patients who presented with complications associated with transvaginal mesh kit procedures was performed. All patients underwent complete surgical removal of the mesh to treat mesh exposure, pain, or vaginal bleeding/discharge followed by an anterior or posterior repair. The mean follow-up time after surgery was 3.4 months. Eight of 12 patients had mesh that had formed a fibrotic band. Six of 12 patients had complete resolution of pain. Of the nine patients with mesh exposure, all required significant resection of the vaginal wall. No further mesh exposure occurred. The use of transvaginal mesh kits may cause previously undescribed complications such as pelvic/vaginal pain or large extrusions requiring complete removal. Removal of all mesh except the arms may cure or significantly improve these problems.

  5. No. 351-Transvaginal Mesh Procedures for Pelvic Organ Prolapse.

    Larouche, Maryse; Geoffrion, Roxana; Walter, Jens-Erik

    2017-11-01

    publications with study groups larger than 20 individuals were selected because this criterion was used in the largest meta-analysis referenced in this guideline. A total of 1470 studies were obtained; after selecting only applicable studies and excluding duplicates, 68 manuscripts were reviewed and included. The content and recommendations were drafted and agreed upon by the principal authors and members of the Urogynaecology Committee. The Board of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation methodology framework. The Summary of Findings is available upon request. It is expected that this guideline will benefit women with pelvic organ prolapse by ensuring that health care providers are aware of outcomes related to transvaginal mesh procedures and steps in the management of related complications. This should guide patient-informed consent before such procedures are undertaken. The benefits clearly outweigh the potential harms or costs of implementation of this guideline, although no direct harms or costs are identified. Evidence will be reviewed 5 years after publication to decide whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations. RECOMMENDATIONS. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  6. Mesh removal following transvaginal mesh placement: a case series of 104 operations.

    Marcus-Braun, Naama; von Theobald, Peter

    2010-04-01

    The objective of the study was to reveal the way we treat vaginal mesh complications in a trained referral center. This is a retrospective review of all patients who underwent surgical removal of transvaginal mesh for mesh-related complications during a 5-year period. Eighty-three patients underwent 104 operations including 61 complete mesh removal, 14 partial excision, 15 section of sub-urethral sling, and five laparoscopies. Main indications were erosion, infection, granuloma, incomplete voiding, and pain. Fifty-eight removals occurred more than 2 years after the primary mesh placement. Mean operation time was 21 min, and there were two intraoperative and ten minor postoperative complications. Stress urinary incontinence (SUI) recurred in 38% and cystocele in 19% of patients. In a trained center, mesh removal was found to be a quick and safe procedure. Mesh-related complications may frequently occur more than 2 years after the primary operation. Recurrence was mostly associated with SUI and less with genital prolapse.

  7. Symptom resolution after operative management of complications from transvaginal mesh.

    Crosby, Erin C; Abernethy, Melinda; Berger, Mitchell B; DeLancey, John O; Fenner, Dee E; Morgan, Daniel M

    2014-01-01

    Complications from transvaginal mesh placed for prolapse often require operative management. The aim of this study is to describe the outcomes of vaginal mesh removal. A retrospective review of all patients having surgery by the urogynecology group in the department of obstetrics and gynecology at our institution for a complication of transvaginal mesh placed for prolapse was performed. Demographics, presenting symptoms, surgical procedures, and postoperative symptoms were abstracted. Comparative statistics were performed using the χ or Fisher's exact test with significance at Pmesh and 84 had follow-up data. The most common presenting signs and symptoms were: mesh exposure, 62% (n=56); pain, 64% (n=58); and dyspareunia, 48% (n=43). During operative management, mesh erosion was encountered unexpectedly in a second area of the vagina in 5% (n=4), in the bladder in 1% (n=1), and in the bowel in 2% (n=2). After vaginal mesh removal, 51% (n=43) had resolution of all presenting symptoms. Mesh exposure was treated successfully in 95% of patients, whereas pain was only successfully treated in 51% of patients. Removal of vaginal mesh is helpful in relieving symptoms of presentation. Patients can be reassured that exposed mesh can almost always be successfully managed surgically, but pain and dyspareunia are only resolved completely in half of patients. III.

  8. Persistent pelvic pain following transvaginal mesh surgery: a cause for mesh removal.

    Marcus-Braun, Naama; Bourret, Antoine; von Theobald, Peter

    2012-06-01

    Persistent pelvic pain after vaginal mesh surgery is an uncommon but serious complication that greatly affects women's quality of life. Our aim was to evaluate various procedures for mesh removal performed at a tertiary referral center in cases of persistent pelvic pain, and to evaluate the ensuing complications and outcomes. A retrospective study was conducted at the University Hospital of Caen, France, including all patients treated for removal or section of vaginal mesh due to pelvic pain as a primary cause, between January 2004 and September 2009. Ten patients met the inclusion criteria. Patients were diagnosed between 10 months and 3 years after their primary operation. Eight cases followed suburethral sling procedures and two followed mesh surgery for pelvic organ prolapse. Patients presented with obturator neuralgia (6), pudendal neuralgia (2), dyspareunia (1), and non-specific pain (1). The surgical treatment to release the mesh included: three cases of extra-peritoneal laparoscopy, four cases of complete vaginal mesh removal, one case of partial mesh removal and two cases of section of the suburethral sling. In all patients with obturator neuralgia, symptoms were resolved or improved, whereas in both cases of pudendal neuralgia the symptoms continued. There were no intra-operative complications. Post-operative Retzius hematoma was observed in one patient after laparoscopy. Mesh removal in a tertiary center is a safe procedure, necessary in some cases of persistent pelvic pain. Obturator neuralgia seems to be easier to treat than pudendal neuralgia. Early diagnosis is the key to success in prevention of chronic disease. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  9. [Implants for genital prolapse : Contra mesh surgery].

    Hampel, C

    2017-12-01

    Alloplastic transvaginal meshes have become very popular in the surgery of pelvic organ prolapse (POP) as did alloplastic suburethral slings in female stress incontinence surgery, but without adequate supporting data. The simplicity of the mesh procedure facilitates its propagation with acceptance of higher revision and complication rates. Since attending physicians do more and more prolapse surgeries without practicing or teaching alternative techniques, expertise in these alternatives, which might be very useful in cases of recurrence, persistence or complications, is permanently lost. It is doubtful that proper and detailed information about alternatives, risks, and benefits of transvaginal alloplastic meshes is provided to every single prolapse patient according to the recommendations of the German POP guidelines, since the number of implanted meshes exceeds the number of properly indicated mesh candidates by far. Although there is no dissent internationally about the available mesh data, thousands of lawsuits in the USA, insolvency of companies due to claims for compensation and unambiguous warnings from foreign urological societies leave German urogynecologists still unimpressed. The existing literature in pelvic organ prolapse exclusively focusses on POP stage and improvement of that stage with surgical therapy. Instead, typical prolapse symptoms should trigger therapy and improvement of these symptoms should be the utmost treatment goal. It is strongly recommended for liability reasons to obtain specific written informed consent.

  10. Documentation for MeshKit - Reactor Geometry (&mesh) Generator

    Jain, Rajeev [Argonne National Lab. (ANL), Argonne, IL (United States); Mahadevan, Vijay [Argonne National Lab. (ANL), Argonne, IL (United States)

    2015-09-30

    This report gives documentation for using MeshKit’s Reactor Geometry (and mesh) Generator (RGG) GUI and also briefly documents other algorithms and tools available in MeshKit. RGG is a program designed to aid in modeling and meshing of complex/large hexagonal and rectilinear reactor cores. RGG uses Argonne’s SIGMA interfaces, Qt and VTK to produce an intuitive user interface. By integrating a 3D view of the reactor with the meshing tools and combining them into one user interface, RGG streamlines the task of preparing a simulation mesh and enables real-time feedback that reduces accidental scripting mistakes that could waste hours of meshing. RGG interfaces with MeshKit tools to consolidate the meshing process, meaning that going from model to mesh is as easy as a button click. This report is designed to explain RGG v 2.0 interface and provide users with the knowledge and skills to pilot RGG successfully. Brief documentation of MeshKit source code, tools and other algorithms available are also presented for developers to extend and add new algorithms to MeshKit. RGG tools work in serial and parallel and have been used to model complex reactor core models consisting of conical pins, load pads, several thousands of axially varying material properties of instrumentation pins and other interstices meshes.

  11. Bilateral Laparoscopic Totally Extraperitoneal Repair Without Mesh Fixation

    Dehal, Ahmed; Woodward, Brandon; Johna, Samir; Yamanishi, Frank

    2014-01-01

    Background and Objectives: Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. Methods: We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for ing...

  12. Vacuum assisted closure therapy in the treatment of mesh infection after hernia repair.

    Tamhankar, A P; Ravi, K; Everitt, N J

    2009-10-01

    Mesh related infection after prosthetic abdominal wall hernia repair is a difficult clinical problem, particularly in an era of evolving microbial resistance. Commonly advocated treatment for such infection involves complete mesh excision which usually leaves a complicated weak wound. We report the use ofVAC therapy for mesh infections that allows mesh preservation leaving a sound wound. From june 2002 to January 2007, four patients with mesh related infection after abdominal wall hernia repair were treated with VAC therapy. Patients' notes were reviewed to gather clinical details. Mesh infection was evident after a variable period (day three to eight years) following hernia repair. Of the four patients, one had infection with methicillin resistant Staphylococcus aureus (MRSA), while the bacteriological cultures from two confirmed Staphylococcus aureus in one and a mixture of Pseudomonas and enterococcus species in the other. One patient failed to show significant bacterial growth on pus swab culture, having had prior broad-spectrum antibiotic treatment for mesh infection. Three patients had complete mesh preservation and one had partial mesh excision. All patients were treated with VAC therapy, following the drainage of their operation sites, until the visible mesh was covered with granulation (one to seven weeks). No patient had a recurrent hernia after complete wound healing. VAC therapy allows salvage of infected exposed mesh by promoting granulation through the mesh. Judicious use of VAC therapy may prevent the need of mesh excision and its wound related complications.

  13. Glue versus suture for mesh fixation in inguinal hernia repair.

    Chandrasekar, Shruthi; Jeyakumar, S; Ganapathy, Tharun

    2018-03-22

    Inguinal hernia is one of the most common surgical problem presenting to the surgical OPD. Surgery is the mainstay of treatment for inguinal hernia today. Surgery for inguinal hernia has undergone a great evolution over a period of several centuries. Lichenstein's tension free hernioplasty is the one of the first surgeries taught to a surgical resident. The main aim of surgeries in this era is to give the best possible results with the least possible pain, scar and time. This has given rise to so many modifications to the classical Lichenstein's procedure and also to laparoscopic hernioplasty. Pain after inguinal hernia surgery is found to be debilitating and altering the quality of life in several patients, which has been attributed to the traumatic fixation of the mesh with sutures. This has paved way to the development of various atraumatic methods of fixation, tissue glue is one such development. Hence this study, to compare traumatic and atraumatic methods of mesh fixation in inguinal hernia repair. The aim of this study was to compare suture fixation versus tissue glue fixation of the mesh in inguinal hernia repair. Primary objective was to compare the immediate and chronic post-operative pain. Secondary objective was to compare the time taken for the procedure by the two methods in use and also to compare the presence of any complications. and methodology: This study was done in the General Surgery department of XXX hospital, medical college and research centre, kattangulathur after Ethics committee clearance. It is a single blinded study. The study was done on 51 patients consenting for the study and meeting the inclusion criterias from the period of March 2016 to August 2017 out of which 26 were selected for glue mesh fixation and 25 for suture mesh fixation according to simple randomization. The suture group patients underwent classical Lichenstein's tension free hernioplasty and the glue group underwent Lichenstein's hernioplasty with glue where dots of

  14. Toward An Unstructured Mesh Database

    Rezaei Mahdiraji, Alireza; Baumann, Peter Peter

    2014-05-01

    Unstructured meshes are used in several application domains such as earth sciences (e.g., seismology), medicine, oceanography, cli- mate modeling, GIS as approximate representations of physical objects. Meshes subdivide a domain into smaller geometric elements (called cells) which are glued together by incidence relationships. The subdivision of a domain allows computational manipulation of complicated physical structures. For instance, seismologists model earthquakes using elastic wave propagation solvers on hexahedral meshes. The hexahedral con- tains several hundred millions of grid points and millions of hexahedral cells. Each vertex node in the hexahedrals stores a multitude of data fields. To run simulation on such meshes, one needs to iterate over all the cells, iterate over incident cells to a given cell, retrieve coordinates of cells, assign data values to cells, etc. Although meshes are used in many application domains, to the best of our knowledge there is no database vendor that support unstructured mesh features. Currently, the main tool for querying and manipulating unstructured meshes are mesh libraries, e.g., CGAL and GRAL. Mesh li- braries are dedicated libraries which includes mesh algorithms and can be run on mesh representations. The libraries do not scale with dataset size, do not have declarative query language, and need deep C++ knowledge for query implementations. Furthermore, due to high coupling between the implementations and input file structure, the implementations are less reusable and costly to maintain. A dedicated mesh database offers the following advantages: 1) declarative querying, 2) ease of maintenance, 3) hiding mesh storage structure from applications, and 4) transparent query optimization. To design a mesh database, the first challenge is to define a suitable generic data model for unstructured meshes. We proposed ImG-Complexes data model as a generic topological mesh data model which extends incidence graph model to multi

  15. Obturator foramen dissection for excision of symptomatic transobturator mesh.

    Reynolds, W Stuart; Kit, Laura Chang; Kaufman, Melissa R; Karram, Mickey; Bales, Gregory T; Dmochowski, Roger R

    2012-05-01

    Groin pain after transobturator synthetic mesh placement can be recalcitrant to conservative therapy and ultimately requires surgical excision. We describe our experiences with and technique of obturator foramen dissection for mesh excision. The records of 8 patients treated from 2005 to 2010, were reviewed. Obturator dissection was performed via a lateral groin incision over the inferior pubic ramus at the level of the obturator foramen, typically in conjunction with orthopedic surgery. Five patients had transobturator mid urethral sling surgery for stress urinary incontinence, 2 had mid urethral sling and trocar based anterior vaginal wall mesh kits with transobturator passage of mesh arms for stress urinary incontinence and pelvic organ prolapse, and 1 had an anterior vaginal wall mesh kit for pelvic organ prolapse. Patients had 0 to 2 prior transvaginal mesh excisions before obturator surgery. All patients presented with intractable pain in the area of the obturator foramen and/or medial groin for which conservative treatment measures had failed. Six patients underwent concurrent vaginal and obturator dissection and 2 underwent obturator dissection alone. In all cases residual mesh (3 to 11 cm) was identified and excised from the obturator foramen. Mesh was closely associated to or traversing the adductor longus muscle and tendon with significant fibrous reaction in all cases. Postoperatively 5 patients were cured of pain and/or infection, and 3 reported no or some improvement at a mean followup of 6 months (range 1 to 12). Our experience suggests that surgical excision of residual mesh can alleviate many of the symptoms in many patients. In all cases mesh remnants were identified and removed, and typically involved neuromuscular structures adjacent to the obturator foramen. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Current role of mesh in vaginal prolapse surgery.

    Richter, Lee A; Carter, Charelle; Gutman, Robert E

    2014-10-01

    This report summarizes the latest literature on transvaginal mesh (TVM) for the treatment of pelvic organ prolapse, with a focus on indications for use and management of complications. We describe trends in TVM by reviewing the recent literature and summarizing national meeting presentations. Vaginal mesh complications are most often managed surgically, and the majority of patients experiencing mesh-related pain have symptom improvement after intervention. New efforts will focus on identifying variables associated with success after intervention for mesh-related complications, to aid reconstructive pelvic surgeons in outcome prediction and patient counselling. Although the use of TVM has plateaued in recent years, we are seeing an exponential rise in synthetic mesh implant removal. Reconstructive pelvic surgeons advising patients with TVM complications should report that surgical intervention is often necessary, improvement rates of pain-related symptoms after surgery are high, and up to a third may require multiple interventions.

  17. Effective selection of hypertensive patients for angiography

    van der Voorde, F.; Derkx, F.H.M.; Bossuyt, P.M.M.; Segaar, R.W.; de Wind, A.; Pieterman, H.

    1989-01-01

    The authors prospectively observed 373 severe hypertensives with either diastolic blood pressure (BP) ≥ 105 and age ≤ 40, or BP with three drugs ≥ 105 (regardless of age). Excluded were patients who were older than 75 or who had creatinine >400. History, physical examination, and laboratory data were used to identify high-yield criteria for arteriography. All patients underwent angiography as the gold standard; angiography showed 127 unilateral renal artery stenoses, 73 bilateral renal artery stenoses, and 173 (nonstenosed) essential hypertensives. The authors constructed a logistic regression model of height, weight, age, smoking, and hypertension duration, which could be used to identify 90% of stenosed patients with 50% fewer angiographies in the essential hypertensives

  18. On Reducing Delay in Mesh-Based P2P Streaming: A Mesh-Push Approach

    Liu, Zheng; Xue, Kaiping; Hong, Peilin

    The peer-assisted streaming paradigm has been widely employed to distribute live video data on the internet recently. In general, the mesh-based pull approach is more robust and efficient than the tree-based push approach. However, pull protocol brings about longer streaming delay, which is caused by the handshaking process of advertising buffer map message, sending request message and scheduling of the data block. In this paper, we propose a new approach, mesh-push, to address this issue. Different from the traditional pull approach, mesh-push implements block scheduling algorithm at sender side, where the block transmission is initiated by the sender rather than by the receiver. We first formulate the optimal upload bandwidth utilization problem, then present the mesh-push approach, in which a token protocol is designed to avoid block redundancy; a min-cost flow model is employed to derive the optimal scheduling for the push peer; and a push peer selection algorithm is introduced to reduce control overhead. Finally, we evaluate mesh-push through simulation, the results of which show mesh-push outperforms the pull scheduling in streaming delay, and achieves comparable delivery ratio at the same time.

  19. Prosthetic Mesh Repair for Incarcerated Inguinal Hernia

    Cihad Tatar

    2016-08-01

    Full Text Available Background: Incarcerated inguinal hernia is a commonly encountered urgent surgical condition, and tension-free repair is a well-established method for the treatment of noncomplicated cases. However, due to the risk of prosthetic material-related infections, the use of mesh in the repair of strangulated or incarcerated hernia has often been subject to debate. Recent studies have demonstrated that biomaterials represent suitable materials for performing urgent hernia repair. Certain studies recommend mesh repair only for cases where no bowel resection is required; other studies, however, recommend mesh repair for patients requiring bowel resection as well. Aim: The aim of this study was to compare the outcomes of different surgical techniques performed for strangulated hernia, and to evaluate the effect of mesh use on postoperative complications. Study Design: Retrospective cross-sectional study. Methods: This retrospective study was performed with 151 patients who had been admitted to our hospital’s emergency department to undergo surgery for a diagnosis of incarcerated inguinal hernia. The patients were divided into two groups based on the applied surgical technique. Group 1 consisted of 112 patients treated with mesh-based repair techniques, while Group 2 consisted of 39 patients treated with tissue repair techniques. Patients in Group 1 were further divided into two sub-groups: one consisting of patients undergoing bowel resection (Group 3, and the other consisting of patients not undergoing bowel resection (Group 4. Results: In Group 1, it was observed that eight (7.14% of the patients had wound infections, while two (1.78% had hematomas, four (3.57% had seromas, and one (0.89% had relapse. In Group 2, one (2.56% of the patients had a wound infection, while three (7.69% had hematomas, one (2.56% had seroma, and none had relapses. There were no statistically significant differences between the two groups with respect to wound infection

  20. Performance of the hybrid wireless mesh protocol for wireless mesh networks

    Boye, Magnus; Staalhagen, Lars

    2010-01-01

    Wireless mesh networks offer a new way of providing end-user access and deploying network infrastructure. Though mesh networks offer a price competitive solution to wired networks, they also come with a set of new challenges such as optimal path selection, channel utilization, and load balancing....... and proactive. Two scenarios of different node density are considered for both path selection modes. The results presented in this paper are based on a simulation model of the HWMP specification in the IEEE 802.11s draft 4.0 implemented in OPNET Modeler....

  1. SUPERIMPOSED MESH PLOTTING IN MCNP

    J. HENDRICKS

    2001-02-01

    The capability to plot superimposed meshes has been added to MCNP{trademark}. MCNP4C featured a superimposed mesh weight window generator which enabled users to set up geometries without having to subdivide geometric cells for variance reduction. The variance reduction was performed with weight windows on a rectangular or cylindrical mesh superimposed over the physical geometry. Experience with the new capability was favorable but also indicated that a number of enhancements would be very beneficial, particularly a means of visualizing the mesh and its values. The mathematics for plotting the mesh and its values is described here along with a description of other upgrades.

  2. Selection of paediatric patients for intensive care

    illness, particularly near-drowning, cardiomyopathy, gastro- enteritis and complicated infectious illness (Table Ill). Cardiorespiratory resuscitation prior to ICU admission was associated with increased mortality (7/11 v. 27/106,. P < 0,05, two-tailed Fisher's exact test). There were no deaths in patients with polytrauma without ...

  3. Clinical use of AO three-dimensionally preformed titanium mesh plates for orbital fractures

    Ming Chen

    2015-01-01

    Full Text Available AIM:To evaluate the accuracy and practicability of three-dimensionally preformed Arbeitsgemeinschaft Osteosynthese AO titanium mesh plates for orbital fractures.METHODS:Forty-seven patients with isolated blow-out orbital fractures were included in this study. Fracture locations were as follows: floor/medial wall(n=26, 55%, medial wall(n=12, 26%, and floor(n=9, 19%. The floor fractures were exposed by a standard transconjunctival approach, whereas a combined transcaruncular transconjunctival approach was used in patients with medial wall fractures with temporary dissection of inferior oblique muscle. A three-dimensionally preformed AO titanium mesh plate was selected according to the size of the defect previously measured on the preoperative computed tomographic scan examination and fixed at the inferior orbital rim with 2 screws. The accuracy of plate positioning of the reconstructed orbit was assessed on the postoperative computed tomography(CTscan. The practicability of clinical use of AO three-dimensionally preformed titanium mesh plates was assessed on the preoperative and postoperative clinical data.RESULTS: Postoperative orbital CT scan showed an anatomic three-dimensional placement of the orbital mesh plates in all of the patients. All patients had a successful treatment outcome without clinical complications. 40 patients(87%had a successful enophthalmos correction. 25 patients(86%had a successful recovery from diplopia.CONCLUSION: Three-dimensionally preformed AO titanium mesh plates for orbital fracture reconstruction results in an accurate anatomic restoration of the bony orbital contour with a high rate of success to correctenophthalmos and diplopia.

  4. Wireless mesh networks.

    Wang, Xinheng

    2008-01-01

    Wireless telemedicine using GSM and GPRS technologies can only provide low bandwidth connections, which makes it difficult to transmit images and video. Satellite or 3G wireless transmission provides greater bandwidth, but the running costs are high. Wireless networks (WLANs) appear promising, since they can supply high bandwidth at low cost. However, the WLAN technology has limitations, such as coverage. A new wireless networking technology named the wireless mesh network (WMN) overcomes some of the limitations of the WLAN. A WMN combines the characteristics of both a WLAN and ad hoc networks, thus forming an intelligent, large scale and broadband wireless network. These features are attractive for telemedicine and telecare because of the ability to provide data, voice and video communications over a large area. One successful wireless telemedicine project which uses wireless mesh technology is the Emergency Room Link (ER-LINK) in Tucson, Arizona, USA. There are three key characteristics of a WMN: self-organization, including self-management and self-healing; dynamic changes in network topology; and scalability. What we may now see is a shift from mobile communication and satellite systems for wireless telemedicine to the use of wireless networks based on mesh technology, since the latter are very attractive in terms of cost, reliability and speed.

  5. Improved patient selection by stratified surgical intervention

    Wang, Miao; Bünger, Cody E; Li, Haisheng

    2015-01-01

    BACKGROUND CONTEXT: Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose...... the most appropriate surgical intervention for patients with spinal metastases. PURPOSE: The purpose of this study was to evaluate the clinical outcome of stratified surgical interventions based on the ASMA, which combines life expectancy and the anatomical classification of patients with spinal metastases...... survival times in the five surgical groups determined by the ASMA were 2.1 (TS 0-4, TC 1-7), 5.1 (TS 5-8, TC 1-7), 12.1 (TS 9-11, TC 1-7 or TS 12-15, TC 7), 26.0 (TS 12-15, TC 4-6), and 36.0 (TS 12-15, TC 1-3) months. The 30-day mortality rate was 7.5%. Postoperative neurological function was maintained...

  6. Local anesthesia selection algorithm in patients with concomitant somatic diseases.

    Anisimova, E N; Sokhov, S T; Letunova, N Y; Orekhova, I V; Gromovik, M V; Erilin, E A; Ryazantsev, N A

    2016-01-01

    The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.

  7. Objective and subjective outcome 3 years after synthetic transobturator nonabsorbable anterior mesh use in symptomatic advanced pelvic organ prolapse surgery

    Tsia-Shu Lo

    2015-05-01

    Conclusion: The Perigee System gave a favorable result in both anatomical and subjective success rates with a low rate of mesh-related morbidities. The strength of the study reported here is its long-term follow up of a relatively large number of patients and the use of validated questionnaires. Limitations are that it is not a RCT; hence, selection and indication bias is unavoidable. The favorable outcome and low morbidities resulting from mesh use is from a single surgeon's perspective and may not be generalized to others.

  8. Spatial memory deficits in patients after unilateral selective amygdalohippocampectomy

    Kessels, R.P.C.; Hendriks, M.P.H.; Schouten, J.A.; Asselen, M. van; Postma, A.

    2004-01-01

    The present study investigated the differential involvement of the right and left hippocampus in various forms of spatial memory: spatial search, positional memory versus object-location binding, and coordinate versus categorical processing. Twenty-five epilepsy patients with selective

  9. Notes on the Mesh Handler and Mesh Data Conversion

    Lee, Sang Yong; Park, Chan Eok

    2009-01-01

    At the outset of the development of the thermal-hydraulic code (THC), efforts have been made to utilize the recent technology of the computational fluid dynamics. Among many of them, the unstructured mesh approach was adopted to alleviate the restriction of the grid handling system. As a natural consequence, a mesh handler (MH) has been developed to manipulate the complex mesh data from the mesh generator. The mesh generator, Gambit, was chosen at the beginning of the development of the code. But a new mesh generator, Pointwise, was introduced to get more flexible mesh generation capability. An open source code, Paraview, was chosen as a post processor, which can handle unstructured as well as structured mesh data. Overall data processing system for THC is shown in Figure-1. There are various file formats to save the mesh data in the permanent storage media. A couple of dozen of file formats are found even in the above mentioned programs. A competent mesh handler should have the capability to import or export mesh data as many as possible formats. But, in reality, there are two aspects that make it difficult to achieve the competence. The first aspect to consider is the time and efforts to program the interface code. And the second aspect, which is even more difficult one, is the fact that many mesh data file formats are proprietary information. In this paper, some experience of the development of the format conversion programs will be presented. File formats involved are Gambit neutral format, Ansys-CFX grid file format, VTK legacy file format, Nastran format and CGNS

  10. Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse.

    Iglesia, Cheryl B; Hale, Douglass S; Lucente, Vincent R

    2013-03-01

    Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon's audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.

  11. Diamond vs. square mesh codend in a multi-species trawl fishery of the western Mediterranean: effects on catch composition, yield, size selectivity and discards

    Ordines, F. (Francesc); Massutí, E. (Enric); Guijarro, B. (Beatriz); Mas, R. (Ramon)

    2006-01-01

    Selectivity studies usually describe the effects on target species, whereas information on by-catch and discards is scarce. Nevertheless, large quantities of undersized individuals and invertebrates are discarded in the Mediterranean multi-species bottom trawl fishery. The present work analyses the data from two surveys carried out on the shallow and deep continental shelf (50–78 m, and 147–189 m, respectively) off the Balearic Islands (western Mediterranean). In these surveys, the traditiona...

  12. Factors Influencing Patient Selection of a Foot and Ankle Surgeon.

    Manning, Blaine T; Bohl, Daniel D; Wang, Kevin C; Hamid, Kamran S; Holmes, George B; Lee, Simon

    2017-09-01

    An increasingly consumer-centric health insurance market has empowered patients to select the providers of their choice. There is a lack of studies investigating the rationale by which patients select a foot and ankle surgeon. In the present study, 824 consecutive new patients seeking treatment from 3 foot-ankle surgeons were consecutively administered an anonymous questionnaire prior to their first appointment. It included rating the importance of 15 factors regarding specialist selection on a 1 to 10 scale, with 10 designated " Very important" and 1 designated " Not important at all." The remaining questions were multiple choice regarding patient perspectives on other surgeon aspects (appointment availability, waiting room times, clinic proximity, etc). Of 824 consecutive patients administered the survey, 305 (37%) responded. Patients rated board certification (9.24 ± 1.87) and on-site imaging availability (8.48 ± 2.37)-on a 1 to 10 scale, with 10 designated "Very important- as the 2 most important criteria in choosing a foot and ankle surgeon. Patients rated advertisements as least important. Among the patients, 91% responded that a maximum of 30 minutes should elapse between clinic check-in and seeing their physician; 61% responded that a maximum of 20 minutes should elapse between clinic check-in and seeing their physician. In the context of an increasingly consumer-driven paradigm of health care delivery and reimbursement, it is important to understand patients' preferences in specialist selection. Level III: Prospective questionnaire.

  13. Conforming to interface structured adaptive mesh refinement: 3D algorithm and implementation

    Nagarajan, Anand; Soghrati, Soheil

    2018-03-01

    A new non-iterative mesh generation algorithm named conforming to interface structured adaptive mesh refinement (CISAMR) is introduced for creating 3D finite element models of problems with complex geometries. CISAMR transforms a structured mesh composed of tetrahedral elements into a conforming mesh with low element aspect ratios. The construction of the mesh begins with the structured adaptive mesh refinement of elements in the vicinity of material interfaces. An r-adaptivity algorithm is then employed to relocate selected nodes of nonconforming elements, followed by face-swapping a small fraction of them to eliminate tetrahedrons with high aspect ratios. The final conforming mesh is constructed by sub-tetrahedralizing remaining nonconforming elements, as well as tetrahedrons with hanging nodes. In addition to studying the convergence and analyzing element-wise errors in meshes generated using CISAMR, several example problems are presented to show the ability of this method for modeling 3D problems with intricate morphologies.

  14. Streaming simplification of tetrahedral meshes.

    Vo, Huy T; Callahan, Steven P; Lindstrom, Peter; Pascucci, Valerio; Silva, Cláudio T

    2007-01-01

    Unstructured tetrahedral meshes are commonly used in scientific computing to represent scalar, vector, and tensor fields in three dimensions. Visualization of these meshes can be difficult to perform interactively due to their size and complexity. By reducing the size of the data, we can accomplish real-time visualization necessary for scientific analysis. We propose a two-step approach for streaming simplification of large tetrahedral meshes. Our algorithm arranges the data on disk in a streaming, I/O-efficient format that allows coherent access to the tetrahedral cells. A quadric-based simplification is sequentially performed on small portions of the mesh in-core. Our output is a coherent streaming mesh which facilitates future processing. Our technique is fast, produces high quality approximations, and operates out-of-core to process meshes too large for main memory.

  15. In vitro extracellular matrix model to evaluate stroma cell response to transvaginal mesh.

    Wu, Ming-Ping; Huang, Kuan-Hui; Long, Cheng-Yu; Yang, Chau-Chen; Tong, Yat-Ching

    2014-04-01

    The use of surgical mesh for female pelvic floor reconstruction has increased in recent years. However, there is paucity of information about the biological responses of host stroma cells to different meshes. This study was aimed to establish an in vitro experimental model to study the micro-environment of extracellular matrix (ECM) with embedded mesh and the stroma cell behaviors to different synthetic meshes. Matrigel multi-cellular co-culture system with embedded mesh was used to evaluate the interaction of stroma cells and synthetic mesh in a simulated ECM environment. Human umbilical vein endothelial cells (HUVEC) and NIH3T3 fibroblasts were inoculated in the system. The established multi-cellular Matrigel co-culture system was used to detect stroma cell recruitment and tube formation ability for different synthetic meshes. HUVEC and NIH3T3 cells were recruited into the mesh interstices and organized into tube-like structures in type I mesh material from Perigee, Marlex and Prolift 24 hr after cell inoculation. On the contrary, there was little recruitment of HUVEC and NIH3T3 cells into the type III mesh of intra-vaginal sling (IVS). The Matrigel multi-cellular co-culture system with embedded mesh offers a useful in vitro model to study the biological behaviors of stroma cells in response to different types of synthetic meshes. The system can help to select ideal mesh candidates before actual implantation into the human body. © 2013 Wiley Periodicals, Inc.

  16. Convergence study of global meshing on enamel-cement-bracket finite element model

    Samshuri, S. F.; Daud, R.; Rojan, M. A.; Basaruddin, K. S.; Abdullah, A. B.; Ariffin, A. K.

    2017-09-01

    This paper presents on meshing convergence analysis of finite element (FE) model to simulate enamel-cement-bracket fracture. Three different materials used in this study involving interface fracture are concerned. Complex behavior ofinterface fracture due to stress concentration is the reason to have a well-constructed meshing strategy. In FE analysis, meshing size is a critical factor that influenced the accuracy and computational time of analysis. The convergence study meshing scheme involving critical area (CA) and non-critical area (NCA) to ensure an optimum meshing sizes are acquired for this FE model. For NCA meshing, the area of interest are at the back of enamel, bracket ligature groove and bracket wing. For CA meshing, area of interest are enamel area close to cement layer, the cement layer and bracket base. The value of constant NCA meshing tested are meshing size 1 and 0.4. The value constant CA meshing tested are 0.4 and 0.1. Manipulative variables are randomly selected and must abide the rule of NCA must be higher than CA. This study employed first principle stresses due to brittle failure nature of the materials used. Best meshing size are selected according to convergence error analysis. Results show that, constant CA are more stable compare to constant NCA meshing. Then, 0.05 constant CA meshing are tested to test the accuracy of smaller meshing. However, unpromising result obtained as the errors are increasing. Thus, constant CA 0.1 with NCA mesh of 0.15 until 0.3 are the most stable meshing as the error in this region are lowest. Convergence test was conducted on three selected coarse, medium and fine meshes at the range of NCA mesh of 0.15 until 3 and CA mesh area stay constant at 0.1. The result shows that, at coarse mesh 0.3, the error are 0.0003% compare to 3% acceptable error. Hence, the global meshing are converge as the meshing size at CA 0.1 and NCA 0.15 for this model.

  17. Ventral hernia repair with poly-4-hydroxybutyrate mesh.

    Plymale, Margaret A; Davenport, Daniel L; Dugan, Adam; Zachem, Amanda; Roth, John Scott

    2018-04-01

    Biomaterial research has made available a biologically derived fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for use in ventral and incisional hernia repair (VIHR). This study evaluates outcomes of patients undergoing VIHR with P4HB mesh. An IRB-approved prospective pilot study was conducted to assess clinical and quality of life (QOL) outcomes for patients undergoing VIHR with P4HB mesh. Perioperative characteristics were defined. Clinical outcomes, employment status, QOL using 12-item short form survey (SF-12), and pain assessments were followed for 24 months postoperatively. 31 patients underwent VIHR with bioresorbable mesh via a Rives-Stoppa approach with retrorectus mesh placement. The median patient age was 52 years, median body mass index was 33 kg/m 2 , and just over half of the patients were female. Surgical site occurrences occurred in 19% of patients, most of which were seroma. Hernia recurrence rate was 0% (median follow-up = 414 days). Patients had significantly improved QOL at 24 months compared to baseline for SF-12 physical component summary and role emotional (p < 0.05). Ventral hernia repair with P4HB bioresorbable mesh results in favorable outcomes. Early hernia recurrence was not identified among the patient cohort. Quality of life improvements were noted at 24 months versus baseline for this cohort of patients with bioresorbable mesh. Use of P4HB mesh for ventral hernia repair was found to be feasible in this patient population. (ClinicalTrials.gov Identifier: NCT01863030).

  18. Surface meshing with curvature convergence

    Li, Huibin; Zeng, Wei; Morvan, Jean-Marie; Chen, Liming; Gu, Xianfengdavid

    2014-01-01

    Surface meshing plays a fundamental role in graphics and visualization. Many geometric processing tasks involve solving geometric PDEs on meshes. The numerical stability, convergence rates and approximation errors are largely determined by the mesh qualities. In practice, Delaunay refinement algorithms offer satisfactory solutions to high quality mesh generations. The theoretical proofs for volume based and surface based Delaunay refinement algorithms have been established, but those for conformal parameterization based ones remain wide open. This work focuses on the curvature measure convergence for the conformal parameterization based Delaunay refinement algorithms. Given a metric surface, the proposed approach triangulates its conformal uniformization domain by the planar Delaunay refinement algorithms, and produces a high quality mesh. We give explicit estimates for the Hausdorff distance, the normal deviation, and the differences in curvature measures between the surface and the mesh. In contrast to the conventional results based on volumetric Delaunay refinement, our stronger estimates are independent of the mesh structure and directly guarantee the convergence of curvature measures. Meanwhile, our result on Gaussian curvature measure is intrinsic to the Riemannian metric and independent of the embedding. In practice, our meshing algorithm is much easier to implement and much more efficient. The experimental results verified our theoretical results and demonstrated the efficiency of the meshing algorithm. © 2014 IEEE.

  19. Surface meshing with curvature convergence

    Li, Huibin

    2014-06-01

    Surface meshing plays a fundamental role in graphics and visualization. Many geometric processing tasks involve solving geometric PDEs on meshes. The numerical stability, convergence rates and approximation errors are largely determined by the mesh qualities. In practice, Delaunay refinement algorithms offer satisfactory solutions to high quality mesh generations. The theoretical proofs for volume based and surface based Delaunay refinement algorithms have been established, but those for conformal parameterization based ones remain wide open. This work focuses on the curvature measure convergence for the conformal parameterization based Delaunay refinement algorithms. Given a metric surface, the proposed approach triangulates its conformal uniformization domain by the planar Delaunay refinement algorithms, and produces a high quality mesh. We give explicit estimates for the Hausdorff distance, the normal deviation, and the differences in curvature measures between the surface and the mesh. In contrast to the conventional results based on volumetric Delaunay refinement, our stronger estimates are independent of the mesh structure and directly guarantee the convergence of curvature measures. Meanwhile, our result on Gaussian curvature measure is intrinsic to the Riemannian metric and independent of the embedding. In practice, our meshing algorithm is much easier to implement and much more efficient. The experimental results verified our theoretical results and demonstrated the efficiency of the meshing algorithm. © 2014 IEEE.

  20. Appropriate selection for omalizumab treatment in patients with severe asthma?

    Nygaard, Leo; Henriksen, Daniel Pilsgaard; Madsen, Hanne

    2017-01-01

    Background: Omalizumab improves asthma control in patients with uncontrolled severe allergic asthma; however, appropriate patient selection is crucial. Information in this field is sparse. Objective: We aimed to estimate whether potential omalizumab candidates were appropriately selected according...... to guidelines, and the clinical effect of omalizumab treatment over time. Design: We performed a retrospective observational study on adult patients with asthma treated with omalizumab during 2006-2015 at the Department of Respiratory Medicine at Odense University Hospital (OUH), Denmark. Data were obtained...... from the Electronic Patient Journal of OUH and Odense Pharmaco-Epidemiological Database. Guideline criteria for omalizumab treatment were used to evaluate the appropriateness of omalizumab candidate selection, and the Asthma Control Test (ACT) to assess the clinical effects of omalizumab at weeks 16...

  1. Leveraging the power of mesh

    Glass, H. [Cellnet, Alpharetta, GA (United States)

    2006-07-01

    Mesh network applications are used by utilities for metering, demand response, and mobile workforce management. This presentation provided an overview of a multi-dimensional mesh application designed to offer improved scalability and higher throughput in advanced metering infrastructure (AMI) systems. Mesh applications can be used in AMI for load balancing and forecasting, as well as for distribution and transmission planning. New revenue opportunities can be realized through the application's ability to improve notification and monitoring services, and customer service communications. Mesh network security features include data encryption, data fragmentation and the automatic re-routing of data. In order to use mesh network applications, networks must have sufficient bandwidth and provide flexibility at the endpoint layer to support multiple devices from multiple vendors, as well as support multiple protocols. It was concluded that smart meters will not enable energy response solutions without an underlying AMI that is reliable, scalable and self-healing. .refs., tabs., figs.

  2. Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh.

    Hoyuela, Carlos; Juvany, Montserrat; Trias, Miquel; Ardid, Jordi; Martrat, Antoni

    2018-01-01

    The rate of incisional hernia in high-risk patients (obesity, cancer, etc.) is high, even in laparoscopic surgery. The aim of this study is to evaluate the safety of the use of cyanoacrylate fixed prophylactic meshes in the assistance incision in overweight or obese patients undergoing laparoscopic colorectal surgery. A prospective, non-randomized cohort study of patients undergoing elective laparoscopic resection for colorectal cancer between January 2013 and March 2016 was performed. Those with a body mass index greater than 25kg / m 2 were evaluated to implant a prophylactic meshes fixed with cyanoacrylate (Histoacryl®) as reinforcement of the assistance incision. 52 patients were analyzed (mean body mass index: 28.4±2kg / m 2 ). Prophylactic meshes was implanted in 15 patients. The time to put the mesh in place was always less than 5minutes. There was no significant difference in wound infection rate (12% vs. 10%). No mesh had to be explanted. Although the mean follow-up was shorter (14.1±4 vs. 22.3±9 months), there were no incisional hernia in the mesh group. On the other hand, in the non-mesh group, 1 acute evisceration (2.7%) and 4 incisional hernia of the assistance incision were observed (10.8%). There were no significant differences between groups regarding trocar incisional hernia (6.6 vs. 5.4%). The implantation of a reinforcement prophylactic mesh in overweight or obese patients undergoing laparoscopic colorectal surgery is safe and seems to reduce the short-term rate of incisional hernia. Fixation with cyanoacrylate is a rapid method that facilitates the procedure without additional complications. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Endoscopic bronchial valve treatment: patient selection and special considerations

    Eberhardt R

    2015-10-01

    Full Text Available Ralf Eberhardt,1,2 Daniela Gompelmann,1,2 Felix JF Herth,1,2 Maren Schuhmann1 1Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, 2Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany Abstract: As well as lung volume reduction surgery, different minimally invasive endoscopic techniques are available to achieve lung volume reduction in patients with severe emphysema and significant hyperinflation. Lung function parameters and comorbidities of the patient, as well as the extent and distribution of the emphysema are factors to be considered when choosing the patient and the intervention. Endoscopic bronchial valve placement with complete occlusion of one lobe in patients with heterogeneous emphysema is the preferred technique because of its reversibility. The presence of high interlobar collateral ventilation will hinder successful treatment; therefore, endoscopic coil placement, polymeric lung volume reduction, or bronchoscopic thermal vapor ablation as well as lung volume reduction surgery can be used for treating patients with incomplete fissures. The effect of endoscopic lung volume reduction in patients with a homogeneous distribution of emphysema is still unclear and this subgroup should be treated only in clinical trials. Precise patient selection is necessary for interventions and to improve the outcome and reduce the risk and possible complications. Therefore, the patients should be discussed in a multidisciplinary approach prior to determining the most appropriate treatment for lung volume reduction. Keywords: lung emphysema, valve treatment, collateral ventilation, patient selection, outcome

  4. Seven-year retrospective clinical study evaluating efficacy of stainless steel mesh in mandibular fractures.

    Chakraborty, Sudip; Ghosh, Samiran; Burman, Richi; Ray, Amit

    2011-10-01

    The use of titanium mesh in communited mandibular fractures has been substantially documented. However, the use of stainless steel mesh for routine fixation in mandibular fractures has not been widely reported. The aim of the present study was to evaluate the efficacy of stainless steel mesh for routine osteosynthesis of mandibular fractures. A total of 252 patients who had been diagnosed with 287 single or multiple mandibular fractures at Guru Nanak Institute of Dental Science and Research from 2002 to 2009 were selected for the present study. Those with condylar fractures and other maxillofacial injuries were excluded from the study. The patients were evaluated preoperatively, intraoperatively, and postoperatively at 1 day, 6 weeks, and 3 and 6 months. The local complications, occlusion (for static function), and chewing (for dynamic function) were evaluated postoperatively. The intraoperative time taken for implant fixation (from site exposure to fixation of the last screw) was 32 minutes. Of the 252 patients, 40 (15.8%) had local complications and 24 patients required implant removal. Of the 252 patients, 82% had bilaterally satisfactory occlusion according to the surgeon at 6 months postoperatively. Discomfort in chewing unilaterally or bilaterally was reported by 17% of the patients. The results of our study have shown that stainless steel mesh has acceptable complication rates and the ability to maintain occlusion and chewing postoperatively compared with the present standards of care of mandibular fractures using miniplates. The lower cost and versatile placement of screws were the principal advantages. However, placement near the mental foramen with an extraoral approach for certain sites is the primary disadvantage. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Use of mesh in laparoscopic paraesophageal hernia repair

    Müller-Stich, Beat P.; Kenngott, Hannes G.; Gondan, Matthias

    2015-01-01

    Introduction. Mesh augmentation seems to reduce recurrences following laparoscopic paraesophageal hernia repair (LPHR). However, there is an uncertain risk of mesh-associated complications. Risk-benefit analysis might solve the dilemma. Materials and Methods. A systematic literature search...... potential benefits of LMAH. All data regarding LMAH were used to estimate risk of mesh-associated complications. Risk-benefit analysis was performed using a Markov Monte Carlo decision-analytic model. Results. Meta-analysis of 3 RCTs and 9 OCSs including 915 patients revealed a significantly lower...

  6. Computed tomography landmark-based semi-automated mesh morphing and mapping techniques: generation of patient specific models of the human pelvis without segmentation.

    Salo, Zoryana; Beek, Maarten; Wright, David; Whyne, Cari Marisa

    2015-04-13

    Current methods for the development of pelvic finite element (FE) models generally are based upon specimen specific computed tomography (CT) data. This approach has traditionally required segmentation of CT data sets, which is time consuming and necessitates high levels of user intervention due to the complex pelvic anatomy. The purpose of this research was to develop and assess CT landmark-based semi-automated mesh morphing and mapping techniques to aid the generation and mechanical analysis of specimen-specific FE models of the pelvis without the need for segmentation. A specimen-specific pelvic FE model (source) was created using traditional segmentation methods and morphed onto a CT scan of a different (target) pelvis using a landmark-based method. The morphed model was then refined through mesh mapping by moving the nodes to the bone boundary. A second target model was created using traditional segmentation techniques. CT intensity based material properties were assigned to the morphed/mapped model and to the traditionally segmented target models. Models were analyzed to evaluate their geometric concurrency and strain patterns. Strains generated in a double-leg stance configuration were compared to experimental strain gauge data generated from the same target cadaver pelvis. CT landmark-based morphing and mapping techniques were efficiently applied to create a geometrically multifaceted specimen-specific pelvic FE model, which was similar to the traditionally segmented target model and better replicated the experimental strain results (R(2)=0.873). This study has shown that mesh morphing and mapping represents an efficient validated approach for pelvic FE model generation without the need for segmentation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Phenotypes selected during chronic lung infection in cystic fibrosis patients

    Ciofu, Oana; Mandsberg, Lotte F; Wang, Hengzhuang

    2012-01-01

    During chronic lung infection of patients with cystic fibrosis, Pseudomonas aeruginosa can survive for long periods of time under the challenging selective pressure imposed by the immune system and antibiotic treatment as a result of its biofilm mode of growth and adaptive evolution mediated by g...... the importance of biofilm prevention strategies by early aggressive antibiotic prophylaxis or therapy before phenotypic diversification during chronic lung infection of patients with cystic fibrosis....

  8. Reconstructive laparoscopic prolapse surgery to avoid mesh erosions

    Devassy, Rajesh

    2013-09-01

    Full Text Available Introduction: The objective of the study is to examine the efficacy of the purely laparoscopic reconstructive management of cystocele and rectocele with mesh, to avoid the risk of erosion by the graft material, a well known complication in vaginal mesh surgery. Material and methods: We performed a prospective, single-case, non-randomized study in 325 patients who received laparoscopic reconstructive management of pelvic organe prolaps with mesh. The study was conducted between January 2004 and December 2012 in a private clinic in India. The most common prolapse symptoms were reducible vaginal lump, urinary stress incontinence, constipation and flatus incontinence, sexual dysfunction and dypareunia. The degree e of the prolaps was staged according to POPQ system. The approach was purely laparoscopic and involved the use of polypropylene (Prolene or polyurethane with activated regenerated cellulose coating (Parietex mesh. Results: The mean age was 55 (30–80 years and the most of the patients were multiparous (272/325. The patients received a plastic correction of the rectocele only (138 cases, a cystocele and rectocele (187 cases with mesh. 132 patients had a concomitant total hysterectomy; in 2 cases a laparoscopic supracervical hysterectomy was performed and 190 patients had a laparoscopic colposuspension. The mean operation time was 82.2 (60–210 minutes. The mean follow up was 3.4 (3–5 years. Urinary retention developed in 1 case, which required a new laparoscopical intervention. Bladder injury, observed in the same case was in one session closed with absorbable suture. There were four recurrences of the rectocele, receiving a posterior vaginal colporrhaphy. Erosions of the mesh were not reported or documented. Conclusion: The pure laparoscopic reconstructive management of the cystocele and rectocele with mesh seems to be a safe and effective surgical procedure potentially avoiding the risk of mesh erosions.

