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Sample records for orifice surgery initial

  1. [Natural Orifice Transluminal Endoscopic Surgery (NOTES)].

    Science.gov (United States)

    Kim, Yong Sik; Kim, Chul Young; Chun, Hoon Jai

    2008-03-01

    Recently, the field of gastrointestinal endoscopy is developing rapidly. Once limited to the gastroinstestinal lumen, the endoscopic technology is now breaking the barriers and extending its boundary to peritoneal and pleural space. In 2004, Dr. Kalloo, a gastroenterologist, observed intraperitoneal organs of a pig using a conventional endoscope through the stomach wall. Since then, new endoscopic technique of intraperitoneal intervention with transluminal approach named the Natural Orifice Transluminal Endoscopic Surgery or NOTES has been introduced. NOTES reaches the target organ by inserting the endoscope through a natural orifice (e.g. mouth, anus, vagina, urethra) and entering the peritoneal lumen by means of making an incision on the luminal wall. After a series of successful experiences in animal studies, NOTES are now being tried on human subjects. There are still many obstacles to overcome, but bright future for this new technology is expected because of its proposed advantages of less pain, lower complication rate, short recovery time, and scarless access. In this review, we plan to learn about NOTES.

  2. Surgery via natural orifices in human beings: yesterday, today, tomorrow.

    Science.gov (United States)

    Moris, Demetrios N; Bramis, Konstantinos J; Mantonakis, Eleftherios I; Papalampros, Efstathios L; Petrou, Athanasios S; Papalampros, Alexandros E

    2012-07-01

    We performed an evaluation of models, techniques, and applicability to the clinical setting of natural orifice surgery (mainly natural orifice transluminal endoscopic surgery [NOTES]) primarily in general surgery procedures. NOTES has attracted much attention recently for its potential to establish a completely alternative approach to the traditional surgical procedures performed entirely through a natural orifice. Beyond the potentially scar-free surgery and abolishment of dermal incision-related complications, the safety and efficacy of this new surgical technology must be evaluated. Studies were identified by searching MEDLINE, EMBASE, Cochrane Library, and Entrez PubMed from 2007 to February 2011. Most of the references were identified from 2009 to 2010. There were limitations as far as the population that was evaluated (only human beings, no cadavers or animals) was concerned, but there were no limitations concerning the level of evidence of the studies that were evaluated. The studies that were deemed applicable for our review were published mainly from 2007 to 2010 (see Methods section). All the evaluated studies were conducted only in human beings. We studied the most common referred in the literature orifices such as vaginal, oral, gastric, esophageal, anal, or urethral. The optimal access route and method could not be established because of the different nature of each procedure. We mainly studied procedures in the field of general surgery such as cholecystectomy, intestinal cancers, renal cancers, appendectomy, mediastinoscopy, and peritoneoscopy. All procedures were feasible and most of them had an uneventful postoperative course. A number of technical problems were encountered, especially as far as pure NOTES procedures are concerned, which makes the need of developing new endoscopic instruments, to facilitate each approach, undeniable. NOTES is still in the early stages of development and more robust technologies will be needed to achieve reliable

  3. Current status of natural orifice trans-endoscopic surgery (NOTES and laparoendoscopic single site surgery (LESS in urologic surgery

    Directory of Open Access Journals (Sweden)

    Rafael E. Sanchez-Salas

    2010-08-01

    Full Text Available Laparoendoscopic single site surgery (LESS and natural orifice transluminal endoscopic surgery (NOTES represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

  4. Natural orifice translumenal endoscopic surgery (NOTES) for innovation in hepatobiliary and pancreatic surgery: preface.

    Science.gov (United States)

    Sugimoto, Maki

    2009-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations. It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006. In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss the potential benefits of these procedures in hepatobiliary and pancreatic surgery. We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use of their specialties.

  5. NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator.

    Science.gov (United States)

    Korzeniowski, Przemyslaw; Barrow, Alastair; Sodergren, Mikael H; Hald, Niels; Bello, Fernando

    2016-12-01

    Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians. We developed NOViSE-the first force-feedback-enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom-built, and the behaviour of the virtual flexible endoscope is based on an established theoretical framework-the Cosserat theory of elastic rods. We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES. VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype, and the initial results indicate that it provides promising foundations for further development.

  6. Orifice jet brazing process development, qualification, and initial application

    International Nuclear Information System (INIS)

    1971-05-01

    Experiments were carried out to develop acceptable procedures for brazing molybdenum alloy orifices to fuel element channel inlets of the NERVA R-1 reactor core. Results achieved with various procedures are described, and qualification tests of the selected process are documented. The recommended procedure includes preplacing of Au-Ni-Cr alloy washers and induction heating to 1600 0 F, holding two minutes, heating further to 2400 0 F, holding one minute, and allowing to cool. Inert atmosphere is used, and fixturing maintains proper positioning of the orifices. Leak testing of the joints has demonstrated reproducibly satisfactory sealing. Repair brazing is feasible if needed. (auth)

  7. Natural orifice transluminal endoscopic surgery vs laparoscopic ovariectomy: Complications and inflammatory response

    Czech Academy of Sciences Publication Activity Database

    Martínek, J.; Ryska, O.; Filípková, T.; Doležel, R.; Juhás, Štefan; Motlík, Jan; Holubová, Monika; Nosek, V.; Rotnáglová, B.; Zavoral, M.; Ryska, M.

    2012-01-01

    Roč. 18, č. 27 (2012), s. 3558-3564 ISSN 1007-9327 Institutional research plan: CEZ:AV0Z50450515 Keywords : Natural orifice transluminal endoscopic surgery * Laparoscopy * Ovariectomy Subject RIV: FP - Other Medical Disciplines Impact factor: 2.547, year: 2012

  8. Technical skill set training in natural orifice transluminal endoscopic surgery: how should we approach it?

    LENUS (Irish Health Repository)

    Nugent, Emmeline

    2011-03-01

    The boundaries in minimally invasive techniques are continually being pushed further. Recent years have brought new and exciting changes with the advent of natural orifice transluminal endoscopic surgery. With the evolution of this field of surgery come challenges in the development of new instruments and the actual steps of the procedure. Included in these challenges is the idea of developing a proficiency-based curriculum for training.

  9. In vivo microrobots for natural orifice transluminal surgery. Current status and future perspectives.

    Science.gov (United States)

    Forgione, A

    2009-06-01

    The possibility to operate inside the peritoneal cavity through small holes performed in hollow organs that is presented by Natural Orifice Transluminal Endoscopic Surgery (NOTES) represents a major paradigm shift in general surgery. While this new approach seems very appealing from patients' perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, it is very challenging for surgeons because of the major constraints imposed by both the mode of access and the limited technology currently available. For this reason NOTES applications at the present time are performed by only a few surgeons and mainly to perform non-complex procedures. While new devices are under development, many of them are trying mainly to simply improve current endoscopic platforms and seem not to offer breakthrough solutions. The numerous challenges introduced by natural orifice approaches require a radical shift in the conception of new technologies in order to make this emerging operative access safe and reproducible. The convergence of several enabling technologies in the field of miniaturization, communication and micro-mechatronics brings the possibility to realize on a large scale the revolutionary concept of miniature in vivo co-operative robots. These robots provide vision and task assistance without the constraints of the entry incision and have been shown in experimental settings to possess many qualities that could be ideal to partner with Natural Orifice Surgery. This article explores the current status of microrobotics as well as presents potential future scenarios of their applications in NOTES.

  10. Development of a Virtual Reality Simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) Cholecystectomy Procedure.

    Science.gov (United States)

    Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Lee, Jason; Li, Baichun; Pan, Junjun; Sankaranarayanan, Ganesh; Roberts, Kurt; De, Suvranu

    2014-01-01

    The first virtual-reality-based simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is developed called the Virtual Translumenal Endoscopic Surgery Trainer (VTESTTM). VTESTTM aims to simulate hybrid NOTES cholecystectomy procedure using a rigid scope inserted through the vaginal port. The hardware interface is designed for accurate motion tracking of the scope and laparoscopic instruments to reproduce the unique hand-eye coordination. The haptic-enabled multimodal interactive simulation includes exposing the Calot's triangle and detaching the gall bladder while performing electrosurgery. The developed VTESTTM was demonstrated and validated at NOSCAR 2013.

  11. Assessing transgastric Natural Orifice Transluminal Endoscopic Surgery prior to clinical implementation

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller

    2014-01-01

    The objective was to investigate whether transgastric Natural Orifice Transluminal Endoscopic Surgery (NOTES) could be implemented safely in clinical practice. The experimental studies proved ultrasonography guided access through the stomach to be feasible and safe without iatrogenic complications......-abdominal abscess formation as a result of contamination from the access route was still present. To reduce this contamination, mouthwash with chlorhexidine was effective in a human randomised study. The same study also found significant higher bacterial load in the stomach of patients using proton pump inhibitor...