  9. Anterior lumbar fusion with titanium threaded and mesh interbody cages.

    Rauzzino, M J; Shaffrey, C I; Nockels, R P; Wiggins, G C; Rock, J; Wagner, J

    1999-12-15

    metastatic breast cancer who had undergone an L-3 corpectomy with placement of a mesh cage. Although her back pain was immediately resolved, she died of systemic disease 3 months after surgery and before fusion could occur. Complications related to the anterior approach included two vascular injuries (two left common iliac vein lacerations); one injury to the sympathetic plexus; one case of superficial phlebitis; two cases of prolonged ileus (greater than 48 hours postoperatively); one anterior femoral cutaneous nerve palsy; and one superficial wound infection. No deaths were directly related to the surgical procedure. There were no cases of dural laceration and no nerve root injury. There were no cases of deep venous thrombosis, pulmonary embolus, retrograde ejaculation, abdominal hernia, bowel or ureteral injury, or deep wound infection. Fusion-related complications included an iliac crest hematoma and prolonged donor-site pain in one patient. There were no complications related to placement or migration of the cages, but there was one case of screw fracture of the Kaneda device that did not require revision. The authors conclude that anterior lumbar fusion performed using titanium interbody or mesh cages, packed with autologous bone, is an effective, safe method to achieve fusion in a wide variety of pathological conditions of the thoracolumbar spine. The fusion rate of 96% compares favorably with results reported in the literature. The complication rate mirrors the low morbidity rate associated with the anterior approach. A detailed study of clinical outcomes is in progress. Patient selection and strategies for avoiding complication are discussed.

  10. Challenging the Myth: Transvaginal Mesh is Not Associated with Carcinogenesis.

    Chughtai, Bilal; Sedrakyan, Art; Mao, Jialin; Thomas, Dominique; Eilber, Karyn S; Clemens, J Quentin; Anger, Jennifer T

    2017-10-01

    We sought to determine if there was a potential link between synthetic polypropylene mesh implantation for transvaginal pelvic organ prolapse and stress urinary incontinence, and carcinogenesis using statewide administrative data. Women who underwent transvaginal surgery for pelvic organ prolapse or stress urinary incontinence with mesh between January 2008 and December 2009 in New York State were identified using ICD-9-CM procedure codes and CPT-4 codes. Patients in the mesh cohort were individually matched to 2 control cohorts based on comorbidities and procedure date. Carcinogenesis was determined before and after matching at 1, 2 and 3 years, and during the entire followup time. A total of 2,229 patients who underwent mesh based pelvic organ prolapse surgery and 10,401 who underwent sling surgery for stress urinary incontinence between January 2008 and December 2009 were included in the study. Mean followup was 6 years (range 5 to 7). Exact matching between the mesh and control cohorts resulted in 1,870 pairs for pelvic organ prolapse mesh and cholecystectomy (1:2), 1,278 pairs for pelvic organ prolapse mesh and hysterectomy (1:1), 7,986 pairs for sling and cholecystectomy (1:1) and 3,810 pairs for sling and hysterectomy (1:1). Transvaginal mesh implantation was not associated with an increased risk of a cancer diagnosis (pelvic/local cancers or any cancer) at 1 year and during the entire followup of up to 7 years. Transvaginal surgery with implantation of mesh was not associated with the development of malignancy at a mean followup of 6 years. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Streaming Compression of Hexahedral Meshes

    Isenburg, M; Courbet, C

    2010-02-03

    We describe a method for streaming compression of hexahedral meshes. Given an interleaved stream of vertices and hexahedral our coder incrementally compresses the mesh in the presented order. Our coder is extremely memory efficient when the input stream documents when vertices are referenced for the last time (i.e. when it contains topological finalization tags). Our coder then continuously releases and reuses data structures that no longer contribute to compressing the remainder of the stream. This means in practice that our coder has only a small fraction of the whole mesh in memory at any time. We can therefore compress very large meshes - even meshes that do not file in memory. Compared to traditional, non-streaming approaches that load the entire mesh and globally reorder it during compression, our algorithm trades a less compact compressed representation for significant gains in speed, memory, and I/O efficiency. For example, on the 456k hexahedra 'blade' mesh, our coder is twice as fast and uses 88 times less memory (only 3.1 MB) with the compressed file increasing about 3% in size. We also present the first scheme for predictive compression of properties associated with hexahedral cells.

  12. Cardiac resynchronization therapy : advances in optimal patient selection

    Bleeker, Gabe Berend

    2007-01-01

    Despite the impressive results of cardiac resynchronization theraphy (CRT) in recent large randomized trials a consistent number of patients fails to improve following CRT implantation when the established CRT selection criteria (NYHA class III-IV heart failure, LV ejection fraction ≤35 % and QRS

  13. [Selection of patients for transcatheter aortic valve implantation].

    Tron, Christophe; Godin, Matthieu; Litzler, Pierre-Yves; Bauer, Fabrice; Caudron, Jérome; Dacher, Jean-Nicolas; Borz, Bogdan; Canville, Alexandre; Kurtz, Baptiste; Bessou, Jean-Paul; Cribier, Alain; Eltchaninoff, Hélène

    2012-06-01

    A good selection of patients is a crucial step before transcatheter aortic valve implantation (TAVI) in order to select the good indications and choose the access route. TAVI should be considered only in patients with symptomatic severe aortic stenosis and either contraindication or high surgical risk. Indication for TAVI should be discussed in a multidisciplinary team meeting. Echocardiography and/or CT scan are mandatory to evaluate the aortic annulus size and select the good prosthesis size. The possibility of transfemoral implantation is evaluated by angiography and CT scan, and based on the arterial diameters, but also on the presence of tortuosities and arterial calcifications. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  14. Mesh Adaptation and Shape Optimization on Unstructured Meshes, Phase I

    National Aeronautics and Space Administration — In this SBIR CRM proposes to implement the entropy adjoint method for solution adaptive mesh refinement into the Loci/CHEM unstructured flow solver. The scheme will...

  15. Individual treatment selection for patients with posttraumatic stress disorder.

    Deisenhofer, Anne-Katharina; Delgadillo, Jaime; Rubel, Julian A; Böhnke, Jan R; Zimmermann, Dirk; Schwartz, Brian; Lutz, Wolfgang

    2018-04-16

    Trauma-focused cognitive behavioral therapy (Tf-CBT) and eye movement desensitization and reprocessing (EMDR) are two highly effective treatment options for posttraumatic stress disorder (PTSD). Yet, on an individual level, PTSD patients vary substantially in treatment response. The aim of the paper is to test the application of a treatment selection method based on a personalized advantage index (PAI). The study used clinical data for patients accessing treatment for PTSD in a primary care mental health service in the north of England. PTSD patients received either EMDR (N = 75) or Tf-CBT (N = 242). The Patient Health Questionnaire (PHQ-9) was used as an outcome measure for depressive symptoms associated with PTSD. Variables predicting differential treatment response were identified using an automated variable selection approach (genetic algorithm) and afterwards included in regression models, allowing the calculation of each patient's PAI. Age, employment status, gender, and functional impairment were identified as relevant variables for Tf-CBT. For EMDR, baseline depressive symptoms as well as prescribed antidepressant medication were selected as predictor variables. Fifty-six percent of the patients (n = 125) had a PAI equal or higher than one standard deviation. From those patients, 62 (50%) did not receive their model-predicted treatment and could have benefited from a treatment assignment based on the PAI. Using a PAI-based algorithm has the potential to improve clinical decision making and to enhance individual patient outcomes, although further replication is necessary before such an approach can be implemented in prospective studies. © 2018 Wiley Periodicals, Inc.

  16. How do intake clinicians use patient characteristics to select treatment for patients with personality disorders?

    van Manen, Janine; Kamphuis, Jan Henk; Visbach, Geny; Ziegler, Uli; Gerritsen, Ad; Van Rossum, Bert; Rijnierse, Piet; Timman, Reinier; Verheul, Roel

    2008-11-01

    Treatment selection in clinical practice is a poorly understood, often largely implicit decision process, perhaps especially for patients with personality disorders. This study, therefore, investigated how intake clinicians use information about patient characteristics to select psychotherapeutic treatment for patients with personality disorder. A structured interview with a forced-choice format was administered to 27 experienced intake clinicians working in five specialist mental health care institutes in the Netherlands. Substantial consensus was evident among intake clinicians. The results revealed that none of the presented patient characteristics were deemed relevant for the selection of the suitable treatment setting. The appropriate duration and intensity are selected using severity or personal strength variables. The theoretical orientation is selected using personal strength variables.

  17. Clinical study for pancreatic fistula after distal pancreatectomy with mesh reinforcement

    Akira Hayashibe

    2018-05-01

    Full Text Available Summary: Background: The purpose of this cohort study was to determine whether distal pancreatectomy with mesh reinforcement can reduce postoperative pancreatic fistula (POPF rates compared with bare stapler. Methods: In total, 51 patients underwent stapled distal pancreatectomy. Out of these, 22 patients (no mesh group underwent distal pancreatectomy with bare stapler and 29 patients (mesh group underwent distal pancreatectomy with mesh reinforced stapler. The risk factor for clinically relevant POPF (grades B and C after distal pancreatectomy was also evaluated. Results: Clinical characteristics were almost similar in both the groups. The days of the mean hospital stay and drainage tube insertion in the mesh group were significantly fewer than those in the no mesh group. The mean level of amylase in the discharge fluid in the mesh group was also significantly lower than that the in no mesh group. The rate of clinically relevant POPF (grades B and C in the mesh group was significantly lower than that in the no mesh group (p=0.016. Univariate analyses of risk factors for POPF (grades B and C revealed that only mesh reinforcement was associated with POPF (grades B and C. Moreover, on multivariate analyses of POPF risk factors with p value<0.2 in univariate analyses by logistic regression, mesh reinforcement was regarded as a significant factor for POPF(grades B and C. Conclusions: The distal pancreatectomy with mesh reinforced stapler was thought to be favorable for the prevention of clinically relevant POPF (grades B and C. Keywords: mesh reinforcement, pancreatic fistula, pancreatic surgery

  18. A THREE-YEAR EXPERIENCE WITH ANTERIOR TRANSOBTURATOR MESH (ATOM AND POSTERIOR ISCHIORECTAL MESH (PIRM

    Marijan Lužnik

    2018-02-01

    Full Text Available Background. Use of alloplastic mesh implantates allow a new urogynecologycal surgical techniques achieve a marked improvement in pelvic organ static and pelvic floor function with minimally invasive needle transvaginal intervention like an anterior transobturator mesh (ATOM and a posterior ischiorectal mesh (PIRM procedures. Methods. In three years, between April 2006 and May 2009, we performed one hundred and eightyfour operative corrections of female pelvic organ prolapse (POP and pelvic floor dysfunction (PFD with mesh implantates. The eighty-three patients with surgical procedure TVT-O or Monarc as solo intervention indicated by stress urinary incontinence without POP, are not included in this number. In 97 % of mesh operations, Gynemesh 10 × 15 cm was used. For correction of anterior vaginal prolapse with ATOM procedure, Gynemesh was individually trimmed in mesh with 6 free arms for tension-free transobturator application and tension-free apical collar. IVS (Intravaginal sling 04 Tunneller (Tyco needle system was used for transobturator application of 6 arms through 4 dermal incisions (2 on right and 2 on left. Minimal anterior median colpotomy was made in two separate parts. For correction of posterior vaginal prolapse with PIRM procedure Gynemesh was trimmed in mesh with 4 free arms and tension-free collar. Two ischiorectal long arms for tension-free application through fossa ischiorectale – right and left, and two short arms for perineal body also on both sides. IVS 02 Tunneller (Tyco needle system was used for tension-free application of 4 arms through 4 dermal incisions (2 on right and 2 on left in PIRM. Results. All 184 procedures were performed relatively safely. In 9 cases of ATOM we had perforation of bladder, in 5 by application of anterior needle, in 3 by application of posterior needle and in one case with pincette when collar was inserted in lateral vesico – vaginal space. In 2 cases of PIRM we had perforation of rectum

  19. Surgeon Experience and Complications of Transvaginal Prolapse Mesh.

    Kelly, Erin C; Winick-Ng, Jennifer; Welk, Blayne

    2016-07-01

    To measure the proportion of women with transvaginal prolapse mesh complications and their association with surgeon volume. We conducted a retrospective, population-based cohort study of all women who underwent a mesh-based prolapse procedure using administrative data (hospital procedure and physician billing records) between 2002 and 2013 in Ontario, Canada. The primary outcome was surgical revision of the mesh. Primary exposure was surgeon volume: high (greater than the 75th percentile, requiring a median of five [interquartile range 5-6] procedures per year) and very high (greater than the 90th percentile, requiring a median of 13 [interquartile range 11-14] procedures per year) volume mesh implanters were identified each year. Primary analysis was an adjusted Cox proportional hazards model. A total of 5,488 women underwent mesh implantation by 1 of 368 unique surgeons. Median follow-up time was 5.4 (interquartile range 3.0-8.0) years. We found that 218 women (4.0%) underwent mesh reoperation a median of 1.17 (interquartile range 0.58-2.90) years after implantation. The hazard of reoperation for complications was only lower for patients of very high-volume surgeons (3.0% [145/3,001] compared with 4.8% [73/2,447], adjusted hazards ratio 0.59, 95% confidence interval 0.40-0.86). In multivariable modeling, younger age, concomitant hysterectomy, blood transfusion, and increased medical comorbidity were all associated with vaginal mesh reoperation. Approximately 5% of women who underwent mesh-based prolapse surgery required reoperation for a mesh complication within 10 years. The risk of reoperation was lowest for surgeons performing 14 or more procedures per year.

  20. GENERATION OF IRREGULAR HEXAGONAL MESHES

    Vlasov Aleksandr Nikolaevich

    2012-07-01

    Decomposition is performed in a constructive way and, as option, it involves meshless representation. Further, this mapping method is used to generate the calculation mesh. In this paper, the authors analyze different cases of mapping onto simply connected and bi-connected canonical domains. They represent forward and backward mapping techniques. Their potential application for generation of nonuniform meshes within the framework of the asymptotic homogenization theory is also performed to assess and project effective characteristics of heterogeneous materials (composites.

  1. Field-aligned mesh joinery

    Cignoni, Paolo; Pietroni, Nico; Malomo, Luigi

    2014-01-01

    Mesh joinery is an innovative method to produce illustrative shape approximations suitable for fabrication. Mesh joinery is capable of producing complex fabricable structures in an efficient and visually pleasing manner. We represent an input geometry as a set of planar pieces arranged to compose a rigid structure, by exploiting an efficient slit mechanism. Since slices are planar, to fabricate them a standard 2D cutting system is enough. We automatically arrange slices according to a smooth ...

  2. Clinical outcomes after parastomal hernia repair with a polyester monofilament composite mesh

    Oma, E; Pilsgaard, B; Jorgensen, L N

    2018-01-01

    with intraperitoneal placement of a polyester monofilament macroporous composite mesh. METHODS: Data on all patients undergoing parastomal hernia repair with Parietex™ Composite Parastomal Mesh at our institution during a 4-year period were examined. Patients with urostomy were excluded. A team of three experienced...... chronic pain. CONCLUSION: In this study, we found low rates of recurrence and chronic pain following parastomal hernia repair using intraperitoneal reinforcement with a polyester monofilament composite mesh....

  3. Method and system for mesh network embedded devices

    Wang, Ray (Inventor)

    2009-01-01

    A method and system for managing mesh network devices. A mesh network device with integrated features creates an N-way mesh network with a full mesh network topology or a partial mesh network topology.

  4. Surgical excision of eroded mesh after prior abdominal sacrocolpopexy.

    South, Mary M T; Foster, Raymond T; Webster, George D; Weidner, Alison C; Amundsen, Cindy L

    2007-12-01

    We previously described an endoscopic-assisted transvaginal mesh excision technique. This study compares surgical outcomes after transvaginal mesh excision vs endoscopic-assisted transvaginal mesh excision. In addition, we reviewed our postoperative outcomes with excision via laparotomy. This was an inclusive retrospective analysis of patients presenting to our institution from 1997 to 2006 for surgical management of vaginal erosion of permanent mesh after sacrocolpopexy. Three techniques were utilized: transvaginal, endoscopic-assisted transvaginal, and laparotomy. For the patients undergoing transvaginal excision, data recorded included number and type of excisions performed, number of prior excisions performed at outside facilities, intraoperative and postoperative complications (including blood transfusions, pelvic abscess, or bowel complications), use of postoperative antibiotics, persistent symptoms of vaginal bleeding and discharge at follow-up, and demographic characteristics. The intraoperative and postoperative complications and the postoperative symptoms were recorded for the laparotomy cases. Thirty-one patients underwent transvaginal mesh excision during this time period: 17 endoscopic-assisted transvaginal and 14 transvaginal without endoscope assistance. In addition, a total of 7 patients underwent abdominal excision via laparotomy. Comparison of the 2 vaginal methods revealed no difference in the demographics or success rate, with success defined as no symptoms at follow-up. Endoscopic-assisted transvaginal excision was successful in 7 of 17 patients and transvaginal without endoscopic assistance in 9 of 13 patients (1 patient excluded for lack of follow-up data) for a total vaginal success rate of 53.3%. No intraoperative and only minor postoperative complications occurred with either vaginal method. Three patients underwent 3 vaginal attempts to achieve complete symptom resolution. The average follow-up time for the entire vaginal group was 14

  5. User Manual for the PROTEUS Mesh Tools

    Smith, Micheal A. [Argonne National Lab. (ANL), Argonne, IL (United States); Shemon, Emily R. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2015-06-01

    This report describes the various mesh tools that are provided with the PROTEUS code giving both descriptions of the input and output. In many cases the examples are provided with a regression test of the mesh tools. The most important mesh tools for any user to consider using are the MT_MeshToMesh.x and the MT_RadialLattice.x codes. The former allows the conversion between most mesh types handled by PROTEUS while the second allows the merging of multiple (assembly) meshes into a radial structured grid. Note that the mesh generation process is recursive in nature and that each input specific for a given mesh tool (such as .axial or .merge) can be used as “mesh” input for any of the mesh tools discussed in this manual.

  6. User Manual for the PROTEUS Mesh Tools

    Smith, Micheal A.; Shemon, Emily R.

    2015-01-01

    This report describes the various mesh tools that are provided with the PROTEUS code giving both descriptions of the input and output. In many cases the examples are provided with a regression test of the mesh tools. The most important mesh tools for any user to consider using are the MT M eshToMesh.x and the MT R adialLattice.x codes. The former allows the conversion between most mesh types handled by PROTEUS while the second allows the merging of multiple (assembly) meshes into a radial structured grid. Note that the mesh generation process is recursive in nature and that each input specific for a given mesh tool (such as .axial or .merge) can be used as ''mesh'' input for any of the mesh tools discussed in this manual.

  7. Outcome of transvaginal mesh and tape removed for pain only.

    Hou, Jack C; Alhalabi, Feras; Lemack, Gary E; Zimmern, Philippe E

    2014-09-01

    Because there is reluctance to operate for pain, we evaluated midterm outcomes of vaginal mesh and synthetic suburethral tape removed for pain as the only indication. After receiving institutional review board approval we reviewed a prospective database of women without a neurogenic condition who underwent surgery for vaginal mesh or suburethral tape removal with a focus on pain as the single reason for removal and a minimum 6-month followup. The primary outcome was pain level assessed by a visual analog scale (range 0 to 10) at baseline and at each subsequent visit with the score at the last visit used for analysis. Parameters evaluated included demographics, mean time to presentation and type of mesh or tape inserted. From 2005 to 2013, 123 patients underwent surgical removal of mesh (69) and suburethral tape (54) with pain as the only indication. Mean followup was 35 months (range 6 to 59) in the tape group and 22 months (range 6 to 47) in the mesh group. The visual analog scale score decreased from a mean preoperative level of 7.9 to 0.9 postoperatively (p = 0.0014) in the mesh group and from 5.3 to 1.5 (p = 0.00074) in the tape group. Pain-free status, considered a score of 0, was achieved in 81% of tape and 67% of mesh cases, respectively. No statistically significant difference was found between the groups. When pain is the only indication for suburethral tape or vaginal mesh removal, a significant decrease in the pain score can be durably expected after removal in most patients at midterm followup. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Cache-Oblivious Mesh Layouts

    Yoon, S; Lindstrom, P; Pascucci, V; Manocha, D

    2005-01-01

    We present a novel method for computing cache-oblivious layouts of large meshes that improve the performance of interactive visualization and geometric processing algorithms. Given that the mesh is accessed in a reasonably coherent manner, we assume no particular data access patterns or cache parameters of the memory hierarchy involved in the computation. Furthermore, our formulation extends directly to computing layouts of multi-resolution and bounding volume hierarchies of large meshes. We develop a simple and practical cache-oblivious metric for estimating cache misses. Computing a coherent mesh layout is reduced to a combinatorial optimization problem. We designed and implemented an out-of-core multilevel minimization algorithm and tested its performance on unstructured meshes composed of tens to hundreds of millions of triangles. Our layouts can significantly reduce the number of cache misses. We have observed 2-20 times speedups in view-dependent rendering, collision detection, and isocontour extraction without any modification of the algorithms or runtime applications

  9. Connectivity editing for quadrilateral meshes

    Peng, Chihan; Zhang, Eugene; Kobayashi, Yoshihiro; Wonka, Peter

    2011-01-01

    We propose new connectivity editing operations for quadrilateral meshes with the unique ability to explicitly control the location, orientation, type, and number of the irregular vertices (valence not equal to four) in the mesh while preserving sharp edges. We provide theoretical analysis on what editing operations are possible and impossible and introduce three fundamental operations to move and re-orient a pair of irregular vertices. We argue that our editing operations are fundamental, because they only change the quad mesh in the smallest possible region and involve the fewest irregular vertices (i.e., two). The irregular vertex movement operations are supplemented by operations for the splitting, merging, canceling, and aligning of irregular vertices. We explain how the proposed highlevel operations are realized through graph-level editing operations such as quad collapses, edge flips, and edge splits. The utility of these mesh editing operations are demonstrated by improving the connectivity of quad meshes generated from state-of-art quadrangulation techniques. © 2011 ACM.

  10. Connectivity editing for quadrilateral meshes

    Peng, Chihan

    2011-12-12

    We propose new connectivity editing operations for quadrilateral meshes with the unique ability to explicitly control the location, orientation, type, and number of the irregular vertices (valence not equal to four) in the mesh while preserving sharp edges. We provide theoretical analysis on what editing operations are possible and impossible and introduce three fundamental operations to move and re-orient a pair of irregular vertices. We argue that our editing operations are fundamental, because they only change the quad mesh in the smallest possible region and involve the fewest irregular vertices (i.e., two). The irregular vertex movement operations are supplemented by operations for the splitting, merging, canceling, and aligning of irregular vertices. We explain how the proposed highlevel operations are realized through graph-level editing operations such as quad collapses, edge flips, and edge splits. The utility of these mesh editing operations are demonstrated by improving the connectivity of quad meshes generated from state-of-art quadrangulation techniques. © 2011 ACM.

  11. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse.

    Altman, Daniel; Väyrynen, Tapio; Engh, Marie Ellström; Axelsen, Susanne; Falconer, Christian

    2011-05-12

    The use of standardized mesh kits for repair of pelvic-organ prolapse has spread rapidly in recent years, but it is unclear whether this approach results in better outcomes than traditional colporrhaphy. In this multicenter, parallel-group, randomized, controlled trial, we compared the use of a trocar-guided, transvaginal polypropylene-mesh repair kit with traditional colporrhaphy in women with prolapse of the anterior vaginal wall (cystocele). The primary outcome was a composite of the objective anatomical designation of stage 0 (no prolapse) or 1 (position of the anterior vaginal wall more than 1 cm above the hymen), according to the Pelvic Organ Prolapse Quantification system, and the subjective absence of symptoms of vaginal bulging 12 months after the surgery. Of 389 women who were randomly assigned to a study treatment, 200 underwent prolapse repair with the transvaginal mesh kit and 189 underwent traditional colporrhaphy. At 1 year, the primary outcome was significantly more common in the women treated with transvaginal mesh repair (60.8%) than in those who underwent colporrhaphy (34.5%) (absolute difference, 26.3 percentage points; 95% confidence interval, 15.6 to 37.0). The surgery lasted longer and the rates of intraoperative hemorrhage were higher in the mesh-repair group than in the colporrhaphy group (Pmesh-repair group and 0.5% in the colporrhaphy group (P=0.07), and the respective rates of new stress urinary incontinence after surgery were 12.3% and 6.3% (P=0.05). Surgical reintervention to correct mesh exposure during follow-up occurred in 3.2% of 186 patients in the mesh-repair group. As compared with anterior colporrhaphy, use of a standardized, trocar-guided mesh kit for cystocele repair resulted in higher short-term rates of successful treatment but also in higher rates of surgical complications and postoperative adverse events. (Funded by the Karolinska Institutet and Ethicon; ClinicalTrials.gov number, NCT00566917.).

  12. Selection of patients for sublingual versus subcutaneous immunotherapy.

    Larenas Linnemann, Désirée E S; Blaiss, Michael S

    2014-01-01

    Allergen immunotherapy is the sole treatment for IgE-mediated allergic diseases directed at the underlying mechanism. The two widely accepted administration routes are sublingual (SLIT) and subcutaneous (SCIT). We reviewed how patients should best be selected for immunotherapy and how the optimal administration route can be defined. Before deciding SCIT or SLIT, appropriate selection of patients for allergen immunotherapy (AIT) is mandatory. To be eligible for AIT, subjects must have a clear medical history of allergic disease, with exacerbation of symptoms on exposure to one or more allergens and a corresponding positive skin or in vitro test. Then the route of administration should be based on: published evidence of clinical and immunologic efficacy (which varies per allergic disease and per allergen); mono- or multi-allergen immunotherapy, for SLIT multi-allergen immunotherapy was not effective; safety: adverse events with SLIT are more frequent, but less severe; and, costs and patient preferences, closely related to adherence issues. All these are discussed in the article.

  13. Evidence to justify retention of transvaginal mesh: comparison between laparoscopic sacral colpopexy and transvaginal Elevate™ mesh.

    To, Valérie; Hengrasmee, Pattaya; Lam, Alan; Luscombe, Georgina; Lawless, Anna; Lam, Justin

    2017-12-01

    To determine if laparoscopic sacral colpopexy (LSC) offers better apical support with a lower exposure rate than transvaginal mesh surgery with Elevate™. This was a retrospective cohort study comparing patients with apical prolapse (POP-Q point C ≥ -1) who underwent Elevate™ mesh repair (n = 146) with patients who underwent laparoscopic sacral colpopexy (n = 267). The sacral colpopexy group had a mean age of 59 years and a BMI of 25.7. Patients in the Elevate™ group were older, with a mean age of 63 and a BMI of 26.3. Most of the patients of both groups presented with pelvic organ prolapse stage III (LSC 73.8% and Elevate™ 87.0%) and their mean POP-Q point C were not significantly different (LSC 1.4 vs Elevate™ 1.2 cm). Operative time was longer in the LSC group (113 vs 91 min, p < 0.001), but estimated blood loss was lower (75 cm 3 vs 137 cm 3 , p < 0.001). No difference in mesh exposure rate could be found between the two groups at one year (Elevate™ 0.7% vs LSC 2.6%, OR 0.26, 95% CI 0.03 to 2.10, p = 0.21). One-year objective cure rate, defined as no descent beyond the hymen, was 97.0% in the LSC group and 96.6% in the Elevate™ group (p = .81). The overall recurrence (objective, subjective recurrence or reoperation) was also not different between the groups (LSC 4.5% vs Elevate 4.8%, p = 0.89). Transvaginal Elevate™ mesh delivers comparable apical support with a low exposure rate similar to that of laparoscopic sacral colpopexy.

  14. Mesh Plug Repair of Inguinal Hernia; Single Surgeon Experience

    Ahmet Serdar Karaca

    2013-10-01

    Full Text Available Aim: Mesh repair of inguinal hernia repairs are shown to be an effective and reliable method. In this study, a single surgeon%u2019s experience with plug-mesh method performs inguinal hernia repair have been reported. Material and Method: 587 patients with plug-mesh repair of inguinal hernia, preoperative age, body / mass index, comorbid disease were recorded in terms of form. All of the patients during the preoperative and postoperative hernia classification of information, duration of operation, antibiotics, perioperative complications, and later, the early and late postoperative complications, infection, recurrence rates and return to normal daily activity, verbal pain scales in terms of time and postoperative pain were evaluated. Added to this form of long-term pain ones. The presence of wound infection was assessed by the presence of purulent discharge from the incision. Visual analog scale pain status of the patients was measured. Results: 587 patients underwent repair of primary inguinal hernia mesh plug. One of the patients, 439 (74% of them have adapted follow-ups. Patients%u2019 ages ranged from 18-86. Was calculated as the mean of 47±18:07. Follow-up period of the patients was found to be a minimum of 3 months, maximum 55 months. Found an average of 28.2±13.4 months. Mean duration of surgery was 35.07±4.00 min (min:22mn-max:52mn, respectively. When complication rates of patients with recurrence in 2 patients (0.5%, hematoma development (1.4% in 6 patients, the development of infection in 11 patients (2.5% and long-term groin pain in 4 patients (0.9% appeared. Discussion: In our experience, the plug-mesh repair of primary inguinal hernia repair safe, effective low recurrence and complication rates can be used.

  15. Comparison of Absorbable Mesh Plate versus Titanium-Dynamic Mesh Plate in Reconstruction of Blow-Out Fracture: An Analysis of Long-Term Outcomes

    Woon Il Baek

    2014-07-01

    Full Text Available Background A blow-out fracture is one of the most common facial injuries in midface trauma. Orbital wall reconstruction is extremely important because it can cause various functional and aesthetic sequelae. Although many materials are available, there are no uniformly accepted guidelines regarding material selection for orbital wall reconstruction. Methods From January 2007 to August 2012, a total of 78 patients with blow-out fractures were analyzed. 36 patients received absorbable mesh plates, and 42 patients received titanium-dynamic mesh plates. Both groups were retrospectively evaluated for therapeutic efficacy and safety according to the incidence of three different complications: enophthalmos, extraocular movement impairment, and diplopia. Results For all groups (inferior wall fracture group, medial wall fractrue group, and combined inferomedial wall fracture group, there were improvements in the incidence of each complication regardless of implant types. Moreover, a significant improvement of enophthalmos occurred for both types of implants in group 1 (inferior wall fracture group. However, we found no statistically significant differences of efficacy or complication rate in every groups between both implant types. Conclusions Both types of implants showed good results without significant differences in long-term follow up, even though we expected the higher recurrent enophthalmos rate in patients with absorbable plate. In conclusion, both types seem to be equally effective and safe for orbital wall reconstruction. In particular, both implant types significantly improve the incidence of enophthalmos in cases of inferior orbital wall fractures.

  16. Evaluation of selective attention in patients with misophonia.

    Silva, Fúlvia Eduarda da; Sanchez, Tanit Ganz

    2018-03-21

    Misophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been inferred that misophonia, as well as tinnitus, is associated with hyperconnectivity between auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet. To characterize a sample of misophonic subjects and compare it with two control groups, one with tinnitus individuals (without misophonia) and the other with asymptomatic individuals (without misophonia and without tinnitus), regarding the selective attention. We evaluated 40 normal-hearing participants: 10 with misophonia, 10 with tinnitus (without misophonia) and 20 without tinnitus and without misophonia. In order to evaluate the selective attention, the dichotic sentence identification test was applied in three situations: firstly, the Brazilian Portuguese test was applied. Then, the same test was applied, combined with two competitive sounds: chewing sound (representing a sound that commonly triggers misophonia), and white noise (representing a common type of tinnitus which causes discomfort to patients). The dichotic sentence identification test with chewing sound, showed that the average of correct responses differed between misophonia and without tinnitus and without misophonia (p=0.027) and between misophonia and tinnitus (without misophonia) (p=0.002), in both cases lower in misophonia. Both, the dichotic sentence identification test alone, and with white noise, failed to show differences in the average of correct responses among the three groups (p≥0.452). The misophonia participants presented a lower percentage of correct responses in the dichotic sentence identification test with chewing sound; suggesting that individuals with misophonia may have selective attention impairment when they are exposed to sounds that trigger this condition. Copyright © 2018 Associa

  17. Patient-based radiographic exposure factor selection: a systematic review

    Ching, William; Robinson, John; McEntee, Mark, E-mail: mark.mcentee@sydney.edu.au [Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, New South Wales (Australia)

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  18. Patient-based radiographic exposure factor selection: a systematic review

    Ching, William; Robinson, John; McEntee, Mark

    2014-01-01

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system

  19. Complications of transvaginal silicone-coated polyester synthetic mesh sling.

    Govier, F E; Kobashi, K C; Kuznetsov, D D; Comiter, C; Jones, P; Dakil, S E; James, R

    2005-10-01

    To report a premarket multicenter trial to test the feasibility of a transvaginal silicone-coated polyester synthetic mesh sling in women with anatomic incontinence. Fifty-one patients in four centers underwent transvaginal placement of a silicone-coated polyester synthetic mesh sling (American Medical Systems) during an 8-month period. Of the 51 patients, 31 were part of a prospective institutional review board-approved feasibility trial in three centers funded by American Medical Systems (group 1) and 20 underwent implantation by a single surgeon and their data were retrospectively reviewed (group 2). The studies were done concomitantly, and all slings were fixed transvaginally with bone anchors. All patients in group 1 were followed up at 4 weeks, 6 months, and 1 year (as applicable) with repeat questionnaires, physical examinations, and pad tests. In group 1, 20 patients completed 6 months of follow-up. Ten patients (32%) required a second surgical procedure at an average of 183 days (range 68 to 343) postoperatively. Eight patients (26%) had vaginal extrusion of the mesh, one (3%) required sling lysis, and one (3%) required sling removal because of infection. In group 2, 8 patients (40%) underwent sling removal for vaginal extrusion at a mean of 160 days (range 83 to 214). Transvaginally placed silicone-coated mesh slings used for the treatment of urinary incontinence demonstrated an unacceptably high vaginal extrusion rate in this study. Once identified, this study was immediately terminated, and this product was not marketed for this application in the United States.

  20. Modelling axisymmetric cod-ends made of different mesh types

    Priour, D.; Herrmann, Bent; O'Neill, F.G.

    2009-01-01

    the selectivity process has become more important. This paper presents a model of the deformation of an axisymmetric cod-end. The twine tension and the catch pressure acting on the knots of each mesh along the cod-end profile are calculated, and a Newton-Raphson scheme is used to estimate the equilibrium position...

  1. Multigrid for refined triangle meshes

    Shapira, Yair

    1997-02-01

    A two-level preconditioning method for the solution of (locally) refined finite element schemes using triangle meshes is introduced. In the isotropic SPD case, it is shown that the condition number of the preconditioned stiffness matrix is bounded uniformly for all sufficiently regular triangulations. This is also verified numerically for an isotropic diffusion problem with highly discontinuous coefficients.

  2. A comparative study of onlay and retrorectus mesh placement in incisional hernia repair

    Kundan Kharde

    2013-01-01

    Full Text Available Introduction: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The retro-rectus mesh placement or the sub-lay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates (0-23% and minimal complications. Aims and Objective: The purpose of this study was to compare the traditional on-lay mesh and retro-rectus mesh placement in incisional hernia repairs in terms of time taken for surgery, early complications (wound infections, Mesh extrusion, and Delayed complications (Recurrence. Materials and Methods: This is a prospective study which was conducted in the surgical department of our hospital. A total of 50 cases were included in this study. Of these cases, 25 cases were operated by the on-lay mesh method and 25 by retro-rectus mesh placement. Only the patients with midline hernias up to 10 cm in diameter were included in the study. Result: The operative time for retro-rectus mesh placement was insignificantly higher than that of on-lay mesh repair, whereas, complications like superficial Surgical site infection SSI were identical in both the study groups, but deep SSI leading to infection of mesh was higher in on-lay mesh repair. The recurrence rate was found to be 4% in on-lay mesh repair and 0% in retro-rectus mesh repair. Conclusion: The follow-up period in this study was 6months; hence, late recurrences were not taken into account. However, the low rate of local complications and the low recurrence rate indicate that retro-rectus mesh repair has an advantage over traditional on-lay repair.

  3. Resterilized Polypropylene Mesh for Inguinal Hernia Repair

    2018-04-19

    Apr 19, 2018 ... Conclusion: The use of sterilized polypropylene mesh for the repair of inguinal ... and nonabsorbable materials to reduce the tissue–mesh. INTRODUCTION ... which we have been practicing in our center since we introduced ...

  4. Comparison of post-operative wound infection after inguinal hernia repair with polypropylene mesh and polyester mesh

    Mughal, M.A.; Ahmed, M.; Sajid, M.T.; Mustafa, Q.U.A.; Shukr, I.; Ahsan, J.

    2012-01-01

    Objective: To compare post operative wound infection frequency after inguinal hernia repair with polypropylene and polyester mesh using standard Lichtenstein hernioplasty technique. Study Design: Randomized controlled trial. Place and Duration: This study was conducted at general surgery department CMH/MH Rawalpindi from 8th April 2007 to 1st Jan 2008 over a period of 09 months. Patients and Materials: Sixty patients received through outpatient department with diagnosis of inguinal hernia satisfying inclusion/exclusion criteria were included. Patients were divided into two groups randomly. Group 1 included those patients in whom polypropylene mesh was used while group II patients were implanted with polyester mesh. Demographic as well as data concerning post operative wound infection was collected and analyzed. Results: Fifty seven patients (95%) were males while remaining (05%) were females. Mean age in group I was 41.17+-9.99 years while in group II was 41.47+-9.79 years (p=0.907). One patient (3.3%) in each group developed wound infection diagnosed by clinical evidence of pain at wound site, redness, induration and purulent discharge. Conclusion: There is no difference in post operative wound infection rate after inguinal Lichtenstein hernioplasty using either polypropylene or polyester mesh. (author)

  5. Computational mesh generation for vascular structures with deformable surfaces

    Putter, S. de; Laffargue, F.; Breeuwer, M.; Vosse, F.N. van de; Gerritsen, F.A.; Philips Medical Systems, Best

    2006-01-01

    Computational blood flow and vessel wall mechanics simulations for vascular structures are becoming an important research tool for patient-specific surgical planning and intervention. An important step in the modelling process for patient-specific simulations is the creation of the computational mesh based on the segmented geometry. Most known solutions either require a large amount of manual processing or lead to a substantial difference between the segmented object and the actual computational domain. We have developed a chain of algorithms that lead to a closely related implementation of image segmentation with deformable models and 3D mesh generation. The resulting processing chain is very robust and leads both to an accurate geometrical representation of the vascular structure as well as high quality computational meshes. The chain of algorithms has been tested on a wide variety of shapes. A benchmark comparison of our mesh generation application with five other available meshing applications clearly indicates that the new approach outperforms the existing methods in the majority of cases. (orig.)

  6. Guidelines for patient selection and performance of carotid artery stenting.

    Bladin, Christopher; Chambers, Brian; New, Gishel; Denton, Michael; Lawrence-Brown, Michael

    2010-06-01

    The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and

  7. 6th International Meshing Roundtable '97

    White, D.

    1997-09-01

    The goal of the 6th International Meshing Roundtable is to bring together researchers and developers from industry, academia, and government labs in a stimulating, open environment for the exchange of technical information related to the meshing process. In the pas~ the Roundtable has enjoyed significant participation born each of these groups from a wide variety of countries. The Roundtable will consist of technical presentations from contributed papers and abstracts, two invited speakers, and two invited panels of experts discussing topics related to the development and use of automatic mesh generation tools. In addition, this year we will feature a "Bring Your Best Mesh" competition and poster session to encourage discussion and participation from a wide variety of mesh generation tool users. The schedule and evening social events are designed to provide numerous opportunities for informal dialog. A proceedings will be published by Sandia National Laboratories and distributed at the Roundtable. In addition, papers of exceptionally high quaIity will be submitted to a special issue of the International Journal of Computational Geometry and Applications. Papers and one page abstracts were sought that present original results on the meshing process. Potential topics include but are got limited to: Unstructured triangular and tetrahedral mesh generation Unstructured quadrilateral and hexahedral mesh generation Automated blocking and structured mesh generation Mixed element meshing Surface mesh generation Geometry decomposition and clean-up techniques Geometry modification techniques related to meshing Adaptive mesh refinement and mesh quality control Mesh visualization Special purpose meshing algorithms for particular applications Theoretical or novel ideas with practical potential Technical presentations from industrial researchers.

  8. Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator

    Gallagher, Brian; Cen, Liyi; Hannan, Edward L

    2005-01-01

    Objective: Evaluate the Agency for Healthcare Research and Quality's Patient Safety Indicator that identifies patients with selected infections that result from medical care during hospital inpatient treatment...

  9. Strategies for selecting effective patient nutrition education materials.

    Clayton, Laura H

    2010-10-01

    Nutrition and diet therapy are at the center of health promotion activities and self-management of chronic diseases. To assist an individual in making informed decisions regarding his or her diet and increase adherence to dietary recommendations or treatments, healthcare professionals must select health information that is appropriate to the client's level of understanding. A systematic approach in the evaluation of patient education material, whether in print or on the World Wide Web, must focus on the information's content, literacy level, graphical displays, layout and typography, motivating principles, cultural relevance, and feasibility. Additional criteria should be evaluated when accessing Web sites and include source, site credibility, conflict of interest, disclaimer, disclosure, navigation, and interactivity information.

  10. Alcohol septal ablation: patient selection and rationality of its application

    М. Г. Каштанов

    2017-04-01

    Full Text Available The article looks at some aspects of selecting patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation (ASA procedure. Based on the world’s experience and in the context of evidence-based medicine, the current positions of ASA in complex treatment of obstructive hypertrophic cardiomyopathy are described. Received 29 September 2016. Accepted 9 January 2017.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsData collection and analysis: Kashtanov M.G. Drafting the article: Kashtanov M.G. Critical revision: Kashtanov M.G., Idov E.M., Chernyshev S.D., Kardapoltsev L.V., Berdnikov S.V.

  11. High-grade hemorrhoids requiring surgical treatment are common after laparoscopic ventral mesh rectopexy

    van Iersel, J. J.; Formijne Jonkers, H. A.; Verheijen, P. M.; Draaisma, W. A.; Consten, E. C J; Broeders, I. A M J

    2016-01-01

    Purpose: To describe patients developing grade III and IV hemorrhoids requiring surgery after laparoscopic ventral mesh rectopexy (LVMR) and to explore the relationship between developing such hemorrhoids and recurrence of rectal prolapse after LVMR. Methods: All consecutive patients receiving LVMR

  12. User Manual for the PROTEUS Mesh Tools

    Smith, Micheal A. [Argonne National Lab. (ANL), Argonne, IL (United States); Shemon, Emily R [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-09-19

    PROTEUS is built around a finite element representation of the geometry for visualization. In addition, the PROTEUS-SN solver was built to solve the even-parity transport equation on a finite element mesh provided as input. Similarly, PROTEUS-MOC and PROTEUS-NEMO were built to apply the method of characteristics on unstructured finite element meshes. Given the complexity of real world problems, experience has shown that using commercial mesh generator to create rather simple input geometries is overly complex and slow. As a consequence, significant effort has been put into place to create multiple codes that help assist in the mesh generation and manipulation. There are three input means to create a mesh in PROTEUS: UFMESH, GRID, and NEMESH. At present, the UFMESH is a simple way to generate two-dimensional Cartesian and hexagonal fuel assembly geometries. The UFmesh input allows for simple assembly mesh generation while the GRID input allows the generation of Cartesian, hexagonal, and regular triangular structured grid geometry options. The NEMESH is a way for the user to create their own mesh or convert another mesh file format into a PROTEUS input format. Given that one has an input mesh format acceptable for PROTEUS, we have constructed several tools which allow further mesh and geometry construction (i.e. mesh extrusion and merging). This report describes the various mesh tools that are provided with the PROTEUS code giving both descriptions of the input and output. In many cases the examples are provided with a regression test of the mesh tools. The most important mesh tools for any user to consider using are the MT_MeshToMesh.x and the MT_RadialLattice.x codes. The former allows the conversion between most mesh types handled by PROTEUS while the second allows the merging of multiple (assembly) meshes into a radial structured grid. Note that the mesh generation process is recursive in nature and that each input specific for a given mesh tool (such as .axial

  13. Vasectomy as a reversible form of contraception for select patients.

    Samplaski, Mary K; Daniel, Ariande; Jarvi, Keith

    2014-04-01

    To provide an effective form of birth control, men may choose a reversible or permanent form of contraception. Vasectomy is presently offered as a permanent option for male contraception. We have had patients who were interested in vasectomy and reversal as a temporary birth control option. The purpose of this paper is to determine if vasectomy should be offered for selected couples as a temporary form of contraception and under which circumstances. A literature review was conducted to determine the available reversible contraceptive options, risks, failure rates and contraindications to each, and the risks and success rates of vasectomy and vasectomy reversal. Reversible contraceptives include hormonally based methods for women, non-hormonal anatomic barrier devices and spermatocidal agents. Hormone based therapies may be contraindicated in women with cardiovascular disease, hypertension, and some cancers. Non-hormonal contraceptives are generally less effective and may be unacceptable for some couples due to higher failure rates, difficulty of use and lack of acceptance. Both vasectomy and vasectomy reversal are low risk procedures. Reversal may be performed with a high degree of success, particularly with a short obstructive interval (97% patency if performed form of sterilization for most couples, there are select couples, unable or unwilling to use other forms of birth control, who would benefit from an informed discussion about using a vasectomy as a reversible form of contraception.

  14. Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure

    Argirović Rajka

    2011-01-01

    Full Text Available Background/Aim. Prolapse of genital organs with or without urinary stress incontinention is the most often health problem in the elderly female population tending to increase with ageing. The aim of this study was to assess the perioperative complications and short-term outcomes of prolaps repair using transvaginal polypropylene mesh (Prolift system, Gynecare, Ethicon, USA. Methods. A retrospective study was conducted evaluating 96 women from September 2006 to January 2010 who undewent vaginal repair with implatation of a soft mesh manufactured by Gynecare, Ethicon, USA. Results. All the patients had a stage 3 or stage 4 prolapse according to the POP-Q system of ICS. Total mesh was used in 12 (13% patients isolated anterior mesh in 52 (54% patients and isolated posterior mesh in 32 (33% patients. We reported one intra-operative bladder injury and no other serious complications. At 3 months, all 96 patients were available for follow-up. Vaginal erosion occured in 9 (9.3% patients, shrinkage of mesh in 6 (6.2% patients and de novo urinary incontinence in 5 (5.2% patients. Failure rate was 6.25% (recurrent prolapse stage 3 or 4 even asymptomatic. Conclusion. Our study suggests that transvaginal polypropylene mesh applied with a tensionfree technique is a safe and effective method with low intraoperative complications and low morbidity rates. However, some complications are serious and require highly specialised management.

  15. [Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure].

    Argirović, Rajka; Berisavac, Milica; Likić-Ladević, Ivana; Kadija, Sasa; Bosković, Vladimir; Zizić, Vojislav

    2011-07-01

    Prolapse of genital organs with or without urinary stress incontinention is the most often health problem in the elderly female population tending to increase with ageing. The aim of this study was to assess the perioperative complications and short-term outcomes of prolaps repair using transvaginal polypropylene mesh (Prolift system, Gynecare, Ethicon, USA). A retrospective study was conducted evaluating 96 women from September 2006 to January 2010 who underwent vaginal repair with implatation of a soft mesh manufactured by Gynecare, Ethicon, USA. All the patients had a stage 3 or stage 4 prolapse according to the POP-Q system of ICS. Total mesh was used in 12 (13%) patients isolated anterior mesh in 52 (54%) patients and isolated posterior mesh in 32 (33%) patients. We reported one intra-operative bladder injury and no other serious complications. At 3 months, all 96 patients were available for follow-up. Vaginal erosion occured in 9 (9.3%) patients, shrinkage of mesh in 6 (6.2%) patients and de novo urinary incontinence in 5 (5.2%) patients. Failure rate was 6.25% (recurrent prolapse stage 3 or 4 even asymptomatic). Our study suggests that transvaginal polypropylene mesh applied with a tension-free technique is a safe and effective method with low intraoperative complications and low morbidity rates. However, some complications are serious and require highly specialised management.

  16. Split thickness skin graft meshing ratio indications and common practices.

    Pripotnev, Stahs; Papp, Anthony

    2017-12-01

    Split thickness skin grafting is a commonly used technique in burn surgery for resurfacing wounds that are unlikely to heal without scarring. Meshing and expanding skin grafts allow for reconstruction of larger wounds with smaller donor sites. A retrospective chart review was performed of 210 patients with burns equal to or greater than 20% total body surface area admitted to Vancouver General Hospital between 1998 and 2014. Charts were reviewed to collect data on patient and burn demographics. A survey was sent to Canadian plastic surgeons registered with the CSPS to collect data on common practices in burn surgery nationwide. The patients that received 3:1 or higher meshed grafts were all flame burns, had a significantly higher average TBSA (51.89%±14.87 vs 29.13%±9.48, p=0.001), and a significantly higher full thickness burn TBSA (25.76%±21.97 vs 6.20%±9.04, p=0.001). We found no significant differences in gender, age, or burn location between the less than 2:1 and 3:1 or greater meshing ratio groups. The survey of plastic surgeons performing burn surgery in Canada revealed that 60% of responders had experience with skin grafts using meshing ratios of 3:1 or higher. Of these surgeons, 100% felt that burn size and 36% felt that burn location would influence their decision to use a 3:1 or higher meshing ratio. A larger burn size is the major influencing factor for the use of higher skin graft meshing ratios by Canadian burn surgeons. Furthermore, burn location determines the choice of donor and recipient sites in these cases. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  17. Selected antibacterial factors in the saliva of diabetic patients.