  12. The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients.

    Science.gov (United States)

    Lehmann, Kai S; Ritz, Jörg P; Wibmer, Andreas; Gellert, Klaus; Zornig, Carsten; Burghardt, Jens; Büsing, Martin; Runkel, Norbert; Kohlhaw, Kay; Albrecht, Roland; Kirchner, Tom G; Arlt, Georg; Mall, Julian W; Butters, Michael; Bulian, Dirk R; Bretschneider, Jörgen; Holmer, Christoph; Buhr, Heinz J

    2010-08-01

    To analyze patient outcome in the first 14 months of the German natural orifice translumenal endoscopic surgery (NOTES) registry (GNR). NOTES is a new surgical concept, which permits scarless intra-abdominal operations through natural orifices, such as the mouth, vagina, rectum, or urethra. The GNR was established as a nationwide outcome database to allow the monitoring and safe introduction of this technique in Germany. The GNR was designed as a voluntary database with online access. All surgeons in Germany who performed NOTES procedures were requested to participate in the registry. The GNR recorded demographical and therapy data as well as data on the postoperative course. A total of 572 target organs were operated in 551 patients. Cholecystectomies accounted for 85.3% of all NOTES procedures. All procedures were performed in female patients using transvaginal hybrid technique. Complications occurred in 3.1% of all patients, conversions to laparoscopy or open surgery in 4.9%. In cholecystectomies, institutional case volume, obesity, and age had substantial effect on conversion rate, operation length, and length of hospital stay, but no effect on complications. Despite the fact that NOTES has just recently been introduced, the technique has already gained considerable clinical application. Transvaginal hybrid NOTES cholecystectomy is a practicable and safe alternative to laparoscopic resection even in obese or older patients.

  13. A review on the status of natural orifice transluminal endoscopic surgery (NOTES cholecystectomy: techniques and challenges

    Directory of Open Access Journals (Sweden)

    Michael C Meadows

    2010-09-01

    Full Text Available Michael C Meadows1,3, Ronald S Chamberlain1,2,31Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA; 3Saint George’s University, School of Medicine, West Indies, GrenadaIntroduction: The evolution of techniques for the performance of a cholecystectomy over the last 25 years has been swift. The laparoscopic approach is now the gold standard for removal of the gall bladder and is the most frequently performed minimally invasive procedure globally. Currently in its infancy stage, natural orifice transluminal endoscopy surgery, or NOTES, is purported to be the next leap forward in minimally invasive approaches. The safety, feasibility, and effectiveness of this procedure, as well as the significance of potential benefits to patients beyond current surgical approaches are yet undetermined.Methods: A comprehensive literature search was conducted using PubMed, a search engine ­created by the National Library of Medicine. Keywords used in the search included “natural orifice transluminal endoscopic surgery”, “NOTES”, “cholecystectomy”, “transcolonic”, “transvaginal”, and “transgastric”. The accumulated literature was critically analyzed and reviewed.Results: One-hundred and eighty-six cases of NOTES cholecystectomies have been published to date. Of these, 174 have been performed through a transvaginal approach. The remainder of the procedures were performed transgastrically. There are no published reports of ­transcolonic cholecystectomies performed in humans. Four of 186 cases (2.15% were converted to traditional laparoscopy due to intraoperative complications. No significant complications or mortalities have been reported.Conclusion: NOTES cholecystectomy appears to be a feasible procedure. However, technical, safety, and ethical issues remain relatively unresolved. Besides improved cosmesis, whether additional

  14. Oophorectomy by natural orifice transluminal endoscopic surgery: feasibility study in dogs.

    Science.gov (United States)

    Freeman, Lynetta J; Rahmani, Emad Y; Sherman, Stuart; Chiorean, Michael V; Selzer, Don J; Constable, Peter D; Snyder, Paul W

    2009-06-01

    Natural orifice transluminal endoscopic surgery (NOTES) represents a potentially less-invasive alternative to conventional or laparoscopic surgery. Our purpose was to develop a canine oophorectomy model for prospective evaluation of intraoperative complications, surgical stress, and postoperative pain and recovery with NOTES. Feasibility study. Academic preclinical research. Ten healthy female dogs. NOTES procedures were performed through gastric access with an electrocautery snare to resect and retrieve the ovaries. The gastrotomy was closed with prototype T-fasteners. Operative time; complications; postoperative pain scores, and nociceptive threshold; surgical stress markers (interleukin-6 [IL-6], C-reactive protein); systemic stress parameters (cortisol, glucose); necropsy evaluation at 10 to 14 days. The mean operative time was 154 minutes (SD +/- 58 minutes) and no animals died as a result of complications from the procedure. The primary difficulty was incomplete ovarian excision and conversion to an open procedure in 1 dog. Serum glucose concentrations increased after surgery and remained elevated for at least 36 hours. The serum cortisol concentration was transiently increased from baseline at 2 hours after surgery. The serum IL-6 concentration peaked at 2 hours after surgery and returned to the baseline value by 18 hours. The serum C-reactive protein concentration increased significantly from baseline, peaked at 12 hours after surgery, and then slowly declined toward baseline but remained elevated at 72 hours after surgery. Nociceptive threshold measurements indicated increased sensitivity to pain for 2 to 24 hours after surgery. At necropsy, surgical sites were healing uneventfully with no significant damage to surrounding organs, no significant growth on bacterial cultures, and no evidence of peritonitis. Small number of animals, single center. The NOTES approach to oophorectomy in dogs appears to be a reasonable alternative to traditional surgery

  15. Feasibility study of natural orifice transluminal endoscopic surgery inguinal hernia repair.

    Science.gov (United States)

    Sherwinter, Danny A; Eckstein, Jeremy G

    2009-07-01

    A potentially less-invasive technique, transluminal surgery, may reduce or eliminate pain and decrease time to full return of activities after abdominal operations. Inguinal hernia repair is perfectly suited to the transgastric endoscopic approach and has not been previously reported. Our purpose was to evaluate the feasibility of transgastric bilateral inguinal herniorrhaphy (BIH). Feasibility study with a nonsurvival canine model. Under general anesthesia, male mongrel dogs weighing 20 to 30 kg had a dual-channel endoscope introduced into the peritoneal cavity over a percutaneously placed guidewire. An overtube with an insufflation channel was used. Peritoneoscopy was performed, and bilateral deep and superficial inguinal rings were identified. The endoscope was removed, premounted with a 4 x 6 cm acellular human dermal implant and then readvanced intraperitoneally through the overtube. The implant was then deployed across the entire myopectineal orifice and draped over the cord structures. Bioglue was then applied endoscopically, and the implant was attached to the peritoneum. After completion of bilateral repairs, the animals were killed and necropsy performed. Five dogs underwent pure natural orifice transluminal endoscopic surgery (NOTES) intraperitoneal onlay mesh (IPOM) BIH. Accurate placement and adequate myopectineal coverage was accomplished in all subjects. At necropsy no injuries to the major structures were noted but Bioglue misapplication with contamination of unintended sites did occur. Our study involved only a small number of subjects in nonsurvival experiments, and no gastric closure was used. Many of the characteristics of inguinal hernia repair are especially well suited to the transgastric approach. The repair is in line with the transgastric endoscope vector, bilateral defects are adjacent, and the IPOM technique does not require significant manipulation or novel instrumentation.

  16. Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Andersen, Luise; Nielsen, Ole Lerberg

    2012-01-01

    Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefi...

  17. Complications of transvaginal natural orifice transluminal endoscopic surgery: a series of 102 patients.

    Science.gov (United States)

    Wood, Stephanie G; Panait, Lucian; Duffy, Andrew J; Bell, Robert L; Roberts, Kurt E

    2014-04-01

    To review the complications encountered in our facility and in previously published studies of transvaginal (TV) natural orifice transluminal endoscopic surgery (NOTES) to date. TV NOTES is currently observed with critical eyes from the surgical community, despite encouraging data to suggest improved short-term recovery and pain. All TV NOTES procedures performed in female patients between 18 and 65 years of age were included. The median follow-up was 90 days. The TV appendectomies and ventral hernia repairs were pure NOTES, through a SILS port in the vagina, whereas TV cholecystectomies were hybrid procedures with the addition of a 5-mm port in the umbilicus. A total of 102 TV NOTES procedures, including 72 TV cholecystectomies, 24 TV appendectomies, and 6 TV ventral hernia repairs, were performed. The average age was 37 years old and body mass index was 29 kg/m. Three major and 7 minor complications occurred. The first major complication was a rectal injury during a TV access port insertion. The second major complication was an omental vessel bleed after a TV cholecystectomy. The third complication was an intra-abdominal abscess after a TV appendectomy. Seven minor complications were urinary retention (4), transient brachial plexus injury, dislodgement of an intrauterine device, and vaginal granulation tissue. As techniques in TV surgery are adopted, inevitably, complications may occur due to the inherent learning curve. Laparoscopic instruments, although adaptable to TV approaches, have yet to be optimized. A high index of suspicion is necessary to identify complications and optimize outcomes for patients.