    Malicka, Barbara; Kaczmarek, Urszula; Skośkiewicz-Malinowska, Katarzyna

    2015-03-01

    Diabetes mellitus leads to many systemic complications, including changes in the morphology, function of the salivary glands, and the composition of saliva. The study comprised a randomly selected 156 adults, of both genders, aged from 21 to 79, out of which patients with diabetes type 1 and 2, and healthy subjects forming two control age- and gender matched to the ill subjects. In unstimulated mixed saliva, total protein, peroxidase, myeloperoxidase and immunoglobulin A were measured as well as salivary flow rate. The periodontal condition was assessed with the use of GI, mSBI and PSR index. The obtained data were analysed with the use of U Mann-Whitney's test, Spearman's rang correlation and Chi-square test at a significant level of p diabetics in comparison to healthy age and gender matched control group had a lower salivary flow rate (p diabetics in comparison to control subjects had a higher level of total protein concentration (p diabetes type 1 and 2 can cause abnormalities in salivary glands function resulting in the diminishing of salivary flow rate and the increase in total protein content. Higher levels of myeloperoxidase and IgA in the saliva can be linked to worse periodontal condition in the diabetic patients. Copyright © 2014. Published by Elsevier Ltd.

  18. Voltammetry at micro-mesh electrodes

    Wadhawan Jay D.

    2003-01-01

    Full Text Available The voltammetry at three micro-mesh electrodes is explored. It is found that at sufficiently short experimental durations, the micro-mesh working electrode first behaves as an ensemble of microband electrodes, then follows the behaviour anticipated for an array of diffusion-independent micro-ring electrodes of the same perimeter as individual grid-squares within the mesh. During prolonged electrolysis, the micro-mesh electrode follows that behaviour anticipated theoretically for a cubically-packed partially-blocked electrode. Application of the micro-mesh electrode for the electrochemical determination of carbon dioxide in DMSO electrolyte solutions is further illustrated.

  19. Bevacizumab in the treatment of NSCLC: patient selection and perspectives

    Russo AE

    2017-12-01

    well tolerated even in those patients subpopulations excluded from pivotal trials. This review outlines the current state-of-the-art on bev use in advanced NSCLC. It also describes patient selection and future perspectives on this antiangiogenic agent. Keywords: bevacizumab, nonsquamous NSCLC, eligibility, safety, subpopulations 

  20. 22nd International Meshing Roundtable

    Staten, Matthew

    2014-01-01

    This volume contains the articles presented at the 22nd International Meshing Roundtable (IMR) organized, in part, by Sandia National Laboratories and was held on Oct 13-16, 2013 in Orlando, Florida, USA.  The first IMR was held in 1992, and the conference series has been held annually since.  Each year the IMR brings together researchers, developers, and application experts in a variety of disciplines, from all over the world, to present and discuss ideas on mesh generation and related topics.  The technical papers in this volume present theoretical and novel ideas and algorithms with practical potential, as well as technical applications in science and engineering, geometric modeling, computer graphics and visualization.

  1. 21st International Meshing Roundtable

    Weill, Jean-Christophe

    2013-01-01

    This volume contains the articles presented at the 21st International Meshing Roundtable (IMR) organized, in part, by Sandia National Laboratories and was held on October 7–10, 2012 in San Jose, CA, USA. The first IMR was held in 1992, and the conference series has been held annually since. Each year the IMR brings together researchers, developers, and application experts in a variety of disciplines, from all over the world, to present and discuss ideas on mesh generation and related topics. The technical papers in this volume present theoretical and novel ideas and algorithms with practical potential, as well as technical applications in science and engineering, geometric modeling, computer graphics, and visualization.

  2. Hybrid NOTES transvaginal intraperitoneal onlay mesh in abdominal wall hernias: an alternative to traditional laparoscopic procedures.

    Descloux, Alexandre; Pohle, Sebastian; Nocito, Antonio; Keerl, Andreas

    2015-12-01

    Abdominal wall hernias are increasingly treated by laparoscopic placement of an intraperitoneal onlay mesh (IPOM). We present an alternative technique for women: the laparoscopic-assisted transvaginal IPOM. Before surgery, all patients underwent a gynecological examination. The patients agreed to IPOM repair via a transvaginal approach, and written informed consent for surgery was obtained. Pneumoperitoneum was established with a Veress needle at the umbilicus. This access was subsequently dilated to 5 mm (VersaStep), and a 5-mm laparoscope was inserted. Under laparoscopic view, the transvaginal trocars (12-mm VersaStep and 5-mm flexible accesses) were safely inserted after lifting the uterus with a uterus manipulator. After preparation of the falciform ligament, the ligamentum teres and the preperitoneal fat, a lightweight composite mesh was introduced through the transvaginal access and fixed with absorbable tacks using the double-crown technique. From September 2011 to December 2012, we performed six laparoscopic-assisted transvaginal IPOM procedures (one epigastric, three umbilical, two combined epigastric and umbilical hernias; all were primary hernias). In the initial phase, only patients with small or medium primary abdominal wall hernia were selected (max. 3 cm diameter). Median hospital stay was 3 days (range 2-6 days). One minor complication occurred perioperatively (second-degree skin burn to the labia majora). At 1-year follow-up, we identified one recurrence in a high-risk patient with a body mass index higher than 35 kg/m(2). No infection and no mortality were observed. Although no final conclusion can be made regarding the presumed non-inferiority of this technique in terms of recurrence and mesh infection compared with traditional laparoscopic IPOM, laparoscopic-assisted transvaginal IPOM is a feasible alternative to treat abdominal wall hernias.

  3. Adaptive Mesh Refinement in CTH

    Crawford, David

    1999-01-01

    This paper reports progress on implementing a new capability of adaptive mesh refinement into the Eulerian multimaterial shock- physics code CTH. The adaptivity is block-based with refinement and unrefinement occurring in an isotropic 2:1 manner. The code is designed to run on serial, multiprocessor and massive parallel platforms. An approximate factor of three in memory and performance improvements over comparable resolution non-adaptive calculations has-been demonstrated for a number of problems

  4. Long-term anisotropic mechanical response of surgical meshes used to repair abdominal wall defects.

    Hernández-Gascón, B; Peña, E; Pascual, G; Rodríguez, M; Bellón, J M; Calvo, B

    2012-01-01

    Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. 42 CFR 482.90 - Condition of participation: Patient and living donor selection.

    2010-10-01

    ... selected to receive a transplant, the center must document in the patient's medical record the patient... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Patient and living... Condition of participation: Patient and living donor selection. The transplant center must use written...

  6. Laser additive manufacturing of 3D meshes for optical applications.

    Essa, Khamis; Sabouri, Aydin; Butt, Haider; Basuny, Fawzia Hamed; Ghazy, Mootaz; El-Sayed, Mahmoud Ahmed

    2018-01-01

    Selective laser melting (SLM) is a widely used additive manufacturing process that can be used for printing of intricate three dimensional (3D) metallic structures. Here we demonstrate the fabrication of titanium alloy Ti-6Al-4V alloy based 3D meshes with nodally-connected diamond like unit cells, with lattice spacing varying from 400 to 1000 microns. A Concept Laser M2 system equipped with laser that has a wavelength of 1075 nm, a constant beam spot size of 50μm and maximum power of 400W was used to manufacture the 3D meshes. These meshes act as optical shutters / directional transmitters and display interesting optical properties. A detailed optical characterisation was carried out and it was found that these structures can be optimised to act as scalable rotational shutters with high efficiencies and as angle selective transmission screens for protection against unwanted and dangerous radiations. The efficiency of fabricated lattice structures can be increased by enlarging the meshing size.

  7. Laser additive manufacturing of 3D meshes for optical applications.

    Khamis Essa

    Full Text Available Selective laser melting (SLM is a widely used additive manufacturing process that can be used for printing of intricate three dimensional (3D metallic structures. Here we demonstrate the fabrication of titanium alloy Ti-6Al-4V alloy based 3D meshes with nodally-connected diamond like unit cells, with lattice spacing varying from 400 to 1000 microns. A Concept Laser M2 system equipped with laser that has a wavelength of 1075 nm, a constant beam spot size of 50μm and maximum power of 400W was used to manufacture the 3D meshes. These meshes act as optical shutters / directional transmitters and display interesting optical properties. A detailed optical characterisation was carried out and it was found that these structures can be optimised to act as scalable rotational shutters with high efficiencies and as angle selective transmission screens for protection against unwanted and dangerous radiations. The efficiency of fabricated lattice structures can be increased by enlarging the meshing size.

  8. Use of biologic mesh at ostomy takedown to prevent incisional hernia: A case series

    Sepehr Lalezari

    Full Text Available Introduction: Incisional hernias are a relatively common occurrence after ostomy takedown with a incidence of 30–35%. The use of biologic mesh offers a means to bolster the stoma incision site with a lower risk of infection than synthetic mesh. Methods: This study represents a retrospective chart review of six patients who underwent stoma takedown and had biologic mesh placed in the retrorectus position during repair from March 2015 until March 2016. Results: There has been a zero-rate of hernia occurrence for the six patients who underwent stoma takedown. No incisional hernias were noted on physical exam with follow up ranging from 11 to 25 months. Conclusion: We conclude that placement of biologic mesh is a safe and effective way of preventing incisional hernias at stoma sites. Keywords: Biologic mesh, Ostomy takedown, Stoma reversal, Incisional hernia, Parastomal hernia, Hernia prophylaxis

  9. Prevention of parastomal hernia with a preperitoneal polypropelene mesh.

    Valdés-Hernández, Javier; Díaz Milanés, Juan Antonio; Capitán Morales, Luis Cristóbal; Del Río la Fuente, Francisco Javier; Torres Arcos, Cristina; Cañete Gómez, Jesús; Oliva Mompeán, Fernando; Padillo Ruiz, Javier

    2015-01-01

    To show our results with the use of a polypropylene mesh at the stoma site, as prophylaxis of parastomal hernias in patients with rectal cancer when a terminal colostomy is performed. From January 2010 until March 2014, 45 consecutive patients with rectal cancer, underwent surgical treatment with the need of a terminal colostomy. A prophylactic mesh was placed in a sublay position at the stoma site in all cases. We analyze Demographics, technical issues and effectiveness of the procedure, as well as subsequent complications. A prophylactic mesh was placed in 45 patients, 35 male and 10 females, mean age of 66.2 (47-88) and Body Mass Index 29.19 (20.4-40.6). A total of 7 middle rectal carcinoma, 36 low rectal carcinoma, one rectal melanoma and one squamous cell anal carcinoma were electively treated with identical protocol. Abdominoperineal resection was performed in 38 patients, and low anterior resection with terminal colostomy in 7. An open approach was elected in 39 patients and laparoscopy in 6, with 2 conversions to open surgery. Medium follow up was 22 months (2.1-53). Overall, 3 parastomal hernias (6.66%) were found, one of which was a radiological finding with no clinical significance. No complications related to the mesh or the colostomy were found. The use of a prophylactic polypropylene mesh placed in a sublay position at the stoma site is a safe and feasible technique. It lowers the incidence of parastomal hernias with no increased morbidity. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. A single centre comparative study of laparoscopic mesh rectopexy versus suture rectopexy

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Aim: The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy. Materials and Methods: In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. Results: Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7 days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1% patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3% patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery. Conclusion: There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.

  11. Prevention of Incisional Hernias with Biological MeshA Systematic Review of the Literature

    FILIP ETIENNE MUYSOMS

    2016-09-01

    Full Text Available Background: Prophylactic mesh augmented reinforcement during closure of abdominal wall incisions has been proposed in patients with increased risk for development of incisional hernias (IH. As part of the BioMesh consensus project, a systematic literature review has been performed to detect those studies where MAR was performed with a non-permanent absorbable mesh (biological or biosynthetic. Methods: A computerized search was performed within 12 databases (Embase, Medline, Web-of-Science, Scopus, Cochrane, CINAHL, Pubmed publisher, Lilacs, Scielo, ScienceDirect, ProQuest, Google scholar with appropriate search terms. Qualitative evaluation was performed using the MINORS score for cohort studies and the Jadad score for RCTs. Results: For midline laparotomy incisions and stoma reversal wounds, 2 RCTs, 2 case control studies and 2 case series were identified. The studies were very heterogeneous in terms of mesh configuration (cross linked versus non cross linked, mesh position (intraperitoneal versus retromuscular versus onlay, surgical indication (gastric bypass versus aortic aneurysm, outcome results (effective versus non effective. After qualitative assessment we have to conclude that the level of evidence on the efficacy and safety of biological meshes for prevention of incisional hernias is very low. No comparative studies were found comparing biological mesh with synthetic non-absorbable meshes for the prevention of incisional hernias. Conclusion: There is no evidence supporting the use of non-permanent absorbable mesh (biological or biosynthetic for prevention of incisional hernias when closing a laparotomy in high-risk patients or in stoma reversal wounds. There is no evidence that a non-permanent absorbable mesh should be preferred to synthetic non-absorbable mesh both in clean or clean-contaminated surgery.

  12. Outcomes of trocar-guided Gynemesh PS™ versus single-incision trocarless Polyform™ transvaginal mesh procedures.

    Larouche, Maryse; Merovitz, Lisa; Correa, José A; Walter, Jens-Erik

    2015-01-01

    The aim of the study was to compare rates of success, mesh exposure, and surgical re-intervention after trocar-guided Gynemesh PS™ and trocarless Polyform™ transvaginal mesh procedures. We conducted a retrospective cohort study of all transvaginal mesh procedures performed at our centers between January 2008 and May 2012. Multiple logistic regression models were used to explore the binary outcomes of objective and subjective success rates, as well as mesh exposure and re-intervention rates, between the two procedures after adjustment for patient's age, parity, body mass index, smoking status, previous hysterectomy, previous prolapse surgery, and follow-up time. We included 103 transvaginal mesh procedures (47 trocar-guided Gynemesh PS™ and 56 trocarless Polyform™). In both groups, Pelvic Organ Prolapse Quantification (POP-Q) scores were significantly improved after the procedure. Median follow-up was 340 days and interquartile range (IQR) 152-644. Objective success rates were 55.3 % (26/47) in the trocar group and 60.7 % (34/56) in the trocarless group (p = 0.9), whereas subjective success was 83.0 % (39/47) and 94.6 % (53/56), respectively (p = 0.1). The adjusted odds of developing mesh exposure were significantly less after trocarless transvaginal mesh procedures compared to trocar-guided ones [odds ratio (OR) 0.16, 95 % confidence interval (CI) 0.03-0.97]. Surgical re-interventions, aimed mostly at treating recurrent prolapse, mesh exposure, and latent stress urinary incontinence, were also significantly less frequent after trocarless procedures [5 patients (8.9 %) requiring re-intervention versus 15 (31.9 %), respectively, adjusted OR 0.15, 95 % CI 0.04-0.60]. Trocar-guided Gynemesh PS™ and trocarless Polyform™ transvaginal mesh systems result in similar objective and subjective success rates. The newer Polyform™ mesh results in significantly fewer mesh exposures and surgical re-interventions.

  13. From 4D medical images (CT, MRI, and Ultrasound) to 4D structured mesh models of the left ventricular endocardium for patient-specific simulations

    Canè, Federico; Verhegghe, Benedict; De Beule, Matthieu; Bertrand, Philippe B.; Van der Geest, Rob J.; Segers, Patrick; De Santis, Gianluca

    2018-01-01

    With cardiovascular disease (CVD) remaining the primary cause of death worldwide, early detection of CVDs becomes essential. The intracardiac flow is an important component of ventricular function, motion kinetics, wash-out of ventricular chambers, and ventricular energetics. Coupling between Computational Fluid Dynamics (CFD) simulations and medical images can play a fundamental role in terms of patient-specific diagnostic tools. From a technical perspective, CFD simulations with moving boun...

  14. Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

    Hemendra N Shah

    2012-01-01

    Full Text Available We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE data (FDA website were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion

  15. Mesh complications in female pelvic floor reconstructive surgery and their management: A systematic review

    Shah, Hemendra N.; Badlani, Gopal H.

    2012-01-01

    We reviewed the incidence, predisposing factors, presentation and management of complications related to the use of synthetic mesh in the management of stress urinary incontinence and pelvic organ prolapse repair. Immediate complications, such as bleeding, hematoma, injury to adjacent organs during placement of mesh and complication of voiding dysfunction are not discussed in this review, since they are primarily related to technique. A PubMed search of related articles published in English was done from April 2008 to March 2011. Key words used were urinary incontinence, mesh, complications, midurethral sling, anterior prolapse, anterior vaginal repair, pelvic organ prolapse, transvaginal mesh, vault prolapse, midurethral slings, female stress urinary incontinence, mesh erosion, vaginal mesh complications, and posterior vaginal wall prolapse. Since there were very few articles dealing with the management of mesh-related complications in the period covered in the search we extended the search from January 2005 onwards. Articles were selected to fit the scope of the topic. In addition, landmark publications and Manufacturer and User Facility Device Experience (MAUDE) data (FDA website) were included on the present topic. A total of 170 articles were identified. The use of synthetic mesh in sub-urethral sling procedures is now considered the standard for the surgical management of stress urinary incontinence. Synthetic mesh is being increasingly used in the management of pelvic organ prolapse. While the incidence of extrusion and erosion with mid-urethral sling is low, the extrusion rate in prolapse repair is somewhat higher and the use in posterior compartment remains controversial. When used through the abdominal approach the extrusion and erosion rates are lower. The management of mesh complication is an individualized approach. The choice of the technique should be based on the type of mesh complication, location of the extrusion and/or erosion, its magnitude

  16. Practical implementation of tetrahedral mesh reconstruction in emission tomography

    Boutchko, R.; Sitek, A.; Gullberg, G. T.

    2013-05-01

    This paper presents a practical implementation of image reconstruction on tetrahedral meshes optimized for emission computed tomography with parallel beam geometry. Tetrahedral mesh built on a point cloud is a convenient image representation method, intrinsically three-dimensional and with a multi-level resolution property. Image intensities are defined at the mesh nodes and linearly interpolated inside each tetrahedron. For the given mesh geometry, the intensities can be computed directly from tomographic projections using iterative reconstruction algorithms with a system matrix calculated using an exact analytical formula. The mesh geometry is optimized for a specific patient using a two stage process. First, a noisy image is reconstructed on a finely-spaced uniform cloud. Then, the geometry of the representation is adaptively transformed through boundary-preserving node motion and elimination. Nodes are removed in constant intensity regions, merged along the boundaries, and moved in the direction of the mean local intensity gradient in order to provide higher node density in the boundary regions. Attenuation correction and detector geometric response are included in the system matrix. Once the mesh geometry is optimized, it is used to generate the final system matrix for ML-EM reconstruction of node intensities and for visualization of the reconstructed images. In dynamic PET or SPECT imaging, the system matrix generation procedure is performed using a quasi-static sinogram, generated by summing projection data from multiple time frames. This system matrix is then used to reconstruct the individual time frame projections. Performance of the new method is evaluated by reconstructing simulated projections of the NCAT phantom and the method is then applied to dynamic SPECT phantom and patient studies and to a dynamic microPET rat study. Tetrahedral mesh-based images are compared to the standard voxel-based reconstruction for both high and low signal-to-noise ratio

  17. Practical implementation of tetrahedral mesh reconstruction in emission tomography

    Boutchko, R; Gullberg, G T; Sitek, A

    2013-01-01

    This paper presents a practical implementation of image reconstruction on tetrahedral meshes optimized for emission computed tomography with parallel beam geometry. Tetrahedral mesh built on a point cloud is a convenient image representation method, intrinsically three-dimensional and with a multi-level resolution property. Image intensities are defined at the mesh nodes and linearly interpolated inside each tetrahedron. For the given mesh geometry, the intensities can be computed directly from tomographic projections using iterative reconstruction algorithms with a system matrix calculated using an exact analytical formula. The mesh geometry is optimized for a specific patient using a two stage process. First, a noisy image is reconstructed on a finely-spaced uniform cloud. Then, the geometry of the representation is adaptively transformed through boundary-preserving node motion and elimination. Nodes are removed in constant intensity regions, merged along the boundaries, and moved in the direction of the mean local intensity gradient in order to provide higher node density in the boundary regions. Attenuation correction and detector geometric response are included in the system matrix. Once the mesh geometry is optimized, it is used to generate the final system matrix for ML-EM reconstruction of node intensities and for visualization of the reconstructed images. In dynamic PET or SPECT imaging, the system matrix generation procedure is performed using a quasi-static sinogram, generated by summing projection data from multiple time frames. This system matrix is then used to reconstruct the individual time frame projections. Performance of the new method is evaluated by reconstructing simulated projections of the NCAT phantom and the method is then applied to dynamic SPECT phantom and patient studies and to a dynamic microPET rat study. Tetrahedral mesh-based images are compared to the standard voxel-based reconstruction for both high and low signal-to-noise ratio

  18. Laparoscopy-like operative vaginoscopy: a new approach to manage mesh erosions.

    Billone, Valentina; Amorim-Costa, Célia; Campos, Sara; Rabischong, Benoĭt; Bourdel, Nicolas; Canis, Michel; Botchorishvili, Revaz

    2015-01-01

    Mesh erosion through the vagina is the most common complication of synthetic mesh used for pelvic organ prolapse repair. However, conventional transvaginal mesh excision has many technical limitations. We aimed at creating and describing a new surgical technique for transvaginal removal of exposed mesh that would enable better exposition and access, thus facilitating optimal treatment. A step-by-step video showing the technique. A university tertiary care hospital. Five patients previously submitted to pelvic organ prolapse repair using synthetic mesh, presenting mesh erosion through the vagina. Mesh excision using a laparoscopy-like operative vaginoscopy in which standard laparoscopic instruments are used through a single-incision laparoscopic surgery port device placed in the vagina. In all cases, a very good exposure of the mesh was achieved, a minimal tissue traction was required, and the procedures were performed in a very ergonomic way. All the patients were discharged on the same day of the surgery and had a painless postoperative course. So far, there have been no cases of relapse. This seems to be a simple, cheap, and valuable minimally invasive technique with many advantages in comparison with the conventional approach. More cases and time are necessary to access its long-term efficacy. It may possibly be used for the management of other conditions. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  19. Laparoscopic appendicectomy for suspected mesh-induced appendicitis after laparoscopic transabdominal preperitoneal polypropylene mesh inguinal herniorraphy

    Jennings Jason

    2010-01-01

    Full Text Available Laparoscopic inguinal herniorraphy via a transabdominal preperitoneal (TAPP approach using Polypropylene Mesh (Mesh and staples is an accepted technique. Mesh induces a localised inflammatory response that may extend to, and involve, adjacent abdominal and pelvic viscera such as the appendix. We present an interesting case of suspected Mesh-induced appendicitis treated successfully with laparoscopic appendicectomy, without Mesh removal, in an elderly gentleman who presented with symptoms and signs of acute appendicitis 18 months after laparoscopic inguinal hernia repair. Possible mechanisms for Mesh-induced appendicitis are briefly discussed.

  20. Mesh Nanoelectronics: Seamless Integration of Electronics with Tissues.

    Dai, Xiaochuan; Hong, Guosong; Gao, Teng; Lieber, Charles M

    2018-02-20

    nanoelectronics into rodent brains. First, we describe the design of ultraflexible mesh nanoelectronics with size features and mechanical properties similar to brain tissue and a novel syringe-injection methodology that allows the mesh nanoelectronics to be precisely delivered to targeted brain regions in a minimally invasive manner. Next, we discuss time-dependent histology studies showing seamless and stable integration of mesh nanoelectronics within brain tissue on at least one year scales without evidence of chronic immune response or glial scarring characteristic of conventional implants. Third, armed with facile input/output interfaces, we describe multiplexed single-unit recordings that demonstrate stable tracking of the same individual neurons and local neural circuits for at least 8 months, long-term monitoring and stimulation of the same groups of neurons, and following changes in individual neuron activity during brain aging. Moving forward, we foresee substantial opportunities for (1) continued development of mesh nanoelectronics through, for example, broadening nanodevice signal detection modalities and taking advantage of tissue-like properties for selective cell targeting and (2) exploiting the unique capabilities of mesh nanoelectronics for tackling critical scientific and medical challenges such as understanding and potentially ameliorating cell and circuit level changes associated with natural and pathological aging, as well as using mesh nanoelectronics as active tissue scaffolds for regenerative medicine and as neuroprosthetics for monitoring and treating neurological diseases.

  1. Comparative efficacy of Prolene and Prolene-Vicryl composite mesh for experimental ventral hernia repair in dogs.

    Anjum, H; Bokhari, S G; Khan, M A; Awais, M; Mughal, Z U; Shahzad, H K; Ijaz, F; Siddiqui, M I; Khan, I U; Chaudhry, A S; Akhtar, R; Aslam, S; Akbar, H; Asif, M; Maan, M K; Khan, M A; Noor, A; Khan, W A; Ullah, A; Hayat, M A

    2016-01-01

    In this study, efficacy of two hernia mesh implants viz. conventional Prolene and a novel Prolene-Vicryl composite mesh was assessed for experimental ventral hernia repair in dogs. Twelve healthy mongrel dogs were selected and randomly divided into three groups, A, Band C (n=4). In all groups, an experimental laparotomy was performed; thereafter, the posterior rectus sheath and peritoneum were sutured together, while, a 5 × 5 cm defect was created in the rectus muscle belly and anterior rectus sheath. For sublay hernioplasty, the hernia mesh (Prolene: group A; Prolene-Vicryl composite mesh: group B), was implanted over the posterior rectus sheath. In group C (control), mesh was not implanted; instead the laparotomy incision was closed after a herniorrhaphy. Post-operative pain, mesh shrinkage and adhesion formation were assessed as short term complications. Post-operatively, pain at surgical site was significantly less (P<0.001) in group B (composite mesh); mesh shrinkage was also significantly less in group B (21.42%, P<0.05) than in group A (Prolene mesh shrinkage: 58.18%). Group B (composite mesh) also depicted less than 25% adhesions (Mean ± SE: 0.75 ± 0.50 scores, P≤0.013) when assessed on the basis of a Quantitative Modified Diamond scale; a Qualitative Adhesion Tenacity scale also depicted either no adhesions (n=2), or, only flimsy adhesions (n=2) in group B (composite mesh), in contrast to group A (Prolene), which manifested greater adhesion formation and presence of dense adhesions requiring blunt dissection. Conclusively, the Prolene-Vicryl composite mesh proved superior to the Prolene mesh regarding lesser mesh contraction, fewer adhesions and no short-term follow-up complications.

  2. Prevention of a parastomal hernia by biological mesh reinforcement

    René H Fortelny

    2015-10-01

    Full Text Available Introduction: In the field of hernia prevention the prophylactic mesh-reinforcement of stoma-sites is one of the most controversially discussed issues. The incidence of parastomal hernias in the literature reported to be up to 48.1% after end colostomy and up to 30.8 % after of loop colostomy respectively, but still remains uncertain due to diagnostic variety of clinical or radiological methods, heterogeneous patient groups and variable follow-up intervals respectively. Anyway, the published data regarding the use of synthetic or bio-prostethic meshes in the prevention of parastomal hernia at the primary operation are very scarce. Methods: A literature search of the Medline database in terms of biological prophylactic mesh implantation in stoma creation identified 6 systematic reviews, 2 randomized controlled trials (RCT, 2 case controlled studies and 1 technical report. Results: In a systematic review focusing on the prevention of parastomal hernia including only RCTs encompassing one RCT using bio-prosthetic mesh the incidence of herniation was 12.5 % compared to 53% in the control group (p<0.0001. In 1 RCT and 2 case control studies respectively, there was a significant smaller incidence of parastomal herniation as well as a similar complication rate compared to the control group respectively. Only in 1 RCT no significant difference regarding the incidence of parastomal hernia was reported with comparable complication rates. Conclusion: Thus so far 2 RCT and 2 case control studies are published with prophylactic bio prosthetic reinforcement in stoma sites. The majority revealed significant better results in terms of parastomal herniation and without any mesh related complications in comparison to the non mesh group. Further multicenter RCT are required to achieve a sufficient level of recommendation.

  3. The effects of vaginal prolapse surgery using synthetic mesh on vaginal wall sensibility, vaginal vasocongestion, and sexual function: a prospective single-center study

    Weber, Maaike A.; Lakeman, Marielle M. E.; Laan, Ellen; Roovers, Jan-Paul W. R.

    2014-01-01

    Vaginal mesh surgery in patients with pelvic organ prolapse (POP) has been associated with sexual dysfunction. Implantation of synthetic mesh might damage vaginal innervation and vascularization, which could cause sexual dysfunction. We aim to evaluate the effects of vaginal mesh surgery on vaginal

  4. Evaluation of the generality and accuracy of a new mesh morphing procedure for the human femur.

    Grassi, Lorenzo; Hraiech, Najah; Schileo, Enrico; Ansaloni, Mauro; Rochette, Michel; Viceconti, Marco

    2011-01-01

    Various papers described mesh morphing techniques for computational biomechanics, but none of them provided a quantitative assessment of generality, robustness, automation, and accuracy in predicting strains. This study aims to quantitatively evaluate the performance of a novel mesh-morphing algorithm. A mesh-morphing algorithm based on radial-basis functions and on manual selection of corresponding landmarks on template and target was developed. The periosteal geometries of 100 femurs were derived from a computed tomography scan database and used to test the algorithm generality in producing finite element (FE) morphed meshes. A published benchmark, consisting of eight femurs for which in vitro strain measurements and standard FE model strain prediction accuracy were available, was used to assess the accuracy of morphed FE models in predicting strains. Relevant parameters were identified to test the algorithm robustness to operative conditions. Time and effort needed were evaluated to define the algorithm degree of automation. Morphing was successful for 95% of the specimens, with mesh quality indicators comparable to those of standard FE meshes. Accuracy of the morphed meshes in predicting strains was good (R(2)>0.9, RMSE%0.05) and partially to the number of landmark used. Producing a morphed mesh starting from the triangularized geometry of the specimen requires on average 10 min. The proposed method is general, robust, automated, and accurate enough to be used in bone FE modelling from diagnostic data, and prospectively in applications such as statistical shape modelling. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

  5. Sierra toolkit computational mesh conceptual model

    Baur, David G.; Edwards, Harold Carter; Cochran, William K.; Williams, Alan B.; Sjaardema, Gregory D.

    2010-01-01

    The Sierra Toolkit computational mesh is a software library intended to support massively parallel multi-physics computations on dynamically changing unstructured meshes. This domain of intended use is inherently complex due to distributed memory parallelism, parallel scalability, heterogeneity of physics, heterogeneous discretization of an unstructured mesh, and runtime adaptation of the mesh. Management of this inherent complexity begins with a conceptual analysis and modeling of this domain of intended use; i.e., development of a domain model. The Sierra Toolkit computational mesh software library is designed and implemented based upon this domain model. Software developers using, maintaining, or extending the Sierra Toolkit computational mesh library must be familiar with the concepts/domain model presented in this report.

  6. [Current state of transvaginal meshes by resolution of pelvic organ prolapse].

    Jírová, J; Pán, M

    Treatment of pelvic organs prolapse with transvaginal mesh kits represents nowadays a widespread surgical method, which partially replaced classic operations due to high success rate and low count of recurrences. Just like any other surgical method, the placement of transvaginal mesh is linked with occurrence of complications. In this article we attempt to review the more and less known facts about trans-vaginal meshes, their efficacy, count of recurrence and the spectrum of complications and we try to compare this technique with traditional surgical methods used to treat pelvic organs prolapse (without graft materials). Review. Department of Obstetrics and Gynecology, Regional hospital Mladá Boleslav a.s., Mladá Boleslav. Overview of the results of recent studies published in the Czech and English language in recent years. Pelvic organ prolapse repair with vaginal mesh has generally lower count of relapse especially in patients with wide genital hiatal area and with major levator ani avulsion. The spectrum of complications differs from classical techniques because of the presence of synthetic nonabsorbable material. Some of the specific complications we did not encounter during classical operations include vaginal mesh erosion, infection of mesh associated with chronic pelvic pain, dyspareunia, protrusion of the mesh into the closest organs or the rejection and progressive extrusion of the mesh. Primary enthusiasm has now been replaced with worries of major complications. Future tasks should therefore be aimed at minimizing the rate of complications associated with transvaginal meshes. Except using well-known and safe materials and providing specialized training of physicians for each mesh implantation technique, other precautions outlined in this article should help, such as a closer specification of indication for the application of transvaginal mesh.

  7. Tension free monofilament macropore polypropylene mesh (Gynemesh PS in female genital prolapse repair

    Vicente Sola

    2006-08-01

    Full Text Available OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure.

  8. Fibrin sealant for mesh fixation in laparoscopic groin hernia repair does not increase long-term recurrence

    Fenger, Andreas Qwist; Helvind, Neel Maria; Pommergaard, Hans-Christian

    2016-01-01

    BACKGROUND: Methods of groin hernia repair include laparoscopic techniques using tissue-penetrating mesh fixation or non-penetrating fixation. Concerns regarding hernia repair include postoperative chronic pain, sexual dysfunction, and recurrence. Earlier estimations of recurrence rates have......) laparoscopic groin hernia repair using either fibrin sealant or tacks for mesh fixation. METHODS: This study used data from the Danish Hernia Database to create the following cohort: All patients operated laparoscopically for primary groin hernia with a TAPP procedure using fibrin sealant for mesh fixation...... difference in long-term reoperation rates and clinical recurrences in patients undergoing TAPP repair with meshes fixated with fibrin sealant compared with tacks....

  9. Unstructured mesh adaptivity for urban flooding modelling

    Hu, R.; Fang, F.; Salinas, P.; Pain, C. C.

    2018-05-01

    Over the past few decades, urban floods have been gaining more attention due to their increase in frequency. To provide reliable flooding predictions in urban areas, various numerical models have been developed to perform high-resolution flood simulations. However, the use of high-resolution meshes across the whole computational domain causes a high computational burden. In this paper, a 2D control-volume and finite-element flood model using adaptive unstructured mesh technology has been developed. This adaptive unstructured mesh technique enables meshes to be adapted optimally in time and space in response to the evolving flow features, thus providing sufficient mesh resolution where and when it is required. It has the advantage of capturing the details of local flows and wetting and drying front while reducing the computational cost. Complex topographic features are represented accurately during the flooding process. For example, the high-resolution meshes around the buildings and steep regions are placed when the flooding water reaches these regions. In this work a flooding event that happened in 2002 in Glasgow, Scotland, United Kingdom has been simulated to demonstrate the capability of the adaptive unstructured mesh flooding model. The simulations have been performed using both fixed and adaptive unstructured meshes, and then results have been compared with those published 2D and 3D results. The presented method shows that the 2D adaptive mesh model provides accurate results while having a low computational cost.

  10. Adaptive hybrid mesh refinement for multiphysics applications

    Khamayseh, Ahmed; Almeida, Valmor de

    2007-01-01

    The accuracy and convergence of computational solutions of mesh-based methods is strongly dependent on the quality of the mesh used. We have developed methods for optimizing meshes that are comprised of elements of arbitrary polygonal and polyhedral type. We present in this research the development of r-h hybrid adaptive meshing technology tailored to application areas relevant to multi-physics modeling and simulation. Solution-based adaptation methods are used to reposition mesh nodes (r-adaptation) or to refine the mesh cells (h-adaptation) to minimize solution error. The numerical methods perform either the r-adaptive mesh optimization or the h-adaptive mesh refinement method on the initial isotropic or anisotropic meshes to equidistribute weighted geometric and/or solution error function. We have successfully introduced r-h adaptivity to a least-squares method with spherical harmonics basis functions for the solution of the spherical shallow atmosphere model used in climate modeling. In addition, application of this technology also covers a wide range of disciplines in computational sciences, most notably, time-dependent multi-physics, multi-scale modeling and simulation

  11. Meshes optimized for discrete exterior calculus (DEC).

    Mousley, Sarah C. [Univ. of Illinois, Urbana-Champaign, IL (United States); Deakin, Michael [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Knupp, Patrick [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Mitchell, Scott A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-12-01

    We study the optimization of an energy function used by the meshing community to measure and improve mesh quality. This energy is non-traditional because it is dependent on both the primal triangulation and its dual Voronoi (power) diagram. The energy is a measure of the mesh's quality for usage in Discrete Exterior Calculus (DEC), a method for numerically solving PDEs. In DEC, the PDE domain is triangulated and this mesh is used to obtain discrete approximations of the continuous operators in the PDE. The energy of a mesh gives an upper bound on the error of the discrete diagonal approximation of the Hodge star operator. In practice, one begins with an initial mesh and then makes adjustments to produce a mesh of lower energy. However, we have discovered several shortcomings in directly optimizing this energy, e.g. its non-convexity, and we show that the search for an optimized mesh may lead to mesh inversion (malformed triangles). We propose a new energy function to address some of these issues.

  12. RGG: Reactor geometry (and mesh) generator

    Jain, R.; Tautges, T.

    2012-01-01

    The reactor geometry (and mesh) generator RGG takes advantage of information about repeated structures in both assembly and core lattices to simplify the creation of geometry and mesh. It is released as open source software as a part of the MeshKit mesh generation library. The methodology operates in three stages. First, assembly geometry models of various types are generated by a tool called AssyGen. Next, the assembly model or models are meshed by using MeshKit tools or the CUBIT mesh generation tool-kit, optionally based on a journal file output by AssyGen. After one or more assembly model meshes have been constructed, a tool called CoreGen uses a copy/move/merge process to arrange the model meshes into a core model. In this paper, we present the current state of tools and new features in RGG. We also discuss the parallel-enabled CoreGen, which in several cases achieves super-linear speedups since the problems fit in available RAM at higher processor counts. Several RGG applications - 1/6 VHTR model, 1/4 PWR reactor core, and a full-core model for Monju - are reported. (authors)

  13. Parallel adaptive simulations on unstructured meshes

    Shephard, M S; Jansen, K E; Sahni, O; Diachin, L A

    2007-01-01

    This paper discusses methods being developed by the ITAPS center to support the execution of parallel adaptive simulations on unstructured meshes. The paper first outlines the ITAPS approach to the development of interoperable mesh, geometry and field services to support the needs of SciDAC application in these areas. The paper then demonstrates the ability of unstructured adaptive meshing methods built on such interoperable services to effectively solve important physics problems. Attention is then focused on ITAPs' developing ability to solve adaptive unstructured mesh problems on massively parallel computers

  14. Short term post-operative morphing of sacrocolpopexy mesh measured by magnetic resonance imaging.

    Sindhwani, Nikhil; Callewaert, Geertje; Deprest, Thomas; Housmans, Susanne; Van Beckevoort, Dirk; Deprest, Jan

    2018-04-01

    Sacrocolpopexy (SC) involves suspension of the vaginal vault or cervix to the sacrum using a mesh. Following insertion, the meshes have been observed to have undergone dimensional changes. To quantify dimensional changes of meshes following implantation and characterize their morphology in-vivo. 24 patients underwent SC using PolyVinyliDeneFluoride mesh loaded with Fe 3 O 4 particles. Tailored anterior and posterior mesh flaps were sutured to the respective vaginal walls, uniting at the apex. The posterior flap continued to the sacrum and was attached there. Meshes were visualized on magnetic resonance (MR) imaging at 12 [3-12] (median [range]) months postoperatively and 3D models of the mesh were generated. Dynamic MR sequences were acquired during valsalva to record mesh mobility. The area of the vagina effectively supported by the mesh (Effective Support Area (ESA)) was calculated. The 3D models' wall thickness map was analyzed to identify the locations of mesh folding. Intraclass correlation (ICC) was calculated to test the reliability of the methods. To measure the laxity and flatness of the mesh, the curvature and the ellipticity of the sacral flap were calculated. The ESA calculation methodology had ICC = 0.97. A reduction of 75.49 [61.55-78.67] % (median [IQR]) in area, 47.64 [38.07-59.81] % in anterior flap, and of 23.95 [10.96-27.21] % in the posterior flap was measured. The mesh appeared thicker near its attachment at the sacral promontory (n = 19) and near the vaginal apex (n = 22). The laxity of the mesh was 1.13 [1.10-1.16] and 60.55 [49.76-76.25] % of the sacral flap was flat. We could not reliably measure mesh mobility (ICC = 0.16). A methodology for complete 3D characterization of SC meshes using MR images was presented. After implantation, the supported area is much lower than what is prepared prior to implantation. We propose this happened during the surgery itself. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. Surgical management of a De Garengeot’s hernia using a biologic mesh: A case report and review of literature

    Amandine Klipfel

    2017-01-01

    Conclusion: The De Garengeot hernia is an uncommon differential diagnosis for patients presenting with clinical signs of strangled femoral hernia. Although hernia repairs with a synthetic mesh in the presence of appendicitis have been reported, we describe a case of femoral hernia repair using a biologic mesh, in a patient with a De Garengot hernia.

  16. Selective angiography in fifty patients with primary hepatocellular carcinoma

    Shou-Zhong, Wang; Xing-Rong, Chen; Gong-Xian, Wang

    1983-06-01

    Selective angiography is of great importance in the diagnosis of primary hepatocellular carcinoma. It offers information on the findings, multicentricity, localisation, extension, and type of growth. This paper discusses angiography from the methodical point of view, the findings to be obtained, the types of hepatocellular carcinoma, and the diagnostic efficiency of selective angiography in the evaluation of this type of tumour.

  17. Evaluation of endoscopic laser excision of polypropylene mesh/sutures following anti-incontinence procedures.

    Davis, N F

    2012-11-01

    We reviewed our experience with and outcome of the largest series to our knowledge of patients who underwent endoscopic laser excision of eroded polypropylene mesh or sutures as a complication of previous anti-incontinence procedures.

  18. Offload zone patient selection criteria to reduce ambulance offload delay

    Laan, Corine Maartje; Vanberkel, Peter T.; Boucherie, Richardus J.; Carter, Alix J.E.

    2016-01-01

    Emergency department overcrowding is a widespread problem and often leads to ambulance offload delay. If no bed is available when a patient arrives, the patient has to wait with the ambulance crew. A recent Canadian innovation is the offload zone—an area where multiple patients can wait with a

  19. Tensile Behaviour of Welded Wire Mesh and Hexagonal Metal Mesh for Ferrocement Application

    Tanawade, A. G.; Modhera, C. D.

    2017-08-01

    Tension tests were conducted on welded mesh and hexagonal Metal mesh. Welded Mesh is available in the market in different sizes. The two types are analysed viz. Ø 2.3 mm and Ø 2.7 mm welded mesh, having opening size 31.75 mm × 31.75 mm and 25.4 mm × 25.4 mm respectively. Tensile strength test was performed on samples of welded mesh in three different orientations namely 0°, 30° and 45° degrees with the loading axis and hexagonal Metal mesh of Ø 0.7 mm, having opening 19.05 × 19.05 mm. Experimental tests were conducted on samples of these meshes. The objective of this study was to investigate the behaviour of the welded mesh and hexagonal Metal mesh. The result shows that the tension load carrying capacity of welded mesh of Ø 2.7 mm of 0° orientation is good as compared to Ø2.3 mm mesh and ductility of hexagonal Metal mesh is good in behaviour.

  20. Mesh optimization for microbial fuel cell cathodes constructed around stainless steel mesh current collectors

    Zhang, Fang; Merrill, Matthew D.; Tokash, Justin C.; Saito, Tomonori; Cheng, Shaoan; Hickner, Michael A.; Logan, Bruce E.

    2011-01-01

    that the mesh properties of these cathodes can significantly affect performance. Cathodes made from the coarsest mesh (30-mesh) achieved the highest maximum power of 1616 ± 25 mW m-2 (normalized to cathode projected surface area; 47.1 ± 0.7 W m-3 based on liquid

  1. Intravesical midurethral sling mesh erosion secondary to transvaginal mesh reconstructive surgery

    Sukanda Bin Jaili

    2015-05-01

    Conclusion: Repeated vaginal reconstructive surgery may jeopardize a primary mesh or sling, and pose a high risk of mesh erosion, which may be delayed for several years. Removal of the mesh erosion and bladder repair are feasible pervaginally with good outcome.

  2. Preperitoneal Surgery Using a Self-Adhesive Mesh for Inguinal Hernia Repair

    Mangram, Alicia; Oguntodu, Olakunle F.; Rodriguez, Francisco; Rassadi, Roozbeh; Haley, Michael; Shively, Cynthia J.; Dzandu, James K.

    2014-01-01

    Background and Objectives: Laparoscopic preperitoneal hernia repair with mesh has been reported to result in improved patient outcomes. However, there are few published data on the use of a totally extraperitoneal (TEP) approach. The purpose of this study was to present our experience and evaluate early outcomes of TEP inguinal hernia repair with self-adhesive mesh. Methods: This cohort study was a retrospective review of patients who underwent laparoscopic TEP inguinal hernial repair from Ap...

  3. Preliminary experience of titanium mesh cages for pathological fracture of middle and lower cervical vertebrae.

    Chuang, Hao-Che; Wei, Sung-Tai; Lee, Han-Chung; Chen, Chun-Chung; Lee, Wen-Yuen; Cho, Der-Yang

    2008-11-01

    The advantages and disadvantages of titanium mesh cages (TMCs) assisted by anterior cervical plates (ACPs) for interbody fusion following cervical corpectomy were investigated. Between January 2002 and September 2006, 17 patients with cervical radiculomyelopathy caused by metastasis-induced pathologic fractures were selected for anterior corpectomy. TMCs were inserted into the post-corpectomy defect and stabilized by placement of ACPs filled with Triosite. Post-operative plain X-ray films indicated maintenance of spinal stability. No ceramic, donor site or surgery-related complications were observed. True trabeculation was observed in axial and reconstructive CT scans in all surviving patients one year after surgery. Neurological recovery, pain control, and good quality of life were achieved. Short hospital stays, minimal blood loss, short operation times and brief periods of bed confinement were also observed. We conclude that a TMC assisted by an ACP is safe and effective for interbody fusion following cervical corpectomy for pathological fractures resulting from cervical vertebral metastases.

  4. Therapeutic management of stoma complications in selected patients.

    Trzciński, Radzisław; Kresińska-Kaba, Teresa; Dziki, Adam

    2013-09-01

    Stoma complications occur in 21-75% of patients, and 30% of them require redo surgery within 10 years after previous surgical treatment. Medical treatment is successful in most cases with no need for surgery. However, severe stoma complications are the real challenge for medical team and require an individual approach to each patient. The aim of the study was to report stoma patients with severe complications of both ileo- and/or colostomy and present different options of medical treatment. Between March 2005 and April 2007 we treated 8 patients with severe stoma complications at the Department of General and Colorectal Surgery, Medical University of Łódź. There were 4 patients with colostomy, 3 patients with ileostomy and one patient with both ileo- and colostomy. The mean age of patients was 56,7 years (range 30-68 years). In all patients we achieved either complete stoma-related wound healing or we observed substantial progress of wound healing with medical treatment. No patient required surgery for stoma complications. Stoma complications still occur in spite of adherence to rules of stoma care and surgical technique. Most of them can be treated conservatively. Much emphasis is put on close team work comprising doctors and nurses in the treatment of severe stoma complications.

  5. Textile properties of synthetic prolapse mesh in response to uniaxial loading

    Barone, William R.; Moalli, Pamela A.; Abramowitch, Steven D.

    2016-01-01

    , with values decreasing by as much as 87% (P mesh products that were tested were found to have porosities that approached 0% and 0 pores with diameters >1 mm. CONCLUSION In this study, it was shown that the pore size of current prolapse meshes dramatically decreases in response to mechanical loading. These findings suggest that prolapse meshes, which are more likely to experience tensile forces in vivo relative to hernia repair meshes, have pores that are unfavorable for tissue integration after surgical tensioning and/or loading in urogynecologic surgeries. Such decreases in pore geometry support the hypothesis that regional increases in the concentration of mesh leads to an enhanced local foreign body response. Although pore deformation in transvaginal meshes requires further characterization, the findings presented here provide a mechanical understanding that can be used to recognize potential areas of concern for complex mesh geometries. Understanding mesh mechanics in response to surgical and in vivo loading conditions may provide improved design criteria for mesh and a refinement of surgical techniques, ultimately leading to better patient outcomes. PMID:27001219

  6. Adaptive radial basis function mesh deformation using data reduction

    Gillebaart, T.; Blom, D. S.; van Zuijlen, A. H.; Bijl, H.

    2016-09-01

    Radial Basis Function (RBF) mesh deformation is one of the most robust mesh deformation methods available. Using the greedy (data reduction) method in combination with an explicit boundary correction, results in an efficient method as shown in literature. However, to ensure the method remains robust, two issues are addressed: 1) how to ensure that the set of control points remains an accurate representation of the geometry in time and 2) how to use/automate the explicit boundary correction, while ensuring a high mesh quality. In this paper, we propose an adaptive RBF mesh deformation method, which ensures the set of control points always represents the geometry/displacement up to a certain (user-specified) criteria, by keeping track of the boundary error throughout the simulation and re-selecting when needed. Opposed to the unit displacement and prescribed displacement selection methods, the adaptive method is more robust, user-independent and efficient, for the cases considered. Secondly, the analysis of a single high aspect ratio cell is used to formulate an equation for the correction radius needed, depending on the characteristics of the correction function used, maximum aspect ratio, minimum first cell height and boundary error. Based on the analysis two new radial basis correction functions are derived and proposed. This proposed automated procedure is verified while varying the correction function, Reynolds number (and thus first cell height and aspect ratio) and boundary error. Finally, the parallel efficiency is studied for the two adaptive methods, unit displacement and prescribed displacement for both the CPU as well as the memory formulation with a 2D oscillating and translating airfoil with oscillating flap, a 3D flexible locally deforming tube and deforming wind turbine blade. Generally, the memory formulation requires less work (due to the large amount of work required for evaluating RBF's), but the parallel efficiency reduces due to the limited

  7. Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse

    Naoko Takazawa

    2018-03-01

    Full Text Available Purpose: This study aimed to evaluate the clinical outcomes and complications of transvaginal minimal mesh repair without using commercially available kits for treatment of pelvic organ prolapse (POP. Materials and Methods: This retrospective cohort study involved 91 women who underwent surgical management of POP with originally designed small mesh between July 2014 and August 2015. This mesh is 56% smaller than the mesh widely used in Japan, and it has only two arms delivered into each right and left sacrospinous ligament. The main study outcome was the anatomic cure rate defined as recurrence of POP quantification (POP-Q stage II or more. We also assessed changes in the overactive bladder symptom score (OABSS and prolapse quality of life questionnaire (P-QOL and evaluated adverse events. Finally, we compared patient backgrounds between the patients with and without recurrence. Results: Prolapse recurred in 10 of 91 patients (11.0%, and all patients with recurrence were diagnosed as POP-Q stage II. As adverse events, only mesh erosion occurred in two (2.2% and pelvic pain in one (1.1% of the 91 patients. The OABSS and P-QOL were significantly improved by the operation. When we compared patient backgrounds between the patients with and without recurrence, body mass index was the only factor influencing affecting recurrence. Conclusions: Transvaginal minimal mesh repair resulted in successful outcomes with low mesh-related complications and anatomic recurrence at one year. Furthermore, significant improvement in QOL was offered by this procedure. Our minimal mesh technique should be considered as one treatment option for the management of POP.