  18. Natural orifice translumenal endoscopic surgery: Progress in humans since white paper

    Institute of Scientific and Technical Information of China (English)

    Byron F Santos; Eric S Hungness

    2011-01-01

    Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices,advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challengeswith visualization, and training for NOTES procedures.An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans. The theoretically increased risk of infection as a result of NOTES procedures has not been substantiated in transvaginal and transgastric procedures so far. Development of suturing and anastomotic devices and advanced platforms for NOTES has progressed slowly,with limited clinical data on their use so far. Data on the optimal management and incidence of intraoperative complications remain sparse, although possible factorscontributing to complications are discussed. Finally, this editorial discusses the likely direction of future NOTES development and its possible role in clinical practice.

  19. Asian-Chinese patient perceptions of natural orifice transluminal endoscopic surgery cholecystectomy.

    Science.gov (United States)

    Teoh, Anthony Yuen Bun; Ng, Enders Kwok Wai; Chock, Alana; Swanstrom, Lee; Varadarajulu, Shyam; Chiu, Philip Wai Yan

    2014-05-01

    Patient and physician perceptions of natural orifice transluminal endoscopic surgery (NOTES) have been reported for the Western population. However, whether Asian-Chinese patients share the same perspectives as compared to the Western population is unknown. This was a cross-sectional survey carried out in the surgical outpatient's clinic at the Prince of Wales Hospital between June and September 2011. Patients were provided with an information leaflet and asked to complete a questionnaire regarding their perceptions of and preferences for NOTES cholecystectomy. Female patients attending the clinic were given an additional questionnaire regarding attitudes towards transvaginal surgery. Two hundred patients were recruited to complete the questionnaire(s) and the male to female ratio was 1:1. One hundred and fourteen patients (57%) preferred to undergo NOTES cholecystectomy for cosmetic reasons (P=0.009). Oral and anal routes were both acceptable for NOTES accesses in males and females. Forty-one percent of the female patients would consider transvaginal NOTES. Of these patients, significantly more patients indicated that the reason for choosing transvaginal NOTES was to minimize the risk of hernia (P=0.016) and to reduce pain associated with the procedure (P=0.017). The risk of complications (84.5%) and the cost of the procedure (58%) were considered the most important aspects when choosing a surgical approach by Asian-Chinese patients. Asian-Chinese preferred NOTES mainly for cosmetic reasons. However, the transvaginal route was less acceptable to females. Significant differences in patient perception on NOTES were observed between Asian-Chinese and Western patients. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  20. An Intestinal Occlusion Device for Prevention of Small Bowel Distention During Transgastric Natural Orifice Transluminal Endoscopic Surgery

    OpenAIRE

    Tomasko, Jonathan M.; Mathew, Abraham; Moyer, Matthew T.; Haluck, Randy S.; Pauli, Eric M.

    2013-01-01

    Background and Objectives: Bowel distention from luminal gas insufflation reduces the peritoneal operative domain during natural orifice transluminal endoscopic surgery (NOTES) procedures, increases the risk for iatrogenic injury, and leads to postoperative patient discomfort. Methods: A prototype duodenal occlusion device was placed in the duodenum before NOTES in 28 female pigs. The occlusion balloon was inflated and left in place during the procedure, and small bowel distension was subject...

  1. EFFECTS OF NATURAL ORIFICE SECRETIONS IN PERITONEAL CAVITY IN THE BACKGROUND OF NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES AN EXPERIMENTAL STUDY IN ANIMALS

    Directory of Open Access Journals (Sweden)

    Devendra

    2015-03-01

    Full Text Available Natural Orifice Transluminal Endoscopic Surgery (NOTES is a new form of minimally invasive surgery which eliminates traditional skin incisions by accessing internal body cavities through natural orifices. In our experimental animal study, we compared the incidences intraperitoneal abscess formation , culture swab of peritoneal cavity positive for organism, intraperitoneal adhesion formation and mean adhesion score before and after lavaging the portal of entry of albino rat , i.e. transgastric and transvaginal. On vaginal route as a portal of entry into peritoneal cavity , on the 7th day , 66% rats developed abscesses , 88% rats had culture swab positive and 88% rats developed intraperitoneal adhesion (grade - 2 before any cleansing of vaginal cavity with antiseptic solution . Now after lavage with povidone iodine solution, only 11% developed abscesses , 22% were peritoneal swab culture positive and 33% had interbowel and parietal adhesion of (grade 0 - 1. On 21 st day , the complication observed was adhesion formation in pre lavage group of 66% incidence and 16% after vaginal lavage. The incidence of complications were reduced significantly after lavage with antiseptic solution as shown by p values (p<0.01 for abscess formation, p< 0.01 for culture positivity and p< 0.01 for adhesions formation. Also the mean adhesion scoring was significantly reduced (p <0.02 after vaginal lavage on the 7 th day. Gastric route as the portal of entry into the peritoneal cavity, again the same variables were compared on the 7th and the 21st day , but wash was given with antibiotic solution (Cefazolin. On the 7th day , 44% had abscesses, 77% were culture positive and 66% had adhesions (Grade 1 - 2 before gastric lavage with antibiotic solution . After wash of stomach, 11% were culture positive and 44% developed adhesions (Grade 0 - 1. Here, abscess formation (p<0.02 and mean adhesion scoring (p<0.05 were significantly reduced after stomach wash. On the 21st day

  2. Cirugía endoscópica transluminal por orificios naturales: NOTES Natural orifice transluminal endoscopic surgery: NOTES

    Directory of Open Access Journals (Sweden)

    M. J. Varas Lorenzo

    2009-04-01

    Full Text Available Se presenta una revisión actual, puesta al día, y punto de vista de los autores sobre un tema sumamente novedoso y atractivo, como es la Cirugía Endoscópica Transluminal por Orificios Naturales (NOTES: Natural Orifice Translumenal Endoscopic Surgery. La mayoría de los trabajos revisados se han realizado en animales de experimentación, pero la publicación de la colecistectomía por vía transvaginal, y la aparición de editoriales y artículos de revisión sobre el tema, nos llevan a realizar una serie de preguntas no resueltas actualmente sobre este tipo de cirugía, que representa un avance potencial para conseguir "una cirugía endoscópica sin cicatrices, sin infecciones, con mínimos requerimientos de anestesia y una inmediata recuperación".A current review and update of an exceedingly novel and appealing topic, namely natural orifice transluminal endoscopic surgery (NOTES, is discussed, as well as the authors' viewpoint thereon. Most reviewed studies were performed in laboratory animals, but reports on transvaginal cholecystectomy and the emergence of editorials and review articles on this topic pose a number of as yet unanswered questions on this type of surgery, which represents a potential advance towards "endoscopic surgery with no scars, no infection, minimal anesthesia requirements, and immediate recovery".

  3. Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery.

    Science.gov (United States)

    Autorino, Riccardo; Stein, Robert J; Lima, Estevão; Damiano, Rocco; Khanna, Rakesh; Haber, Georges-Pascal; White, Michael A; Kaouk, Jihad H

    2010-05-01

    Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

  4. Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy.

    Science.gov (United States)

    Freeman, Lynetta J; Rahmani, Emad Y; Al-Haddad, Mohammad; Sherman, Stuart; Chiorean, Michael V; Selzer, Don J; Snyder, Paul W; Constable, Peter D

    2010-08-01

    Few studies are available to compare the potential benefits of natural orifice transluminal endoscopic surgery (NOTES) approaches to traditional surgery. To compare complications, surgical stress, and postoperative pain. Prospective study in dogs. Research laboratory. Thirty dogs. Oophorectomy procedures were performed via NOTES and laparoscopic and traditional open surgery. Operative time, pain scores, systemic stress parameters (cortisol, glucose), surgical stress markers (interleukin 6, C-reactive protein), 3-day observation. Median operative times were 76, 44, and 35 minutes for the NOTES, laparoscopic, and open procedures, respectively, with the NOTES procedure being significantly longer than the other 2 procedures. All ovaries were completely excised, and all the animals survived without complications. The NOTES animals had greater increases in serum cortisol concentrations at 2 hours but no statistically significant differences in glucose concentrations compared with the other groups. Serum interleukin 6 and C-reactive protein concentrations were significantly increased at specific times compared with baseline in the NOTES group, but not in the open or laparoscopic surgery groups. Based on the cumulative pain score and nociceptive thresholds, the animals in the NOTES group demonstrated less evidence of pain. Small sample size, limited follow-up. Although the NOTES oophorectomy procedures took approximately twice as long and there may be more evidence of tissue damage as judged by increases in serum cortisol and interleukin 6 concentrations, the dogs in the NOTES group had lower pain scores, especially when compared with animals undergoing open surgery. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  5. Endoscopic management of intraoperative small bowel laceration during natural orifice translumenal endoscopic surgery: a blinded porcine study.