  8. Short-term outcomes of the transvaginal minimal mesh procedure for pelvic organ prolapse.

    Takazawa, Naoko; Fujisaki, Akiko; Yoshimura, Yasukuni; Tsujimura, Akira; Horie, Shigeo

    2018-03-01

    This study aimed to evaluate the clinical outcomes and complications of transvaginal minimal mesh repair without using commercially available kits for treatment of pelvic organ prolapse (POP). This retrospective cohort study involved 91 women who underwent surgical management of POP with originally designed small mesh between July 2014 and August 2015. This mesh is 56% smaller than the mesh widely used in Japan, and it has only two arms delivered into each right and left sacrospinous ligament. The main study outcome was the anatomic cure rate defined as recurrence of POP quantification (POP-Q) stage II or more. We also assessed changes in the overactive bladder symptom score (OABSS) and prolapse quality of life questionnaire (P-QOL) and evaluated adverse events. Finally, we compared patient backgrounds between the patients with and without recurrence. Prolapse recurred in 10 of 91 patients (11.0%), and all patients with recurrence were diagnosed as POP-Q stage II. As adverse events, only mesh erosion occurred in two (2.2%) and pelvic pain in one (1.1%) of the 91 patients. The OABSS and P-QOL were significantly improved by the operation. When we compared patient backgrounds between the patients with and without recurrence, body mass index was the only factor influencing affecting recurrence. Transvaginal minimal mesh repair resulted in successful outcomes with low mesh-related complications and anatomic recurrence at one year. Furthermore, significant improvement in QOL was offered by this procedure. Our minimal mesh technique should be considered as one treatment option for the management of POP.

  9. Robust diamond meshes with unique wettability properties.

    Yang, Yizhou; Li, Hongdong; Cheng, Shaoheng; Zou, Guangtian; Wang, Chuanxi; Lin, Quan

    2014-03-18

    Robust diamond meshes with excellent superhydrophobic and superoleophilic properties have been fabricated. Superhydrophobicity is observed for water with varying pH from 1 to 14 with good recyclability. Reversible superhydrophobicity and hydrophilicity can be easily controlled. The diamond meshes show highly efficient water-oil separation and water pH droplet transference.

  10. 7th International Meshing Roundtable '98

    Eldred, T.J.

    1998-10-01

    The goal of the 7th International Meshing Roundtable is to bring together researchers and developers from industry, academia, and government labs in a stimulating, open environment for the exchange of technical information related to the meshing process. In the past, the Roundtable has enjoyed significant participation from each of these groups from a wide variety of countries.

  11. Converting skeletal structures to quad dominant meshes

    Bærentzen, Jakob Andreas; Misztal, Marek Krzysztof; Welnicka, Katarzyna

    2012-01-01

    We propose the Skeleton to Quad-dominant polygonal Mesh algorithm (SQM), which converts skeletal structures to meshes composed entirely of polar and annular regions. Both types of regions have a regular structure where all faces are quads except for a single ring of triangles at the center of each...

  12. Adaptive mesh refinement in titanium

    Colella, Phillip; Wen, Tong

    2005-01-21

    In this paper, we evaluate Titanium's usability as a high-level parallel programming language through a case study, where we implement a subset of Chombo's functionality in Titanium. Chombo is a software package applying the Adaptive Mesh Refinement methodology to numerical Partial Differential Equations at the production level. In Chombo, the library approach is used to parallel programming (C++ and Fortran, with MPI), whereas Titanium is a Java dialect designed for high-performance scientific computing. The performance of our implementation is studied and compared with that of Chombo in solving Poisson's equation based on two grid configurations from a real application. Also provided are the counts of lines of code from both sides.

  13. Automatic mesh generation with QMESH program

    Ise, Takeharu; Tsutsui, Tsuneo

    1977-05-01

    Usage of the two-dimensional self-organizing mesh generation program, QMESH, is presented together with the descriptions and the experience, as it has recently been converted and reconstructed from the NEACPL version to the FACOM. The program package consists of the QMESH code to generate quadrilaterial meshes with smoothing techniques, the QPLOT code to plot the data obtained from the QMESH on the graphic COM, and the RENUM code to renumber the meshes by using a bandwidth minimization procedure. The technique of mesh reconstructuring coupled with smoothing techniques is especially useful when one generates the meshes for computer codes based on the finite element method. Several typical examples are given for easy access to the QMESH program, which is registered in the R.B-disks of JAERI for users. (auth.)

  14. Patient mental adjustment to selected types of cancer.

    Religioni, Urszula; Czerw, Aleksandra; Deptała, Andrzej

    2018-02-28

    Physical symptoms related to cancer are associated with various mental conditions. An adopted attitude towards pain and disease affects the quality of life of patients and may even decide about the final outcome of therapy. The objective of the study was to assess the degree of mental adjustment of patients diagnosed with breast, lung, colorectal and prostate cancer. The analysis also covered the effect of socioeconomic factors on mental adjustment in patients in the above groups. The study included 902 patients treated on an outpatient basis at the Center of Oncology, the Maria Skłodowska-Curie Institute in Warsaw, in the year 2013. The study participants were patients diagnosed with breast, lung, colorectal and prostate carcinoma. The Paper and Pencil Interview (PAPI) technique was applied. The questionnaire interview included demographic-type questions (socioeconomic variables) and the Mini-Mental Adjustment to Cancer (mini-MAC) scale, which measures the degree of mental adjustment to disease. The highest scores in the anxious preoccupation and helplessness-hopelessness subclasses were those of the lung, colorectal, breast and prostate cancer patients. In breast and lung cancer study participants, differences between individual categories distinguished due to socioeconomic features proved statistically insignificant. However, significant dependencies were observed between mental adjustment to disease and chemotherapy in the past year; though, the results differ with respect to the primary site. The primary site affects patient adjustment to disease. Socioeconomic factors in the area of mental adaptation differentiate colorectal carcinoma patients.

  15. A prospective randomised trial comparing mesh types and fixation in totally extraperitoneal inguinal hernia repairs.

    Cristaudo, Adam; Nayak, Arun; Martin, Sarah; Adib, Reza; Martin, Ian

    2015-05-01

    The totally extraperitoneal (TEP) approach for surgical repair of inguinal hernias has emerged as a popular technique. We conducted a prospective randomised trial to compare patient comfort scores using different mesh types and fixation using this technique. Over a 14 month period, 146 patients underwent 232 TEP inguinal hernia repairs. We compared the comfort scores of patients who underwent these procedures using different types of mesh and fixation. A non-absorbable 15 × 10 cm anatomical mesh fixed with absorbable tacks (Control group) was compared with either a non-absorbable 15 × 10 cm folding slit mesh with absorbable tacks (Group 2), a partially-absorbable 15 × 10 cm mesh with absorbable tacks (Group 3) or a non-absorbable 15 × 10 cm anatomical mesh fixed with 2 ml fibrin sealant (Group 4). Outcomes were compared at 1, 2, 4 and 12 weeks using the Carolina Comfort Scale (CCS) scores. At 1, 2, 4 and 12 weeks, the median global CCS scores were low for all treatment groups. Statistically significant differences were seen only for median CCS scores and subscores with the use of partially-absorbable mesh with absorbable tacks (Group 3) at weeks 2 and 4. However, these were no longer significant at week 12. In this study, the TEP inguinal hernia repair with minimal fixation results in low CCS scores. There were no statistical differences in CCS scores when comparing types of mesh, configuration of the mesh or fixation methods. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  16. Transvaginal mesh kits--how "serious" are the complications and are they reversible?

    Lee, Dominic; Dillon, Benjamin; Lemack, Gary; Gomelsky, Alex; Zimmern, Philippe

    2013-01-01

    To review the merit of the U.S. Food and Drug Administration-issued warnings on the use of transvaginal mesh in women with pelvic organ prolapse because of escalating complications. On institutional review board approval, we reviewed the data from 2 tertiary institutions managing complications of transvaginal mesh. The data recorded included mesh type, details of surgical removal, and patient-reported clinical outcomes. From 2006 to March 2011, 58 women were evaluated. Their mean age was 54.6 years (range 32-80), with a mean follow-up of 13 months (range 6-67). The mean interval to mesh excision surgery from the original prolapse surgery was 21 months (range 2-60). Of the 58 women, 35 (60%) had undergone concurrent midurethral sling surgery with the transvaginal mesh surgery. Also, 21 of the 58 patients (36%) had undergone initial mesh removal attempts before their referral to either tertiary institution. Most women presented with multiple complaints, with mesh extrusion the most frequently reported (n=43 [74%]). Of the 58 women, 17 (29%) required re-excision of residual mesh, 13 once and 4 twice. Five women developed recurrent symptomatic pelvic organ prolapse (7%). The residual rate of dyspareunia and pelvic pain was 14% and 22%, respectively. Fourteen women (24%) were treated successfully, with complete resolution of all presenting symptoms. As outlined in the Food and Drug Administration notifications, patients should be forewarned that some transvaginal mesh complications are life altering and might not always be surgically correctable. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Analysis of Surgical Outcomes and Determinants of Litigation Among Women With Transvaginal Mesh Complications.

    Zoorob, Dani; Karram, Mickey; Stecher, Anna; Maxwell, Rose; Whiteside, James

    To identify litigation predictors among women with complications of transvaginal mesh. Chart review and patient survey were conducted among women who had undergone a complication-related explant of a transvaginal prolapse or incontinence sling mesh. Trained study personnel administered a 57-question survey addressing subjective complaints related to bowel, bladder, sexual dysfunction, and development of pain or recurrent prolapse. These data were analyzed with respect to the subject's reported pursuit of litigation related to the mesh complication. Categorical and continuous variables were analyzed using the χ test and the t test as indicated. Ninety-five (68%) of 139 women completed the surveys with 60% of the patients pursuing litigation at the time of the survey. Individual risk factors for pursuing litigation included development of vaginal pain after mesh placement (P = 0.01); dyspareunia after mesh placement (P = 0.01); persistence of dyspareunia, suprapubic pain, and groin pain after mesh excision (P = 0.04, P = 0.02, and P = 0.001, respectively); unsuccessful attempts at conservative management of pelvic pain using pelvic floor rehabilitation (P = 0.002). There is an association between a higher likelihood of pursuing litigation and new-onset or persistent pain symptoms attributable to transvaginal mesh.

  18. Fog water collection effectiveness: Mesh intercomparisons

    Fernandez, Daniel; Torregrosa, Alicia; Weiss-Penzias, Peter; Zhang, Bong June; Sorensen, Deckard; Cohen, Robert; McKinley, Gareth; Kleingartner, Justin; Oliphant, Andrew; Bowman, Matthew

    2018-01-01

    To explore fog water harvesting potential in California, we conducted long-term measurements involving three types of mesh using standard fog collectors (SFC). Volumetric fog water measurements from SFCs and wind data were collected and recorded in 15-minute intervals over three summertime fog seasons (2014–2016) at four California sites. SFCs were deployed with: standard 1.00 m2 double-layer 35% shade coefficient Raschel; stainless steel mesh coated with the MIT-14 hydrophobic formulation; and FogHa-Tin, a German manufactured, 3-dimensional spacer fabric deployed in two orientations. Analysis of 3419 volumetric samples from all sites showed strong relationships between mesh efficiency and wind speed. Raschel mesh collected 160% more fog water than FogHa-Tin at wind speeds less than 1 m s–1 and 45% less for wind speeds greater than 5 m s–1. MIT-14 coated stainless-steel mesh collected more fog water than Raschel mesh at all wind speeds. At low wind speeds of steel mesh collected 3% more and at wind speeds of 4–5 m s–1, it collected 41% more. FogHa-Tin collected 5% more fog water when the warp of the weave was oriented vertically, per manufacturer specification, than when the warp of the weave was oriented horizontally. Time series measurements of three distinct mesh across similar wind regimes revealed inconsistent lags in fog water collection and inconsistent performance. Since such differences occurred under similar wind-speed regimes, we conclude that other factors play important roles in mesh performance, including in-situ fog event and aerosol dynamics that affect droplet-size spectra and droplet-to-mesh surface interactions.

  19. Prevalence of Dental Fear and Anxiety amongst Patients in Selected Dental Clinics in Ghana

    Ofori, Marian A.; Adu-Ababio, F.; Nyako, E. A.; Ndanu, Tom A.

    2009-01-01

    Objective: To find out the prevalence of dental anxiety and fear amongst patients in various selected dental clinics in Accra, Ghana. Study design: Dental patients (n = 279) who had either been exposed to dental treatments or had no prior dental exposure, attending four selected dental clinics in Accra were randomly sampled. They were interviewed…

  20. The use of the waiting list in a fair selection of patients for nursing home care

    Meiland, F. J.; Danse, J. A.; Hoos, A. M.; Wendte, J. F.; Gunning-Schepers, L. J.

    1996-01-01

    When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was

  1. Vaginal mucosal flap as a sling preservation for the treatment of vaginal exposure of mesh.

    Kim, Sea Young; Park, Jong Yeon; Kim, Han Kwon; Park, Chang Hoo; Kim, Sung Jin; Sung, Gi Teck; Park, Chang Myon

    2010-06-01

    Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days. Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence. Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.

  2. Assessment of Pain and Quality of Life in Lichtenstein Hernia Repair Using a New Monofilament PTFE Mesh: Comparison of Suture vs. Fibrin-Sealant Mesh Fixation.

    Fortelny, René H; Petter-Puchner, Alexander H; Redl, Heinz; May, Christopher; Pospischil, Wolfgang; Glaser, Karl

    2014-01-01

    Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e., the Infinit(®) mesh by W. L. Gore & Associates. This study was designed as a controlled prospective single-center two-cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin-sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e., seroma, infection), pain, and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1 year. Significantly, less postoperative pain was reported in the fibrin-sealant group compared to the suture group at 6 weeks (P = 0.035), 6 months (P = 0.023), and 1 year (P = 0.011) postoperatively. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay were seen in the fibrin-sealant group. Fibrin-sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair.

  3. Assessment of pain and quality of life in Lichtenstein hernia repair using a new monofilament PTFE mesh: comparison of suture vs. fibrin sealant mesh fixation

    René H Fortelny

    2014-11-01

    Full Text Available Background: Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e. the Infinit® mesh by W. L. Gore & Associates. Methods: This study was designed as a controlled prospective single-centre two cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e. seroma, infection, pain and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1 year.Results: Significantly less postoperative pain was reported in the fibrin sealant group compared to the suture group at 6 weeks (P=0.035, 6 months (P=0.023 and 1 year (P=0.011 postoperatively. Additionally trends towards a higher postoperative quality of life, a faster surgical procedure and a shorter hospital stay were seen in the fibrin sealant group.Conclusion: Fibrin sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair.

  4. Treatment selection for stage IIIA Hodgkin's disease patients

    Prosnitz, L.R.; Cooper, D.; Cox, E.B.; Kapp, D.S.; Farber, L.R.

    1985-01-01

    Two treatment policies for the therapy of patients with Stage IIIA Hodgkin's disease are compared. From 1969-1976, 49 newly diagnosed and pathologically staged IIIA patients received total nodal irradiation (TNI) alone (no liver irradiation). Although actuarial survival was 80% at 5 years and 68% at 10 years, actuarial freedom from relapse was only 38% at 5 years. Accordingly, a new treatment policy was instituted in 1976. Patients with either CS IIIA disease, multiple splenic nodules, IIIA with a large mediastinal mass or III 2 , received combined modality therapy (combination chemotherapy and irradiation). All others received TNI. Thirty-six patients have been treated under the new program. The actuarial survival is 90% at 5 years and the relapse-free survival is 87%, suggesting the superiority of this approach. Complications from the treatments are discussed

  5. Simplified Technique for Incorporating a Metal Mesh into Record Bases for Mandibular Implant Overdentures.

    Godoy, Antonio; Siegel, Sharon C

    2015-12-01

    Mandibular implant-retained overdentures have become the standard of care for patients with mandibular complete edentulism. As part of the treatment, the mandibular implant-retained overdenture may require a metal mesh framework to be incorporated to strengthen the denture and avoid fracture of the prosthesis. Integrating the metal mesh framework as part of the acrylic record base and wax occlusion rim before the jaw relation procedure will avoid the distortion of the record base and will minimize the chances of processing errors. A simplified method to incorporate the mesh into the record base and occlusion rim is presented in this technique article. © 2015 by the American College of Prosthodontists.

  6. Parallel 3D Mortar Element Method for Adaptive Nonconforming Meshes

    Feng, Huiyu; Mavriplis, Catherine; VanderWijngaart, Rob; Biswas, Rupak

    2004-01-01

    High order methods are frequently used in computational simulation for their high accuracy. An efficient way to avoid unnecessary computation in smooth regions of the solution is to use adaptive meshes which employ fine grids only in areas where they are needed. Nonconforming spectral elements allow the grid to be flexibly adjusted to satisfy the computational accuracy requirements. The method is suitable for computational simulations of unsteady problems with very disparate length scales or unsteady moving features, such as heat transfer, fluid dynamics or flame combustion. In this work, we select the Mark Element Method (MEM) to handle the non-conforming interfaces between elements. A new technique is introduced to efficiently implement MEM in 3-D nonconforming meshes. By introducing an "intermediate mortar", the proposed method decomposes the projection between 3-D elements and mortars into two steps. In each step, projection matrices derived in 2-D are used. The two-step method avoids explicitly forming/deriving large projection matrices for 3-D meshes, and also helps to simplify the implementation. This new technique can be used for both h- and p-type adaptation. This method is applied to an unsteady 3-D moving heat source problem. With our new MEM implementation, mesh adaptation is able to efficiently refine the grid near the heat source and coarsen the grid once the heat source passes. The savings in computational work resulting from the dynamic mesh adaptation is demonstrated by the reduction of the the number of elements used and CPU time spent. MEM and mesh adaptation, respectively, bring irregularity and dynamics to the computer memory access pattern. Hence, they provide a good way to gauge the performance of computer systems when running scientific applications whose memory access patterns are irregular and unpredictable. We select a 3-D moving heat source problem as the Unstructured Adaptive (UA) grid benchmark, a new component of the NAS Parallel

  7. Transumbilical breast augmentation (TUBA): patient selection, technique, and clinical experience.

    Pound, E C; Pound, E C

    2001-07-01

    The TUBA procedure offers another approach to placing inflatable breast implants in the subglandular or submuscular position. It is an easy procedure to learn and to perform, using only a few relatively inexpensive specialized instruments. It also can be modified to use preexisting scars on the abdomen as the access point. The authors believe that complications seem to occur less with TUBA patients than with patients having breast augmentation by other approaches, an observation shared by other plastic surgeons offering the TUBA procedure. Limitations include the fact that only inflatable implants can be used. Also, with increasing distance from the breast, there is less control over manipulation of the pocket. Fortunately, the authors have not found this to be a problem in achieving symmetry. Furthermore, bleeding tends to be minimal with this approach. Nevertheless, should technical difficulties arise, conversion to a standard breast incision is an easy back-up option and should be discussed with the patient before surgery. Interest in the TUBA approach to breast augmentation continues to grow. Patients appreciate the lack of scarring on the breast and the short recovery that allows them to resume their normal lifestyle quickly. The authors' caseload has increased considerably over the past 8 years through word-of-mouth advertising from satisfied patients. Other plastic surgeons who offer this approach agree that patient demand for this operation continues to grow dramatically in their practices.

  8. [New methods of patient selection for improved anticholinergic therapy].

    Neuhaus, J; Schwalenberg, T; Schlichting, N; Schulze, M; Horn, L-C; Stolzenburg, J-U

    2007-09-01

    M3-specific inhibitors are currently preferred for anticholinergic therapy of OAB. However, not all of the patients profit from this regimen. This might reflect a heterogeneity of the patient group. The aim of this work is to define subgroups of patients with specific alterations of receptor expression and to profile the receptor expression individually. These receptor profiles might be used for the development of evidence-based "tailored" therapies. Detrusor probes from bladder carcinoma patients (BCa, n=9 F, n=7 male) and interstitial cystitis patients (IC, n=9 female) were examined using confocal immunofluorescence and PCR. M2, M3, P2X1-3, and H1-3 mRNAs were demonstrated in detrusor tissue. As revealed by immunofluorescence, the M2 receptor expression was significantly higher in female compared to male BCa tissues. In addition, the M2 receptor was further upregulated in IC vs BCa in female detrusor. IC patients showed specific alterations of their receptor profile. Individual receptor profiles might be used to optimize medicinal therapies.

  9. Selection of oncoplastic surgical technique in Asian breast cancer patients

    Eui Sun Shin

    2018-01-01

    Full Text Available Background Oncoplastic surgery is being increasingly performed in Korean women; however, unlike Westerners, Korean women usually have small to moderate-sized breasts. To achieve better outcomes in reconstructed breasts, several factors should be considered to determine the optimal surgical method. Methods A total of 108 patients who underwent oncoplastic surgery from January 2013 to December 2016 were retrospectively investigated. We used various methods, including glandular tissue reshaping, latissimus dorsi (LD flap transposition, and reduction oncoplasty, to restore the breast volume and symmetry. Results The mean weight of the tumor specimens was 40.46 g, and the ratio of the tumor specimen weight to breast volume was 0.12 g/mL in the patients who underwent glandular tissue reshaping (n=59. The corresponding values were 101.47 g and 0.14 g/mL, respectively, in the patients who underwent reduction oncoplasty (n=17, and 82.54 g and 0.20 g/mL, respectively, in those treated with an LD flap (n=32. Glandular tissue reshaping was mostly performed in the upper outer quadrant, and LD flap transposition was mostly performed in the lower inner quadrant. No major complications were noted. Most patients were satisfied with the aesthetic results. Conclusions We report satisfactory outcomes of oncoplastic surgical procedures in Korean patients. The results regarding specimen weight and the tumor-to-breast ratio of Asian patients will be a helpful reference point for determining the most appropriate oncoplastic surgical technique.

  10. Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder

    Cihan Sahin

    2013-04-01

    Full Text Available Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients include body dysmorphic disorder (BDD, narcissistic personality disorder and histrionic personality disorders. BDD is of particular importance to plastic surgeons. Because outrageous dissatisfaction with one's appearance may conceal psychopathologic traits that are not always easily recognizable, and which, if neglected, may result in serious iatrogenic and medicolegal consequences, we hope that this paper will help plastic surgeons in ultimately preventing patient and surgeon dissatisfaction within the population of patients with psychiatric disorders, and should recognize the diagnostic features of body dysmorphic disorder and screen psychologically unstable patients who may never be satisfied with surgery. [Arch Clin Exp Surg 2013; 2(2.000: 109-115

  11. Laser patterned carbon–polyethylene mesh electrodes for wound diagnostics

    Phair, Jolene; Joshi, Mayank; Benson, John; McDonald, Damian; Davis, James, E-mail: james.davis@ulster.ac.uk

    2014-02-14

    Carbon loaded polyethylene films were selected as the base substrate for a mechanically flexible and conductive sensing material for use wound monitoring technologies. The films were processed using laser ablation of the surface to increase the effective surface area of the electrode and then subject to an oxidative electrochemical etch to improve the electron transfer kinetics. The surface morphology of the resulting films was analysed and the electrode performance in relation to monitoring uric acid, a key wound biomarker, was optimized. A prototype smart bandage was designed, based on interfacing the mesh to a portable potentiostat, and the response to urate and potential interferences assessed. - Highlights: • Innovative use of a carbon–polyethylene mesh for wound sensing applications. • Electroanalytical characterisation of a mechanically flexible conductive film. • Design and preliminary characterisation of an integrated smart bandage.

  12. Laser patterned carbon–polyethylene mesh electrodes for wound diagnostics

    Phair, Jolene; Joshi, Mayank; Benson, John; McDonald, Damian; Davis, James

    2014-01-01

    Carbon loaded polyethylene films were selected as the base substrate for a mechanically flexible and conductive sensing material for use wound monitoring technologies. The films were processed using laser ablation of the surface to increase the effective surface area of the electrode and then subject to an oxidative electrochemical etch to improve the electron transfer kinetics. The surface morphology of the resulting films was analysed and the electrode performance in relation to monitoring uric acid, a key wound biomarker, was optimized. A prototype smart bandage was designed, based on interfacing the mesh to a portable potentiostat, and the response to urate and potential interferences assessed. - Highlights: • Innovative use of a carbon–polyethylene mesh for wound sensing applications. • Electroanalytical characterisation of a mechanically flexible conductive film. • Design and preliminary characterisation of an integrated smart bandage

  13. Transvaginal mesh in the media following the 2011 US food and drug administration public health notification update.

    Koo, Kevin; Gormley, E Ann

    2017-02-01

    Prompted by patients' changing perceptions of transvaginal mesh, this study examines how mesh has been reported in the news following the 2011 US Food and Drug Administration (FDA) updated notification about the use of mesh in the treatment of pelvic organ prolapse. Two national newspaper databases were queried for articles discussing transvaginal mesh published within 3 years of the FDA announcement. Content analysis included headline subjects, mesh-related complications, quoted sources, and the FDA recommendations. To determine whether more widely read sources publish higher quality reporting, a subgroup analysis was conducted based on newspaper circulation. Ninety-five articles met inclusion criteria. Mesh-related litigation was the most common headline subject (36 articles, 38%), and 54% of all articles referenced legal action. Fifty-seven articles (60%) cited at least one mesh-related complication. Only 18 articles (19%) quoted surgeons who use transvaginal mesh. For the FDA update, 40% of articles that first reported the announcement accurately specified that it applies to mesh for prolapse, not incontinence. This ambiguity persisted: half of all articles cited the warning, but only 23% distinguished between prolapse and incontinence. Higher newspaper circulation did not significantly improve the quality of reporting about the content or context of the FDA's recommendations. Despite frequent media coverage of transvaginal mesh and its complications since 2011, very few news sources that cited the FDA warning distinguished between prolapse and incontinence. Given prevalent reporting of mesh-related litigation, the findings raise concern about how patients perceive the safety and efficacy of transvaginal mesh, regardless of indication. Neurourol. Urodynam. 36:329-332, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  14. [Selected ethical problems of oncologic patients during the terminal period].

    Iwaszczyszyn, J; Kwiecińska, A

    2001-01-01

    Patient suffering from terminal disease is depended on his environment more than any other one. He often suffers from nervous break down, anxiety and fear and he is usually unprotected from the environment. Fast development of medical science and its technicisation can lead towards dehumanization and lack of psychological and spiritual care, which should be based on clear ethical principles. Main lines of ethical principles of Health Service which are included in Deontological Code of Physicians and Collection of ethical principles for a qualified nurse are the main rules how to proceed as to fulfill the rule: "benefit of a patient is the superior law." According to its speciality Palliative Medicine introduces also four general ethical principles: 1. Patient will is a rule of treatment. 2. The principle of proportion--benefits from the treatment should be higher than losses and suffering from iatrogenic acting. 3. The principle of equality--stop taking a cure does not differ from not undertaking treatment. 4. The principle of relativity--life is not an absolute good, death is not an absolute evil. Holistic acts of Palliative Medicine determines also specific ethical attitudes, especially in the following: 1. Communication between a therapist and a patient and his family (interpersonal attitudes). 2. Procedures how to lessen suffering and its interpretation according to culture, tradition and religion ("nonsense and significance of suffering"). 3. Negation of euthanasia. 4. Spiritual, psychological and social care of patients.

  15. Successful selective arterial thrombolysis in patient with acute abdominal thromboembolism

    Christo Tsekov

    2016-06-01

    Full Text Available The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS. The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk. Keywords: Mesenterial circulation, Abdominal thromboembolism, Arterial thrombolysis

  16. Towards a real time computation of the dose in a phantom segmented into homogeneous meshes

    Blanpain, B.

    2009-10-01

    Automatic radiation therapy treatment planning necessitates a very fast computation of the dose delivered to the patient. We propose to compute the dose by segmenting the patient's phantom into homogeneous meshes, and by associating, to the meshes, projections to dose distributions pre-computed in homogeneous phantoms, along with weights managing heterogeneities. The dose computation is divided into two steps. The first step impacts the meshes: projections and weights are set according to physical and geometrical criteria. The second step impacts the voxels: the dose is computed by evaluating the functions previously associated to their mesh. This method is very fast, in particular when there are few points of interest (several hundreds). In this case, results are obtained in less than one second. With such performances, practical realization of automatic treatment planning becomes practically feasible. (author)

  17. Outpatient desensitization in selected patients with platinum hypersensitivity reactions.

    O'Malley, David M; Vetter, Monica Hagan; Cohn, David E; Khan, Ambar; Hays, John L

    2017-06-01

    Platinum-based chemotherapies are a standard treatment for both initial and recurrent gynecologic cancers. Given this widespread use, it is important to be aware of the features of platinum hypersensitivity reactions and the subsequent treatment of these reactions. There is also increasing interest in the development of desensitization protocols to allow patients with a history of platinum hypersensitivity to receive further platinum based therapy. In this review, we describe the management of platinum hypersensitivity reactions and the desensitization protocols utilized at our institution. We also describe the clinical categorizations utilized to triage patients to appropriate desensitization protocols. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Fog water collection effectiveness: Mesh intercomparisons

    Fernandez, Daniel; Torregrosa, Alicia; Weiss-Penzias, Peter; Zhang, Bong June; Sorensen, Deckard; Cohen, Robert; McKinley, Gareth; Kleingartner, Justin; Oliphant, Andrew; Bowman, Matthew

    2018-01-01

    To explore fog water harvesting potential in California, we conducted long-term measurements involving three types of mesh using standard fog collectors (SFC). Volumetric fog water measurements from SFCs and wind data were collected and recorded in 15-minute intervals over three summertime fog seasons (2014–2016) at four California sites. SFCs were deployed with: standard 1.00 m2 double-layer 35% shade coefficient Raschel; stainless steel mesh coated with the MIT-14 hydrophobic formulation; and FogHa-Tin, a German manufactured, 3-dimensional spacer fabric deployed in two orientations. Analysis of 3419 volumetric samples from all sites showed strong relationships between mesh efficiency and wind speed. Raschel mesh collected 160% more fog water than FogHa-Tin at wind speeds less than 1 m s–1 and 45% less for wind speeds greater than 5 m s–1. MIT-14 coated stainless-steel mesh collected more fog water than Raschel mesh at all wind speeds. At low wind speeds of wind speeds of 4–5 m s–1, it collected 41% more. FogHa-Tin collected 5% more fog water when the warp of the weave was oriented vertically, per manufacturer specification, than when the warp of the weave was oriented horizontally. Time series measurements of three distinct mesh across similar wind regimes revealed inconsistent lags in fog water collection and inconsistent performance. Since such differences occurred under similar wind-speed regimes, we conclude that other factors play important roles in mesh performance, including in-situ fog event and aerosol dynamics that affect droplet-size spectra and droplet-to-mesh surface interactions.

  19. Mesh optimization for microbial fuel cell cathodes constructed around stainless steel mesh current collectors

    Zhang, Fang

    2011-02-01

    Mesh current collectors made of stainless steel (SS) can be integrated into microbial fuel cell (MFC) cathodes constructed of a reactive carbon black and Pt catalyst mixture and a poly(dimethylsiloxane) (PDMS) diffusion layer. It is shown here that the mesh properties of these cathodes can significantly affect performance. Cathodes made from the coarsest mesh (30-mesh) achieved the highest maximum power of 1616 ± 25 mW m-2 (normalized to cathode projected surface area; 47.1 ± 0.7 W m-3 based on liquid volume), while the finest mesh (120-mesh) had the lowest power density (599 ± 57 mW m-2). Electrochemical impedance spectroscopy showed that charge transfer and diffusion resistances decreased with increasing mesh opening size. In MFC tests, the cathode performance was primarily limited by reaction kinetics, and not mass transfer. Oxygen permeability increased with mesh opening size, accounting for the decreased diffusion resistance. At higher current densities, diffusion became a limiting factor, especially for fine mesh with low oxygen transfer coefficients. These results demonstrate the critical nature of the mesh size used for constructing MFC cathodes. © 2010 Elsevier B.V. All rights reserved.

  20. Polygonal Prism Mesh in the Viscous Layers for the Polyhedral Mesh Generator, PolyGen

    Lee, Sang Yong; Park, Chan Eok; Kim, Shin Whan

    2015-01-01

    Polyhedral mesh has been known to have some benefits over the tetrahedral mesh. Efforts have been made to set up a polyhedral mesh generation system with open source programs SALOME and TetGen. The evaluation has shown that the polyhedral mesh generation system is promising. But it is necessary to extend the capability of the system to handle the viscous layers to be a generalized mesh generator. A brief review to the previous works on the mesh generation for the viscous layers will be made in section 2. Several challenging issues for the polygonal prism mesh generation will be discussed as well. The procedure to generate a polygonal prism mesh will be discussed in detail in section 3. Conclusion will be followed in section 4. A procedure to generate meshes in the viscous layers with PolyGen has been successfully designed. But more efforts have to be exercised to find the best way for the generating meshes for viscous layers. Using the extrusion direction of the STL data will the first of the trials in the near future

  1. Patient and personnel dose measurements at selective coronarangiography

    Maripuu, E.

    1977-01-01

    During 1975 dose measurements were performed on patients and doctors at the thoraxradiologic department of the Caroline Hospital in Stockholm, Sweden. The doses were measured during angiography. Skin doses are listed in tables. Also the doses to the bone marrow was estimated. LiF-dosemeters were used for the measurements. Calibration of the dosemeters and errors in the measurements are discussed

  2. Deep brain stimulation for dystonia: patient selection and outcomes

    Speelman, J. D.; Contarino, M. F.; Schuurman, P. R.; Tijssen, M. A. J.; de Bie, R. M. A.

    2010-01-01

    In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For

  3. Deep brain stimulation for dystonia : Patient selection and outcomes

    Speelman, J. D.; Contarino, M. F.; Schuurman, P. R.; Tijssen, M. A. J.; de Bie, R. M. A.

    In a literature survey, 341 patients with primary and 109 with secondary dystonias treated with deep brain stimulation (DBS) of the internal segment of the globus pallidus (GPi) were identified. In general, the outcomes for primary dystonias were more favourable compared to the secondary forms. For

  4. Selective use of diagnostic laparoscopy in patients with suspected appendicitis

    van den Broek, W. T.; Bijnen, A. B.; van Eerten, P. V.; de Ruiter, P.; Gouma, D. J.

    2000-01-01

    BACKGROUND: Diagnostic laparoscopy has been introduced as a new diagnostic tool for patients with acute appendicitis. We performed diagnostic laparoscopy when the clinical diagnosis of appendicitis was in doubt. The aims of this study were to evaluate this strategy and to analyze the efficacy of

  5. Automatic selective feature retention in patient specific elastic surface registration

    Jansen van Rensburg, GJ

    2011-01-01

    Full Text Available The accuracy with which a recent elastic surface registration algorithm deforms the complex geometry of a skull is examined. This algorithm is then coupled to a line based algorithm as is frequently used in patient specific feature registration...

  6. Engagement of Metal Debris into Gear Mesh

    handschuh, Robert F.; Krantz, Timothy L.

    2010-01-01

    A series of bench-top experiments was conducted to determine the effects of metallic debris being dragged through meshing gear teeth. A test rig that is typically used to conduct contact fatigue experiments was used for these tests. Several sizes of drill material, shim stock and pieces of gear teeth were introduced and then driven through the meshing region. The level of torque required to drive the "chip" through the gear mesh was measured. From the data gathered, chip size sufficient to jam the mechanism can be determined.

  7. Mesh requirements for neutron transport calculations

    Askew, J.R.

    1967-07-01

    Fine-structure calculations are reported for a cylindrical natural uranium-graphite cell using different solution methods (discrete ordinate and collision probability codes) and varying the spatial mesh. It is suggested that of formulations assuming the source constant in a mesh interval the differential approach is generally to be preferred. Due to cancellation between approximations made in the derivation of the finite difference equations and the errors in neglecting source variation, the discrete ordinate code gave a more accurate estimate of fine structure for a given mesh even for unusually coarse representations. (author)

  8. Dynamic evaluation of pelvic floor reconstructive surgery using radiopaque meshes and three-dimensional helical CT

    Paulo Palma

    2010-04-01

    Full Text Available PURPOSE: This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes. MATERIALS AND METHODS: A total of 30 female patients with stress urinary incontinence (SUI, anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively. RESULTS: In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines. CONCLUSION: Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.

  9. [The ultrasound semiotics of uncomplicated wound healing after inguinal mesh plastics].

    Kharitonov, S V; Ziniakova, M V

    2012-01-01

    Dynamic ultrasound (US) investigation was performed in 89 patients operated on inguinal hernia with the use of meshes of various type. The US scanning proved to be a highly informative means of visualization, allowing the objective postoperative assessment of muscular and aponeurotic structures as well as the implant form and position. The study showed, that the mesh implantation was always accompanied by the exudative tissue reaction, which was determined by the physico-chemical characteristics of the implant.

  10. The Role of Vaginal Mesh Procedures in Pelvic Organ Prolapse Surgery in View of Complication Risk

    Ellington, David R.; Richter, Holly E.

    2013-01-01

    Synthetic transvaginal mesh has been employed in the treatment of pelvic organ prolapse for more than a decade. As the use of these devices increased during this period so did adverse event reporting. In 2008, the Food and Drug Administration (FDA) Public Health Notification informed physicians and patients of rising concerns with the use of synthetic transvaginal mesh. Shortly thereafter and in parallel to marked increases in adverse event reporting within the Manufacturer and User Device E...

  11. Fair packet scheduling in Wireless Mesh Networks

    Nawab, Faisal

    2014-02-01

    In this paper we study the interactions of TCP and IEEE 802.11 MAC in Wireless Mesh Networks (WMNs). We use a Markov chain to capture the behavior of TCP sessions, particularly the impact on network throughput due to the effect of queue utilization and packet relaying. A closed form solution is derived to numerically determine the throughput. Based on the developed model, we propose a distributed MAC protocol called Timestamp-ordered MAC (TMAC), aiming to alleviate the unfairness problem in WMNs. TMAC extends CSMA/CA by scheduling data packets based on their age. Prior to transmitting a data packet, a transmitter broadcasts a request control message appended with a timestamp to a selected list of neighbors. It can proceed with the transmission only if it receives a sufficient number of grant control messages from these neighbors. A grant message indicates that the associated data packet has the lowest timestamp of all the packets pending transmission at the local transmit queue. We demonstrate that a loose ordering of timestamps among neighboring nodes is sufficient for enforcing local fairness, subsequently leading to flow rate fairness in a multi-hop WMN. We show that TMAC can be implemented using the control frames in IEEE 802.11, and thus can be easily integrated in existing 802.11-based WMNs. Our simulation results show that TMAC achieves excellent resource allocation fairness while maintaining over 90% of maximum link capacity across a large number of topologies.

  12. Metabolic complications of endogenous Cushing: patient selection for screening

    Zh E Belaya

    2013-03-01

    Full Text Available Aims: this study evaluates the most common associations of symptoms and complications in patients with Cushing’s syndrome (CS in order to choose a potential population to be screened for CS and estimates the diagnostic accuracy of first line screening tests (cortisol, ACTH to differentiate ACTH-ectopic CS from Cushing’s disease. Materials and Methods: The clinical data of 259 patients with proven CS during 2001–2011 was analyzed. The clinical presentations of 197 patients (159 Cushing’s disease, 28 ACTH-ectopic CS and 10 cases of benign cortisol-secreting adrenal adenoma were compared according to the cause of hypercortisolism. ROC-analysis was performed to estimate the diagnostic accuracy of the first line tests (cortisol, ACTH to suggest ACTH-ectopic CS. A threshold for the test with the highest area under the curves was chosen based on the maximum sum of the sensitivity and specificity. Results: The most frequent complaints were related to fatigue, muscle weakness, weight gain and changes in appearance (facial plethora and fullness, striae. Among the complications of CS the most frequent were being overweight or obese (71%, hypertension (63%, dislipoproteinemia (41%, low traumatic fractures (43% and steroid-induced diabetes (31%. In women, 16% were older than 50, in those who were younger amenorrhea was registered in 43%. The patients with ACTH-ectopic CS had higher rate of low traumatic fractures (p=0.04, increased serum late-night cortisol, 24 hours urinary free cortisol, morning and evening ACTH and lower levels of potassium (p<0.01 for all parameters. Plasma late-night ACTH measurements showed the highest AUC (0,811 (95% CI 0,712–0,909 to differentiate ACTH-ectopic CS from Cushing’s disease. A cut off value of 108.9 pg/ml for late-night ACTH yielded a sensitivity of 60,7% and a specificity of 79%. Conclusions: patients with a coexistence of obesity, muscle weakness, fatigue, some components of metabolic syndrome and especially

  13. SELECTIVE INTESTINAL DECONTAMINATION FOR PREVENTION OF WOUND COLONIZATION IN SEVERELY BURNED PATIENTS - A RETROSPECTIVE ANALYSIS

    MANSON, WL; KLASEN, HJ; SAUER, EW; OLIEMAN, A

    In this study the effect of selective intestinal decontamination of the digestive tract (SDD) on wound colonization was investigated. Ninety-one patients with at least 25 per cent total burned surface area (TBSA) were included in this study. All patients received oral polymyxin. In 63 patients oral

  14. Electromyographic control of functional electrical stimulation in selected patients.

    Graupe, D; Kohn, K H; Basseas, S; Naccarato, E

    1984-07-01

    The paper describes initial results of above-lesion electromyographic (EMG) controlled functional electrical stimulation (FES) of paraplegics. Such controlled stimulation is to provide upper-motor-neuron paraplegics (T5 to T12) with self-controlled standing and some walking without braces and with only the help of walkers or crutches. The above-lesion EMG signal employed serves to map the posture of the patient's upper trunk via a computerized mapping of the temporal patterns of that EMG. Such control also has an inherent safety feature in that it prevents the patient from performing a lower-limb movement via FES unless his trunk posture is adequate. Copyright 2013, SLACK Incorporated.

  15. Mitral valve prolapse and hyperthyroidism: effect of patient selection.

    Zullo, M A; Devereux, R B; Kramer-Fox, R; Lutas, E M; Brown, W T

    1985-11-01

    Patients with mitral valve prolapse and hyperthyroidism have common symptoms; the most outstanding symptom is palpitation. To determine whether or not common symptoms contributed to the reported association of these conditions, we evaluated 220 patients with symptomatic mitral valve prolapse and 216 first-degree relatives in 72 families; 65 relatives with mitral valve prolapse and 151 relatives without mitral valve prolapse, all greater than or equal to 16 years of age. Thirty subjects, aged 49 +/- 13 years (p less than 0.025 vs entire study group), had thyroid disease (23 subjects had definite thyroid disease, seven subjects had probable); 27 of 30 subjects with thyroid disease (90%) were female (p less than 0.005). The age- and sex-adjusted prevalence of hyperthyroidism was significantly higher in probands with mitral valve prolapse than in family members without mitral valve prolapse (3.5% vs 0%, p = 0.03), while an intermediate prevalence of hyperthyroidism (2.2%) was observed in family members with mitral valve prolapse. Thus, the prevalence of hyperthyroidism is increased among symptomatic patients with mitral valve prolapse as compared to family members without mitral valve prolapse, but the prevalence of thyroid conditions is similar among family members with or without this condition. These findings are explained by the effect of common symptoms on clinical detection of both mitral valve prolapse and hyperthyroidism.

  16. Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment.

    Mohr, Stefan; Siegenthaler, Franziska; Imboden, Sara; Kuhn, Annette; Mueller, Michael D

    To show a new technique of using single-incision laparoscopic surgery (SILS) equipment in vaginal surgery to create a "pneumovagina." Explanatory video demonstrating the technique and intraoperative findings. University hospital. The 68-year-old patient was referred with a vaginal mesh erosion that resulted in abscess formation at the vaginal apex. The patient was symptomatic with an increasingly foul-smelling vaginal discharge for about 1 year. She had a laparoscopic sacrocolpopexy in a remote hospital 22 months before the current operation and had a total abdominal hysterectomy 15 years ago. The, patient's history was uneventful without dyspareunia, incontinence or voiding difficulties, and she was otherwise content with the sacrocolpopexy result. The local institutional review board granted exemption for this publication. Frequently, pelvic organ prolapse can only be effectively treated if the surgical procedure comprises support of the central compartment. Laparoscopic sacrocolpopexy shows superior outcomes for this indication, with success rates of up to 96%. However, a rare side effect of laparoscopic sacrocolpopexy is mesh erosion, occurring in up to 2.4% [1]. These erosions are usually treated laparoscopically [2]. In this video we show an alternative route for excision of a symptomatic exposed mesh by using a transvaginal approach: The SILS trocar is used vaginally for abscess irrigation and mesh excision with minimally invasive instruments. For treatment of the abscess and removal of the exposed mesh, the SILS trocar was placed vaginally, and laparoscopic instruments were used. The abscess was incised, cleansed and irrigated, debrided, and the mesh excised. Because no mesh material was exposed after excision, the vagina was not closed to avoid creating a cavity with the risk of promoting reabscess formation, and secondary wound healing was anticipated. Laparoscopy was used to confirm that no intra-abdominal lesion coexisted or occurred. There were

  17. OUR EXPERINCE WITH USE OF POSTERIOR MESH RECTOPEXY IN COMPLETE RECTAL PROLAPSE

    Sudhansu Sekhar Mohanty

    2017-12-01

    Full Text Available BACKGROUND Mesh rectopexy is one of the accepted treatment options for rectal prolapse. We used polypropylene posterior mesh rectopexy for prolapse rectum. The aim of the study was to see demographic, clinical and functional outcome of posterior mesh rectopexy in our setup. MATERIALS AND METHODS The case report of 33 patients under gone posterior abdominal mesh rectopexy in MKCG medical college and hospital from 1st July 2012 to 1st July 2017 were reviewed retrospectively and the patients were followed up in surgical OPD/telephonic questionnaire. All patients had undergone standard posterior abdominal mesh rectopexy without the division of lateral ligaments with utmost care for prevention of bleeding and nerve damage. RESULTS Out of 33 cases of abdominal rectopexy, 12 (36% were males and 21 (64% were females. 27 (82% were within 61-80 years of age group. The most common symptoms were mass per annum (100% followed by incontinence for liquid stool and flatus 24 (72%. There was no operative mortality. The average hospital stay 7.8 days (5-11 days. The constipation (p=0.019 and incontinence (p=0.0165 were better postoperatively. There was 1 (3% partial recurrence of rectal prolapse in 91-year-old lady in 2 years follow up. CONCLUSION The recurrence rate as well as clinical and functional outcome of open abdominal mesh rectopexy seems to be satisfactory, however, long-term effect has to be seen.

  18. Biologic mesh reconstruction of the pelvic floor after extralevator abdominoperineal excision; a systematic review

    Nasra N Alam

    2016-02-01

    Full Text Available IntroductionThe aim of this review is to provide an overview of the evidence for the use of biologic mesh in the reconstruction of the pelvic floor after extralevator abdominoperineal excision of the rectum (ELAPE.MethodsA systematic search of PubMed was conducted using the search terms ‘ELAPE’, ‘extralevator abdominoperineal excision of rectum’ or ‘extralevator abdominoperineal resection’. The search yielded 17 studies.ResultsBiologic mesh was used in perineal reconstruction in 463 cases. There were 41 perineal hernias reported but rates were not consistently reported in all studies. The most common complications were perineal wound infection (n = 93, perineal sinus and fistulae (n = 26 and perineal haematoma or seroma (n = 11. There were very few comparative studies, with only one RCT identified that compared patients undergoing ELAPE with perineal reconstruction using a biological mesh, with patients undergoing a conventional abdominoperineal excision of the rectum with no mesh. There was no significant difference in perineal hernia rates or perineal wound infections between the groups. Other comparative studies comparing the use of biologic mesh with techniques such as the use of myocutaneous flaps were of low quality.ConclusionsBiologic mesh-assisted perineal reconstruction is a promising technique to improve wound healing and has comparable complications rates to other techniques. However, there is not enough evidence to support its use in all patients who have undergone ELAPE. Results from high-quality prospective RCTs and national/international collaborative audits are required.

  19. Road to recovery after transvaginal surgery for urethral mesh perforation: evaluation of outcomes and subsequent procedures.

    Kowalik, Casey G; Cohn, Joshua A; Kakos, Andrea; Lang, Patrick; Reynolds, W Stuart; Kaufman, Melissa R; Karram, Mickey M; Dmochowski, Roger R

    2018-01-29

    Urethral injury resulting from transvaginal mesh slings is a rare complication with an estimated incidence of surgical management and functional outcomes of women presenting with urethral mesh perforation following midurethral sling (MUS) placement. This was a retrospective multicenter review of women who from January 2011 to March 2016 at two institutions underwent mesh sling excision for urethral perforation with Female Pelvic Medicine and Reconstructive Surgery fellowship-trained surgeons. Data comprising preoperative symptoms, operative details, and postoperative outcomes were collected by telephone (n 13) or based on their last follow-up appointment. Nineteen women underwent transvaginal sling excision for urethral mesh perforation. Eight (42%) patients had undergone previous sling revision surgery. Sixty percent of women had resolution of their pelvic pain postoperatively. At follow-up, 92% reported urinary incontinence (UI), and three had undergone five additional procedures for vaginal prolapse mesh exposure (n 1), incontinence (onabotulinum toxin injection n 1, rectus fascia autologous sling n 1), prolapse (colpopexy n 1), and pain (trigger-point injection n 1). Patient global impression of improvement data was available for 13 patients, of whom seven (54%) rated their postoperative condition as Very much better or Much better. The management of urethral mesh perforation is complex. Most women reported resolution of their pelvic pain and a high rate of satisfaction with their postoperative condition despite high rates of incontinence.

  20. Anterior six arms prolene mesh for high stage vaginal prolapse: five years follow-up

    Luis Gustavo M. de Toledo

    Full Text Available ABSTRACT Introduction In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable. Objective To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses. Materials and Methods We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q. Intervention Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision. Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis. Results Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years, 16 (89% patients were continent, mean Ba point came from +4.7cm to - 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm. There were two (11% objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion. Conclusions The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.

  1. Obtuse triangle suppression in anisotropic meshes

    Sun, Feng; Choi, Yi King; Wang, Wen Ping; Yan, Dongming; Liu, Yang; Lé vy, Bruno L.

    2011-01-01

    Anisotropic triangle meshes are used for efficient approximation of surfaces and flow data in finite element analysis, and in these applications it is desirable to have as few obtuse triangles as possible to reduce the discretization error. We present a variational approach to suppressing obtuse triangles in anisotropic meshes. Specifically, we introduce a hexagonal Minkowski metric, which is sensitive to triangle orientation, to give a new formulation of the centroidal Voronoi tessellation (CVT) method. Furthermore, we prove several relevant properties of the CVT method with the newly introduced metric. Experiments show that our algorithm produces anisotropic meshes with much fewer obtuse triangles than using existing methods while maintaining mesh anisotropy. © 2011 Elsevier B.V. All rights reserved.

  2. Connectivity editing for quad-dominant meshes

    Peng, Chihan; Wonka, Peter

    2013-01-01

    and illustrate the advantages and disadvantages of different strategies for quad-dominant mesh design. © 2013 The Author(s) Computer Graphics Forum © 2013 The Eurographics Association and John Wiley & Sons Ltd.

  3. Grid adaptation using chimera composite overlapping meshes

    Kao, Kai-Hsiung; Liou, Meng-Sing; Chow, Chuen-Yen

    1994-01-01

    The objective of this paper is to perform grid adaptation using composite overlapping meshes in regions of large gradient to accurately capture the salient features during computation. The chimera grid scheme, a multiple overset mesh technique, is used in combination with a Navier-Stokes solver. The numerical solution is first converged to a steady state based on an initial coarse mesh. Solution-adaptive enhancement is then performed by using a secondary fine grid system which oversets on top of the base grid in the high-gradient region, but without requiring the mesh boundaries to join in any special way. Communications through boundary interfaces between those separated grids are carried out using trilinear interpolation. Application to the Euler equations for shock reflections and to shock wave/boundary layer interaction problem are tested. With the present method, the salient features are well-resolved.

  4. Grid adaption using Chimera composite overlapping meshes

    Kao, Kai-Hsiung; Liou, Meng-Sing; Chow, Chuen-Yen

    1993-01-01

    The objective of this paper is to perform grid adaptation using composite over-lapping meshes in regions of large gradient to capture the salient features accurately during computation. The Chimera grid scheme, a multiple overset mesh technique, is used in combination with a Navier-Stokes solver. The numerical solution is first converged to a steady state based on an initial coarse mesh. Solution-adaptive enhancement is then performed by using a secondary fine grid system which oversets on top of the base grid in the high-gradient region, but without requiring the mesh boundaries to join in any special way. Communications through boundary interfaces between those separated grids are carried out using tri-linear interpolation. Applications to the Euler equations for shock reflections and to a shock wave/boundary layer interaction problem are tested. With the present method, the salient features are well resolved.

  5. Shape space exploration of constrained meshes

    Yang, Yongliang

    2011-12-12

    We present a general computational framework to locally characterize any shape space of meshes implicitly prescribed by a collection of non-linear constraints. We computationally access such manifolds, typically of high dimension and co-dimension, through first and second order approximants, namely tangent spaces and quadratically parameterized osculant surfaces. Exploration and navigation of desirable subspaces of the shape space with regard to application specific quality measures are enabled using approximants that are intrinsic to the underlying manifold and directly computable in the parameter space of the osculant surface. We demonstrate our framework on shape spaces of planar quad (PQ) meshes, where each mesh face is constrained to be (nearly) planar, and circular meshes, where each face has a circumcircle. We evaluate our framework for navigation and design exploration on a variety of inputs, while keeping context specific properties such as fairness, proximity to a reference surface, etc. © 2011 ACM.

  6. Shape space exploration of constrained meshes

    Yang, Yongliang; Yang, Yijun; Pottmann, Helmut; Mitra, Niloy J.

    2011-01-01

    We present a general computational framework to locally characterize any shape space of meshes implicitly prescribed by a collection of non-linear constraints. We computationally access such manifolds, typically of high dimension and co-dimension, through first and second order approximants, namely tangent spaces and quadratically parameterized osculant surfaces. Exploration and navigation of desirable subspaces of the shape space with regard to application specific quality measures are enabled using approximants that are intrinsic to the underlying manifold and directly computable in the parameter space of the osculant surface. We demonstrate our framework on shape spaces of planar quad (PQ) meshes, where each mesh face is constrained to be (nearly) planar, and circular meshes, where each face has a circumcircle. We evaluate our framework for navigation and design exploration on a variety of inputs, while keeping context specific properties such as fairness, proximity to a reference surface, etc. © 2011 ACM.

  7. Obtuse triangle suppression in anisotropic meshes

    Sun, Feng

    2011-12-01

    Anisotropic triangle meshes are used for efficient approximation of surfaces and flow data in finite element analysis, and in these applications it is desirable to have as few obtuse triangles as possible to reduce the discretization error. We present a variational approach to suppressing obtuse triangles in anisotropic meshes. Specifically, we introduce a hexagonal Minkowski metric, which is sensitive to triangle orientation, to give a new formulation of the centroidal Voronoi tessellation (CVT) method. Furthermore, we prove several relevant properties of the CVT method with the newly introduced metric. Experiments show that our algorithm produces anisotropic meshes with much fewer obtuse triangles than using existing methods while maintaining mesh anisotropy. © 2011 Elsevier B.V. All rights reserved.

  8. Mesh Processing in Medical Image Analysis

    The following topics are dealt with: mesh processing; medical image analysis; interactive freeform modeling; statistical shape analysis; clinical CT images; statistical surface recovery; automated segmentation; cerebral aneurysms; and real-time particle-based representation....

  9. Capacity Analysis of Wireless Mesh Networks

    M. I. Gumel

    2012-06-01

    Full Text Available The next generation wireless networks experienced a great development with emergence of wireless mesh networks (WMNs, which can be regarded as a realistic solution that provides wireless broadband access. The limited available bandwidth makes capacity analysis of the network very essential. While the network offers broadband wireless access to community and enterprise users, the problems that limit the network capacity must be addressed to exploit the optimum network performance. The wireless mesh network capacity analysis shows that the throughput of each mesh node degrades in order of l/n with increasing number of nodes (n in a linear topology. The degradation is found to be higher in a fully mesh network as a result of increase in interference and MAC layer contention in the network.

  10. Energy-efficient wireless mesh networks

    Ntlatlapa, N

    2007-06-01

    Full Text Available This paper outlines the objectives of a recently formed research group at Meraka Institute. The authors consider application of wireless mesh networks in rural infrastructure deficient parts of the African continent where nodes operate on batteries...

  11. LR: Compact connectivity representation for triangle meshes

    Gurung, T; Luffel, M; Lindstrom, P; Rossignac, J

    2011-01-28

    We propose LR (Laced Ring) - a simple data structure for representing the connectivity of manifold triangle meshes. LR provides the option to store on average either 1.08 references per triangle or 26.2 bits per triangle. Its construction, from an input mesh that supports constant-time adjacency queries, has linear space and time complexity, and involves ordering most vertices along a nearly-Hamiltonian cycle. LR is best suited for applications that process meshes with fixed connectivity, as any changes to the connectivity require the data structure to be rebuilt. We provide an implementation of the set of standard random-access, constant-time operators for traversing a mesh, and show that LR often saves both space and traversal time over competing representations.

  12. Quality of pharmacy-specific Medical Subject Headings (MeSH) assignment in pharmacy journals indexed in MEDLINE.

    Minguet, Fernando; Salgado, Teresa M; van den Boogerd, Lucienne; Fernandez-Llimos, Fernando

    2015-01-01

    The Medical Subject Headings (MeSH) is the National Library of Medicine (NLM) controlled vocabulary for indexing articles. Inaccuracies in the MeSH thesaurus have been reported for several areas including pharmacy. To assess the quality of pharmacy-specific MeSH assignment to articles indexed in pharmacy journals. The 10 journals containing the highest number of articles published in 2012 indexed under the MeSH 'Pharmacists' were identified. All articles published over a 5-year period (2008-2012) in the 10 previously selected journals were retrieved from PubMed. MeSH terms used to index these articles were extracted and pharmacy-specific MeSH terms were identified. The frequency of use of pharmacy-specific MeSH terms was calculated across journals. A total of 6989 articles were retrieved from the 10 pharmacy journals, of which 328 (4.7%) were articles not fully indexed and therefore did not contain any MeSH terms assigned. Among the 6661 articles fully indexed, the mean number of MeSH terms was 10.1 (SD = 4.0), being 1.0 (SD = 1.3) considered as Major MeSH. Both values significantly varied across journals. The mean number of pharmacy-specific MeSH terms per article was 0.9 (SD = 1.2). A total of 3490 (52.4%) of the 6661 articles were indexed in pharmacy journals without a single pharmacy-specific MeSH. Of the total 67193 MeSH terms assigned to articles, on average 10.5% (SD = 13.9) were pharmacy-specific MeSH. A statistically significant different pattern of pharmacy-specific MeSH assignment was identified across journals (Kruskal-Wallis P journals can be improved to further enhance evidence gathering in pharmacy. Over half of the articles published in the top-10 journals publishing pharmacy literature were indexed without a single pharmacy-specific MeSH. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Postoperative Urinary Retention and Urinary Tract Infections Predict Midurethral Sling Mesh Complications.

    Punjani, Nahid; Winick-Ng, Jennifer; Welk, Blayne

    2017-01-01

    To determine if postoperative urinary retention and urinary tract infections (UTIs) were predictors of future mesh complications requiring surgical intervention after midurethral sling (MUS). Administrative data in Ontario, Canada, between 2002 and 2013 were used to identify all women who underwent a mesh-based MUS. The primary outcome was revision of the transvaginal mesh sling (including mesh removal/erosion/fistula, or urethrolysis). Two potential risk factors were analyzed: postoperative retention (within 30 days of procedure) and number of postoperative emergency room visits or hospital admissions for UTI symptoms. A total of 59,556 women had a MUS, of which 1598 (2.7%) required revision surgery. Of the 2025 women who presented to the emergency room or were admitted to hospital for postoperative retention, 212 (10.5%) required operative mesh revision. Of the 11,747 patients who had at least one postoperative UTI, 366 (3.1%) patients required operative mesh revision. In adjusted analysis, postoperative retention was significantly predictive of future reoperation (hazard ratio [HR] 3.46, 95% confidence interval [CI] 2.97-4.02), and this difference persisted when urethrolysis was excluded as a reason for sling revision (HR 3.08, 95% CI 2.62-3.63). Similarly, in adjusted analysis, each additional postoperative hospital visit for UTI symptoms increased the risk for surgical intervention for mesh complications (HR 1.74, 95% CI 1.61-1.87). Postoperative urinary retention and hospital presentation for UTI symptoms are associated with an increased risk of reoperation for MUS complications. These patients should be followed and investigated for mesh complications when appropriate. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. MHD simulations on an unstructured mesh

    Strauss, H.R.; Park, W.; Belova, E.; Fu, G.Y.; Sugiyama, L.E.

    1998-01-01

    Two reasons for using an unstructured computational mesh are adaptivity, and alignment with arbitrarily shaped boundaries. Two codes which use finite element discretization on an unstructured mesh are described. FEM3D solves 2D and 3D RMHD using an adaptive grid. MH3D++, which incorporates methods of FEM3D into the MH3D generalized MHD code, can be used with shaped boundaries, which might be 3D

  15. Towards Blockchain-enabled Wireless Mesh Networks

    Selimi, Mennan; Kabbinale, Aniruddh Rao; Ali, Anwaar; Navarro, Leandro; Sathiaseelan, Arjuna

    2018-01-01

    Recently, mesh networking and blockchain are two of the hottest technologies in the telecommunications industry. Combining both can reformulate internet access and make connecting to the Internet not only easy, but affordable too. Hyperledger Fabric (HLF) is a blockchain framework implementation and one of the Hyperledger projects hosted by The Linux Foundation. We evaluate HLF in a real production mesh network and in the laboratory, quantify its performance, bottlenecks and limitations of th...

  16. Unstructured Mesh Movement and Viscous Mesh Generation for CFD-Based Design Optimization, Phase II

    National Aeronautics and Space Administration — The innovations proposed are twofold: 1) a robust unstructured mesh movement method able to handle isotropic (Euler), anisotropic (viscous), mixed element (hybrid)...

  17. MHD simulations on an unstructured mesh

    Strauss, H.R.; Park, W.

    1996-01-01

    We describe work on a full MHD code using an unstructured mesh. MH3D++ is an extension of the PPPL MH3D resistive full MHD code. MH3D++ replaces the structured mesh and finite difference / fourier discretization of MH3D with an unstructured mesh and finite element / fourier discretization. Low level routines which perform differential operations, solution of PDEs such as Poisson's equation, and graphics, are encapsulated in C++ objects to isolate the finite element operations from the higher level code. The high level code is the same, whether it is run in structured or unstructured mesh versions. This allows the unstructured mesh version to be benchmarked against the structured mesh version. As a preliminary example, disruptions in DIIID reverse shear equilibria are studied numerically with the MH3D++ code. Numerical equilibria were first produced starting with an EQDSK file containing equilibrium data of a DIII-D L-mode negative central shear discharge. Using these equilibria, the linearized equations are time advanced to get the toroidal mode number n = 1 linear growth rate and eigenmode, which is resistively unstable. The equilibrium and linear mode are used to initialize 3D nonlinear runs. An example shows poloidal slices of 3D pressure surfaces: initially, on the left, and at an intermediate time, on the right

  18. How to model wireless mesh networks topology

    Sanni, M L; Hashim, A A; Anwar, F; Ali, S; Ahmed, G S M

    2013-01-01

    The specification of network connectivity model or topology is the beginning of design and analysis in Computer Network researches. Wireless Mesh Networks is an autonomic network that is dynamically self-organised, self-configured while the mesh nodes establish automatic connectivity with the adjacent nodes in the relay network of wireless backbone routers. Researches in Wireless Mesh Networks range from node deployment to internetworking issues with sensor, Internet and cellular networks. These researches require modelling of relationships and interactions among nodes including technical characteristics of the links while satisfying the architectural requirements of the physical network. However, the existing topology generators model geographic topologies which constitute different architectures, thus may not be suitable in Wireless Mesh Networks scenarios. The existing methods of topology generation are explored, analysed and parameters for their characterisation are identified. Furthermore, an algorithm for the design of Wireless Mesh Networks topology based on square grid model is proposed in this paper. The performance of the topology generated is also evaluated. This research is particularly important in the generation of a close-to-real topology for ensuring relevance of design to the intended network and validity of results obtained in Wireless Mesh Networks researches

  19. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study

    Smet, A.M. de; Kluytmans, J.A.; Blok, H.E.; Mascini, E.M.; Benus, R.F.; Bernards, A.T.; Kuijper, E.J.; Leverstein-van Hall, M.A.; Jansz, A.R.; Jongh, B.M. de; Asselt, G.J. van; Frenay, I.H.; Thijsen, S.F.; Conijn, S.N.; Kaan, J.A.; Arends, J.P.; Sturm, P.D.J.; Bootsma, M.C.; Bonten, M.J.

    2011-01-01

    BACKGROUND: Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for

  20. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units : an open-label, clustered group-randomised, crossover study

    de Smet, Anne Marie G. A.; Kluytmans, Jan A. J. W.; Blok, Hetty E. M.; Mascini, Ellen M.; Benus, Robin F. J.; Bernards, Alexandra T.; Kuijper, Ed J.; Leverstein-van Hall, Maurine A.; Jansz, Arjan R.; de Jongh, Bartelt M.; van Asselt, Gerard J.; Frenay, Ine H. M. E.; Thijsen, Steven F. T.; Conijn, Simon N. M.; Kaan, Jan A.; Arends, Jan P.; Sturm, Patrick D. J.; Bootsma, Martin C. J.; Bonten, Marc J. M.

    Background Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for prevention

  1. Fire performance of basalt FRP mesh reinforced HPC thin plates

    Hulin, Thomas; Hodicky, Kamil; Schmidt, Jacob Wittrup

    2013-01-01

    An experimental program was carried out to investigate the influence of basalt FRP (BFRP) reinforcing mesh on the fire behaviour of thin high performance concrete (HPC) plates applied to sandwich elements. Samples with BFRP mesh were compared to samples with no mesh, samples with steel mesh...

  2. Reducing wrong patient selection errors: exploring the design space of user interface techniques.

    Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

    2014-01-01

    Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients' identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed.

  3. Psychosocial and Patient Education Needs of Prostate Cancers Selecting Watchful Waiting

    Knight, Sara J; Latini, David M

    2006-01-01

    ... of this approach to disease management. We propose to gather data from prostate cancer patients selecting watchful waiting in lieu of an active treatment for their cancer in order to understand the psychosocial and symptom management...

  4. Cost effectiveness of selective decontamination of the digestive tract in liver transplant patients

    van Enckevort, PJ; Zwaveling, JH; Bottema, JT; Maring, JK; Klompmaker, IJ; Slooff, MJH; TenVergert, EM

    2001-01-01

    Objective: To assess the cost effectiveness of selective decontamination of the digestive tract (SDD) in liver transplant patients. Design: Randomised, placebo-controlled, double-blind trial with an integrated economic evaluation. Setting: Two university hospitals in The Netherlands. Cost

  5. [Medpor plus titanic mesh implant in the repair of orbital blowout fractures].

    Han, Xiao-hui; Zhang, Jia-yu; Cai, Jian-qiu; Shi, Ming-guang

    2011-05-10

    To study the efficacy of porous polyethylene (Medpor) plus titanic mesh sheets in the repair of orbital blowout fractures. A total of 20 patients underwent open surgical reduction with the combined usage of Medpor and titanic mesh. And they were followed up for average period of 14.5 months (range: 9 - 18). There is no infection or extrusion of medpor and titanic mesh in follow-up periods. There was no instance of decreased visual acuity at post-operation. And all cases of enophthalmos were corrected. The post-operative protrusion degree of both eyes was almost identical at less than 2 mm. The movement of eye balls was satisfactory in all directions. Diplopia disappeared in 18 cases with a cure rate of 90%, 1 case improved and 1 case persisted. Medpor plus titanic mesh implant is a safe and effective treatment in the repair of orbital blow out fractures.

  6. Infection of PTFE mesh 15 years following pedicled TRAM flap breast reconstruction: mechanism and aetiology.

    Elfaki, A; Gkorila, A; Khatib, M; Malata, C M

    2018-01-01

    The pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure is still widely used for breast reconstruction. The repair of the flap harvest site in the transverse rectus abdominis muscle and sheath is often assisted by the use of prosthetic meshes. This decreases the risk of abdominal wall weakness and herniation but, being a foreign body, it also carries the risk of infection. In this report, we describe the case of a 63-year-old patient who, whilst receiving chemotherapy for metastatic breast cancer, presented with an infected polytetrafluoroethylene mesh 15 years after pedicled TRAM flap immediate breast reconstruction. This necessitated mesh removal to treat the infection. Following a thorough review of the English literature, this is the longest recorded presentation of an abdominal prosthetic mesh infection. The mechanism and aetiology of such a late complication are discussed.

  7. Feasibility and outcome after laparoscopic ventral hernia repair using Proceed mesh

    Rosenberg, J.; Burcharth, J.

    2008-01-01

    laparoscopic ventral hernia repair using the Proceed mesh secured with tackers with a double crown technique. Patients were discharged according to standard discharge criteria, and follow-up was performed with a search in the national patient database and with manual search in the patients' files. RESULTS: Our...

  8. Exploring Visual Selective Attention towards Novel Stimuli in Alzheimer's Disease Patients

    Sarah A. Chau; Nathan Herrmann; Moshe Eizenman; Jonathan Chung; Krista L. Lanctôt

    2015-01-01

    Background: Alzheimer's disease (AD) is associated with selective attention impairments, which could contribute to cognitive and functional deficits. Selective attention can be explored through examination of novelty preference. Aims: In this study, we quantified novelty preference in AD patients by measuring visual scanning behaviour using an eye tracking paradigm. Methods: Mild-to-moderate AD patients and elderly controls viewed slides containing novel and repeated images simultaneously. Th...

  9. Surgical treatment of subcostal incisional hernia with polypropylene mesh - analysis of late results

    Marco Antonio de Oliveira Peres

    Full Text Available OBJECTIVE: To evaluate the results of subcostal incisional hernia repair using polypropylene mesh, the technical aspects of musculo-aponeurotic reconstruction, routine fixation of supra-aponeurotic mesh and follow-up for five years.METHODS: We conducted a retrospective study that assessed 24 patients undergoing subcostal incisional hernia repair with use of polypropylene mesh; 15 patients (62.5% were female; ages ranged from 33 to 82, and 79.1% had comorbidities.RESULTS: Early complications: three cases (12.5% of wound infection, three cases (12.5% of seroma, one case (4.1% of hematoma; and one case (4.1% of wound dehiscence. Late complications occurred in one case (4.1% of hernia recurrence attributed to technical failure in the fixation of the mesh and in one case (4.1% of chronic pain. There were no cases of exposure or rejection of the mesh.CONCLUSION: The subcostal incisional hernia, though not very relevant, requires adequate surgical treatment. Its surgical correction involves rebuilding the muscle-aponeurotic defect, supra-aponeurotic fixation of polypropylene mesh, with less complexity and lower rates of complications and recurrences.

  10. Efficacy of Prophylactic Mesh in End-Colostomy Construction: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

    Wang, Shuanhu; Wang, Wenbin; Zhu, Bing; Song, Guolei; Jiang, Congqiao

    2016-10-01

    Parastomal hernia is a very common complication after colostomy, especially end-colostomy. It is unclear whether prophylactic placement of mesh at the time of stoma formation could prevent parastomal hernia formation after surgery for rectal cancer. A systematic review and meta-analysis were conducted to evaluate the efficacy of prophylactic mesh in end-colostomy construction. PubMed, Embase, and the Cochrane Library were searched, covering records entered from their inception to September 2015. Randomized controlled trials (RCTs) comparing stoma with mesh to stoma without mesh after surgery for rectal cancer were included. The primary outcome was the incidence of parastomal hernia. Pooled risk ratios (RR) with 95 % confidence intervals (CI) were obtained using random effects models. Six RCTs containing 309 patients were included. Parastomal hernia occurred in 24.4 % (38 of 156) of patients with mesh and 50.3 % (77 of 153) of patients without mesh. Meta-analysis showed a lower incidence of parastomal hernia (RR, 0.42; 95 % CI 0.22-0.82) and reoperation related to parastomal hernia (RR, 0.23; 95 % CI 0.06-0.89) in patients with mesh. Stoma-related morbidity was similar between mesh group and non-mesh group (RR, 0.65; 95 % CI 0.33-1.30). Prophylactic placement of a mesh at the time of a stoma formation seems to be associated with a significant reduction in the incidence of parastomal hernia and reoperation related to parastomal hernia after surgery for rectal cancer, but not the rate of stoma-related morbidity. However, the results should be interpreted with caution because of the heterogeneity among the studies.

  11. Non-selective beta-blockers decrease thrombotic events in patients with heart failure

    De Peuter, Olav R.; Souverein, Patrick C.; Klungel, Olaf H.; Lip, Gregory Y.; Buller, Harry R.; De Boer, Anthonius; Kamphuisen, Pieter W.

    2010-01-01

    Background: Beta-blockers are often prescribed to patients with heart failure (HF) without distinctions between types of beta-blockers. The 2002 COMET study showed superiority of carvedilol (a non-selective beta-blocker) over metoprolol (selective beta-blocker) on mortality and cardiovascular events

  12. Mesh hernia repair and male infertility: a retrospective register study.

    Hallén, Magnus; Westerdahl, Johan; Nordin, Pär; Gunnarsson, Ulf; Sandblom, Gabriel

    2012-01-01

    Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further. Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and 2007 were cross-linked with all men in the same age group with the diagnosis of male infertility according to the Swedish National Patient Register. The cumulative and expected incidences of infertility were analyzed. Separate multivariate logistic analyses, adjusted for age and years elapsed since the first repair, were performed for men with unilateral and bilateral repair, respectively. Overall, 34,267 men were identified with a history of at least 1 inguinal hernia repair. A total of 233 (0.7%) of these had been given the diagnosis of male infertility after their first operation. We did not find any differences between expected and observed cumulative incidences of infertility in men operated with hernia repair. Men with bilateral hernia repair had a slightly increased risk for infertility when mesh was used on either side. However, the cumulative incidence was less than 1%. Inguinal hernia repair with mesh is not associated with an increased incidence of, or clinically important risk for, male infertility. Copyright © 2012 Mosby, Inc. All rights reserved.

  13. Feature-Sensitive Tetrahedral Mesh Generation with Guaranteed Quality

    Wang, Jun; Yu, Zeyun

    2012-01-01

    Tetrahedral meshes are being extensively used in finite element methods (FEM). This paper proposes an algorithm to generate feature-sensitive and high-quality tetrahedral meshes from an arbitrary surface mesh model. A top-down octree subdivision is conducted on the surface mesh and a set of tetrahedra are constructed using adaptive body-centered cubic (BCC) lattices. Special treatments are given to the tetrahedra near the surface such that the quality of the resulting tetrahedral mesh is prov...

  14. Multi-scale salient feature extraction on mesh models

    Yang, Yongliang; Shen, ChaoHui

    2012-01-01

    We present a new method of extracting multi-scale salient features on meshes. It is based on robust estimation of curvature on multiple scales. The coincidence between salient feature and the scale of interest can be established straightforwardly, where detailed feature appears on small scale and feature with more global shape information shows up on large scale. We demonstrate this multi-scale description of features accords with human perception and can be further used for several applications as feature classification and viewpoint selection. Experiments exhibit that our method as a multi-scale analysis tool is very helpful for studying 3D shapes. © 2012 Springer-Verlag.

  15. The impact of exercise myocardial perfusion SPECT imaging on the selection of patients for coronary angiography

    Song Liping; He Zuoxiang; Liu Xiujie; Shi Rongfang; Liu Yunzhong; Tian Yueqin; Zhang Xiaoli; Qin Xuewen; Chen Jilin; Gao Runlin

    2001-01-01

    Objective: Exercise 99 Tc m -MIBI myocardial perfusion SPECT is accurate for the diagnosis of coronary artery disease (CAD). This study assessed the impact of exercise myocardial perfusion imaging on the selection of patients for coronary angiography. Methods: 2188 consecutive patients who underwent exercise myocardial perfusion SPECT in authors' department in 1999 were retrospectively analyzed. Among them, 1807 were men, 381 women (average age: 53.5 +- 7.2 years). Overall, exercise myocardial SPECT was normal in 1731 patients, abnormal in 359 cases, and equivocal in 98 patients. There were 141 patients who underwent CAG within 60 days after myocardial SPECT. Results: Overall, 12% of the patients with abnormal SPECT imaging underwent coronary angiography, but only 5% of the patients with a normal SPECT imaging did (P < 0.001). Among these 141 patients who underwent coronary angiography, significant coronary stenosis was present in 91% of the patients who had had an abnormal SPECT imaging, but only 8% of those who had had a normal SPECT imaging (P < 0.001). In those patients who underwent coronary angiography, revascularization rate was 25% for the patients with abnormal SPECT imaging, but only 1% for the patients with a normal SPECT imaging. Conclusion: The results of exercise myocardial perfusion SPECT have a significant impact on the selection of patients for coronary angiography and revascularization

  16. Evaluation of a selective management strategy of patients with primary cystic neoplasms of the pancreas

    de Castro, S. M. M.; Houwert, J. T.; van der Gaag, N. A.; Busch, O. R. C.; van Gulik, T. M.; Gouma, D. J.

    2011-01-01

    Recent studies have shown that a selective group of patients with primary cystic neoplasms of the pancreas can be managed conservatively by radiological follow-up. The aim of this study was to analyze if such a strategy is efficient and safe. A retrospective analyses was performed of patients who

  17. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

    Han-Song Sheng

    2017-08-01

    Conclusion: Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.

  18. Native-tissue repair of isolated primary rectocele compared with nonabsorbable mesh

    Madsen, Lene Duch; Nussler, Emil; Kesmodel, Ulrik Schioler

    2017-01-01

    and included 3988 women with a primary operation for rectocele between 2006 and 2014: 3908 women had native-tissue repair, 80 were operated with nonabsorbable mesh. No concurrent operations were performed. Pre- and perioperative data were collected from doctors and patients. Patient-reported outcomes were......INTRODUCTION: We evaluated patient-reported outcomes and complications after treatment of isolated primary rectocele in routine health-care settings using native-tissue repair or nonabsorbable mesh. METHODS: We used prospective data from the Swedish National Register for Gynaecological Surgery...

  19. Cartesian anisotropic mesh adaptation for compressible flow

    Keats, W.A.; Lien, F.-S.

    2004-01-01

    Simulating transient compressible flows involving shock waves presents challenges to the CFD practitioner in terms of the mesh quality required to resolve discontinuities and prevent smearing. This paper discusses a novel two-dimensional Cartesian anisotropic mesh adaptation technique implemented for compressible flow. This technique, developed for laminar flow by Ham, Lien and Strong, is efficient because it refines and coarsens cells using criteria that consider the solution in each of the cardinal directions separately. In this paper the method will be applied to compressible flow. The procedure shows promise in its ability to deliver good quality solutions while achieving computational savings. The convection scheme used is the Advective Upstream Splitting Method (Plus), and the refinement/ coarsening criteria are based on work done by Ham et al. Transient shock wave diffraction over a backward step and shock reflection over a forward step are considered as test cases because they demonstrate that the quality of the solution can be maintained as the mesh is refined and coarsened in time. The data structure is explained in relation to the computational mesh, and the object-oriented design and implementation of the code is presented. Refinement and coarsening algorithms are outlined. Computational savings over uniform and isotropic mesh approaches are shown to be significant. (author)

  20. Mesh networks: an optimum solution for AMR

    Mimno, G.

    2003-12-01

    Characteristics of mesh networks and the advantage of using them in automatic meter reading equipment (AMR) are discussed. Mesh networks are defined as being similar to a fishing net made of knots and links. In mesh networks the knots represent meter sites and the links are the radio paths between the meter sites and the neighbourhood concentrator. In mesh networks any knot in the communications chain can link to any other and the optimum path is calculated by the network by hopping from meter to meter until the radio message reaches a concentrator. This mesh communications architecture is said to be vastly superior to many older types of radio-based meter reading technologies; its main advantage is that it not only significantly improves the economics of fixed network deployment, but also supports time-of-use metering, remote disconnect services and advanced features, such as real-time pricing, demand response, and other efficiency measures, providing a better return on investment and reliability.

  1. Patients' selection for treatment of caliceal diverticular stones with extracorporeal shock wave lithotripsy

    Lee, Won Hong; Lee, Hee Jeong; Son, Soon Yong; Kang, Seong Ho; Cho, Cheong Chan; Ryu, Meung Sun [AMC, Seoul (Korea, Republic of); Kim, Seung Kook [Kwang-Ju Health College, Kwang-Ju (Korea, Republic of)

    2001-06-01

    Symptoms of caliceal diverticular stones are commonly associated with pain, recurrent urinary tract infection and hematuria. The aim of this study is to select the proper patient for the application of more successful extracorporeal shock wave lithotripsy(ESWL) as a treatment of caliceal diverticular stone. 16 patients with caliceal diverticular stones were treated with ESWL, and all patients had single caliceal diverticulum. The diagnosis of caliceal diverticulum with stones was made by intraveneous pyelography to all patients. On these intravenous pyelogram, we also classified diverticular type, whether the diverticular neck is connected with urinary tract patently, diverticular site and stone number and size. All patients were followed after ESWL by plain film of the kidneys, ureters and bladder and interviewed. Of all patients 44% was shown stone-free completely, also 83% was rendered symptom-free. All patients whose diverticular neck connected with urinary tract patently on the intraveneous pyelogram became stone-free. Of solitary stone 60% and multiple stones (more than 2) 17% became symptom-free. The patients with infection before ESWL 75% had residual stones, of these patients 33% had slightly flank pain, and 25% of patients with stones recurred become stone-free. We propose that more successful ESWL for patients with caliceal diverticular stones select satisfactory patients including that the diverticular neck is connected with urinary tract patently, solitary stone and no infection simultaneously.

  2. Patients' selection for treatment of caliceal diverticular stones with extracorporeal shock wave lithotripsy

    Lee, Won Hong; Lee, Hee Jeong; Son, Soon Yong; Kang, Seong Ho; Cho, Cheong Chan; Ryu, Meung Sun; Kim, Seung Kook

    2001-01-01

    Symptoms of caliceal diverticular stones are commonly associated with pain, recurrent urinary tract infection and hematuria. The aim of this study is to select the proper patient for the application of more successful extracorporeal shock wave lithotripsy(ESWL) as a treatment of caliceal diverticular stone. 16 patients with caliceal diverticular stones were treated with ESWL, and all patients had single caliceal diverticulum. The diagnosis of caliceal diverticulum with stones was made by intraveneous pyelography to all patients. On these intravenous pyelogram, we also classified diverticular type, whether the diverticular neck is connected with urinary tract patently, diverticular site and stone number and size. All patients were followed after ESWL by plain film of the kidneys, ureters and bladder and interviewed. Of all patients 44% was shown stone-free completely, also 83% was rendered symptom-free. All patients whose diverticular neck connected with urinary tract patently on the intraveneous pyelogram became stone-free. Of solitary stone 60% and multiple stones (more than 2) 17% became symptom-free. The patients with infection before ESWL 75% had residual stones, of these patients 33% had slightly flank pain, and 25% of patients with stones recurred become stone-free. We propose that more successful ESWL for patients with caliceal diverticular stones select satisfactory patients including that the diverticular neck is connected with urinary tract patently, solitary stone and no infection simultaneously

  3. Evaluation of the effects of patient-selected music therapy on the sleep quality and pain intensity of burn patients

    Fatemeh Muhaddith Ardabili

    2016-02-01

    Full Text Available Background: Sleep disturbances and pain are some of the most common problems among burn patients, which have adverse effects on recovery process and patient comfort. Given the use of music as a non-pharmacological approach to alleviate pain and provide comfort, this study aimed to evaluate the effect of patient-selected music on sleep quality and pain intensity in burn patients. Methods: This clinical trial was conducted on burn patients hospitalized in one of the hospitals of Tehran, Iran in 2015. In total, 50 patients were selected using randomized convenience sampling and divided into two intervention (n=25 and control (n=25 groups. Intervention was carried out for the intervention group through playing instrumental music, selected by the patients, in three consecutive 45-minute sessions before sleep. Severity of pain in the participants was evaluated for three nights (before and five minutes after the intervention using visual analog scale (VAS. In addition, sleep quality of the samples was assessed three days before the intervention using Pittsburgh sleep quality index (PSQI and during the post-intervention days through interviews. The mentioned scales were applied for the control group as well. Data analysis was performed in SPSS version 18 using Chi-square, as well as paired and independent t-tests. Results: In this study, a significant improvement was observed in sleep quality (P<0.001 and pain intensity (P=0.012 in the participants of intervention group after listening to music. Moreover, a significant difference was observed between the study groups after the intervention in terms of mean sleep quality score (P<0.001 and pain intensity (P=0.046. Conclusion: According to the results of this study, application of patient-selected music therapy could be associated with a significant improve in sleep quality and decrease in pain intensity in burn patients. Therefore, it is recommended that this intervention approach be applied by

  4. Evaluation of the effect of patient-selected music on sleep quality and pain intensity in burn patients

    Mohaddes Ardabili Fatemeh

    2016-08-01

    Full Text Available Background and Objective: Sleep disturbances and pain are some of the most common problems among burn patients, which have adverse effects on recovery process and patient comfort. Given the use of music as a non-pharmacological approach to alleviate pain and provide comfort, this study aimed to evaluate the effect of patient-selected music on sleep quality and pain intensity in burn patients. Materials and Method: This clinical trial was conducted on burn patients hospitalized in one of the hospitals of Tehran, Iran in 2015. In total, 50 patients were selected using randomized convenience sampling and divided into two intervention (n=25 and control (n=25 groups. Intervention was carried out for the intervention group through playing instrumental music, selected by the patients, in three consecutive 45-minute sessions before sleep. Severity of pain in the participants was evaluated for three nights (before and five minutes after the intervention using visual analog scale (VAS. In addition, sleep quality of the samples was assessed three days before the intervention using Pittsburgh sleep quality index (PSQI and during the post-intervention days through interviews. The mentioned scales were applied for the control group as well. Data analysis was performed in SPSS version 18 using Chi-square, as well as paired and independent t-tests. Results: In this study, a significant improvement was observed in sleep quality (P<0.001  and pain intensity (P=0.012 in the participants of intervention group after listening to music. Moreover, a significant difference was observed between the study groups after the intervention in terms of mean sleep quality score (P<0.001 and pain intensity (P=0.046. Conclusion: According to the results of this study, application of patient-selected music therapy could be associated with a significant improve in sleep quality and decrease in pain intensity in burn patients. Therefore, it is recommended that this intervention

  5. 3D-2D Deformable Image Registration Using Feature-Based Nonuniform Meshes.

    Zhong, Zichun; Guo, Xiaohu; Cai, Yiqi; Yang, Yin; Wang, Jing; Jia, Xun; Mao, Weihua

    2016-01-01

    By using prior information of planning CT images and feature-based nonuniform meshes, this paper demonstrates that volumetric images can be efficiently registered with a very small portion of 2D projection images of a Cone-Beam Computed Tomography (CBCT) scan. After a density field is computed based on the extracted feature edges from planning CT images, nonuniform tetrahedral meshes will be automatically generated to better characterize the image features according to the density field; that is, finer meshes are generated for features. The displacement vector fields (DVFs) are specified at the mesh vertices to drive the deformation of original CT images. Digitally reconstructed radiographs (DRRs) of the deformed anatomy are generated and compared with corresponding 2D projections. DVFs are optimized to minimize the objective function including differences between DRRs and projections and the regularity. To further accelerate the above 3D-2D registration, a procedure to obtain good initial deformations by deforming the volume surface to match 2D body boundary on projections has been developed. This complete method is evaluated quantitatively by using several digital phantoms and data from head and neck cancer patients. The feature-based nonuniform meshing method leads to better results than either uniform orthogonal grid or uniform tetrahedral meshes.

  6. 3D-2D Deformable Image Registration Using Feature-Based Nonuniform Meshes

    Zichun Zhong

    2016-01-01

    Full Text Available By using prior information of planning CT images and feature-based nonuniform meshes, this paper demonstrates that volumetric images can be efficiently registered with a very small portion of 2D projection images of a Cone-Beam Computed Tomography (CBCT scan. After a density field is computed based on the extracted feature edges from planning CT images, nonuniform tetrahedral meshes will be automatically generated to better characterize the image features according to the density field; that is, finer meshes are generated for features. The displacement vector fields (DVFs are specified at the mesh vertices to drive the deformation of original CT images. Digitally reconstructed radiographs (DRRs of the deformed anatomy are generated and compared with corresponding 2D projections. DVFs are optimized to minimize the objective function including differences between DRRs and projections and the regularity. To further accelerate the above 3D-2D registration, a procedure to obtain good initial deformations by deforming the volume surface to match 2D body boundary on projections has been developed. This complete method is evaluated quantitatively by using several digital phantoms and data from head and neck cancer patients. The feature-based nonuniform meshing method leads to better results than either uniform orthogonal grid or uniform tetrahedral meshes.

  7. Stress adapted embroidered meshes with a graded pattern design for abdominal wall hernia repair

    Hahn, J.; Bittrich, L.; Breier, A.; Spickenheuer, A.

    2017-10-01

    Abdominal wall hernias are one of the most relevant injuries of the digestive system with 25 million patients in 2013. Surgery is recommended primarily using allogenic non-absorbable wrap-knitted meshes. These meshes have in common that their stress-strain behaviour is not adapted to the anisotropic behaviour of native abdominal wall tissue. The ideal mesh should possess an adequate mechanical behaviour and a suitable porosity at the same time. An alternative fabrication method to wrap-knitting is the embroidery technology with a high flexibility in pattern design and adaption of mechanical properties. In this study, a pattern generator was created for pattern designs consisting of a base and a reinforcement pattern. The embroidered mesh structures demonstrated different structural and mechanical characteristics. Additionally, the investigation of the mechanical properties exhibited an anisotropic mechanical behaviour for the embroidered meshes. As a result, the investigated pattern generator and the embroidery technology allow the production of stress adapted mesh structures that are a promising approach for hernia reconstruction.

  8. The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study.

    Miklos, John R; Chinthakanan, Orawee; Moore, Robert D; Mitchell, Gretchen K; Favors, Sheena; Karp, Deborah R; Northington, Gina M; Nogueiras, Gladys M; Davila, G Willy

    2016-06-01

    The objective was to report patterns of sling and transvaginal mesh-related complications using the IUGA/ICS classification of prosthesis-related complications. This was a retrospective chart review of all patients who underwent surgical removal of sling, transvaginal mesh, and sacrocolpopexy for mesh-related complications from 2011 to 2013 at three tertiary referral centers. The International Urogynecological Association (IUGA)/International Continence Society (ICS) classification system was utilized. We identified 445 patients with mesh complications, 506 pieces of synthetic mesh were removed, and 587 prostheses-related complications were classified. 3.7 % of patients had viscus organ penetration or vaginal exposure as their presenting chief complaint and 59.7 % were classified as not having any vaginal epithelial separation or category 1. The most common category was spontaneous pain (1Be: 32.5 %) followed by dyspareunia (1Bc: 14.7 %). The sling group was 20 % more likely to have pain compared with the pelvic organ prolapse (POP) mesh group (OR 1.2, 95 % CI 0.8-1.6). The most commonly affected site (S2) was away from the suture line (49 %). Compared with the sling group, the POP group had a higher rate of mesh exposure, which mostly occurred at the suture line area. The majority of patients presented with mesh-related complications more than 1 year post-insertion (T4; average 3.68 ± 2.47 years). Surgeons should be aware that patients with vaginal mesh complications routinely exhibit complications more than 1 year after the implantation with pain as the most common presenting symptom.

  9. Comparison of the Bronchodilative Effects of Salbutamol Delivered via Three Mesh Nebulizers in Children with Bronchial Asthma

    Fumitake Kurosaka

    2009-01-01

    Conclusions: Overall, all 3 mesh nebulizers were useful devices in treating bronchial asthma, although some differences in lung function improvement were evident. The limitation of this study is that subjects did not include patients with severe asthma attacks.

  10. Selective oropharyngeal decontamination versus selective digestive decontamination in critically ill patients: a meta-analysis of randomized controlled trials

    Zhao D

    2015-07-01

    Full Text Available Di Zhao,1,* Jian Song,2,* Xuan Gao,3 Fei Gao,4 Yupeng Wu,2 Yingying Lu,5 Kai Hou1 1Department of Neurosurgery, The First Hospital of Hebei Medical University, 2Department of Neurosurgery, 3Department of Neurology, The Second Hospital of Hebei Medical University, 4Hebei Provincial Procurement Centers for Medical Drugs and Devices, 5Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang People’s Republic of China *These authors contributed equally to this work Background: Selective digestive decontamination (SDD and selective oropharyngeal decontamination (SOD are associated with reduced mortality and infection rates among patients in intensive care units (ICUs; however, whether SOD has a superior effect than SDD remains uncertain. Hence, we conducted a meta-analysis of randomized controlled trials (RCTs to compare SOD with SDD in terms of clinical outcomes and antimicrobial resistance rates in patients who were critically ill. Methods: RCTs published in PubMed, Embase, and Web of Science were systematically reviewed to compare the effects of SOD and SDD in patients who were critically ill. Outcomes included day-28 mortality, length of ICU stay, length of hospital stay, duration of mechanical ventilation, ICU-acquired bacteremia, and prevalence of antibiotic-resistant Gram-negative bacteria. Results were expressed as risk ratio (RR with 95% confidence intervals (CIs, and weighted mean differences (WMDs with 95% CIs. Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. Results: A total of four RCTs involving 23,822 patients met the inclusion criteria and were included in this meta-analysis. Among patients whose admitting specialty was surgery, cardiothoracic surgery (57.3% and neurosurgery (29.7% were the two main types of surgery being performed. Pooled results showed that SOD had similar effects as SDD in day-28 mortality (RR =1

  11. Connectivity editing for quad-dominant meshes

    Peng, Chihan

    2013-08-01

    We propose a connectivity editing framework for quad-dominant meshes. In our framework, the user can edit the mesh connectivity to control the location, type, and number of irregular vertices (with more or fewer than four neighbors) and irregular faces (non-quads). We provide a theoretical analysis of the problem, discuss what edits are possible and impossible, and describe how to implement an editing framework that realizes all possible editing operations. In the results, we show example edits and illustrate the advantages and disadvantages of different strategies for quad-dominant mesh design. © 2013 The Author(s) Computer Graphics Forum © 2013 The Eurographics Association and John Wiley & Sons Ltd.

  12. ZONE: a finite element mesh generator

    Burger, M.J.

    1976-05-01

    The ZONE computer program is a finite-element mesh generator which produces the nodes and element description of any two-dimensional geometry. The geometry is subdivided into a mesh of quadrilateral and triangular zones arranged sequentially in an ordered march through the geometry. The order of march can be chosen so that the minimum bandwidth is obtained. The node points are defined in terms of the x and y coordinates in a global rectangular coordinate system. The zones generated are quadrilaterals or triangles defined by four node points in a counterclockwise sequence. Node points defining the outside boundary are generated to describe pressure boundary conditions. The mesh that is generated can be used as input to any two-dimensional as well as any axisymmetrical structure program. The output from ZONE is essentially the input file to NAOS, HONDO, and other axisymmetric finite element programs. 14 figures

  13. Open preperitoneal groin hernia repair with mesh

    Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    Background For the repair of inguinal hernias, several surgical methods have been presented where the purpose is to place a mesh in the preperitoneal plane through an open access. The aim of this systematic review was to describe preperitoneal repairs with emphasis on the technique. Data sources...... A systematic review was conducted and reported according to the PRISMA statement. PubMed, Cochrane library and Embase were searched systematically. Studies were included if they provided clinical data with more than 30 days follow up following repair of an inguinal hernia with an open preperitoneal mesh......-analysis. Open preperitoneal techniques with placement of a mesh through an open approach seem promising compared with the standard anterior techniques. This systematic review provides an overview of these techniques together with a description of surgical methods and clinical outcomes....

  14. Open preperitoneal groin hernia repair with mesh

    Andresen, Kristoffer; Rosenberg, Jacob

    2017-01-01

    BACKGROUND: For the repair of inguinal hernias, several surgical methods have been presented where the purpose is to place a mesh in the preperitoneal plane through an open access. The aim of this systematic review was to describe preperitoneal repairs with emphasis on the technique. DATA SOURCES......: A systematic review was conducted and reported according to the PRISMA statement. PubMed, Cochrane library and Embase were searched systematically. Studies were included if they provided clinical data with more than 30 days follow up following repair of an inguinal hernia with an open preperitoneal mesh......-analysis. Open preperitoneal techniques with placement of a mesh through an open approach seem promising compared with the standard anterior techniques. This systematic review provides an overview of these techniques together with a description of surgical methods and clinical outcomes....

  15. Patient's decision making in selecting a hospital for elective orthopaedic surgery.

    Moser, Albine; Korstjens, Irene; van der Weijden, Trudy; Tange, Huibert

    2010-12-01

    The admission to a hospital for elective surgery, like arthroplasty, can be planned ahead. The elective nature of arthroplasty and the increasing stimulus of the public to critically select a hospital raise the issue of how patients actually take such decisions. The aim of this paper is to describe the decision-making process of selecting a hospital as experienced by people who underwent elective joint arthroplasty and to understand what factors influenced the decision-making process. Qualitative descriptive study with 18 participants who had a hip or knee replacement within the last 5 years. Data were gathered from eight individual interviews and four focus group interviews and analysed by content analysis. Three categories that influenced the selection of a hospital were revealed: information sources, criteria in decision making and decision-making styles within the GP- patient relationship. Various contextual aspects influenced the decision-making process. Most participants gave higher priority to the selection of a medical specialist than to the selection of a hospital. Selecting a hospital for arthroplasty is extremely complex. The decision-making process is a highly individualized process because patients have to consider and assimilate a diversity of aspects, which are relevant to their specific situation. Our findings support the model of shared decision making, which indicates that general practitioners should be attuned to the distinct needs of each patient at various moments during the decision making, taking into account personal, medical and contextual factors. © 2010 Blackwell Publishing Ltd.

  16. Unstructured Adaptive Meshes: Bad for Your Memory?

    Biswas, Rupak; Feng, Hui-Yu; VanderWijngaart, Rob

    2003-01-01

    This viewgraph presentation explores the need for a NASA Advanced Supercomputing (NAS) parallel benchmark for problems with irregular dynamical memory access. This benchmark is important and necessary because: 1) Problems with localized error source benefit from adaptive nonuniform meshes; 2) Certain machines perform poorly on such problems; 3) Parallel implementation may provide further performance improvement but is difficult. Some examples of problems which use irregular dynamical memory access include: 1) Heat transfer problem; 2) Heat source term; 3) Spectral element method; 4) Base functions; 5) Elemental discrete equations; 6) Global discrete equations. Nonconforming Mesh and Mortar Element Method are covered in greater detail in this presentation.