    Science.gov (United States)

    Fyock, Christopher J; Forsmark, Chris E; Wagh, Mihir S

    2011-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) has recently gained great enthusiasm, but there is concern regarding the ability to endoscopically manage complications purely via natural orifices. To assess the feasibility of endoscopically managing enteral perforation during NOTES using currently available endoscopic accessories. Twelve pigs underwent transgastric or transcolonic endoscopic exploration. Full-thickness enterotomies were intentionally created to mimic accidental small bowel lacerations during NOTES. These lacerations were then closed with endoclips. In the blinded arm of the study, small bowel repair was performed by a second blinded endoscopist. Adequate closure of the laceration was confirmed with a leak test. Primary access sites were closed with endoclips or T-anchors. At necropsy, the peritoneal cavity was inspected for abscesses, bleeding, or damage to surrounding structures. The enterotomy site was examined for adequacy of closure, adhesions, or evidence of infection. Fifteen small bowel lacerations were performed in 12 animals. Successful closure was achieved in all 10 cases in the nonblinded arm. Survival animals had an uncomplicated postoperative course and all enterotomy sites were well healed without evidence of necrosis, adhesions, abscess, or bleeding at necropsy. Leak test was negative in all animals. In the blinded arm, both small intestinal lacerations could not be identified by the blinded endoscopist. Necropsy revealed open small bowel lacerations. Small intestinal injuries are difficult to localize with currently available flexible endoscopes and accessories. Endoscopic clips, however, may be adequate for closure of small bowel lacerations if the site of injury is known.

  6. Impact of body image on patients' attitude towards conventional, minimal invasive, and natural orifice surgery.

    Science.gov (United States)

    Lamadé, Wolfram; Friedrich, Colin; Ulmer, Christoph; Basar, Tarkan; Weiss, Heinz; Thon, Klaus-Peter

    2011-03-01

    A series of investigations proposed that patients' preference on minimal invasive and scarless surgery may be influenced by age, sex, and surgical as well as endoscopic history of the individual patient. However, it is unknown which psychological criteria lead to the acceptance of increased personal surgical risk or increased personal expenses in patients demanding scarless operations. We investigated whether individual body image contributes to the patient's readiness to assume higher risk in favor of potentially increased cosmesis. We conducted a nonrandomized survey among 63 consecutive surgical patients after receiving surgery. Individual body image perception was assessed postoperatively applying the FKB-20 questionnaire extended by four additional items. The FKB-20 questionnaire is a validated tool for measuring body image disturbances resulting in a two-dimensional score with negative body image (NBI) and vital body dynamics (VBD) being the two resulting scores. A subgroup analysis was performed according to the conducted operations: conventional open surgery = group 1, traditional laparoscopic surgery = group 2, and no scar surgery = group 3. There was a significant correlation between a negative body image and the preference for scar sparing and scarless surgery indicated by a significantly increased acceptance of surgical risks and the willingness to spend additional money for receiving scarless surgery (r = 0.333; p = 0.0227). Allocated to operation subgroups, 17 of 63 patients belonged to group 1 (OS), 29 to group 2 (minimally invasive surgery), and 17 patients to group 3 (no scar). Although age and sex were unequally distributed, the groups were homogenous regarding body mass index and body image (NBI). Subgroup analysis revealed that postoperative desire for scar sparing approaches was most frequently expressed by patients who received no scar operations. Patients with an NBI tend towards scarless surgery and are willing to accept increased

  7. Single-incision laparoscopic surgery through an ostomy site: a natural approach by an unnatural orifice.

    Science.gov (United States)