  17. Local adaptive mesh refinement for shock hydrodynamics

    Berger, M.J.; Colella, P.; Lawrence Livermore Laboratory, Livermore, 94550 California)

    1989-01-01

    The aim of this work is the development of an automatic, adaptive mesh refinement strategy for solving hyperbolic conservation laws in two dimensions. There are two main difficulties in doing this. The first problem is due to the presence of discontinuities in the solution and the effect on them of discontinuities in the mesh. The second problem is how to organize the algorithm to minimize memory and CPU overhead. This is an important consideration and will continue to be important as more sophisticated algorithms that use data structures other than arrays are developed for use on vector and parallel computers. copyright 1989 Academic Press, Inc

  18. Adaptive mesh refinement for storm surge

    Mandli, Kyle T.; Dawson, Clint N.

    2014-01-01

    An approach to utilizing adaptive mesh refinement algorithms for storm surge modeling is proposed. Currently numerical models exist that can resolve the details of coastal regions but are often too costly to be run in an ensemble forecasting framework without significant computing resources. The application of adaptive mesh refinement algorithms substantially lowers the computational cost of a storm surge model run while retaining much of the desired coastal resolution. The approach presented is implemented in the GeoClaw framework and compared to ADCIRC for Hurricane Ike along with observed tide gauge data and the computational cost of each model run. © 2014 Elsevier Ltd.

  19. MUSIC: a mesh-unrestricted simulation code

    Bonalumi, R.A.; Rouben, B.; Dastur, A.R.; Dondale, C.S.; Li, H.Y.H.

    1978-01-01

    A general formalism to solve the G-group neutron diffusion equation is described. The G-group flux is represented by complementing an ''asymptotic'' mode with (G-1) ''transient'' modes. A particular reduction-to-one-group technique gives a high computational efficiency. MUSIC, a 2-group code using the above formalism, is presented. MUSIC is demonstrated on a fine-mesh calculation and on 2 coarse-mesh core calculations: a heavy-water reactor (HWR) problem and the 2-D lightwater reactor (LWR) IAEA benchmark. Comparison is made to finite-difference results

  20. Adaptive mesh refinement for storm surge

    Mandli, Kyle T.

    2014-03-01

    An approach to utilizing adaptive mesh refinement algorithms for storm surge modeling is proposed. Currently numerical models exist that can resolve the details of coastal regions but are often too costly to be run in an ensemble forecasting framework without significant computing resources. The application of adaptive mesh refinement algorithms substantially lowers the computational cost of a storm surge model run while retaining much of the desired coastal resolution. The approach presented is implemented in the GeoClaw framework and compared to ADCIRC for Hurricane Ike along with observed tide gauge data and the computational cost of each model run. © 2014 Elsevier Ltd.

  1. Long-term results of incisional hernia repair with retromuscular mesh

    Miran Rems

    2011-04-01

    Conclusions: The retromuscular mesh placement for postoperative hernia repair results in a low rate of recurrences and postoperative complications. Complications are more common in patients admitted due to incarceration and in patients having suffered from stoma. Pain inflicted by postoperative hernia repair is an underrated with treatment results.

  2. Treatment of Mesh Skin Grafted Scars Using a Plasma Skin Regeneration System

    Takamitsu Higashimori

    2010-01-01

    Full Text Available Objectives. Several modalities have been advocated to treat traumatic scars, including surgical techniques and laser resurfacing. Recently, a plasma skin regeneration (PSR system has been investigated. There are no reports on plasma treatment of mesh skin grafted scars. The objective of our study is to evaluate the effectiveness and complications of plasma treatment of mesh skin grafted scars in Asian patients. Materials and Methods. Four Asian patients with mesh skin grafted scars were enrolled in the study. The plasma treatments were performed at monthly intervals with PSR, using energy settings of 3 to 4 J. Improvement was determined by patient questionnaires and physician evaluation of digital photographs taken prior to treatment and at 3 months post treatment. The patients were also evaluated for any side effects from the treatment. Results. All patients showed more than 50% improvement. The average pain score on a 10-point scale was 6.9 +/− 1.2 SD and all patients tolerated the treatments. Temporary, localized hypopigmentation was observed in two patients. Hyperpigmentation and worsening of scarring were not observed. Conclusions. Plasma treatment is clinically effective and is associated with minimal complications when used to treat mesh skin grafted scars in Asian patients.

  3. Long-term quality-of-life outcome after mesh sacrocolpopexy for vaginal vault prolapse.

    Thomas, Arun Z

    2009-12-01

    To evaluate the long-term outcome of mesh sacrocolpopexy (MSC, which aims to restore normal pelvic floor anatomy to alleviate prolapse related symptoms) and its effect on patient\\'s quality of life, as women with vaginal vault prolapse commonly have various pelvic floor symptoms that can affect urinary, rectal and sexual function.

  4. Supracricoid hemilaryngopharyngectomy for selected pyriform sinus carcinoma patients – a retrospective chart review

    Yiotakis Ioannis E

    2009-08-01

    Full Text Available Abstract Background The aim of this study is to assess the functional and oncologic results of supracricoid hemilaryngopharyngectomy and report our experience in the technique, local control and overall survival rates. Materials and methods 18 selected patients with pyriform sinus cancer treated by supracricoid hemilaryngopharyngectomy in a University Hospital setting. Retrospective chart review was used to assess functional and oncologic results of the procedure. Results The actuarial 5 year survival rate in our study was 55.56% and the actuarial neck recurrence rate was 16.67%. All patients were successfully decannulated. Aspiration pneumonia was the most common postoperative complication (22.23% and was treated mostly conservatively. One patient required a temporary gastrostomy but no patient needed total laryngectomy in the postoperative period. Conclusion Supracricoid hemilaryngopharyngectomy in experienced hands is a reliable technique for selected patients with pyriform sinus cancer.

  5. Postherniotomy dysejaculation: successful treatment with mesh removal and nerve transection

    Aasvang, Eske Kvanner; Kehlet, H.

    2008-01-01

    Dysejaculation following groin hernia repair can occur in about 1-2% of patients, resulting in impairment of sexual function. We report a case of chronic postherniotomy dysejaculation treated with transection of the ilioinguinal and iliohypogastric nerves and decompression of vas deferens...... that was embedded and twisted in shrunken mesh and scar tissue. At three months follow-up, there was reduced overall pain and no dysejaculation, and quantitative sensory testing showed reversal of sensory abnormalities, except for sensory loss, compared with preoperative values Udgivelsesdato: 2008/12...

  6. Pure transvaginal excision of mesh erosion involving the bladder.

    Firoozi, Farzeen; Goldman, Howard B

    2013-06-01

    We present a pure transvaginal approach to the removal of eroded mesh involving the bladder secondary to placement of transvaginal mesh for management of pelvic organ prolapse (POP) using a mesh kit. Although technically challenging, we demonstrate the feasibility of a purely transvaginal approach, avoiding a potentially more morbid transabdominal approach. The video presents the surgical technique of pure transvaginal excision of mesh erosion involving the bladder after mesh placement using a prolapse kit was performed. This video shows that purely transvaginal removal of mesh erosion involving the bladder can be done safely and is feasible.

  7. Properties of meshes used in hernia repair: a comprehensive review of synthetic and biologic meshes.

    Ibrahim, Ahmed M S; Vargas, Christina R; Colakoglu, Salih; Nguyen, John T; Lin, Samuel J; Lee, Bernard T

    2015-02-01

    Data on the mechanical properties of the adult human abdominal wall have been difficult to obtain rendering manufacture of the ideal mesh for ventral hernia repair a challenge. An ideal mesh would need to exhibit greater biomechanical strength and elasticity than that of the abdominal wall. The aim of this study is to quantitatively compare the biomechanical properties of the most commonly used synthetic and biologic meshes in ventral hernia repair and presents a comprehensive literature review. A narrative review of the literature was performed using the PubMed database spanning articles from 1982 to 2012 including a review of company Web sites to identify all available information relating to the biomechanical properties of various synthetic and biologic meshes used in ventral hernia repair. There exist differences in the mechanical properties and the chemical nature of different meshes. In general, most synthetic materials have greater stiffness and elasticity than what is required for abdominal wall reconstruction; however, each exhibits unique properties that may be beneficial for clinical use. On the contrary, biologic meshes are more elastic but less stiff and with a lower tensile strength than their synthetic counterparts. The current standard of practice for the treatment of ventral hernias is the use of permanent synthetic mesh material. Recently, biologic meshes have become more frequently used. Most meshes exhibit biomechanical properties over the known abdominal wall thresholds. Augmenting strength requires increasing amounts of material contributing to more stiffness and foreign body reaction, which is not necessarily an advantage. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study.

    Turk, Aquilla S; Magarick, Jordan Asher; Frei, Don; Fargen, Kyle Michael; Chaudry, Imran; Holmstedt, Christine A; Nicholas, Joyce; Mocco, J; Turner, Raymond D; Huddle, Daniel; Loy, David; Bellon, Richard; Dooley, Gwendolyn; Adams, Robert; Whaley, Michelle; Fanale, Chris; Jauch, Edward

    2013-11-01

    The treatment of acute ischemic stroke is traditionally centered on time criteria, although recent evidence suggests that physiologic neuroimaging may be useful. In a multicenter study we evaluated the use of CT perfusion, regardless of time from symptom onset, in patients selected for intra-arterial treatment of ischemic stroke. Three medical centers retrospectively assessed stroke patients with a National Institute of Health Stroke Scale of ≥ 8, regardless of time from symptom onset. CT perfusion maps were qualitatively assessed. Patients with defined salvageable penumbra underwent intra-arterial revascularization of their occlusion. Functional outcome using the modified Rankin Score (mRS) was recorded. Two hundred and forty-seven patients were selected to undergo intra-arterial treatment based on CT perfusion imaging. The median time from symptom onset to procedure was 6 h. Patients were divided into two groups for analysis: ≤ 8 h and >8 h from symptom onset to endovascular procedure. We found no difference in functional outcome between the two groups (42.8% and 41.9% achieved 90-day mRS ≤ 2, respectively (p=1.0), and 54.9% vs 55.4% (p=1.0) achieved 90-day mRS ≤ 3, respectively). Overall, 48 patients (19.4%) had hemorrhages, of which 20 (8.0%) were symptomatic, with no difference between the groups (p=1.0). In a multicenter study, we demonstrated similar rates of good functional outcome and intracranial hemorrhage in patients with ischemic stroke when endovascular treatment was performed based on CT perfusion selection rather than time-guided selection. Our findings suggest that physiologic imaging-guided patient selection rather than time for endovascular reperfusion in ischemic stroke may be effective and safe.

  9. Transvaginal Resection of an Infected Sacrocolpopexy Mesh by Single-Port Trocar.

    Schaub, Marie; Lecointre, Lise; Faller, Emilie; Boisramé, Thomas; Baldauf, Jean-Jacques; Akladios, Cherif Youssef

    Laparoscopy using a single port improves morbidity while keeping the same level of requirement. This technique has been evaluated in gynecology for salpingectomy, ovarian surgery, and hysterectomy. Here, the authors illustrate a new use of a single port using the transvaginal approach. Case report (Canadian Task Force classification III). Tertiary referral center in Strasbourg, France. Woman age 59 years. Single-port platform used in the transvaginal approach for resection of sacrocolpopexy mesh. The local institutional review board approved the video. A 59-year-old woman suffering from insulin-dependent diabetes and a tobacco user had 2 laparoscopic sacrocolpopexies for recurrent rectocele, the first in 2007 and the second in 2012. The sequences were marked by mesh erosion and granuloma in the vagina, requiring its surgical excision in 2016. The patient was then symptomatic, with an increasingly foul-smelling vaginal discharge with recurrent mesh erosion. Magnetic resonance imaging showed an abscess formation along the length of the mesh to the promontory. The patient then underwent surgery, realized under probabilistic antibiotic therapy, consisting of complete excision of the sacrocolpopexy mesh by the transvaginal approach. After putting the single-port trocar (GelPoint; Applied Medical, Rancho Santa Margarita, CA) into the vagina and obtaining distension with the insufflator (AirSeal; Conmed, Utica, NY), classic laparoscopic instruments were introduced by the single-port trocar. The mesh was entirely resected in the retroperitoneal space. Mesh was again used because the exposed space is almost always surrounded by loose granulation tissue that facilitates dissection and also prevents injury to adjacent structures such as bladder, rectum, and peritoneum. Moreover, the opening of adjacent structures will manifest gas leaks and, consequently, loss of the pneumovagina. At the end of procedure, the vagina is not closed to permit optimal drainage with a multitubular

  10. Indications and Complications Associated with the Removal of 506 Pieces of Vaginal Mesh Used in Pelvic Floor Reconstruction: A Multicenter Study.

    Miklos, John R; Chinthakanan, Orawee; Moore, Robert D; Karp, Deborah R; Nogueiras, Gladys M; Davila, G Willy

    2016-10-26

    Synthetic mesh utilized to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can often result in postoperative complications. The objectives of this study were to determine: 1) the most common indications for mesh removal; 2) the incidences of the removal of specific mesh procedures (such as suburethral sling [SUS], transvaginal mesh [TVM], or sacrocolpopexy); and 3) the idences and types of surgical complications associated with mesh removal. This was a retrospective study. Design Classification: Canadian Task Force II-3. Three tertiary referral centers in the United States. We examined data from all patients at the three centers who underwent surgical removal of synthetic materials from previous SUS, TVM, and sacrocolpopexy procedures for mesh-related complications from 2011 to 2013. Patients underwent vaginal, intra-abdominal, and inguinal mesh revisions by cutting, partial removal, or total removal of the mesh for mesh-related complications. Overall, 445 patients with complications underwent mesh removal laparoscopically, via groin dissection and/or transvaginally. There were a total of 506 mesh products removed. Of these, 56.5% were slings and 43.5% were for pelvic organ prolapse (POP). Synthetic mesh removed from patients included: transvaginal mesh (TVM) anterior for anterior vaginal prolapse, TVM posterior for posterior vaginal prolapse, sacrocolpopexy mesh, and suburethral slings (SUS) for stress urinary incontinence. Synthetic SUS removed included: retropubic (RPS), transobturator (TOT), and single-incision slings (SIS). TOT was the most common type of sling removed. Patients with a sling who only complained of vaginal pain with or without intercourse underwent a vaginal approach for surgical revision/removal of the sling (86.6%). Patients with an RPS with lower abdominal/suprapubic pain and vaginal pain underwent a vaginal and laparoscopic approach for sling removal (18.4%). Patients with a TOT sling who complained of vaginal and

  11. Dasatinib for the treatment of chronic myeloid leukemia: patient selection and special considerations.

    Keskin, Dilek; Sadri, Sevil; Eskazan, Ahmet Emre

    2016-01-01

    Dasatinib is one of the second-generation tyrosine kinase inhibitors used in imatinib resistance and/or intolerance, as well as in the frontline setting in patients with chronic myeloid leukemia-chronic phase, and also in patients with advanced disease. It is also utilized in Philadelphia chromosome-positive acute lymphocytic leukemia. While choosing the appropriate tyrosine kinase inhibitor (ie, dasatinib) for each individual patient, comorbidities and BCR-ABL1 kinase domain mutations should always be taken into consideration, among other things. This review mainly focuses on patient selection prior to dasatinib administration in the treatment of chronic myeloid leukemia.

  12. A PCT-wide collaborative clinical audit selecting recall intervals for patients according to risk.

    Cannell, P J

    2011-03-26

    This audit was carried out to assess the level to which recall intervals were individually and appropriately selected for patients attending dental practices across a primary care trust (PCT) area in Essex. A retrospective audit was carried out by reference to patient records to assess various criteria, including whether patients were categorised according to risk of oral disease, whether an appropriate recall had been selected and whether a discussion regarding a recall interval had been undertaken. An educational event highlighting the issue of recall intervals was held. Subsequent to this a prospective audit was undertaken to assess relevant criteria. Prospective audit data showed a marked increase in the use of patient risk assessments for caries, periodontal disease, oral cancer and non-carious tooth surface loss (NCTSL). Recall intervals were also more often selected based on a patient's risk status and discussed with the patient compared to that observed in the retrospective audit data. This audit was successful as a tool to bring about change in the behaviour of dentists regarding their determination of appropriate recall intervals for patients. Whether that change in behaviour is long-term or transient requires further investigation.

  13. Highly Symmetric and Congruently Tiled Meshes for Shells and Domes

    Rasheed, Muhibur; Bajaj, Chandrajit

    2016-01-01

    We describe the generation of all possible shell and dome shapes that can be uniquely meshed (tiled) using a single type of mesh face (tile), and following a single meshing (tiling) rule that governs the mesh (tile) arrangement with maximal vertex, edge and face symmetries. Such tiling arrangements or congruently tiled meshed shapes, are frequently found in chemical forms (fullerenes or Bucky balls, crystals, quasi-crystals, virus nano shells or capsids), and synthetic shapes (cages, sports domes, modern architectural facades). Congruently tiled meshes are both aesthetic and complete, as they support maximal mesh symmetries with minimal complexity and possess simple generation rules. Here, we generate congruent tilings and meshed shape layouts that satisfy these optimality conditions. Further, the congruent meshes are uniquely mappable to an almost regular 3D polyhedron (or its dual polyhedron) and which exhibits face-transitive (and edge-transitive) congruency with at most two types of vertices (each type transitive to the other). The family of all such congruently meshed polyhedra create a new class of meshed shapes, beyond the well-studied regular, semi-regular and quasi-regular classes, and their duals (platonic, Catalan and Johnson). While our new mesh class is infinite, we prove that there exists a unique mesh parametrization, where each member of the class can be represented by two integer lattice variables, and moreover efficiently constructable. PMID:27563368

  14. Parallel Adaptive Mesh Refinement for High-Order Finite-Volume Schemes in Computational Fluid Dynamics

    Schwing, Alan Michael

    For computational fluid dynamics, the governing equations are solved on a discretized domain of nodes, faces, and cells. The quality of the grid or mesh can be a driving source for error in the results. While refinement studies can help guide the creation of a mesh, grid quality is largely determined by user expertise and understanding of the flow physics. Adaptive mesh refinement is a technique for enriching the mesh during a simulation based on metrics for error, impact on important parameters, or location of important flow features. This can offload from the user some of the difficult and ambiguous decisions necessary when discretizing the domain. This work explores the implementation of adaptive mesh refinement in an implicit, unstructured, finite-volume solver. Consideration is made for applying modern computational techniques in the presence of hanging nodes and refined cells. The approach is developed to be independent of the flow solver in order to provide a path for augmenting existing codes. It is designed to be applicable for unsteady simulations and refinement and coarsening of the grid does not impact the conservatism of the underlying numerics. The effect on high-order numerical fluxes of fourth- and sixth-order are explored. Provided the criteria for refinement is appropriately selected, solutions obtained using adapted meshes have no additional error when compared to results obtained on traditional, unadapted meshes. In order to leverage large-scale computational resources common today, the methods are parallelized using MPI. Parallel performance is considered for several test problems in order to assess scalability of both adapted and unadapted grids. Dynamic repartitioning of the mesh during refinement is crucial for load balancing an evolving grid. Development of the methods outlined here depend on a dual-memory approach that is described in detail. Validation of the solver developed here against a number of motivating problems shows favorable

  15. Lichtenstein Mesh Repair (LMR) v/s Modified Bassini’s Repair (MBR) + Lichtenstein Mesh Repair of Direct Inguinal Hernias in Rural Population – A Comparative Study

    Patil, Santosh M; Kumar, Ashok; Kumar, Kuthadi Sravan; Mithun, Gorre

    2016-01-01

    Introduction Lichtenstein’s tension free mesh hernioplasty is the commonly done open technique for inguinal hernias. As our hospital is in rural area, majority of patients are labourers, open hernias are commonly done. The present study was done by comparing Lichtenstein Mesh Repair (LMR) v/s Modified Bassini’s repair (MBR) + Lichtenstein mesh repair (LMR) of direct Inguinal Hernias to compare the technique of both surgeries and its outcome like postoperative complications and recurrence rate. Materials and Methods A comparative randomized study was conducted on patients reporting to MNR hospital, sangareddy with direct inguinal hernias. A total of fifty consecutive patients were included in this study of which, 25 patients were operated by LMR and 25 patients were operated by MBR+LMR and followed up for a period of two years. The outcomes of the both techniques were compared. Results Study involved 25 each of Lichtenstein’s mesh repair (LMR) and modified bassini’s repair (MBR) + LMR, over a period of 2 years. The duration of surgery for lichtenstein mesh repair is around 34.56 min compared to LMR+MBR, which is 47.56 min which was statistically significant (p-value is MBR group in POD 1, but not statistically significant (p-value is 0.0949) and from POD 7 the pain was almost similar in both groups. The recurrence rate is 2% for LMR and 0% for MBR+LMR. Conclusion LMR+MBR was comparatively better than only LMR in all direct inguinal hernias because of low recurrence rate (0%) and low postoperative complications, which showed in our present study. PMID:27042517

  16. Lichtenstein Mesh Repair (LMR) v/s Modified Bassini's Repair (MBR) + Lichtenstein Mesh Repair of Direct Inguinal Hernias in Rural Population - A Comparative Study.

    Patil, Santosh M; Gurujala, Avinash; Kumar, Ashok; Kumar, Kuthadi Sravan; Mithun, Gorre

    2016-02-01

    Lichtenstein's tension free mesh hernioplasty is the commonly done open technique for inguinal hernias. As our hospital is in rural area, majority of patients are labourers, open hernias are commonly done. The present study was done by comparing Lichtenstein Mesh Repair (LMR) v/s Modified Bassini's repair (MBR) + Lichtenstein mesh repair (LMR) of direct Inguinal Hernias to compare the technique of both surgeries and its outcome like postoperative complications and recurrence rate. A comparative randomized study was conducted on patients reporting to MNR hospital, sangareddy with direct inguinal hernias. A total of fifty consecutive patients were included in this study of which, 25 patients were operated by LMR and 25 patients were operated by MBR+LMR and followed up for a period of two years. The outcomes of the both techniques were compared. Study involved 25 each of Lichtenstein's mesh repair (LMR) and modified bassini's repair (MBR) + LMR, over a period of 2 years. The duration of surgery for lichtenstein mesh repair is around 34.56 min compared to LMR+MBR, which is 47.56 min which was statistically significant (p-value is MBR group in POD 1, but not statistically significant (p-value is 0.0949) and from POD 7 the pain was almost similar in both groups. The recurrence rate is 2% for LMR and 0% for MBR+LMR. LMR+MBR was comparatively better than only LMR in all direct inguinal hernias because of low recurrence rate (0%) and low postoperative complications, which showed in our present study.

  17. Symptoms and Character Traits in Patients Selected for Long-term Psychodynamic Psychotherapy

    Wilczek, Alexander; Weinryb, Robert M.; Gustavsson, Petter J.; Barber, Jacques P.; Schubert, Johan; ÅSBERG, Marie

    1998-01-01

    In this naturalistic study of 55 outpatients selected for long-term psychodynamic psychotherapy, two Swedish assessment instruments are presented (the Karolinska Psychodynamic Profile and the Karolinska Scales of Personality), and the significance of psychodynamic criteria for the selection of patients is discussed. Thirty patients (55%) fulfilled criteria for a DSM-III-R diagnosis. The most prominent psychodynamically defined character pathology was found in the areas of coping with aggressive affects; dependency and separation; frustration tolerance; and impulse control. Some psychodynamically defined character traits, particularly poor frustration tolerance, were related to symptomatic suffering. PMID:9407473

  18. ANALYSIS OF THE SECONDARY CURVES IN PATIENTS UNDERGOING SELECTIVE ARTHRODESIS LENKE I

    TADEU GERVAZONI DEBOM

    2015-12-01

    Full Text Available Objective : To radiographically evaluate the behavior of the secondary curves in the coronal and sagittal planes in patients with AIS classified as Lenke I, who underwent surgical treatment of selective arthrodesis by posterior approach. Methods : Retrospective study which analyzed 40 patients with AIS, being 33 female. The measurement of the radiographic parameters used followed the recommendations by Cobb. Results : The average correction of the thoracic proximal, primary and lumbar curves was 34.73%, 75.06% and 64.64%, respectively. Conclusion : Surgical treatment by selective arthrodesis in cases of AIS Lenke type I provide correction of compensatory curves in the coronal and maintenance in the sagittal plane.

  19. Prediction of hepatocellular carcinoma biological behavior in patient selection for liver transplantation

    Cillo, Umberto; Giuliani, Tommaso; Polacco, Marina; Herrero Manley, Luz Maria; Crivellari, Gino; Vitale, Alessandro

    2016-01-01

    Morphological criteria have always been considered the benchmark for selecting hepatocellular carcinoma (HCC) patients for liver transplantation (LT). These criteria, which are often inappropriate to express the tumor’s biological behavior and aggressiveness, offer only a static view of the disease burden and are frequently unable to correctly stratify the tumor recurrence risk after LT. Alpha-fetoprotein (AFP) and its progression as well as AFP-mRNA, AFP-L3%, des-γ-carboxyprothrombin, inflammatory markers and other serological tests appear to be correlated with post-transplant outcomes. Several other markers for patient selection including functional imaging studies such as 18F-FDG-PET imaging, histological evaluation of tumor grade, tissue-specific biomarkers, and molecular signatures have been outlined in the literature. HCC growth rate and response to pre-transplant therapies can further contribute to the transplant evaluation process of HCC patients. While AFP, its progression, and HCC response to pre-transplant therapy have already been used as a part of an integrated prognostic model for selecting patients, the utility of other markers in the transplant setting is still under investigation. This article intends to review the data in the literature concerning predictors that could be included in an integrated LT selection model and to evaluate the importance of biological aggressiveness in the evaluation process of these patients. PMID:26755873

  20. Home noninvasive ventilatory support for patients with chronic obstructive pulmonary disease : patient selection and perspectives

    Storre, Jan Hendrik; Callegari, Jens; Magnet, Friederike Sophie; Schwarz, Sarah Bettina; Duiverman, Marieke Leontine; Wijkstra, Peter Jan; Windisch, Wolfram

    2018-01-01

    Long-term or home mechanical noninvasive ventilation (Home-NIV) has become a well-established form of therapy over the last few decades for chronic hypercapnic COPD patients in European countries. However, meta-analyses and clinical guidelines do not recommend Home-NIV for COPD patients on a routine

  1. Markov Random Fields on Triangle Meshes

    Andersen, Vedrana; Aanæs, Henrik; Bærentzen, Jakob Andreas

    2010-01-01

    In this paper we propose a novel anisotropic smoothing scheme based on Markov Random Fields (MRF). Our scheme is formulated as two coupled processes. A vertex process is used to smooth the mesh by displacing the vertices according to a MRF smoothness prior, while an independent edge process label...

  2. Performance Evaluation of Coded Meshed Networks

    Krigslund, Jeppe; Hansen, Jonas; Pedersen, Morten Videbæk

    2013-01-01

    of the former to enhance the gains of the latter. We first motivate our work through measurements in WiFi mesh networks. Later, we compare state-of-the-art approaches, e.g., COPE, RLNC, to CORE. Our measurements show the higher reliability and throughput of CORE over other schemes, especially, for asymmetric...

  3. Solid Mesh Registration for Radiotherapy Treatment Planning

    Noe, Karsten Østergaard; Sørensen, Thomas Sangild

    2010-01-01

    We present an algorithm for solid organ registration of pre-segmented data represented as tetrahedral meshes. Registration of the organ surface is driven by force terms based on a distance field representation of the source and reference shapes. Registration of internal morphology is achieved usi...

  4. Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis.

    Oostdijk, Evelien A N; de Wit, G A; Bakker, Marina; de Smet, Anne Marie G A; Bonten, M J M

    2013-03-05

    To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). A post hoc analysis of a previously performed cluster-randomised trial (NEJM 2009;360:20). 13 Dutch ICUs. Patients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990). SDD or SOD. Effects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation. Total costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving. SDD and SOD were both effective and cost-saving in Dutch ICUs.

  5. Mortality in perforated peptic ulcer patients after selective management of stratified poor risk cases.

    Rahman, M Mizanur; Islam, M Saiful; Flora, Sabrina; Akhter, S Fariduddin; Hossain, Shahid; Karim, Fazlul

    2007-12-01

    Perforated peptic ulcer disease continues to inflict high morbidity and mortality. Although patients can be stratified according to their surgical risk, optimal management has yet to be described. In this study we demonstrate a treatment option that improves the mortality among critically ill, poor risk patients with perforated peptic ulcer disease. In our study, two series were retrospectively reviewed: group A patients (n = 522) were treated in a single surgical unit at the Dhaka Medical College Hospital, Dhaka, Bangladesh during the 1980s. Among them, 124 patients were stratified as poor risk based on age, delayed presentation, peritoneal contamination, and coexisting medical problems. These criteria were the basis for selecting a group of poor risk patients (n = 84) for minimal surgical intervention (percutaneous peritoneal drainage) out of a larger group of patients, group B (n = 785) treated at Khulna Medical College Hospital during the 1990s. In group A, 479 patients underwent conventional operative management with an operative mortality of 8.97%. Among the 43 deaths, 24 patients were >60 years of age (55.8%), 12 patients had delayed presentation (27.9%), and 7 patients were in shock or had multiple coexisting medical problems (16.2%). In group B, 626 underwent conventional operative management, with 26 deaths at a mortality rate of 4.15%. Altogether, 84 patients were stratified as poor risk and were managed with minimal surgical intervention (percutaneous peritoneal drainage) followed by conservative treatment. Three of these patients died with an operative mortality of 3.5%. Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease.

  6. Technique and complications of reconstruction of the pelvic floor with polyglactin mesh

    Sener, S.F.; Imperato, J.P.; Blum, M.D.; Ignatoff, J.M.; Soper, T.G.; Winchester, D.P.; Meiselman, M.

    1989-01-01

    A polyglactin mesh sling was used to reconstruct the pelvis in eight patients after colorectal or urologic resections in preparation for postoperative radiation therapy. There were three perioperative complications--a pelvic abscess requiring percutaneous drainage, a wound dehiscence and a herniation of the small intestine between the pelvic sidewall and mesh requiring small intestinal resection. There were two delayed complications, both partial small intestinal obstructions. One occurred just after the conclusion of radiation treatment and the other occurred five months after the conclusion of radiation therapy. Both obstructions responded to conservative management. None of the common acute radiation effects occurred during radiotherapy. One patient with delayed partial small intestinal obstruction had possible late radiation effects. The median follow-up period after radiation therapy was 12.5 months. Despite the complications described in this report, the use of a polyglactin mesh sling as an adjunct to resection of carcinoma of the pelvis has merit and should be studied further

  7. [Expandable metal mesh stents for treatment of tracheal stenoses and tracheomalacia].

    Müller, C; Dienemann, H; Hoffmann, H; Berger, H; Storck, M; Jolk, A; Schildberg, F W

    1993-01-01

    The treatment of tracheo-bronchial stenosis or tracheomalacia is mainly carried out by means of resection or tracheoplastic operative strategies. Since the introduction of metal-mesh stents, a definitive endoluminal therapy has to be considered under new aspects. Six patients with malignant stenosis or tracheomalacia due to compression were treated by implantation of Palmaz- or Wallstents. Immediately after the implantation, patients were relieved from dyspnoea, the forced inspiratory volume-1 (FIV1) was normalized. All implanted stents were well tolerated, even in the long-time follow-up (19 months). Bronchoscopic control showed overgrowth of the metal meshes by respiratory epithelium. The implantation of metal-mesh stents is an adequate alternative in the treatment of malignant stenosis and tracheomalacia.

  8. Shear Alignment of Diblock Copolymers for Patterning Nanowire Meshes

    Gustafson, Kyle T. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2016-09-08

    Metallic nanowire meshes are useful as cheap, flexible alternatives to indium tin oxide – an expensive, brittle material used in transparent conductive electrodes. We have fabricated nanowire meshes over areas up to 2.5 cm2 by: 1) mechanically aligning parallel rows of diblock copolymer (diBCP) microdomains; 2) selectively infiltrating those domains with metallic ions; 3) etching away the diBCP template; 4) sintering to reduce ions to metal nanowires; and, 5) repeating steps 1 – 4 on the same sample at a 90° offset. We aligned parallel rows of polystyrene-b-poly(2-vinylpyridine) [PS(48.5 kDa)-b-P2VP(14.5 kDa)] microdomains by heating above its glass transition temperature (Tg ≈ 100°C), applying mechanical shear pressure (33 kPa) and normal force (13.7 N), and cooling below Tg. DiBCP samples were submerged in aqueous solutions of metallic ions (15 – 40 mM ions; 0.1 – 0.5 M HCl) for 30 – 90 minutes, which coordinate to nitrogen in P2VP. Subsequent ozone-etching and sintering steps yielded parallel nanowires. We aimed to optimize alignment parameters (e.g. shear and normal pressures, alignment duration, and PDMS thickness) to improve the quality, reproducibility, and scalability of meshes. We also investigated metals other than Pt and Au that may be patterned using this technique (Cu, Ag).

  9. Using small meshed collecting bags on trawls to quantify trawls seabed disturbance of aquatic organisms

    Krag, Ludvig Ahm

    impact on commercial fishing grounds. In this study we develop and test small-meshed collecting bags designed to retain juvenile fish and benthic megafauna. The collecting bags are mounted in the wings and body of the trawl. The catches in the collection bags provide information of the species and size...... in the mechanical effect, such as penetration depth of the ground gear of different trawl designs. Collecting bags are also mounted to the different sections of the trawl in pairs, one to collect the organisms that pass through the trawl meshes and one to collect the population. Standard selectivity analyses...

  10. Reduced order modelling techniques for mesh movement strategies as applied to fluid structure interactions

    Bogaers, Alfred EJ

    2010-01-01

    Full Text Available of Laplacian or Bi-harmonic equations [7], radial basis function (RBF) interpolation [3, 15] or through mesh optimization [1, 6]. Despite the successes of these algorithms in reducing the frequency and necessity for re- meshing, they still account for a... simulations of a real system. What makes POD remarkable is that the selected modes are not only appropriate but make up the optimal linear basis for describing any given system. POD has been applied in a wide range of disciplines including image processing...

  11. Vertex Normals and Face Curvatures of Triangle Meshes

    Sun, Xiang; Jiang, Caigui; Wallner, Johannes; Pottmann, Helmut

    2016-01-01

    This study contributes to the discrete differential geometry of triangle meshes, in combination with discrete line congruences associated with such meshes. In particular we discuss when a congruence defined by linear interpolation of vertex normals

  12. Surgical Management of Pelvic floor Prolapse in women using Mesh

    RAH

    polytetrafluoroethylene) . This article reviews our experience with polypropylene mesh in pelvic floor repair at the. Southern General Hospital Glasgow. The objective was to determine the safety and effectiveness of the prolene mesh in the repair ...

  13. VARIABLE MESH STIFFNESS OF SPUR GEAR TEETH USING ...

    gear engagement. A gear mesh kinematic simulation ... model is appropnate for VMS of a spur gear tooth. The assumptions for ... This process has been continued until one complete tooth meshing cycle is ..... Element Method. Using MATLAB,.

  14. The Importance of Registries in the Postmarketing Surveillance of Surgical Meshes.

    Köckerling, Ferdinand; Simon, Thomas; Hukauf, Martin; Hellinger, Achim; Fortelny, Rene; Reinpold, Wolfgang; Bittner, Reinhard

    2017-06-07

    To assess the role of registries in the postmarketing surveillance of surgical meshes. To date, surgical meshes are classified as group II medical devices. Class II devices do not require premarket clearance by clinical studies. Ethicon initiated a voluntary market withdrawal of Physiomesh for laparoscopic use after an analysis of unpublished data from the 2 large independent hernia registries-Herniamed German Registry and Danish Hernia Database. This paper now presents the relevant data from the Herniamed Registry. The present analysis compares the prospective perioperative and 1-year follow-up data collected for all patients with incisional hernia who had undergone elective laparoscopic intraperitoneal onlay mesh repair either with Physiomesh (n = 1380) or with other meshes recommended in the guidelines (n = 3834). Patients with Physiomesh repair had a markedly higher recurrence rate compared with the other recommended meshes (12.0% vs 5.0%; P manufacturing company must be taken into account.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.

  15. The Role of Vaginal Mesh Procedures in Pelvic Organ Prolapse Surgery in View of Complication Risk

    David R. Ellington

    2013-01-01

    Full Text Available Synthetic transvaginal mesh has been employed in the treatment of pelvic organ prolapse for more than a decade. As the use of these devices increased during this period so did adverse event reporting. In 2008, the Food and Drug Administration (FDA Public Health Notification informed physicians and patients of rising concerns with the use of synthetic transvaginal mesh. Shortly thereafter and in parallel to marked increases in adverse event reporting within the Manufacturer and User Device Experience (MAUDE, the FDA released a Safety Communication regarding urogynecologic surgical mesh use. Following this report and in the wake of increased medical industry product withdrawal, growing medicolegal concerns, patient safety, and clinical practice controversy, many gynecologists and pelvic reconstructive surgeons are left with limited long-term data, clinical guidance, and growing uncertainty regarding the role of synthetic transvaginal mesh use in pelvic organ prolapse. This paper reviews the reported complications of synthetic transvaginal mesh with an evidence-based approach as well as providing suggested guidance for the future role of its use amidst the controversy.

  16. A prospective study of transobturator tape as treatment for stress urinary incontinence after transvaginal mesh repair.

    Lau, Hui-Hsuan; Su, Tsung-Hsien; Huang, Wen-Chu; Hsieh, Ching-Hung; Su, Chin-Hui; Chang, Rhu-Chu

    2013-10-01

    The transobturator suburethral sling is a common surgical treatment for stress urinary incontinence (SUI). In patients with incontinence after trocar-guided transvaginal mesh repair (Prolift), data on outcome remain limited. In the present study, we hypothesized that transobturator tape in such cases is assumed to be as effective as surgery alone. This was a prospective analysis of outcomes of transobturator slings in women who had undergone transvaginal mesh repair and in those who underwent sling surgery alone (controls). Objective cure was defined as the absence of urinary leakage during the stress test at filling cystometry and a negative cough test during pelvic examination. The success rates were evaluated 3-6 months postoperatively. One hundred women were recruited for the study. Compared to the control group, women after transvaginal mesh repair had a significantly lower objective success rate (62 vs 86%, p = 0.005) and poorer bladder neck mobility (0.5 ± 0.8 vs 1.1 ± 0.5 cm, p = 0.001). The transobturator sling has lower objective success rate in women after transvaginal mesh that may be due to decreased bladder neck mobility. Patients with post-mesh repair SUI who opt for sling surgery should be informed of these less satisfactory outcomes during preoperative counseling.

  17. The Role of Vaginal Mesh Procedures in Pelvic Organ Prolapse Surgery in View of Complication Risk

    Ellington, David R.; Richter, Holly E.

    2013-01-01

    Synthetic transvaginal mesh has been employed in the treatment of pelvic organ prolapse for more than a decade. As the use of these devices increased during this period so did adverse event reporting. In 2008, the Food and Drug Administration (FDA) Public Health Notification informed physicians and patients of rising concerns with the use of synthetic transvaginal mesh. Shortly thereafter and in parallel to marked increases in adverse event reporting within the Manufacturer and User Device Experience (MAUDE), the FDA released a Safety Communication regarding urogynecologic surgical mesh use. Following this report and in the wake of increased medical industry product withdrawal, growing medicolegal concerns, patient safety, and clinical practice controversy, many gynecologists and pelvic reconstructive surgeons are left with limited long-term data, clinical guidance, and growing uncertainty regarding the role of synthetic transvaginal mesh use in pelvic organ prolapse. This paper reviews the reported complications of synthetic transvaginal mesh with an evidence-based approach as well as providing suggested guidance for the future role of its use amidst the controversy. PMID:24069035

  18. Treatment of Prolapsing Hemorrhoids in HIV-Infected Patients with Tissue-Selecting Technique

    Zhe Fan

    2017-01-01

    Full Text Available The aim of this retrospective study was to evaluate the outcome of a tissue-selecting therapy stapler (TST for prolapsing hemorrhoids in HIV-infected patients. Sixty-two patients with stage III-IV hemorrhoidal prolapse were treated with TST by a single surgeon between June and November 2014. The TST group comprised 32 patients (4 females, and the TST + HIV group comprised 30 HIV-infected patients (3 females. Age, gender, and preoperative examination as well as intraoperative and postoperative features were assessed. There was no marked difference in hemorrhoidal prolapse between the TST and HIV + TST groups, except for patient satisfaction at 12 months. TST is an effective and safe technique for treatment of prolapsing hemorrhoids in HIV-infected patients.

  19. Laparoscopic removal of mesh used in pelvic floor surgery.

    Khong, Su-Yen; Lam, Alan

    2009-01-01

    Various meshes are being used widely in clinical practice for pelvic reconstructive surgery despite the lack of evidence of their long-term safety and efficacy. Management of complications such as mesh erosion and dyspareunia can be challenging. Most mesh-related complications can probably be managed successfully via the transvaginal route; however, this may be impossible if surgical access is poor. This case report demonstrates the successful laparoscopic removal of mesh after several failed attempts via the vaginal route.

  20. GRAPHICAL SELECTION OF SIEVE MESH FOR GRAIN SIEVES by ...

    ES Obe

    grain seeds from foreign matter at maximum efficiency thereby facilitating the proper design of a cleaning system. The method depends upon the statistical analysis of the physical/mechanical ... has been used as an important aerodynamic property of materials in pneumatic separation operations. An aerodynamic tube ...

  1. ABOUT ESTIMATION OF THE OPTIMAL PARAMETERS OF MESH IN FISHING GEAR FOR FISHERY IN UKRAINE

    A. Chuklin

    2013-06-01

    Full Text Available The analysis of biometric exterior indicators of haarder (Liza haematocheilus in the Azov Sea is given and by example of use of these indicators the calculations for optimization of the parameters of mesh in fishing gear for fish catching in the Ukraine is complete. The calculations show that the minimum mesh size which provides selective catch capacity concerning haarder of commercial measure (more than 38 cm should be increased in size from 30 mm to 40 mm. In this case, the probability to continue catching of juveniles from 26.8 cm to 38 cm remains, but its share will be significantly less than in case of using adopted now mesh size of 30 mm. The proposed method is recommended for engineering and biological calculations for the design of new gear and improvement of commercial fishing regulations in order to optimize and improve the effectiveness of management of fish stocks.

  2. A new anisotropic mesh adaptation method based upon hierarchical a posteriori error estimates

    Huang, Weizhang; Kamenski, Lennard; Lang, Jens

    2010-03-01

    A new anisotropic mesh adaptation strategy for finite element solution of elliptic differential equations is presented. It generates anisotropic adaptive meshes as quasi-uniform ones in some metric space, with the metric tensor being computed based on hierarchical a posteriori error estimates. A global hierarchical error estimate is employed in this study to obtain reliable directional information of the solution. Instead of solving the global error problem exactly, which is costly in general, we solve it iteratively using the symmetric Gauß-Seidel method. Numerical results show that a few GS iterations are sufficient for obtaining a reasonably good approximation to the error for use in anisotropic mesh adaptation. The new method is compared with several strategies using local error estimators or recovered Hessians. Numerical results are presented for a selection of test examples and a mathematical model for heat conduction in a thermal battery with large orthotropic jumps in the material coefficients.

  3. Fault diagnosis for wind turbine planetary ring gear via a meshing resonance based filtering algorithm.

    Wang, Tianyang; Chu, Fulei; Han, Qinkai

    2017-03-01

    Identifying the differences between the spectra or envelope spectra of a faulty signal and a healthy baseline signal is an efficient planetary gearbox local fault detection strategy. However, causes other than local faults can also generate the characteristic frequency of a ring gear fault; this may further affect the detection of a local fault. To address this issue, a new filtering algorithm based on the meshing resonance phenomenon is proposed. In detail, the raw signal is first decomposed into different frequency bands and levels. Then, a new meshing index and an MRgram are constructed to determine which bands belong to the meshing resonance frequency band. Furthermore, an optimal filter band is selected from this MRgram. Finally, the ring gear fault can be detected according to the envelope spectrum of the band-pass filtering result. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

  4. Meshed doped silicon photonic crystals for manipulating near-field thermal radiation

    Elzouka, Mahmoud; Ndao, Sidy

    2018-01-01

    The ability to control and manipulate heat flow is of great interest to thermal management and thermal logic and memory devices. Particularly, near-field thermal radiation presents a unique opportunity to enhance heat transfer while being able to tailor its characteristics (e.g., spectral selectivity). However, achieving nanometric gaps, necessary for near-field, has been and remains a formidable challenge. Here, we demonstrate significant enhancement of the near-field heat transfer through meshed photonic crystals with separation gaps above 0.5 μm. Using a first-principle method, we investigate the meshed photonic structures numerically via finite-difference time-domain technique (FDTD) along with the Langevin approach. Results for doped-silicon meshed structures show significant enhancement in heat transfer; 26 times over the non-meshed corrugated structures. This is especially important for thermal management and thermal rectification applications. The results also support the premise that thermal radiation at micro scale is a bulk (rather than a surface) phenomenon; the increase in heat transfer between two meshed-corrugated surfaces compared to the flat surface (8.2) wasn't proportional to the increase in the surface area due to the corrugations (9). Results were further validated through good agreements between the resonant modes predicted from the dispersion relation (calculated using a finite-element method), and transmission factors (calculated from FDTD).

  5. SLIC: an interactive mesh generator for finite element and finite difference application programs

    Gerhard, M.A.; Greenlaw, R.C.

    1979-01-01

    Computers with extended memory, such as the CDC STAR 100 and the CRAY 1 with mega-word capacities, are greatly enlarging the size of finite element problems which can be solved. The cost of developing and testing large meshes can be prohibitive unless one uses a computer program for mesh generation and plotting. SLIC is an interactive mesh program which builds and plots 2- and 3-D continuum meshes from interactive terminal or disc input. The user inputs coordinates for certain key points and enters commands which complete the description of the geometry. Entire surfaces and volumes are then generated from the geometric skeleton. SLIC allows the user to correct input errors and saves the corrected command list for later reuse. The mesh can be plotted on a video display at any stage of development to evaluate the work in progress. Output is in the form of an input file to a user-selected computer code. Among the available output types are ADINA, SAP4, and NIKE2D. 11 figures

  6. LOPES: Selective control of gait functions during the gait rehabilitation of CVA patients

    Ekkelenkamp, R.; Veneman, J.F.; van der Kooij, Herman

    2005-01-01

    LOPES aims for an active role of the patient by selective and partial support of gait functions during robotic treadmill training sessions. Virtual model control (VMC) was applied to the robot as an intuitive method for translating current treadmill gait rehabilitation therapy programs into robotic

  7. Selective digestive decontamination in patients in intensive care. The Dutch Working Group on Antibiotic Policy

    Bonten, M. J.; Kullberg, B. J.; van Dalen, R.; Girbes, A. R.; Hoepelman, I. M.; Hustinx, W.; van der Meer, J. W.; Speelman, P.; Stobberingh, E. E.; Verbrugh, H. A.; Verhoef, J.; Zwaveling, J. H.

    2000-01-01

    Selective digestive decontamination (SDD) is the most extensively studied method for the prevention of infection in patients in intensive care units (ICUs). Despite 27 prospective randomized studies and six meta-analyses, routine use of SDD is still controversial. In this review, we summarize the

  8. How does PET/CT help in selecting therapy for patients with Hodgkin lymphoma?

    Hutchings, Martin

    2012-01-01

    investigating the use of PET/CT for early response-adapted therapy, with therapeutic stratification based on interim PET/CT results. Posttreatment PET/CT is a cornerstone of the revised response criteria and enables the selection of advanced-stage patients without the need for consolidation radiotherapy. Once...

  9. GSK2586184, a JAK1 selective inhibitor, in two patients with ulcerative colitis

    de Vries, Leonie C. S.; Ludbrook, Valerie J.; Hicks, Kirsty J.; D'Haens, Geert R.

    2017-01-01

    Tofacitinib, a non-selective Janus kinase (JAK) inhibitor, is effective in inducing clinical and endoscopic remission in patients with active ulcerative colitis (UC). Tofacitinib inhibits cytokine signalling through blockade of JAK1, JAK2, JAK3 and tyrosine kinase 2 (TYK2). Adverse events including

  10. 21 CFR 870.3650 - Pacemaker polymeric mesh bag.

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker polymeric mesh bag. 870.3650 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3650 Pacemaker polymeric mesh bag. (a) Identification. A pacemaker polymeric mesh bag is an implanted device used to hold a...

  11. Multiphase flow of immiscible fluids on unstructured moving meshes

    Misztal, Marek Krzysztof; Erleben, Kenny; Bargteil, Adam

    2012-01-01

    In this paper, we present a method for animating multiphase flow of immiscible fluids using unstructured moving meshes. Our underlying discretization is an unstructured tetrahedral mesh, the deformable simplicial complex (DSC), that moves with the flow in a Lagrangian manner. Mesh optimization op...

  12. Multiphase Flow of Immiscible Fluids on Unstructured Moving Meshes

    Misztal, Marek Krzysztof; Erleben, Kenny; Bargteil, Adam

    2013-01-01

    In this paper, we present a method for animating multiphase flow of immiscible fluids using unstructured moving meshes. Our underlying discretization is an unstructured tetrahedral mesh, the deformable simplicial complex (DSC), that moves with the flow in a Lagrangian manner. Mesh optimization op...

  13. Effectiveness of L2 spinal nerve infiltration for selective discogenic low back pain patients

    Ohtori, Seiji; Nakamura, Shinichiro; Koshi, Takana

    2010-01-01

    It has been reported that rat L5/6 lumbar discs are innervated mainly by L2 dorsal root ganglion neurons. We previously reported that L2 spinal nerve infiltration was effective for discogenic low back pain (DLBP) patients, although the diagnosis was based only on the results of physical examination, plain films, and magnetic resonance imaging (MRI). The purpose of the current study was to evaluate L2 spinal nerve block for DLBP patients retrospectively based on MRI findings and surgical results. A total of 62 patients with only LBP and no accompanying radicular pain were investigated. Patients had only one level of disc degeneration on MRI. When pain was provoked during discography, we performed surgery at the next stage (40 patients). In all, 22 patients were excluded owing to negative discography results. Of the 40 patients, we evaluated 25 strictly selected patients suffering from DLBP. DLBP was diagnosed when the patient experienced pain relief at least 2 years after anterior lumbar interbody fusion. Fifteen patients who did not show pain relief after surgery were used for the non-DLBP group. L2 spinal nerve infiltration using 1.5 ml of lidocaine was performed in all 40 patients before surgery. The visual analogue scale (VAS) score after L2 spinal nerve infiltration was recorded, and an association of L2 spinal nerve infiltration and DLBP was explored. Low back pain scores assessed using the VAS score, the Japanese Orthopedic Association score, and the Oswestry Disability Index score in the two groups were not significantly different. L2 spinal nerve infiltration was effective for 27 patients but not effective for 13 patients; the VAS score after 15 min and 2 h improved in the DLBP group compared with that of the non-DLBP group (P<0.05). L2 spinal nerve infiltration was more effective in DLBP patients (21 patients, 84%) than in the non-DLBP group (6 patients, 40%) (P<0.05). In the current study, L2 spinal nerve infiltration was effective in 84% of selected DLBP

  14. Selecting patients with young-onset colorectal cancer for mismatch repair gene analysis

    Walker, M; O'Sullivan, B; Perakath, B

    2007-01-01

    BACKGROUND: Young patients with colorectal cancer are at increased risk of carrying a germline mutation in mismatch repair (MMR) genes. This study investigated the role of clinical criteria and immunohistochemistry for MMR proteins in selecting young patients for mutation testing. METHODS: A cohort...... of 56 consecutive patients with colorectal cancer aged less than 45 years were stratified into three groups based on clinical criteria: 'Amsterdam criteria', 'high risk' and 'young onset only'. Immunohistochemistry for four MMR proteins was carried out and the rate of compliance with clinical guidelines...

  15. Atlas-Based Automatic Generation of Subject-Specific Finite Element Tongue Meshes.

    Bijar, Ahmad; Rohan, Pierre-Yves; Perrier, Pascal; Payan, Yohan

    2016-01-01

    Generation of subject-specific 3D finite element (FE) models requires the processing of numerous medical images in order to precisely extract geometrical information about subject-specific anatomy. This processing remains extremely challenging. To overcome this difficulty, we present an automatic atlas-based method that generates subject-specific FE meshes via a 3D registration guided by Magnetic Resonance images. The method extracts a 3D transformation by registering the atlas' volume image to the subject's one, and establishes a one-to-one correspondence between the two volumes. The 3D transformation field deforms the atlas' mesh to generate the subject-specific FE mesh. To preserve the quality of the subject-specific mesh, a diffeomorphic non-rigid registration based on B-spline free-form deformations is used, which guarantees a non-folding and one-to-one transformation. Two evaluations of the method are provided. First, a publicly available CT-database is used to assess the capability to accurately capture the complexity of each subject-specific Lung's geometry. Second, FE tongue meshes are generated for two healthy volunteers and two patients suffering from tongue cancer using MR images. It is shown that the method generates an appropriate representation of the subject-specific geometry while preserving the quality of the FE meshes for subsequent FE analysis. To demonstrate the importance of our method in a clinical context, a subject-specific mesh is used to simulate tongue's biomechanical response to the activation of an important tongue muscle, before and after cancer surgery.

  16. The routine use of prosthetic mesh in austere environments: dogma vs data.

    Kuckelman, John P; Barron, Morgan R; Blair, Kelly; Martin, Matthew J

    2016-05-01

    Mesh repair has become the standard in adult hernia repairs. Mesh infection is an uncommon but potentially devastating complication. Currently, there is widespread dogma against the use of prosthetic mesh (PM) in deployed or austere environments but little available data to support or refute this bias. Retrospective review of all hernia repairs over 1 year in a forward deployed surgical unit in Afghanistan. Demographics, hernia type, repair performed, and mesh type were evaluated. Follow-up was completed up to 6 weeks and then as needed for up to a year, and complications to include infection were recorded. Sixty-six patients were identified, mean age was 38 (range 3 to 80) and 98% were male. Single-dose perioperative antibiotics and standard sterile technique were used in all cases. The majority (70%) had PM placed. The mean operative time was 54 min, and mean estimated blood loss was less than 25 cm(3). The vast majority of our hernias were inguinal (95%) with 1 ventral and 2 umbilical hernias. In the PM group, there were no surgical site infections, no mesh infections, and no mesh explantation or reoperation. There were no recurrences in either group identified at up to 1-year postoperation. There was no statistically significant difference in any outcome measure between the PM and no-PM groups. The use of PM for hernia repairs in the austere or forward environment appears safe and did not increase the risk of wound infection, mesh infections, or recurrence. Published by Elsevier Inc.

  17. Preliminary report of a sutureless onlay technique for incisional hernia repair using fibrin glue alone for mesh fixation.

    Stoikes, Nathaniel; Webb, David; Powell, Ben; Voeller, Guy

    2013-11-01

    The Rives repair for ventral/incisional (V/I) hernias involves sublay mesh placement requiring retrorectus dissection and transfascial stitches. Chevrel described a repair by onlaying mesh after a unique primary fascial closure. Although Chevrel fixated mesh to the anterior fascia with sutures, he used fibrin glue for fascial closure reinforcement. We describe an onlay technique with mesh fixated to the anterior fascia solely with fibrin glue without suture fixation. From January 2010 to January 2012, 50 patients underwent a V/I hernia onlay technique with fibrin glue mesh fixation. Records were reviewed for technical details, demographics, mesh characteristics, and postoperative outcomes. Primary fascial closure with interrupted permanent suture was done with or without myofascial advancement flaps. Onlay polypropylene mesh was placed providing 8 cm of overlap. Fibrin glue was applied over the prosthesis and subcutaneous drains were placed. Mean age was 62.4 years. Mean body mass index was 30.1 kg/m(2). Average mesh size was 14.5 cm × 19.1 cm. Mean operative time was 144.4 minutes (range, 38 to 316 minutes). Mean discharge was postoperative Day 2.9 (range, 0 to 15 days). Morbidity included eight seromas, one hematoma, and three wound infections. Seventeen patients required components separation. Mean follow-up was 19.5 months with no recurrences. This is the first series describing fibrin glue alone for mesh fixation for V/I hernia repair. It allows for immediate prosthesis fixation to the anterior fascia. Early results are promising. Potential advantages include less operative time, less technical difficulty, and less long-term pain. A prospective trial is needed to evaluate this approach.

  18. Configuring the Mesh Size, Side Taper and Wing Depth of Penaeid Trawls to Reduce Environmental Impacts

    Broadhurst, Matt K.; Sterling, David J.; Millar, Russell B.

    2014-01-01

    The effects of reducing mesh size while concomitantly varying the side taper and wing depth of a generic penaeid-trawl body were investigated to improve engineering performance and minimize bycatch. Five trawl bodies (with the same codends) were tested across various environmental (e.g. depth and current) and biological (e.g. species and sizes) conditions. The first trawl body comprised 41-mm mesh and represented conventional designs (termed the ‘41 long deep-wing'), while the remaining trawl bodies were made from 32-mm mesh and differed only in their side tapers, and therefore length (i.e. 1N3B or ‘long’ and ∼28o to the tow direction vs 1N5B or ‘short’ and ∼35o) and wing depths (‘deep’–97 T vs ‘shallow’–60 T). There were incremental drag reductions (and therefore fuel savings – by up to 18 and 12% per h and ha trawled) associated with reducing twine area via either modification, and subsequently minimizing otter-board area in attempts to standardize spread. Side taper and wing depth had interactive and varied effects on species selectivity, but compared to the conventional 41 long deep-wing trawl, the 32 short shallow-wing trawl (i.e. the least twine area) reduced the total bycatch by 57% (attributed to more fish swimming forward and escaping). In most cases, all small-meshed trawls also caught more smaller school prawns Metapenaeus macleayi but to decrease this effect it should be possible to increase mesh size slightly, while still maintaining the above engineering benefits and species selectivity. The results support precisely optimizing mesh size as a precursor to any other anterior penaeid-trawl modifications designed to improve environmental performance. PMID:24911786

  19. Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection

    Lange Jochen

    2010-12-01

    Full Text Available Abstract Background Selective decontamination of the digestive tract (SDD to eliminate gram-negative bacteria is still not widely accepted, although it reduces the incidence of nosocomial infections. In a previous retrospective study, a clear benefit to perioperative morbidity, and a reduction in nosocomial infections were found in patients who underwent an esophageal anastomosis. Thus, SDD was applied routinely for esophageal anastomoses. We report the outcome of a cohort of 81 patients who underwent this treatment. Methods From 2002, patients who underwent an esophageal anastomosis (esophagojejunostomy were prospectively recorded. Perioperatively, patients received polymyxin, tobramycin, vancomycin and nystatin by mouth four times a day. Outcome was compared to a control group that was treated before 2002 (68 patients without SDD and 53 patients with SDD. Postoperative morbidity and mortality were assessed. Results Between 2002 and 2007, 81 patients who underwent an esophageal anastomosis received SDD. Compared to a retrospective control group, patients with SDD had significantly less pneumonia (OR 0.06 (0.01-0.46, p Conclusions SDD significantly reduces perioperative morbidity and mortality in patients who undergo a distal esophageal anastomosis compared to a historical control group. In patients with an anastomotic leakage, there was a strong tendency of SDD to reduce postoperative mortality.

  20. The Disability Impact and Associated Cost per Disability in Women Who Underwent Surgical Revision of Transvaginal Mesh Kits for Prolapse Repair.

    Javadian, Pouya; Shobeiri, S Abbas

    2017-09-13

    The aim of this study was to investigate disability impact in patients and cost to the families of patients who have had complications of transvaginal prolapse mesh kits and underwent surgical revision. Patients who developed complications of transvaginal mesh kits for prolapse and who had undergone vaginal prolapse mesh surgical revision/removal in 2009 to 2014 at a single institution were identified by Current Procedural Terminology codes. The group was invited to complete a phone survey pertaining to the initial vaginal mesh used for prolapse surgery utilizing Sheehan Disability Scale (scale 0-10) and Years of life Lived with Disability (YLDs) questionnaires. The data collected were used to estimate the disability and cost analysis. We used our data to estimate the economic and quality-of-life impact of vaginal mesh complications on patients in the United States RESULTS: Sixty-two patients (62/198 [31.2%]) were consented to participate and completed the questionnaires by phone. Extremely disabled patients were 18 (29%) of 62 of whole cases, and 5 (8%) of 62 reported that they had no disability after vaginal mesh surgery. The median for overall disability score after vaginal mesh procedure was 8 (which reflects marked disability on a scale of 0-10). The majority of patients missed a median of 12 months of their school or work because of their mesh complications. Thirty-seven (59.6%) of 62 did not improve after mesh removal. Twenty-one (33.9%) of 62 stated that their family income dropped because of productivity loss related to mesh complications. The mean time between vaginal mesh surgery and mesh removal procedure was 4.7 years. Sheehan Disability Scale scores are significantly correlated with YLDs outcomes. Patients' overall disability score showed a significant correlation with YLDs scores (P mesh for prolapse reduction complications had a sustained disability impact that continued despite mesh removal. Likewise, the complications were associated with

  1. Using a knowledge-based planning solution to select patients for proton therapy.

    Delaney, Alexander R; Dahele, Max; Tol, Jim P; Kuijper, Ingrid T; Slotman, Ben J; Verbakel, Wilko F A R

    2017-08-01

    Patient selection for proton therapy by comparing proton/photon treatment plans is time-consuming and prone to bias. RapidPlan™, a knowledge-based-planning solution, uses plan-libraries to model and predict organ-at-risk (OAR) dose-volume-histograms (DVHs). We investigated whether RapidPlan, utilizing an algorithm based only on photon beam characteristics, could generate proton DVH-predictions and whether these could correctly identify patients for proton therapy. Model PROT and Model PHOT comprised 30 head-and-neck cancer proton and photon plans, respectively. Proton and photon knowledge-based-plans (KBPs) were made for ten evaluation-patients. DVH-prediction accuracy was analyzed by comparing predicted-vs-achieved mean OAR doses. KBPs and manual plans were compared using salivary gland and swallowing muscle mean doses. For illustration, patients were selected for protons if predicted Model PHOT mean dose minus predicted Model PROT mean dose (ΔPrediction) for combined OARs was ≥6Gy, and benchmarked using achieved KBP doses. Achieved and predicted Model PROT /Model PHOT mean dose R 2 was 0.95/0.98. Generally, achieved mean dose for Model PHOT /Model PROT KBPs was respectively lower/higher than predicted. Comparing Model PROT /Model PHOT KBPs with manual plans, salivary and swallowing mean doses increased/decreased by <2Gy, on average. ΔPrediction≥6Gy correctly selected 4 of 5 patients for protons. Knowledge-based DVH-predictions can provide efficient, patient-specific selection for protons. A proton-specific RapidPlan-solution could improve results. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. [Vaginal mesh operations in the urogynecological practice after the FDA warnings. Use or not to use mesh?

    Fekete, Zoltán; Körösi, Szilvia; Németh, Gábor

    2018-03-01

    The prevalence of pelvic organ prolapse (POP) with aging is escalating alarmingly, and now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh (TVM) has been employed with increasing popularity in the treatment of POP until the end of the last decade. After the U.S. Drug and Food Administration (FDA) warnings in the years 2008 and 2011, the number of vaginal mesh operations has decreased dramatically. The aim of the study was to evaluate and compare the anti-POP effectivity, the anti-stress incontinence (anti-SUI) efficacy, and the late (36 months) post-operative complications of the anterior vaginoplasty and the TVM operations. We analysed the clinical data from 120 patients with stage II-III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2013 and January 2014. Sixty patients underwent Kelly-Stoeckel vaginoplasty and the other 60 cases had TVM operation. The surgical complications were classified using the Clavien-Dindo (CD) classification system. The anti-POP (91.6% vs. 63.3%; pmesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications. Orv Hetil. 2018; 159(10): 397-404.

  3. CHARACTERISTICS OF SLUDGE BOTTOM MESH

    Kamil Szydłowski

    2016-05-01

    Full Text Available The main aim of the study was to assess the selected heavy metals pollution of bottom sediments of small water bodies of different catchment management. Two ponds located in Mostkowo village were chosen for investigation. The first small water reservoir is surrounded by the cereal fields, cultivated without the use of organic and mineral fertilizers (NPK. The second reservoir is located in a park near rural buildings. Sediment samples were collected by the usage of KC Denmark sediments core probe. Samples were taken from 4 layers of sediment, from depth: 0–5, 5–10, 10–20 and 20–30 cm. Sampling was made once during the winter period (2014 year when ice occurred on the surface of small water bodies, from three points. The material was prepared for further analysis according to procedures used in soil science. The content of heavy metals (Cd, Cr, Cu, Ni, Pb and Zn were determined by atomic absorption spectrometry by usage of ASA ICE 3000 Thermo Scientific after prior digestion in the mixture (5: 1 of concentrated acids (HNO3 and HClO4. Higher pH values ​​were characteristic for sediments of pond located in a park than in pond located within the agricultural fields. In both small water bodies the highest heavy metal concentrations occurred in the deepest points of the research. In the sediments of the pond located within crop fields the highest concentration of cadmium, copper, lead and zinc were observed in a layer of 0–5 cm, wherein the nickel and chromium in a layer of 20–30 cm. In the sediments of the pond, located in the park the highest values ​​occurred at the deepest sampling point in the layer taken form 10–20 cm. Sediments from second reservoir were characterized by the largest average concentrations of heavy metals, except the lead content in sediment form the layer of 10–20 cm. According to the geochemical evaluation of sediments proposed by Bojakowska and Sokołowska [1998], the majority of samples belongs to Ist

  4. Complications of Transvaginal Mesh for Pelvic Organ Prolapse and Stress Urinary Incontinence: Tips for Prevention, Recognition, and Management.

    MacDonald, Susan; Terlecki, Ryan; Costantini, Elisabetta; Badlani, Gopal

    2016-08-01

    Mesh-related complications following transvaginal management of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) have received significant attention in the last decade. We sought to identify patient, product, and technical factors associated with an increased risk of complications after mesh-based transvaginal repair of anterior POP and SUI. In this review we clarify the different pattern of complications after POP and SUI repairs. Our aim is to provide a practical evidence-based guide for physicians to prevent and, if necessary, manage product-associated complications in a stepwise manner. We conducted a comprehensive PubMed search of all English-language articles published from 2010 to June 2016, using these search terms: mesh, pelvic organ prolapse, and stress urinary incontinence. Expert opinion is also provided. Mesh-related complications are much lower after repair of SUI compared with POP, despite its more frequent use. Vaginal exposure is the most common mesh-specific complication. Patients may present with vaginal discharge, dyspareunia, pain, recurrent urinary tract infection, and/or hematuria. Conversely, patients may be asymptomatic. Small asymptomatic mesh exposures (mesh encountered within the urinary tract must be fully excised. Following excision, pain may persist in up to 50% of patients. Vaginal extrusion, persistent pain, and urethral and/or bladder erosion are the three most common product-specific complications following mesh-based repair for SUI or POP. Conservative therapies may be attempted, but most patients ultimately require partial or complete mesh excision. We reviewed the recent literature on mesh-related complications after repair of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Vaginal exposure, persistent pain, and erosion into the urinary tract are the most common. These often require surgical management, best suited to a urologist with training and experience in this area. Evidence supports

  5. Partitioning of unstructured meshes for load balancing

    Martin, O.C.; Otto, S.W.

    1994-01-01

    Many large-scale engineering and scientific calculations involve repeated updating of variables on an unstructured mesh. To do these types of computations on distributed memory parallel computers, it is necessary to partition the mesh among the processors so that the load balance is maximized and inter-processor communication time is minimized. This can be approximated by the problem, of partitioning a graph so as to obtain a minimum cut, a well-studied combinatorial optimization problem. Graph partitioning algorithms are discussed that give good but not necessarily optimum solutions. These algorithms include local search methods recursive spectral bisection, and more general purpose methods such as simulated annealing. It is shown that a general procedure enables to combine simulated annealing with Kernighan-Lin. The resulting algorithm is both very fast and extremely effective. (authors) 23 refs., 3 figs., 1 tab

  6. Adaptive upscaling with the dual mesh method

    Guerillot, D.; Verdiere, S.

    1997-08-01

    The objective of this paper is to demonstrate that upscaling should be calculated during the flow simulation instead of trying to enhance the a priori upscaling methods. Hence, counter-examples are given to motivate our approach, the so-called Dual Mesh Method. The main steps of this numerical algorithm are recalled. Applications illustrate the necessity to consider different average relative permeability values depending on the direction in space. Moreover, these values could be different for the same average saturation. This proves that an a priori upscaling cannot be the answer even in homogeneous cases because of the {open_quotes}dynamical heterogeneity{close_quotes} created by the saturation profile. Other examples show the efficiency of the Dual Mesh Method applied to heterogeneous medium and to an actual field case in South America.

  7. Variational mesh segmentation via quadric surface fitting

    Yan, Dongming

    2012-11-01

    We present a new variational method for mesh segmentation by fitting quadric surfaces. Each component of the resulting segmentation is represented by a general quadric surface (including plane as a special case). A novel energy function is defined to evaluate the quality of the segmentation, which combines both L2 and L2 ,1 metrics from a triangle to a quadric surface. The Lloyd iteration is used to minimize the energy function, which repeatedly interleaves between mesh partition and quadric surface fitting. We also integrate feature-based and simplification-based techniques in the segmentation framework, which greatly improve the performance. The advantages of our algorithm are demonstrated by comparing with the state-of-the-art methods. © 2012 Elsevier Ltd. All rights reserved.

  8. Variational mesh segmentation via quadric surface fitting

    Yan, Dongming; Wang, Wen Ping; Liu, Yang; Yang, Zhouwang

    2012-01-01

    We present a new variational method for mesh segmentation by fitting quadric surfaces. Each component of the resulting segmentation is represented by a general quadric surface (including plane as a special case). A novel energy function is defined to evaluate the quality of the segmentation, which combines both L2 and L2 ,1 metrics from a triangle to a quadric surface. The Lloyd iteration is used to minimize the energy function, which repeatedly interleaves between mesh partition and quadric surface fitting. We also integrate feature-based and simplification-based techniques in the segmentation framework, which greatly improve the performance. The advantages of our algorithm are demonstrated by comparing with the state-of-the-art methods. © 2012 Elsevier Ltd. All rights reserved.

  9. Meshed split skin graft for extensive vitiligo

    Srinivas C

    2004-05-01

    Full Text Available A 30 year old female presented with generalized stable vitiligo involving large areas of the body. Since large areas were to be treated it was decided to do meshed split skin graft. A phototoxic blister over recipient site was induced by applying 8 MOP solution followed by exposure to UVA. The split skin graft was harvested from donor area by Padgett dermatome which was meshed by an ampligreffe to increase the size of the graft by 4 times. Significant pigmentation of the depigmented skin was seen after 5 months. This procedure helps to cover large recipient areas, when pigmented donor skin is limited with minimal risk of scarring. Phototoxic blister enables easy separation of epidermis thus saving time required for dermabrasion from recipient site.

  10. A Wrapping Method for Inserting Titanium Micro-Mesh Implants in the Reconstruction of Blowout Fractures

    Tae Joon Choi

    2016-01-01

    Full Text Available Titanium micro-mesh implants are widely used in orbital wall reconstructions because they have several advantageous characteristics. However, the rough and irregular marginal spurs of the cut edges of the titanium mesh sheet impede the efficacious and minimally traumatic insertion of the implant, because these spurs may catch or hook the orbital soft tissue, skin, or conjunctiva during the insertion procedure. In order to prevent this problem, we developed an easy method of inserting a titanium micro-mesh, in which it is wrapped with the aseptic transparent plastic film that is used to pack surgical instruments or is attached to one side of the inner suture package. Fifty-four patients underwent orbital wall reconstruction using a transconjunctival or transcutaneous approach. The wrapped implant was easily inserted without catching or injuring the orbital soft tissue, skin, or conjunctiva. In most cases, the implant was inserted in one attempt. Postoperative computed tomographic scans showed excellent placement of the titanium micro-mesh and adequate anatomic reconstruction of the orbital walls. This wrapping insertion method may be useful for making the insertion of titanium micro-mesh implants in the reconstruction of orbital wall fractures easier and less traumatic.

  11. Laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse after failed transvaginal polypropylene mesh surgery.

    Schmid, Corina; O'Rourke, Peter; Maher, Christopher

    2013-05-01

    A prospective case series to assess the safety and efficacy of laparoscopic sacrocolpopexy for the surgical management of recurrent pelvic organ prolapse (POP) after transvaginal polypropylene mesh prolapse surgery. Between January and December 2010, women with post-hysterectomy recurrent prolapse (≥ stage 2 POP-Q) after transvaginal polypropylene mesh prolapse surgery were included. Perioperative morbidity and short-term complications were recorded and evaluated. Surgical outcomes were objectively assessed utilising the Pelvic Organ Prolapse Quantification system (POP-Q), the validated, condition-specific Australian Pelvic Floor Questionnaire (APFQ) and the Patient Global Impression of Improvement (PGI-I) at 12 months. All 16 women in this study had undergone surgery with trocar-guided transvaginal polypropylene mesh kits. In 75% the recurrent prolapse affected the compartment of prior mesh surgery with the anterior (81%) and apical (75%) compartment prolapse predominating. At a mean follow-up of 12 months, all women had resolution of awareness of prolapse, had transvaginal mesh surgery is feasible and safe. Further widespread evaluation is required.

  12. Real-time 3D echo in patient selection for cardiac resynchronization therapy.

    Kapetanakis, Stamatis; Bhan, Amit; Murgatroyd, Francis; Kearney, Mark T; Gall, Nicholas; Zhang, Qing; Yu, Cheuk-Man; Monaghan, Mark J

    2011-01-01

    this study investigated the use of 3-dimensional (3D) echo in quantifying left ventricular mechanical dyssynchrony (LVMD), its interhospital agreement, and potential impact on patient selection. assessment of LVMD has been proposed as an improvement on conventional criteria in selecting patients for cardiac resynchronization therapy (CRT). Three-dimensional echo offers a reproducible assessment of left ventricular (LV) structure, function, and LVMD and may be useful in selecting patients for this intervention. we studied 187 patients at 2 institutions. Three-dimensional data from baseline and longest follow-up were quantified for volume, left ventricular ejection fraction (LVEF), and systolic dyssynchrony index (SDI). New York Heart Association (NYHA) functional class was assessed independently. Several outcomes from CRT were considered: 1) reduction in NYHA functional class; 2) 20% relative increase in LVEF; and 3) 15% reduction in LV end-systolic volume. Sixty-two cases were shared between institutions to analyze interhospital agreement. there was excellent interhospital agreement for 3D-derived LV end-diastolic and end- systolic volumes, EF, and SDI (variability: 2.9%, 1%, 7.1%, and 7.6%, respectively). Reduction in NYHA functional class was found in 78.9% of patients. Relative improvement in LVEF of 20% was found in 68% of patients, but significant reduction in LV end-systolic volume was found in only 41.5%. The QRS duration was not predictive of any of the measures of outcome (area under the curve [AUC]: 0.52, 0.58, and 0.57 for NYHA functional class, LVEF, and LV end-systolic volume), whereas SDI was highly predictive of improvement in these parameters (AUC: 0.79, 0.86, and 0.66, respectively). For patients not fulfilling traditional selection criteria (atrial fibrillation, QRS duration <120 ms, or undergoing device upgrade), SDI had similar predictive value. A cutoff of 10.4% for SDI was found to have the highest accuracy for predicting improvement following

  13. FDG-PET improves the staging and selection of patients with recurrent colorectal cancer

    Lonneux, Max; Reffad, Abdel-Malek; Pauwels, Stanislas; Detry, Roger; Kartheuser, Alex; Gigot, Jean-Francois

    2002-01-01

    Whole-body fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has proved effective in the diagnosis and staging of recurrent colorectal cancer. In this study, we analysed how PET affects the management of patients with recurrent colorectal cancer by permitting more accurate selection of candidates for curative resection. The data of 79 patients with known or suspected recurrent colorectal cancer were analysed. Conventional imaging modalities (CIM) and PET results were compared with regard to their accuracy in determining the extent and the resectability of tumour recurrence. Recurrence was demonstrated in 68 of the 79 patients. The data indicate that PET was superior to CIM for detection of recurrence at all sites except the liver. Based on the CIM+PET staging, surgery with curative intent was proposed in 39 patients and was indeed achieved in 31 of them (80%). PET was more accurate than CIM alone in predicting the resectability or non-resectability of the recurrence (82% vs 68%, P=0.02). It is concluded that whole-body FDG-PET is highly sensitive for both the diagnosis and the staging of patients with recurrent colorectal cancer. Its use in conjunction with conventional imaging procedures results in a more accurate selection of patients for surgical treatment with curative intent. (orig.)

  14. Efficacy of Patient Selection for Diagnostic Coronary Angiography in Suspected Coronary Artery Disease

    Francisco Flávio Costa Filho

    2015-11-01

    Full Text Available AbstractBackground:Guidelines recommend that in suspected stable coronary artery disease (CAD, a clinical (non-invasive evaluation should be performed before coronary angiography.Objective:We assessed the efficacy of patient selection for coronary angiography in suspected stable CAD.Methods:We prospectively selected consecutive patients without known CAD, referred to a high-volume tertiary center. Demographic characteristics, risk factors, symptoms and non-invasive test results were correlated to the presence of obstructive CAD. We estimated the CAD probability based on available clinical data and the incremental diagnostic value of previous non-invasive tests.Results:A total of 830 patients were included; median age was 61 years, 49.3% were males, 81% had hypertension and 35.5% were diabetics. Non-invasive tests were performed in 64.8% of the patients. At coronary angiography, 23.8% of the patients had obstructive CAD. The independent predictors for obstructive CAD were: male gender (odds ratio [OR], 3.95; confidence interval [CI] 95%, 2.70 - 5.77, age (OR for 5 years increment, 1.15; CI 95%, 1.06 - 1.26, diabetes (OR, 2.01; CI 95%, 1.40 - 2.90, dyslipidemia (OR, 2.02; CI 95%, 1.32 - 3.07, typical angina (OR, 2.92; CI 95%, 1.77 - 4.83 and previous non-invasive test (OR 1.54; CI 95% 1.05 - 2.27.Conclusions:In this study, less than a quarter of the patients referred for coronary angiography with suspected CAD had the diagnosis confirmed. A better clinical and non-invasive assessment is necessary, to improve the efficacy of patient selection for coronary angiography.

  15. Energy-efficient wireless mesh infrastructures

    Al-Hazmi, Y.; de Meer, Hermann; Hummel, Karin Anna; Meyer, Harald; Meo, Michela; Remondo Bueno, David

    2011-01-01

    The Internet comprises access segments with wired and wireless technologies. In the future, we can expect wireless mesh infrastructures (WMIs) to proliferate in this context. Due to the relatively low energy efficiency of wireless transmission, as compared to wired transmission, energy consumption of WMIs can represent a significant part of the energy consumption of the Internet as a whole. We explore different approaches to reduce energy consumption in WMIs, taking into accoun...

  16. MESHREF, Finite Elements Mesh Combination with Renumbering

    1973-01-01

    1 - Nature of physical problem solved: The program can assemble different meshes stored on tape or cards. Renumbering is performed in order to keep band width low. Voids and/ or local refinement are possible. 2 - Method of solution: Topology and geometry are read according to input specifications. Abundant nodes and elements are eliminated. The new topology and geometry are stored on tape. 3 - Restrictions on the complexity of the problem: Maximum number of nodes = 2000. Maximum number of elements = 1500

  17. Symmetries and the coarse-mesh method

    Makai, M.

    1980-10-01

    This report approaches the basic problem of the coarse-mesh method from a new side. Group theory is used for the determination of the space dependency of the flux. The result is a method called ANANAS after the analytic-analytic solution. This method was tested on two benchmark problems: one given by Melice and the IAEA benchmark. The ANANAS program is an experimental one. The method was intended for use in hexagonal geometry. (Auth.)

  18. Wireless experiments on a Motorola mesh testbed.

    Riblett, Loren E., Jr.; Wiseman, James M.; Witzke, Edward L.

    2010-06-01

    Motomesh is a Motorola product that performs mesh networking at both the client and access point levels and allows broadband mobile data connections with or between clients moving at vehicular speeds. Sandia National aboratories has extensive experience with this product and its predecessors in infrastructure-less mobile environments. This report documents experiments, which characterize certain aspects of how the Motomesh network performs when obile units are added to a fixed network infrastructure.

  19. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders

    Gross, Douglas P; Armijo-Olivo, Susan; Shaw, William S

    2016-01-01

    Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying...... the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses...

  20. Current situation of transvaginal mesh repair for pelvic organ prolapse.

    Zhu, Lan; Zhang, Lei

    2014-09-01

    Surgical mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repair abdominal hernias. In the 1970s, gynecologists began using surgical mesh products to indicate the repair of pelvic organ prolapse (POP), and in the 1990s, gynecologists began using surgical mesh for POP. Then the U.S. Food and Drug Administration (FDA) approved the first surgical mesh product specifically for use in POP. Surgical mesh materials can be divided into several categories. Most surgical mesh devices cleared for POP procedures are composed of non-absorbable synthetic polypropylene. Mesh can be placed in the anterior vaginal wall to aid in the correction of cystocele (anterior repair), in the posterior vaginal wall to aid in correction of rectocele (posterior repair), or attached to the top of the vagina to correct uterine prolapse or vaginal apical prolapse (apical repair). Over the past decades, surgical mesh products for transvaginal POP repair became incorporated into "kits" that included tools to aid in the delivery and insertion of the mesh. Surgical mesh kits continue to evolve, adding new insertion tools, tissue fixation anchors, surgical techniques, and ab- sorbable and biological materials. This procedure has been performed popularly. It was also performed increased in China. But this new technique met some trouble recently and let shake in urogynecology.

  1. Predicting mesh density for adaptive modelling of the global atmosphere.

    Weller, Hilary

    2009-11-28

    The shallow water equations are solved using a mesh of polygons on the sphere, which adapts infrequently to the predicted future solution. Infrequent mesh adaptation reduces the cost of adaptation and load-balancing and will thus allow for more accurate mapping on adaptation. We simulate the growth of a barotropically unstable jet adapting the mesh every 12 h. Using an adaptation criterion based largely on the gradient of the vorticity leads to a mesh with around 20 per cent of the cells of a uniform mesh that gives equivalent results. This is a similar proportion to previous studies of the same test case with mesh adaptation every 1-20 min. The prediction of the mesh density involves solving the shallow water equations on a coarse mesh in advance of the locally refined mesh in order to estimate where features requiring higher resolution will grow, decay or move to. The adaptation criterion consists of two parts: that resolved on the coarse mesh, and that which is not resolved and so is passively advected on the coarse mesh. This combination leads to a balance between resolving features controlled by the large-scale dynamics and maintaining fine-scale features.

  2. Age-stratified analysis of long-term outcomes of transvaginal mesh repair for treatment of pelvic organ prolapse.

    Dong, Shengnan; Zhong, Yanbo; Chu, Lei; Li, Huaifang; Tong, Xiaowen; Wang, Jianjun

    2016-10-01

    To investigate long-term outcomes after transvaginal mesh repair among patients with pelvic organ prolapse in different age groups. A retrospective cohort study was conducted among women who underwent transvaginal mesh repair with polypropylene mesh for pelvic organ prolapse of stage II or higher between January 2007 and November 2011 at a center in Shanghai, China. Patients were invited to attend a follow-up appointment between July 2014 and May 2015. Surgical outcomes were compared among three age groups (≤59, 60-74, and ≥75 years), and quality-of-life questionnaires were evaluated. Multivariate logistic regression was used to identify risk factors associated with recurrent prolapse and mesh exposure. Among 158 patients, 143 (90.5%) were objectively cured and 149 (94.3%) were subjectively cured at follow-up. Surgical outcomes were similar across all age groups. Significant improvements were observed on the Pelvic Floor Distress Inventory across all applicable subscales in all age groups (Pmesh exposure (odds ratio 11.89, 95% confidence interval 1.08-131.48; P=0.043). Transvaginal mesh repair was found to be a safe and effective technique for treating pelvic organ prolapse among women of all ages. An active postoperative sex life increased the odds of mesh exposure. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Topological patterns of mesh textures in serpentinites

    Miyazawa, M.; Suzuki, A.; Shimizu, H.; Okamoto, A.; Hiraoka, Y.; Obayashi, I.; Tsuji, T.; Ito, T.

    2017-12-01

    Serpentinization is a hydration process that forms serpentine minerals and magnetite within the oceanic lithosphere. Microfractures crosscut these minerals during the reactions, and the structures look like mesh textures. It has been known that the patterns of microfractures and the system evolutions are affected by the hydration reaction and fluid transport in fractures and within matrices. This study aims at quantifying the topological patterns of the mesh textures and understanding possible conditions of fluid transport and reaction during serpentinization in the oceanic lithosphere. Two-dimensional simulation by the distinct element method (DEM) generates fracture patterns due to serpentinization. The microfracture patterns are evaluated by persistent homology, which measures features of connected components of a topological space and encodes multi-scale topological features in the persistence diagrams. The persistence diagrams of the different mesh textures are evaluated by principal component analysis to bring out the strong patterns of persistence diagrams. This approach help extract feature values of fracture patterns from high-dimensional and complex datasets.

  4. Improved Mesh_Based Image Morphing ‎

    Mohammed Abdullah Taha

    2017-11-01

    Full Text Available Image morphing is a multi-step process that generates a sequence of transitions between two images. The thought is to get a ₔgrouping of middle pictures which, when ₔassembled with the first pictures would represent the change from one picture to the other.  The process of morphing requires time and attention to detail in order to get good results. Morphing image requires at least two processes warping and cross dissolve. Warping is the process of geometric transformation of images. The cross dissolve is the process interpolation of color of eachₔ pixel from the first image value to theₔ corresponding second imageₔ value over the time. Image morphing techniques differ from in the approach of image warping procedure. This work presents a survey of different techniques to construct morphing images by review the different warping techniques. One of the predominant approaches of warping process is mesh warping which suffers from some problems including ghosting. This work proposed and implements an improved mesh warping technique to construct morphing images. The results show that the proposed approach can overcome the problems of the traditional mesh technique

  5. Cu mesh for flexible transparent conductive electrodes.

    Kim, Won-Kyung; Lee, Seunghun; Hee Lee, Duck; Hee Park, In; Seong Bae, Jong; Woo Lee, Tae; Kim, Ji-Young; Hun Park, Ji; Chan Cho, Yong; Ryong Cho, Chae; Jeong, Se-Young

    2015-06-03

    Copper electrodes with a micromesh/nanomesh structure were fabricated on a polyimide substrate using UV lithography and wet etching to produce flexible transparent conducting electrodes (TCEs). Well-defined mesh electrodes were realized through the use of high-quality Cu thin films. The films were fabricated using radio-frequency (RF) sputtering with a single-crystal Cu target--a simple but innovative approach that overcame the low oxidation resistance of ordinary Cu. Hybrid Cu mesh electrodes were fabricated by adding a capping layer of either ZnO or Al-doped ZnO. The sheet resistance and the transmittance of the electrode with an Al-doped ZnO capping layer were 6.197 ohm/sq and 90.657%, respectively, and the figure of merit was 60.502 × 10(-3)/ohm, which remained relatively unchanged after thermal annealing at 200 °C and 1,000 cycles of bending. This fabrication technique enables the mass production of large-area flexible TCEs, and the stability and high performance of Cu mesh hybrid electrodes in harsh environments suggests they have strong potential for application in smart displays and solar cells.

  6. Numerical Investigation of Corrugated Wire Mesh Laminate

    Jeongho Choi

    2013-01-01

    Full Text Available The aim of this work is to develop a numerical model of Corrugated Wire Mesh Laminate (CWML capturing all its complexities such as nonlinear material properties, nonlinear geometry and large deformation behaviour, and frictional behaviour. Development of such a model will facilitate numerical simulation of the mechanical behaviour of the wire mesh structure under various types of loading as well as the variation of the CWML configuration parameters to tailor its mechanical properties to suit the intended application. Starting with a single strand truss model consisting of four waves with a bilinear stress-strain model to represent the plastic behaviour of stainless steel, the finite element model is gradually built up to study single-layer structures with 18 strands of corrugated wire meshes consistency and double- and quadruple-layered laminates with alternating crossply orientations. The compressive behaviour of the CWML model is simulated using contact elements to model friction and is compared to the load-deflection behaviour determined experimentally in uniaxial compression tests. The numerical model of the CWML is then employed to conduct the aim of establishing the upper and lower bounds of stiffness and load capacity achievable by such structures.

  7. Data-Parallel Mesh Connected Components Labeling and Analysis

    Harrison, Cyrus; Childs, Hank; Gaither, Kelly

    2011-04-10

    We present a data-parallel algorithm for identifying and labeling the connected sub-meshes within a domain-decomposed 3D mesh. The identification task is challenging in a distributed-memory parallel setting because connectivity is transitive and the cells composing each sub-mesh may span many or all processors. Our algorithm employs a multi-stage application of the Union-find algorithm and a spatial partitioning scheme to efficiently merge information across processors and produce a global labeling of connected sub-meshes. Marking each vertex with its corresponding sub-mesh label allows us to isolate mesh features based on topology, enabling new analysis capabilities. We briefly discuss two specific applications of the algorithm and present results from a weak scaling study. We demonstrate the algorithm at concurrency levels up to 2197 cores and analyze meshes containing up to 68 billion cells.

  8. Assessing the impact of short-term surgical education on practice: a retrospective study of the introduction of mesh for inguinal hernia repair in sub-Saharan Africa.

    Wang, Y T; Meheš, M M; Naseem, H-R; Ibrahim, M; Butt, M A; Ahmed, N; Wahab Bin Adam, M A; Issah, A-W; Mohammed, I; Goldstein, S D; Cartwright, K; Abdullah, F

    2014-08-01

    Inguinal hernia repair is the most common general surgery operation performed globally. However, the adoption of tension-free hernia repair with mesh has been limited in low-income settings, largely due to a lack of technical training and resources. The present study evaluates the impact of a 2-day training course instructing use of polypropylene mesh for inguinal hernia repair on the practice patterns of sub-Saharan African physicians. A surgical training course on tension-free mesh repair of hernias was provided to 16 physicians working in rural Ghanaian and Liberian hospitals. Three physicians were requested to prospectively record all their inguinal hernia surgeries, performed with or without mesh, during the 14-month period following the training. Demographic variables, diagnoses, and complications were collected by an independent data collector for mesh and non-mesh procedures. Surgery with mesh increased significantly following intervention, from near negligible levels prior to the training to 8.1 % of all inguinal hernia repairs afterwards. Mesh repair accounted for 90.8 % of recurrent hernia repairs and 2.9 % of primary hernia repairs after training. Overall complication rates between mesh and non-mesh procedures were not significantly different (p = 0.20). Three physicians who participated in an intensive education course were routinely using mesh for inguinal hernia repair 14 months after the training. This represents a significant change in practice pattern. Complication rates between patients who underwent inguinal hernia repairs with and without mesh were comparable. The present study provides evidence that short-term surgical training initiatives can have a substantial impact on local healthcare practice in resource-limited settings.

  9. Transvaginal Mesh and Transanal Resection to Treat Outlet Obstruction Constipation Caused by Rectocele

    Shi, Yang; Yu, Yongjun; Zhang, Xipeng; Li, Yuwei

    2017-01-01

    Background The aim of this study was to evaluate the curative effect of transvaginal mesh repair (TVMR) and stapled transanal rectal resection (STARR) in treating outlet obstruction constipation caused by rectocele. Material/Methods Patients who had outlet obstruction constipation caused by rectocele were retrospectively analyzed and 39 patients were enrolled the study. Patients were assigned to either the TVMR or STARR group. Postoperative factors such as complications, pain, recurrence rate...

  10. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Saulino M

    2014-11-01

    Full Text Available Michael Saulino,1,2 Philip S Kim,3,4 Erik Shaw5 1MossRehab, Elkins Park, PA, USA; 2Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA; 3Helen F Graham Cancer Center, Christiana Care Health System, Newark, DE, USA; 4Center for Interventional Pain Spine, LLC., Bryn Mawr, PA, USA; 5Shepherd Pain Institute, Shepherd Center, Atlanta, GA, USA Abstract: Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been

  11. Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis?

    Woodall, Charles E; Scoggins, Charles R; Ellis, Susan F; Tatum, Clifton M; Hahl, Michael J; Ravindra, Kadiyala V; McMasters, Kelly M; Martin, Robert C G

    2009-03-01

    The goal of this study was to examine the safety and efficacy of selective internal radioembolization (SIR) for hepatocellular carcinoma (HCC) with portal vein or caval thrombosis (VT), or both. Recent reports have demonstrated that SIR is safe for patients with HCC, but the impact on efficacy of venous thrombosis is unknown. Prospective single-arm study of the use of Therasphere in patients with unresectable HCC enrolled from January 2004 to June 2007. Patients were categorized into three groups based on VT status and therapy. Fifty-two patients were enrolled: 20 patients without VT who received SIR, 15 patients with VT who were treated, and 17 patients (10 with VT) who were not treated because of preprocedure screening failure. Fifty-eight treatments were administered, with a median of two treatments per patient (range of one to three treatments). Child's score was different between groups. Of the VT patients treated, 67% had portal VT, 7% had cava VT, and 26% had both. There were no treatment-related deaths. There was no difference in complications among groups (p = 0.34). Treated patients without thrombosis had a median overall survival of 13.9 months versus 2.7 months for those treated with thrombosis and 5.2 months for the untreated group given best supportive care only (p = 0.01). SIR is safe in patients with HCC. Although SIR can be delivered with minimal morbidity, there might be no benefit for patients with VT. Continued emphasis on multimodality therapy in this population is needed to improve survival.

  12. Non-invasive examinations successfully select patients with medial temporal lobe epilepsy for anterior temporal lobectomy

    Morioka, Takato; Nishio, Shunji; Kawamura, Tadao; Fukui, Kimiko; Sasaki, Masayuki; Fukui, Masashi [Kyushu Univ., Fukuoka (Japan). Graduate School of Medical Sciences

    2001-06-01

    We retrospectively analyzed 8 patients with intractable medial temporal lobe epilepsy (MTLE) who underwent the anterior temporal lobectomy with hippocampectomy (ATL) without invasive examinations such as chronic subdural electrode recording. Five patients had a history of febrile convulsion. While all 8 patients had oral automatism, automatism of ipsilateral limbs with dystonic posture of contralateral limbs was demonstrated in 2 patients. Bilateral temporal paroxysmal activities on interictal EEG was observed in 4 patients and all patients had clear ictal onset zone on unilateral anterior temporal region. MRI demonstrated unilateral hippocampal sclerosis in 5 cases. Interictal FDG-PET depicted hypometabolism of the unilateral temporal lobe in all cases, however, ECD-SPECT failed to reveal the hypoperfusion of the unilateral temporal lobe in a case. Postoperatively, 7 cases became seizure free, and one had rare seizure. Non-invasive examinations, especially ictal EEG and concordant FDG-PET findings, in patients with oral automatism in seizure semiology, successfully select patients with MTLE for ATL. (author)

  13. Non-invasive examinations successfully select patients with medial temporal lobe epilepsy for anterior temporal lobectomy

    Morioka, Takato; Nishio, Shunji; Kawamura, Tadao; Fukui, Kimiko; Sasaki, Masayuki; Fukui, Masashi

    2001-01-01

    We retrospectively analyzed 8 patients with intractable medial temporal lobe epilepsy (MTLE) who underwent the anterior temporal lobectomy with hippocampectomy (ATL) without invasive examinations such as chronic subdural electrode recording. Five patients had a history of febrile convulsion. While all 8 patients had oral automatism, automatism of ipsilateral limbs with dystonic posture of contralateral limbs was demonstrated in 2 patients. Bilateral temporal paroxysmal activities on interictal EEG was observed in 4 patients and all patients had clear ictal onset zone on unilateral anterior temporal region. MRI demonstrated unilateral hippocampal sclerosis in 5 cases. Interictal FDG-PET depicted hypometabolism of the unilateral temporal lobe in all cases, however, ECD-SPECT failed to reveal the hypoperfusion of the unilateral temporal lobe in a case. Postoperatively, 7 cases became seizure free, and one had rare seizure. Non-invasive examinations, especially ictal EEG and concordant FDG-PET findings, in patients with oral automatism in seizure semiology, successfully select patients with MTLE for ATL. (author)

  14. Plasma cytokine profiles in depressed patients who fail to respond to selective serotonin reuptake inhibitor therapy.

    O'Brien, Sinead M

    2012-02-03

    OBJECTIVE: Approximately 30% of patients with depression fail to respond to a selective serotonin reuptake inhibitor (SSRI). Few studies have attempted to define these patients from a biological perspective. Studies suggest that overall patients with depression show increased production of proinflammatory cytokines. We examined pro- and anti-inflammatory cytokine levels in patients who were SSRI resistant. METHODS: Plasma concentrations of IL-6, IL-8, IL-10, TNF-alpha and sIL-6R were measured with enzyme linked immunosorbent assays (ELISA) in DSM-1V major depressives who were SSRI resistant, in formerly SSRI resistant patients currently euthymic and in healthy controls. RESULTS: Patients with SSRI-resistant depression had significantly higher production of the pro-inflammatory cytokines IL-6 (p=0.01) and TNF-alpha (p=0.004) compared to normal controls. Euthymic patients who were formerly SSRI resistant had proinflammatory cytokine levels which were similar to the healthy subject group. Anti-inflammatory cytokine levels did not differ across the 3 groups. CONCLUSION: Suppression of proinflammatory cytokines does not occur in depressed patients who fail to respond to SSRIs and is necessary for clinical recovery.

  15. Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoring

    Kappos, Ludwig; Bates, David; Edan, Gilles

    2011-01-01

    Natalizumab, a highly specific α4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very......, based on additional long-term follow-up of clinical studies and post-marketing observations, including appropriate patient selection and management recommendations.......Natalizumab, a highly specific α4-integrin antagonist, is approved for treatment of patients with active relapsing-remitting multiple sclerosis (RRMS). It is generally recommended for individuals who have not responded to a currently available first-line disease-modifying therapy or who have very...... active disease. The expected benefits of natalizumab treatment have to be weighed against risks, especially the rare but serious adverse event of progressive multifocal leukoencephalopathy. In this Review, we revisit and update previous recommendations on natalizumab for treatment of patients with RRMS...

  16. Treatment compliance and challenges among tuberculosis patients across selected health facilities in Osun State Nigeria.

    Ajao, K O; Ogundun, O A; Afolabi, O T; Ojo, T O; Atiba, B P; Oguntunase, D O

    2014-12-01

    Tuberculosis (TB) is a major public health problem in the world and Africa has approximately one quarter of the world's cases. One of the greatest challenges facing most TB programmes is the non-compliance to TB treatment among TB patients. This study aimed at determining the challenges of management of tuberculosis (TB) across selected Osun State health facilities. The study employed a descriptive cross-sectional design. A semi-structured questionnaire was used to collect data from 102 TB patients in the health facilities. The instrument measured socio-demographic variables, patient related factors, socio-economic variables, health care system related factors to TB disease and treatment. Data were analysed and summarized using descriptive and inferential statistics. Statistical significance was placed at p facilities (χ2 = 21.761, p facility and patient-related factors were largely responsible.

  17. Alternatives for OSAHS treatment: selection of patients for upper airway surgery and oral appliances

    A. Boudewyns

    2007-12-01

    Full Text Available Although continuous positive airway pressure (CPAP is considered to represent the standard treatment for patients with moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS, poor treatment compliance and/or refusal is an issue in 20–30% of these patients. As an alternative to life-long CPAP treatment, conservative procedures exist with dental appliances for mandibular advancement, as well as curative surgical techniques. Surgical treatment of OSAHS can be divided into the following two main groups: 1 upper airway surgery by soft tissue resection (uvulopalatopharyngoplasty, etc., and 2 skeletal procedures, such as maxillo-mandibular advancement. Proper selection of patients for the different treatment modalities is the key for full treatment success. Patient-related factors, such as the site of upper airway collapse, craniofacial characteristics, dental health, obesity, age, profession and positional dependence, as well as treatment-related factors, should be evaluated before a final proposal for these treatment alternatives is formulated.

  18. Appropriateness guidelines and predictive rules to select patients for upper endoscopy: a nationwide multicenter study.

    Buri, Luigi; Hassan, Cesare; Bersani, Gianluca; Anti, Marcello; Bianco, Maria Antonietta; Cipolletta, Livio; Di Giulio, Emilio; Di Matteo, Giovanni; Familiari, Luigi; Ficano, Leonardo; Loriga, Pietro; Morini, Sergio; Pietropaolo, Vincenzo; Zambelli, Alessandro; Grossi, Enzo; Intraligi, Marco; Buscema, Massimo

    2010-06-01

    Selecting patients appropriately for upper endoscopy (EGD) is crucial for efficient use of endoscopy. The objective of this study was to compare different clinical strategies and statistical methods to select patients for EGD, namely appropriateness guidelines, age and/or alarm features, and multivariate and artificial neural network (ANN) models. A nationwide, multicenter, prospective study was undertaken in which consecutive patients referred for EGD during a 1-month period were enrolled. Before EGD, the endoscopist assessed referral appropriateness according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, also collecting clinical and demographic variables. Outcomes of the study were detection of relevant findings and new diagnosis of malignancy at EGD. The accuracy of the following clinical strategies and predictive rules was compared: (i) ASGE appropriateness guidelines (indicated vs. not indicated), (ii) simplified rule (>or=45 years or alarm features vs. <45 years without alarm features), (iii) logistic regression model, and (iv) ANN models. A total of 8,252 patients were enrolled in 57 centers. Overall, 3,803 (46%) relevant findings and 132 (1.6%) new malignancies were detected. Sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) of the simplified rule were similar to that of the ASGE guidelines for both relevant findings (82%/26%/0.55 vs. 88%/27%/0.52) and cancer (97%/22%/0.58 vs. 98%/20%/0.58). Both logistic regression and ANN models seemed to be substantially more accurate in predicting new cases of malignancy, with an AUC of 0.82 and 0.87, respectively. A simple predictive rule based on age and alarm features is similarly effective to the more complex ASGE guidelines in selecting patients for EGD. Regression and ANN models may be useful in identifying a relatively small subgroup of patients at higher risk of cancer.

  19. ROLE OF MESH REPAIR IN PELVIC ORGAN PROLAPSE, WITH PARTICULAR REFERENCE TO VAULT PROLAPSE & NULLIPAROUS PROLAPSE

    Geeta Vandana Reddi

    2017-12-01

    Full Text Available BACKGROUND Pelvic organ prolapse is a common complaint in gynaecological practice. Nulliparous prolapse is seen in 2% of female population and vault prolapse in 0.5% following hysterectomy. Various surgical procedures have been described for the repair of vault prolapse e.g. transvaginal sacrospinous colpopexy, transabdominal sacral colpopexy, Le Forte's operation, colpoclesis, posterior intravaginal sling plasty etc. The introduction of synthetic mesh like Prolene, Mersilene for the repair of vault prolapse have the advantage of tensile strength. In nulliparous prolapse and uterovaginal prolapse also, the supports of uterus are weakened, so there seems to be a definite advantage of mesh repair over sling surgeries. MATERIALS AND METHODS A prospective study done in 50 patients with vault prolapse, Nulliparous prolapse and patients with UV prolapse who want to retain their menstrual and reproductive function were identified and repair of defects were done. 2 cases who underwent both hysterectomy and sacral colpopexy in two sittings were included in the study. They were followed up for a period of 6 weeks - 29 months. RESULTS In the present study, the mean age for vault prolapse was 52.14 years, mean parity was 3.36. Vault prolapses were found to be more common after abdominal hysterectomy 60.97% compared to vaginal 39.02%. Common indication for hysterectomy is pelvic organ prolapse followed by DUB in this study. The mean time between the hysterectomy and vault prolapse in this study was 5.46 years. Importance should be given to proper enterocoele repair and vault suspense time of primary surgery. In this study incidence of smoking in vault prolapse cases was 34.14% significant. In cases of sacral colpopexy for vault prolapse in this study there were no major mesh related complications and the cure rate was 97.5%. So, sacral colpopexy with prolene mesh i.e. abdominal mesh repair can be employed as the primary surgery for vault prolapse. The safety

  20. Opportunities for inhaler device selection in elderly patients with asthma or COPD

    Barrons R

    2015-12-01

    Full Text Available Robert Barrons,1 James Wheeler,2 J Andrew Woods1 1Wingate University School of Pharmacy, Wingate, NC, USA; 2University of Tennessee Health Science Center, Nashville, TN, USA Abstract: An anticipated surge in the elderly population will be accompanied by a rise in aging patients with asthma or COPD. Clinician selection of inhalers needs to address the unique challenges to elderly patients. These challenges to the use of inhalers include diminished physical and cognitive abilities, as well as cost reimbursement issues associated with polypharmacy and the Medicare gap. Clinicians should consider patient preferences for an inhaler device that provides ease of administration, and addresses conveniences such as portability, visual, and auditory indicators of dosing completion. The addition of spacer devices resolves hand-breath coordination difficulty with pressurized metered dose inhalers, but reduces overall inhaler convenience. Soft mist inhalers (Respimat® improve ease of administration, but use may be limited by cost and formulary availability. Multiple dose dry powder inhalers provide convenience and simplified use by requiring only one to two steps prior to administration, but concerns of peak inspiratory flow requirements remain among patients with advanced age and severity of COPD. If unaddressed, these challenges to inhaler selection contribute to inappropriate use of inhalers in 41% to 69% of patients, accompanied by at least 51% non-adherence to treatment. Clinicians must first avail themselves of reputable educational resources regarding new inhaler developments and administration, for competent patient instruction. Patient education should include a checklist of inhaler technique, with physical demonstration of each device by the patient and provider. Device demonstration significantly improves inhaler technique and identifies the need for nebulization therapy. Clinician and patient knowledge of available inhalers and their

  1. Interferon and ribavarin associated depression in hcv patients and role of selective serotonin reuptake inhibitors

    Bashir, K.; Hussain, C.A.; Amer, K.

    2013-01-01

    Objective: To determine the frequency and severity of depression associated with antiviral therapy of Hepatitis C Virus (HCV) infection and effect of selective serotonin reuptake Inhibitors (SSRIs) to treat these depressive symptoms. Type of Study: Observational Analytical study. Place of Study and Duration: The study was conducted at Psychiatry, Medicine and Pathology department of Combined Military Hospital Sialkot Pakistan from February 2009 to July 2010. Subjects and Methods: All the patients in this study were suffering from HCV infection and were managed with Interferon (3 m.i.u. s/c thrice weekly) and Cap Ribavirin (400 mg bid) for six months. Patients were assessed by Hospital Anxiety and Depression Scale (HADS) - Urdu Version and Beck's Depressive Inventory (BDI) Scores after twelve weeks of antiviral therapy. Depressed patients were managed with selective serotonin reuptake inhibitors (SSRIs) for six weeks and again evaluated on HADS and BDI Scores. Response to SSRIs was defined as complete response, partial response and no response. Results: A total of 105 patients were studied out of which 75 were male and 30 were female with mean age 29.4 years. Out of these 54 (51.43%) patients developed depression and this tendency to develop depression was not related with the age and sex of the patients. The mean HADS and BDI scores before and after treatments with SSRIs were compared for significance and it was quite significant. There was not a single patient who did not show response to SSRIs. Conclusion: Depression is frequently associated with antiviral therapy of HCV RNA viraemia with interferon and SSRIs have proved an effective and safe remedy in these patients. (author)

  2. Patients with chronic insomnia have selective impairments in memory that are modulated by cortisol.

    Chen, Gui-Hai; Xia, Lan; Wang, Fang; Li, Xue-Wei; Jiao, Chuan-An

    2016-10-01

    Memory impairment is a frequent complaint in insomniacs; however, it is not consistently demonstrated. It is unknown whether memory impairment in insomniacs involves neuroendocrine dysfunction. The participants in this study were selected from the clinical setting and included 21 patients with chronic insomnia disorder (CID), 25 patients with insomnia and comorbid depressive disorder (CDD), and 20 control participants without insomnia. We evaluated spatial working and reference memory, object working and reference memory, and object recognition memory using the Nine Box Maze Test. We also evaluated serum neuroendocrine hormone levels. Compared to the controls, the CID patients made significantly more errors in spatial working and object recognition memory (p memory types (p memory (r = .534, p = .033) and negatively correlated with the errors in object recognition memory (r = -.659, p = .006) in the CID patients. The results suggest that the CID patients had selective memory impairment, which may be mediated by increased cortisol levels. © 2016 Society for Psychophysiological Research.

  3. Selected problems associated with the treatment and care for patients with colostomy – part 2

    Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzisława; Charzyńska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

    2013-01-01

    Generally, ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. The study presents practical solutions related to care for the colostomy patient, i.e. an ostomy on the large intestine. The following issues will be discussed: regulating the defecation cycle, risk connected with improper selection of ostomy equipment, instruction on colostomy irrigation with practical advice and irrigation equipment supply. The knowledge of these rules and mastering them in practice is to provide ostomy patients not only with highest-standard care and help but also to prepare them for dealing with problems independently, i.e. for self-care. PMID:24596509

  4. Selected problems associated with the treatment and care for patients with colostomy - part 2.

    Muzyczka, Katarzyna; Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzisława; Charzyńska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

    2013-01-01

    Generally, ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. The study presents practical solutions related to care for the colostomy patient, i.e. an ostomy on the large intestine. The following issues will be discussed: regulating the defecation cycle, risk connected with improper selection of ostomy equipment, instruction on colostomy irrigation with practical advice and irrigation equipment supply. The knowledge of these rules and mastering them in practice is to provide ostomy patients not only with highest-standard care and help but also to prepare them for dealing with problems independently, i.e. for self-care.

  5. Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy

    Mistiaen, W.; Van Hee, R.; Blockx, P.; Hubens, A. (Univ. of Antwerp (Belgium))

    1990-03-01

    In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with (99mTc)stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1-18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.

  6. A general coarse and fine mesh solution scheme for fluid flow modeling in VHTRS

    Clifford, I; Ivanov, K; Avramova, M.

    2011-01-01

    Coarse mesh Computational Fluid Dynamics (CFD) methods offer several advantages over traditional coarse mesh methods for the safety analysis of helium-cooled graphite-moderated Very High Temperature Reactors (VHTRs). This relatively new approach opens up the possibility for system-wide calculations to be carried out using a consistent set of field equations throughout the calculation, and subsequently the possibility for hybrid coarse/fine mesh or hierarchical multi scale CFD simulations. To date, a consistent methodology for hierarchical multi-scale CFD has not been developed. This paper describes work carried out in the initial development of a multi scale CFD solver intended to be used for the safety analysis of VHTRs. The VHTR is considered on any scale to consist of a homogenized two-phase mixture of fluid and stationary solid material of varying void fraction. A consistent set of conservation equations was selected such that they reduce to the single-phase conservation equations for the case where void fraction is unity. The discretization of the conservation equations uses a new pressure interpolation scheme capable of capturing the discontinuity in pressure across relatively large changes in void fraction. Based on this, a test solver was developed which supports fully unstructured meshes for three-dimensional time-dependent compressible flow problems, including buoyancy effects. For typical VHTR flow phenomena the new solver shows promise as an effective candidate for predicting the flow behavior on multiple scales, as it is capable of modeling both fine mesh single phase flows as well as coarse mesh flows in homogenized regions containing both fluid and solid materials. (author)

  7. [Three years results of transvaginal cystocele repair with polypropylene mesh using a tension-free technique].

    El Harrech, Y; Ameur, A; Janane, A; Moufide, K; Ghadouane, M; Abbar, M

    2010-01-01

    To evaluate the long term efficacy and safety of transvaginal implantation of a non-resorbable synthetic prosthesis (Gynemesh) for the treatment of cystocele using transvaginal free tension technique. Prospective study of patients that have been submitted to correction of cystocele between April 2004 and July 2007. A prolene mesh was cut to an appropriate size to cover the whole cystocele leaving two tabs on each side. The two tabs of the mesh were then placed in paravaginal spaces, tension free, without stitches. Mesh was used in 31 patients. All patients had a symptomatic cystocele >or= 2 according to Baden-Walker halfway classification. Patients were reviewed initially at 1 and 3 month and then every 6 months. The mean age of the patients was 58 years (range: 47-70 years). Mean parity was 5.8 (range 1-11), and mean weight was 75 kg (range 60-82Kg). All women were postmenopausal. The operation was combined with vaginal hysterectomy in 2 patients, Posterior colporraphy in 2 patients, Perineorrhaphy in 1 patient, Sacrospinous fixation in 2 patients, transobturator tape for stress urinary incontinence in 7 women. Average time of surgery was 23 minutes for cystocele. There were no major complications, such as trauma to the bladder, urethra, bowels, or large vessels in the patient group treated. There was no immediate postoperative complications (up to 7 days) recorded. No hematoma or infection was observed in the operative area. Mesh erosion was detected in one patient. It was treated by excision of the eroded part of the mesh. Mean follow-up was 36.4 months (18 to 52 months). Using our definition of success based on both anatomic and functional outcomes, the overall cure rate was 74.19% (asymptomatic with no or grade 1 cystocele). The improvement rate (asymptomatic with a grade 2 cystocele) was 19.35% and the overall failure rate (symptomatic or with a grade 3 or 4 cystocele) was only 6.4% (2 women). The interposition of a sub-vesical transversal tension

  8. Selected aspects of nursing care for an elderly patient with chronic obstructive pulmonary disease

    Budnik, Marta; Galikowska, Anna; Marzec, Izabela; Balcerak, Dominika; Kobus, Edyta; Posieczek, Zuzanna

    2017-01-01

    Budnik Marta, Galikowska Anna, Marzec Izabela, Balcerak Dominika, Kobus Edyta, Posieczek Zuzanna. Selected aspects of nursing care for an elderly patient with chronic obstructive pulmonary disease. Journal of Education, Health and Sport. 2017;7(6):34-44. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.802926 http://ojs.ukw.edu.pl/index.php/johs/article/view/4501 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation...

  9. Selected problems associated with the treatment and care for patients with colostomy – part 2

    Muzyczka, Katarzyna; Kachaniuk, Hanna; Szadowska-Szlachetka, Zdzisława; Charzyńska-Gula, Marianna; Kocka, Katarzyna; Bartoszek, Agnieszka; Celej-Szuster, Jolanta

    2013-01-01

    Generally, ostomy is a purposeful connection of the lumen of the intestine with abdominal integuments by surgery. The study presents practical solutions related to care for the colostomy patient, i.e. an ostomy on the large intestine. The following issues will be discussed: regulating the defecation cycle, risk connected with improper selection of ostomy equipment, instruction on colostomy irrigation with practical advice and irrigation equipment supply. The knowledge of these rules and maste...

  10. Selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty with duplex scanning

    Bostroem Ardin, A.; Hellberg, A.; Ljungman, C.; Logason, K.; Karacagil, S.; Loefberg, A.M.; Andren, B.

    2002-01-01

    Aim: To evaluate the role of duplex scanning in the selection of patients with infrainguinal arterial occlusive disease for percutaneous transluminal angioplasty (PTA). Material and Methods: From January 1995 through May 2000, 702 patients (952 limbs), with chronic lower extremity ischemia due to infrainguinal atherosclerotic disease diagnosed by duplex scanning, were retrospectively studied. Diagnostic angiography (130 limbs) or infrainguinal PTA (108 limbs) was performed in 238 limbs. Two investigators retrospectively analyzed the duplex examinations and angiographies in a blinded manner and used similar criteria for the interpretation of lesions suitable or not suitable for PTA. Results: The superficial femoral, popliteal and crural artery lesions were correctly selected for PTA in 85%, 66% and 32%, respectively. The accuracy, sensitivity, specificity, negative predictive value and positive predictive value of duplex scanning to appropriately categorize femoropopliteal lesions as suitable or unsuitable for PTA were 89%, 83%, 92%, 94% and 78%, respectively. The accuracy of duplex scanning for predicting the performance of infrainguinal PTA was 83%. Conclusion: Duplex scanning has an important impact on the selection of treatment modalities in limbs with infrainguinal arterial occlusive disease. Femoropopliteal lesions can be reliably selected to PTA according to duplex scan findings

  11. Application of individually performed titanium mesh in infraorbital wall fracture reconstruction

    Kai-Jian Sun

    2016-04-01

    Full Text Available AIM:To discuss the application effect of individually performed titanium mesh in infraorbital wall fracture reconstruction. METHODS:Sixty-seven patients(67 eyesdiagnosed as infraorbital fracture from January 2011 to February 2014 were performed reconstruction with individually performed titanium mesh. The recovery of incision, visual acuity, eyeball mobility, diplopia and proptosis were monitored by post-operation follow-up which lasted for 1a. RESULTS:No infection, titanium mesh transposition, prolapse, deformities, exclusion or ectropion were occurred in the follow-up period. The eyeball embole was less than 2mm by bilateral proptosis contrast. The diplopia in 5 eyes were disappeared in 4 and approved in one. The eyeball descent in 2 cases was disappeared. The visual acuity was the same compared with pre-operation. The rate of disappeared diplopia at primary position was 93% and improved significantly in the other 3 patients. The rate of disappeared diplopia at peripheral visual field was 86% and improved significantly in the other 2 patients.CONCLUSION:The reconstruction effect of individually performed titanium mesh in infraorbital wall fracture was satisfied and safe.

  12. Prophylactic mesh at end-colostomy construction reduces parastomal hernia rate: a randomized trial.

    Lambrecht, J R; Larsen, S G; Reiertsen, O; Vaktskjold, A; Julsrud, L; Flatmark, K

    2015-10-01

    Parastomal hernia (PSH) is the most common complication of an end-colostomy and about one-quarter of patients need operative repair, which is often unsuccessful. A randomized trial was carried out to compare the results of using mesh or no mesh at the time of formation of a colostomy with the clinical identification of PSH as the primary outcome. In this two-centre randomized trial (Oslo University Hospital and Sykehuset Innlandet Hospital Trust, Norway), patients with rectal cancer undergoing open pelvic surgery were randomized to receive a retromuscular synthetic mesh (study group, n = 32) or no mesh (control group, n = 26) at the time of end-colostomy formation. Postoperative follow up was not blinded and included clinical examination and routine CT. The median period of follow up was 40 (range: 84) months. There were no differences in demographic variables or complications between the study and control groups. PSH developed in two patients of the study group and in 12 of the control group [OR = 0.04 (95% CI: 0.01-0.30) and hazard ratio 0.134 (95% CI: 0.030-0.603); P colostomy reduced the risk of PSH. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  13. Determination of Selected Amino Acids in Serum of Patients with Liver Disease.

    Kanďár, Roman; Drábková, Petra; Toiflová, Tereza; Čegan, Alexander

    2016-01-01

    The determination of amino acids can be a reliable approach for extended diagnosis of liver diseases. This is because liver disease can be a cause of impaired amino acid metabolism. Therefore, a method for the determination of serum amino acids, applicable for clinical purposes, is necessary. The aim of this study was to find differences in the levels of selected amino acids between patients with liver disease and a control group. Samples of peripheral venous blood were obtained from a group of patients with liver disease (n = 131, 59 women at an average age of 60 years and 72 men at an average age of 52 years) and a control group (n = 105, 47 women at an average age of 62 years and 58 men at an average age of 58 years). Before the separation, the amino acids were derivatized with naphthalene-2,3-dicarboxaldehyde. For the separation, reverse phase column was used. The effluent was monitored with a fluorescence detector. There were significant differences in the concentrations of some amino acids between the patients and the control group, but also between women and men. Correlations between some amino acids and markers of liver blood tests and lipid metabolism were observed. A simple, relatively rapid and selective HPLC method with fluorescence detection for the determination of selected amino acids in serum has been developed.

  14. Update on prescription extended-release opioids and appropriate patient selection

    Brennan MJ

    2013-07-01

    Full Text Available Michael J Brennan The Pain Center of Fairfield, Fairfield, CT, USA Abstract: Chronic pain is largely underdiagnosed, often undertreated, and expected to increase as the American population ages. Many patients with chronic pain require long-term treatment with analgesic medications, and pain management may involve use of prescription opioids for patients whose pain is inadequately controlled through other therapies. Yet because of the potential for abuse and addiction, many clinicians hesitate to treat their patients with pain with potentially beneficial agents. Finding the right opioid for the right patient is the first – often complicated – step. Ensuring that patients continue to properly use the medication while achieving therapeutic analgesic effects is the long-term goal. Combined with careful patient selection and ongoing monitoring, new formulations using extended-release technologies incorporating tamper-resistant features may help combat the growing risk of abuse or misuse, which will hopefully reduce individual suffering and the societal burden of chronic pain. The objective of this manuscript is to provide an update on extended-release opioids and to provide clinicians with a greater understanding of which patients might benefit from these new opioid formulations and how to integrate the recommended monitoring for abuse potential into clinical practice. Keywords: chronic pain, opioid analgesics, extended release, abuse prevention

  15. [The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer].

    Rödel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-08-01

    Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category.

  16. The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer

    Roedel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-01-01

    Background: Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Methods: Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). Results: By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. Conclusion: To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category. (orig.)

  17. Exploring Visual Selective Attention towards Novel Stimuli in Alzheimer's Disease Patients

    Sarah A. Chau

    2015-12-01

    Full Text Available Background: Alzheimer's disease (AD is associated with selective attention impairments, which could contribute to cognitive and functional deficits. Selective attention can be explored through examination of novelty preference. Aims: In this study, we quantified novelty preference in AD patients by measuring visual scanning behaviour using an eye tracking paradigm. Methods: Mild-to-moderate AD patients and elderly controls viewed slides containing novel and repeated images simultaneously. The outcome measure was time spent on specific images, with novelty preference defined by greater relative fixation time (RFT on novel versus repeated images. Cognitive status (Standardized Mini-Mental State Examination, SMMSE and attention (Digit Span, DS were also measured. Results: AD patients (age 79.2 ± 6.7 years, SMMSE 22.2 ± 4.0, n = 41 and controls (age 76.2 ± 6.4 years, SMMSE 28.1 ± 2.0, n = 24 were similar in age, education and sex. Compared with controls, AD patients had lower RFT on novel than on repeated images (F1,63 = 11.18, p = 0.001. Further, reduced RFT was associated with lower scores on SMMSE (r63 = 0.288, p = 0.020 and DS (r63 = 0.269, p = 0.030. Within individuals, novelty preference was detected in 92.3% of patients and in 100% of controls. Conclusion: These findings suggest that novelty preference, measured by visual scanning behaviour, can differentiate cognitively healthy and impaired people and may offer a nonverbal, less cognitively demanding method of assessing selective attention.

  18. Exploring Visual Selective Attention towards Novel Stimuli in Alzheimer's Disease Patients.

    Chau, Sarah A; Herrmann, Nathan; Eizenman, Moshe; Chung, Jonathan; Lanctôt, Krista L

    2015-01-01

    Alzheimer's disease (AD) is associated with selective attention impairments, which could contribute to cognitive and functional deficits. Selective attention can be explored through examination of novelty preference. In this study, we quantified novelty preference in AD patients by measuring visual scanning behaviour using an eye tracking paradigm. Mild-to-moderate AD patients and elderly controls viewed slides containing novel and repeated images simultaneously. The outcome measure was time spent on specific images, with novelty preference defined by greater relative fixation time (RFT) on novel versus repeated images. Cognitive status (Standardized Mini-Mental State Examination, SMMSE) and attention (Digit Span, DS) were also measured. AD patients (age 79.2 ± 6.7 years, SMMSE 22.2 ± 4.0, n = 41) and controls (age 76.2 ± 6.4 years, SMMSE 28.1 ± 2.0, n = 24) were similar in age, education and sex. Compared with controls, AD patients had lower RFT on novel than on repeated images (F1,63 = 11.18, p = 0.001). Further, reduced RFT was associated with lower scores on SMMSE (r63 = 0.288, p = 0.020) and DS (r63 = 0.269, p = 0.030). Within individuals, novelty preference was detected in 92.3% of patients and in 100% of controls. These findings suggest that novelty preference, measured by visual scanning behaviour, can differentiate cognitively healthy and impaired people and may offer a nonverbal, less cognitively demanding method of assessing selective attention.

  19. Collagenase Clostridium histolyticum in the treatment of Peyronie’s disease: patient selection and perspectives

    Kuhlmann PK

    2017-03-01

    Full Text Available Paige K Kuhlmann,1 Kenneth J DeLay,2 James Anaissie,2 Wayne JG Hellstrom,2 Faysal A Yafi3 1University of Missouri-Columbia School of Medicine, Columbia, MO, 2Department of Urology, Tulane University School of Medicine, New Orleans, LA, 3Department of Urology, University of California Irvine, Orange, CA, USA Abstract: The safety and efficacy of the use of collagenase Clostridium histolyticum (CCH for the treatment of Peyronie’s disease has been confirmed over the past several years. However, identification of the ideal patient population for use of this treatment is not well established. Multiple studies have attempted to delineate various patient-specific factors that may predict response to treatment with CCH, with the intent of enhancing patient selection. To date, these include baseline curvature severity, duration of disease, disease phase at presentation, plaque calcification, baseline erectile function, plaque size, age, comorbid diabetes, previous penile trauma, responsiveness to first treatment cycle, baseline penile shortening or pain, prior treatment with intralesional injection, compliance with plaque modeling, and atypical curvature. In addition, other studies have sought to explore various aspects of treatment with CCH that may affect patient perspective of treatment. They have focused on patient-reported outcomes, female partner considerations, cost of treatment, and potential confounders of patient satisfaction. This review provides a summary and analysis of currently available literature on topics of patient selection and perspectives in regard to treatment of Peyronie’s disease with CCH. Keywords: Peyronie’s disease, collagenase Clostridium histolyticum, Peyronie’s disease questionnaire, curvature deformity, intralesional injection, erectile function

  20. Primary ICD-therapy in patients with advanced heart failure: selection strategies and future trials.

    Frankenstein, Lutz; Zugck, Christian; Nelles, Manfred; Schellberg, Dieter; Remppis, Andrew; Katus, Hugo

    2008-09-01

    For allocation of primary ICD-therapy, a possible lower limit of inclusion criteria--defining overly advanced heart failure--is less well investigated. Also, a multi-variable approach to stratification beyond ejection fraction (LVEF) appears warranted. We examined whether adding a selection limit of peak VO(2) patients with systolic CHF were recruited consecutively since 1994. Of these patients, 292 met the selection criteria described above. The mean age was 57.6 +/- 9.5 years, 83% were male, 37% had ischemic cardiomyopathy and 28% received primary ICD-therapy. All cause mortality was considered as end point. Median follow-up was 45 (18-86) months. ICD was not a significant predictor of outcome either for the entire population, or grouped according to aetiology of CHF. Still, 3-year mortality was 15% (ICD-patients) Vs. 28% (non-ICD-patients); P = 0.05; under combination medical therapy. Inversely, in ICD-patients medical combination therapy conveyed a significant survival benefit (P < 0.001). Consequently, the number-needed-to-treat was eight under combination therapy and the size estimate amounts to 300 patients for a prospective trial in this cohort. A cut-off of LVEF patients that do not draw a significant survival benefit from adjunct primary ICD-therapy. Our results indicate the need for a specific randomized trial in this cohort. The according mortality data and a size estimate are provided.

  1. Patient Selection for Drip and Ship Thrombolysis in Acute Ischemic Stroke.

    Lyerly, Michael J; Albright, Karen C; Boehme, Amelia K; Shahripour, Reza Bavarsad; Donnelly, John P; Houston, James T; Rawal, Pawan V; Kapoor, Niren; Alvi, Muhammad; Sisson, April; Alexandrov, Anne W; Alexandrov, Andrei V

    2015-07-01

    The drip and ship model is a method used to deliver thrombolysis to acute stroke patients in facilities lacking onsite neurology coverage. We sought to determine whether our drip and ship population differs from patients treated directly at our stroke center (direct presenters). We retrospectively reviewed consecutive patients who received thrombolysis at an outside facility with subsequent transfer to our center between 2009 and 2011. Patients received thrombolysis after telephone consultation with a stroke specialist. We examined demographics, vascular risk factors, laboratory values, and stroke severity in drip and ship patients compared with direct presenters. Ninety-six patients were identified who received thrombolysis by drip and ship compared with 212 direct presenters. The two groups did not differ with respect to sex, ethnicity, vascular risk factors, or admission glucose. The odds ratio (OR) of arriving at our hospital as a drip and ship for someone 80 years or older was 0.31 (95% confidence interval [CI] 0.15-0.61, P < 0.001). Only 21% of drip and ship patients were black versus 38% of direct presenters (OR 0.434, 95% CI 0.25-0.76, P = 0.004). Even after stratifying by age (<80 vs ≥80), a smaller proportion of drip and ship patients were black (OR 0.44, 95% CI 0.24-0.81, P = 0.008). Furthermore, we found that fewer black patients with severe strokes arrived by drip and ship (OR 0.33, 95% CI 0.11-0.98, P = 0.0028). Our study showed that a smaller proportion of blacks and older adults arrived at our center by the drip and ship model. This may reflect differences in how patients are selected for thrombolysis and transfer to a higher level of care.

  2. The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection.

    Schoeller, Thomas; Huemer, Georg M; Wechselberger, Gottfried

    2008-07-01

    The transverse musculocutaneous gracilis (TMG) flap has received little attention in the literature as a valuable alternative source of donor tissue in the setting of breast reconstruction. The authors give an in-depth review of their experience with breast reconstruction using the TMG flap. A retrospective review of 111 patients treated with a TMG flap for breast reconstruction in an immediate or a delayed setting between August of 2002 and July of 2007 was undertaken. Of these, 26 patients underwent bilateral reconstruction and 68 underwent unilateral reconstruction, and 17 patients underwent reconstruction unilaterally with a double TMG flap. Patient age ranged between 24 and 65 years (mean, 37 years). Twelve patients had to be taken back to the operating room because of flap-related problems and nine patients underwent successful revision microsurgically, resulting in three complete flap losses in a series of 111 patients with 154 transplanted TMG flaps. Partial flap loss was encountered in two patients, whereas fat tissue necrosis was managed conservatively in six patients. Donor-site morbidity was an advantage of this flap, with a concealed scar and minimal contour irregularities of the thigh, even in unilateral harvest. Complications included delayed wound healing (n = 10), hematoma (n = 5), and transient sensory deficit over the posterior thigh (n = 49). The TMG flap is more than an alternative to the deep inferior epigastric perforator (DIEP) flap in microsurgical breast reconstruction in selected patients. In certain indications, such as bilateral reconstructions, it possibly surpasses the DIEP flap because of a better concealed donor scar and easier harvest.

  3. Texturing of continuous LOD meshes with the hierarchical texture atlas

    Birkholz, Hermann

    2006-02-01

    For the rendering of detailed virtual environments, trade-offs have to be made between image quality and rendering time. An immersive experience of virtual reality always demands high frame-rates with the best reachable image qual-ity. Continuous Level of Detail (cLoD) triangle-meshes provide an continuous spectrum of detail for a triangle mesh that can be used to create view-dependent approximations of the environment in real-time. This enables the rendering with a constant number of triangles and thus with constant frame-rates. Normally the construction of such cLoD mesh representations leads to the loss of all texture information of the original mesh. To overcome this problem, a parameter domain can be created, in order to map the surface properties (colour, texture, normal) to it. This parameter domain can be used to map the surface properties back to arbitrary approximations of the original mesh. The parameter domain is often a simplified version of the mesh to be parameterised. This limits the reachable simplification to the domain mesh which has to map the surface of the original mesh with the least possible stretch. In this paper, a hierarchical domain mesh is presented, that scales between very coarse domain meshes and good property-mapping.

  4. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  5. Economic considerations and patients' preferences affect treatment selection for patients with rheumatoid arthritis: a discrete choice experiment among European rheumatologists.

    Hifinger, M; Hiligsmann, M; Ramiro, S; Watson, V; Severens, J L; Fautrel, B; Uhlig, T; van Vollenhoven, R; Jacques, P; Detert, J; Canas da Silva, J; Scirè, C A; Berghea, F; Carmona, L; Péntek, M; Keat, A; Boonen, A

    2017-01-01

    To compare the value that rheumatologists across Europe attach to patients' preferences and economic aspects when choosing treatments for patients with rheumatoid arthritis. In a discrete choice experiment, European rheumatologists chose between two hypothetical drug treatments for a patient with moderate disease activity. Treatments differed in five attributes: efficacy (improvement and achieved state on disease activity), safety (probability of serious adverse events), patient's preference (level of agreement), medication costs and cost-effectiveness (incremental cost-effectiveness ratio (ICER)). A Bayesian efficient design defined 14 choice sets, and a random parameter logit model was used to estimate relative preferences for rheumatologists across countries. Cluster analyses and latent class models were applied to understand preference patterns across countries and among individual rheumatologists. Responses of 559 rheumatologists from 12 European countries were included in the analysis (49% females, mean age 48 years). In all countries, efficacy dominated treatment decisions followed by economic considerations and patients' preferences. Across countries, rheumatologists avoided selecting a treatment that patients disliked. Latent class models revealed four respondent profiles: one traded off all attributes except safety, and the remaining three classes disregarded ICER. Among individual rheumatologists, 57% disregarded ICER and these were more likely from Italy, Romania, Portugal or France, whereas 43% disregarded uncommon/rare side effects and were more likely from Belgium, Germany, Hungary, the Netherlands, Norway, Spain, Sweden or UK. Overall, European rheumatologists are willing to trade between treatment efficacy, patients' treatment preferences and economic considerations. However, the degree of trade-off differs between countries and among individuals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  6. Porcine dermis compared with polypropylene mesh for laparoscopic sacrocolpopexy: a randomized controlled trial.

    Culligan, Patrick J; Salamon, Charbel; Priestley, Jennifer L; Shariati, Amir

    2013-01-01

    To compare the surgical outcomes 12 months after laparoscopic sacrocolpopexy performed with porcine dermis and the current gold standard of polypropylene mesh. Patients scheduled for laparoscopic sacrocolpopexy were eligible for this randomized controlled trial. Both our clinical research nurse and the patients were blinded as to which material was used. Our primary end point was objective anatomic cure defined as no pelvic organ prolapse quantification (POP-Q) points Stage 2 or greater at any postoperative interval. Our sample size calculation called for 57 patients in each group to achieve 90% power to detect a 23% difference in objective anatomic cure at 12 months (α=0.05). Our secondary end point was clinical cure. Any patient with a POP-Q point greater than zero, or Point C less than or equal to -5, or any complaints of prolapse symptoms whatsoever on Pelvic Floor Distress Inventory-20 or Pelvic Floor Impact Questionnaire, Short Form 7, or reoperation for prolapse were considered "clinical failures"; the rest were "clinical cures." Statistical comparisons were performed using the χ or independent samples t test as appropriate. As expected, there were no preoperative differences between the porcine (n=57) and mesh (n=58) groups. The 12-month objective anatomic cure rates for the porcine and mesh groups were 80.7% and 86.2%, respectively (P=.24), and the "clinical cure" rates for the porcine and mesh groups were 84.2% and 89.7%, respectively (P=.96). Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire, Short Form 7 score improvements were significant for both groups with no differences found between groups. There were no major operative complications. There were similar outcomes in subjective or objective results 12 months after laparoscopic sacrocolpopexy performed with either porcine dermis or polypropylene mesh. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00564083. I.

  7. Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism

    Narges Pishva

    2015-02-01

    Full Text Available Objective: Although metabolic diseases individually are rare ,but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases.Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province. The following clinical features were used as inclusion criteria for investigation of the patients.Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death.Result: Organic acidemia with 40 cases (42% was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism(30%, 15 patient had classic galactosemia(GALT

  8. Selective screening of 650 high risk Iranian patients for detection of inborn error of metabolism

    Narges Pishva

    2015-02-01

    Full Text Available Objective: Although metabolic diseases individually are rare ,but overall have an incidence of 1/2000 and can cause devastating and irreversible effect if not diagnosed early and treated promptly. selective screening is an acceptable method for detection of these multi presentation diseases. Method: using panel neonatal screening for detection of metabolic diseases in 650 high risk Iranian patients in Fars province. The following clinical features were used as inclusion criteria for investigation of the patients. Lethargy, poor feeding ,persistent vomiting, cholestasis, intractable seizure ,decreased level of consciousness ,persistent hypoglycemia, unexplained acid base disturbance and unexplained neonatal death. Result: Organic acidemia with 40 cases (42% was the most frequent disorder diagnosed in our high risk populations, followed by disorder of galactose metabolism(30%, 15 patient had classic galactosemia(GALT

  9. Motor-evacuatory gastric function in patients with duodenal cancer after selective proximal vagotomy

    Aliev, M A; Kabdrakhmanov, T K; Kashkin, K A; Darmenov, O K; Kuspangaljeva, Sh U [Kazakhskij Inst. Klinicheskoj i Ehksperimental' noj Khirurgii Minzdrava Kazakhskoj SSR, Alma-Ata

    1983-06-01

    Motor-evacuatory stomach function by using continuous radiogastrography was studied in patients with duodenal ulcers. Radiogastrograms were analyzed before operation, on the 7th-15th day after selective proximal vagotomy performed either independently or in combination with draining operations. A faster evacuation of food from the stomach prevailed in an uncomplicated form of duodenal ulcer and compensated stenosis of the pyloroduodenal zone, evacuatory stomach function was retarded or absent in subcompensated and decompensated stenosis. Discoordinated gastric peristalsis and a reverse food input were noted in patients with subcompensated stenosis. At early time after operations temporary inhibition of evacuatory stomach function occurred in 94.2% of the patients; it could be corrected with conservative therapeutic measures.

  10. Motor-evacuatory gastric function in patients with duodenal cancer after selective proximal vagotomy

    Aliev, M.A.; Kabdrakhmanov, T.K.; Kashkin, K.A.; Darmenov, O.K.; Kuspangaljeva, Sh.U.

    1983-01-01

    Motor-evacuatory stomach function by using continuous radiogastrography was studied in patients with duodenal ulcers. Radiogastrograms were analyzed before operation, on the 7th-15th day after selective proximal vagotomy performed either independently or in combination with draining operations. A faster evacuation of food from the stomach prevailed in an uncomplicated form of duodenal ulcer and compensated stenosis of the pyloroduodenal zone, evacuatory stomach function was retarded or absent in subcompensated and decompensated stenosis. Discoordinated gastric peristalsis and a reverse food input were noted in patients with subcompensated stenosis. At early time after operations temporary inhibition of evacuatory stomach function occurred in 94.2% of the patients; it could be corrected with conservative therapeutic measures

  11. Disturbed prepulse inhibition in patients with schizophrenia is consequential to dysfunction of selective attention.

    Scholes, Kirsty E; Martin-Iverson, Mathew T

    2010-03-01

    Controversy exists as to the cause of disturbed prepulse inhibition (PPI) in patients with schizophrenia. This study aimed to clarify the nature of PPI in schizophrenia using improved methodology. Startle and PPI were measured in 44 patients with schizophrenia and 32 controls across a range of startling stimulus intensities under two conditions, one while participants were attending to the auditory stimuli (ATTEND condition) and one while participants completed a visual task in order to ensure they were ignoring the auditory stimuli (IGNORE condition). Patients showed reduced PPI of R(MAX) (reflex capacity) and increased PPI of Hillslope (reflex efficacy) only under the INGORE condition, and failed to show the same pattern of attentional modulation of the reflex parameters as controls. In conclusion, disturbed PPI in schizophrenia appears to result from deficits in selective attention, rather than from preattentive dysfunction.

  12. Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

    Edivaldo Massazo Utiyama

    Full Text Available OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years; 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

  13. Protection from radiation enteritis by an absorbable polyglycolic acid mesh sling

    Devereux, D.F.; Thompson, D.; Sandhaus, L.; Sweeney, W.; Haas, A.

    1987-01-01

    Patients with malignant tumors of the pelvis who cannot be cured surgically often are treated with radiation after surgery. A devastating side effect of this treatment is radiation-associated small bowel injury (RASBI). The purpose of this study was to test the hypothesis that removal of the small bowel from the radiation field would protect it against RASBI. Twenty cebus monkeys underwent low anterior resection. In 10 animals an absorbable polyglycolic acid (PGA) mesh was sewn circumferentially around the interior of the abdominal cavity as a supporting apron, which prevented the small bowel's descent into the pelvis. The other 10 monkeys did not receive the mesh. All animals received 2000 rads by linear acceleration in a single dose. Twenty-four-hour stool fat, serum vitamin B12, and other serum values were obtained during the study. Animals were sacrificed after 1, 2, 3, 6, and 12 months, and the small bowel and rectum were examined histologically in a blind manner. Two monkeys who did not undergo surgery, or exposure to radiation served as controls. At all sacrifice periods, the animals with PGA mesh slings demonstrated normal small bowel function and histologic structure. Animals without mesh slings had abnormal stool and blood values at 1 month, and by 2 months all had died of small bowel necrosis. The animals that received the slings had no evidence of infection or obstruction, and by 6 months all evidence of the mesh was gone. Support of the small bowel out of the pelvis by an absorbable PGA mesh sling protects against RASBI and is without apparent complications

  14. Usefulness of oral loading of oxcarbazepine suspension in selected patients with epilepsy.

    Kim, Dong Wook; Gu, Namyi; Lee, Howard; Jang, In-Jin; Chu, Kon; Yu, Kyung-Sang; Cho, Joo-Youn; Yoon, Seo Hyun; Na, Hyun Jeong; Lee, Sang Kun

    2013-10-01

    Oral loading of oxcarbazepine tablet is effective and well tolerated to adequately achieve the therapeutic levels of its active metabolite, 10,11-dihydro-10-hydroxy-carbazepine (monohydroxy derivative, MHD) in epilepsy patients. The present study was performed to investigate the safety, tolerability, and pharmacokinetic profiles of oral loading of oxcarbazepine suspension in epilepsy patients with a high risk of recurrent seizures. Oxcarbazepine suspension was administered orally at a single loading dose of 30 mg/kg to 38 adult patients with recurrent seizures, who required rapid seizure control or temporarily discontinued antiepileptic drugs for diagnostic or pre-surgical evaluation. Plasma concentrations of oxcarbazepine and MHD were determined, and adverse events were assessed at 2, 4, 6, 8, 10, 12, 14, 16, and 24 hours after oral loading of oxcarbazepine suspension. 30 patients experienced ≥ 1 adverse event during the first 24 hours after oral loading of oxcarbazepine (e.g., dizziness, transient diplopia, nausea or vomiting), most of which occurred within 4 hours after loading, suggesting no temporal association with MHD plasma levels. 35 (92.1%) patients were still compliant with a maintenance dose of oxcarbazepine after discharge from hospital. 34 (89.4%) patients reached the lower therapeutic level of MHD (12 mg/l) at 4 hours after oral loading of oxcarbazepine suspension, which lasted up to 24 hours in most patients. No patient reached the supratherapeutic levels of MHD (> 35 mg/l) during the study. The mean plasma concentration-time curves and pharmacokinetic profiles of oral loading of oxcarbazepine suspension were similar to those of oral loading of oxcarbazepine tablet. Oral loading of oxcarbazepine suspension followed by maintenance dosing is well tolerated and effective in steadily achieving the therapeutic level of MHD in selected patients with epilepsy.

  15. Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis

    Oostdijk, E.A.; Wit, G.A. de; Bakker, M; Smet, A.M. de; Bonten, M.J.; Hoeven, J.G. van der; Pickkers, P.; Sturm, P.D.J.; Voss, A.; et al.,

    2013-01-01

    OBJECTIVE: To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). DESIGN: A post hoc analysis of a

  16. Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients : a cost-effectiveness analysis

    Oostdijk, Evelien A. N.; de Wit, G. A.; Bakker, Marina; de Smet, Anne-Marie; Bonten, M. J. M.

    2013-01-01

    Objective: To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). Design: A post hoc analysis of a

  17. EVALUATION OF N-RATIO IN SELECTING PATIENTS FOR ADJUVANT CHEMORADIOTHERAPY AFTER D2-GASTRECTOMY

    Wilson Luiz da COSTA JUNIOR

    2013-12-01

    Full Text Available Context Whether adjuvant chemoradiotherapy may contribute to improve survival outcomes after D2-gastrectomy remains controvertial. Objective To explore the clinical utility of N-Ratio in selecting gastric cancer patients for adjuvant chemoradiotherapy after D2-gastrectomy. Methods A retrospective cohort study was carried out on gastric cancer patients who underwent D2-gastrectomy alone or D2-gastrectomy plus adjuvant chemoradiotherapy (INT-0116 protocol at the Hospital A. C. Camargo from September 1998 to December 2008. Statistical analysis were performed using multiple conventional methods, such as c-statistic, adjusted Cox's regression and stratified survival analysis. Results Our analysis involved 128 patients. According to c-statistic, the N-Ratio (i.e., as a continuous variable presented “area under ROC curve” (AUC of 0.713, while the number of metastatic nodes presented AUC of 0.705. After categorization, the cut-offs provide by Marchet et al. displayed the highest discriminating power – AUC value of 0.702. This N-Ratio categorization was confirmed as an independent predictor of survival using multivariate analyses. There also was a trend of better survival by adding of adjuvant chemoradiotherapy only for patients with milder degrees of lymphatic spread – 5-year survival of 23.1% vs 66.9%, respectively (HR = 0.426, 95% CI 0.150–1.202; P = 0.092. Conclusions This study confirms the N-Ratio as a tool to improve the lymph node metastasis staging in gastric cancer and suggests the cut-offs provided by Marchet et al. as the best way for its categorization after a D2-gastrectomy. In these settings, the N-Ratio appears a useful tool to select patients for adjuvant chemoradiotherapy, and the benefit of adding this type of adjuvancy to D2-gastrectomy is suggested to be limited to patients with milder degrees of lymphatic spread (i.e., NR2, 10%–25%.

  18. Home blood pressure monitoring and self-titration of antihypertensive medications: Proposed patient selection criteria.

    Hill, James R

    2016-05-01

    Recent studies have demonstrated that home blood pressure monitoring (HBPM), coupled with self-titration of medications is a viable intervention to control hypertension. There are currently no established criteria to evaluate patients for inclusion in such a program. The purpose of this discussion is to propose criteria for determining if a patient is appropriate to participate in a program of HBPM and self-titration. Inclusion criteria for two self-titration trials were examined, and additional factors in clinical practice were identified and discussed. Additional selection criteria were proposed to support the decision to enroll a patient in an antihypertensive self-titration program. Inclusion criteria from self-titration trials provide a reasonable starting point for choosing appropriate patients in clinical practice, but additional research is necessary. Adaptation of these criteria and consideration of the identified factors can be used to develop decision support instruments. Such instruments should be evaluated for effectiveness and reliability prior to use in clinical practice. HBPM combined with self-titration is an effective patient-centered approach for hypertension management. Decision support instruments to determine appropriate patients are necessary for safe and effective use in clinical practice. ©2015 American Association of Nurse Practitioners.

  19. Biaxial Mechanical Evaluation of Absorbable and Nonabsorbable Synthetic Surgical Meshes Used for Hernia Repair: Physiological Loads Modify Anisotropy Response.

    Cordero, A; Hernández-Gascón, B; Pascual, G; Bellón, J M; Calvo, B; Peña, E

    2016-07-01

    The aim of this study was to obtain information about the mechanical properties of six meshes commonly used for hernia repair (Surgipro(®), Optilene(®), Infinit(®), DynaMesh(®), Ultrapro™ and TIGR(®)) by planar biaxial tests. Stress-stretch behavior and equibiaxial stiffness were evaluated, and the anisotropy was determined by testing. In particular, equibiaxial test (equal simultaneous loading in both directions) and biaxial test (half of the load in one direction following the Laplace law) were selected as a representation of physiologically relevant loads. The majority of the meshes displayed values in the range of 8 and 18 (N/mm) in each direction for equibiaxial stiffness (tangent modulus under equibiaxial load state in both directions), while a few achieved 28 and 50 (N/mm) (Infinit (®) and TIGR (®)). Only the Surgipro (®) mesh exhibited planar isotropy, with similar mechanical properties regardless of the direction of loading, and an anisotropy ratio of 1.18. Optilene (®), DynaMesh (®), Ultrapro (®) and TIGR (®) exhibited moderate anisotropy with ratios of 1.82, 1.84, 2.17 and 1.47, respectively. The Infinit (®) scaffold exhibited very high anisotropy with a ratio of 3.37. These trends in material anisotropic response changed during the physiological state in the human abdominal wall, i.e. T:0.5T test, which the meshes were loaded in one direction with half the load used in the other direction. The Surgipro (®) mesh increased its anisotropic response (Anis[Formula: see text] = 0.478) and the materials that demonstrated moderate and high anisotropic responses during multiaxial testing presented a quasi-isotropic response, especially the Infinit(®) mesh that decreased its anisotropic response from 3.369 to 1.292.

  20. Unbiased Sampling and Meshing of Isosurfaces

    Yan, Dongming

    2014-05-07

    In this paper, we present a new technique to generate unbiased samples on isosurfaces. An isosurface, F(x,y,z) = c , of a function, F , is implicitly defined by trilinear interpolation of background grid points. The key idea of our approach is that of treating the isosurface within a grid cell as a graph (height) function in one of the three coordinate axis directions, restricted to where the slope is not too high, and integrating / sampling from each of these three. We use this unbiased sampling algorithm for applications in Monte Carlo integration, Poisson-disk sampling, and isosurface meshing.