    Lopez, Nicole E; Peterson, Carrie Y; Ramamoorthy, Sonia L; McLemore, Elisabeth C; Sedrak, Michael F; Lowy, Andrew M; Horgan, Santiago; Talamini, Mark A; Sicklick, Jason K

    2015-02-01

    Single-incision laparoscopic surgery (SILS) is gaining popularity for a wide variety of surgical operations and capitalizes on the benefits of traditional laparoscopic surgery without incurring multiple incision sites. Traditionally, SILS is performed by a midline periumbilical approach. However, such a minimally invasive approach may be utilized in patients who already have an abdominal incision. Our series retrospectively reviews 7 cases in which we utilized the fascial defect at the time of after ostomy reversal as our SILS incision site. In turn, we performed a variety of concurrent intra-abdominal procedures with excellent technical success and outcomes. Our study is the largest single-institution case series of this novel approach and suggests that utilizing an existing ostomy-site abdominal incision is a safe and effective location for SILS port placement and should be considered in patients undergoing concurrent procedures.

  8. Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250).

    Science.gov (United States)

    Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C

    2012-12-01

    Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.

  9. Preoperative ultrasound measurements predict the feasibility of gallbladder extraction during transgastric natural orifice translumenal endoscopic surgery cholecystectomy.

    Science.gov (United States)

    Santos, Byron F; Auyang, Edward D; Hungness, Eric S; Desai, Kush R; Chan, Edward S; van Beek, Darren B; Wang, Edward C; Soper, Nathaniel J

    2011-04-01

    Extraction of a gallbladder through an endoscopic overtube during natural orifice translumenal endoscopic surgery (NOTES) transgastric cholecystectomy avoids potential injury to the esophagus. This study examined the rate of successful gallbladder specimen extraction through an overtube and hypothesized that preoperative ultrasound findings could predict successful specimen passage. Gallbladder specimens from patients undergoing laparoscopic cholecystectomy were measured, and an attempt was made to pull the specimens through a commercially available overtube with an inner diameter of 16.7-mm. A radiologist blinded to the outcomes reviewed the available preoperative ultrasound measurements from these patients. Ultrasound dimensions including gallbladder length, width, and depth; wall thickness; common bile duct diameter; and size of the largest gallstone (LGS) were recorded. Multiple logistic regression analysis was performed to determine whether ultrasound findings and patient characteristics (age, body mass index [BMI], and sex) could predict the ability of a specimen to pass through the overtube. Of 57 patients, 44 (77%) who had preoperative ultrasounds available for electronic review were included in the final analysis. Gallstones were present in 35 (79%) of these 44 patients. Intraoperative gallbladder perforation occurred in 18 (41%) of the 44 patients, and 16 (36%) of the 44 gallbladders could be extracted through the overtube. Measurement of LGS was possible for 23 patients, and indeterminate gallstone size (IGS) was determined for 12 patients. The rate for passage of perforated versus intact gallbladders was similar (40% vs. 23%; p = 0.054). The LGS (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.02-1.33; p = 0.021) and IGS (OR, 22.97; 95% CI, 1.99-265.63; p = 0.025) predicted failed passage on multivariate logistic regression analysis. The passage rate was 80% for LGS smaller than 10 mm or no stones present, 18% for LGS 10 mm or larger, and 8% for

  10. Sealed Orifice Laparoscopic or Endoscopic (SOLE) Surgery: technology and technique convergence for next-step colorectal surgery.

    LENUS (Irish Health Repository)

    Cahill, R A

    2012-02-01

    The new avenue of minimally invasive surgery, referred to as single-incision\\/access laparoscopy, is often presented as an alternative to standard multiport approaches, whereas in fact it is more usefully perceived as a complementary modality. The emergence of the technique can be of greater use both to patients and to the colorectal specialty if its principles can be merged into next-stage evolution by synergy with more conventional practice. In particular, rather than device specificity, what is needed is convergence of capability that can be applied by the same surgeon in differing scenarios depending on the individualized patient and disease characteristics. We detail here the global applicability of a simple access device construct that allows the provision of simple and complex single-port laparoscopy as well as contributing to multiport laparoscopic and transanal resections in a manner that is reliable, reproducible, ergonomical and economical.

  11. Natural-orifice transluminal endoscopic surgery (NOTES) in Europe: summary of the working group reports of the Euro-NOTES meeting 2010

    DEFF Research Database (Denmark)

    Meining, A; Feussner, H; Swain, P

    2011-01-01

    The fourth Euro-NOTES workshop took place in September 2010 and focused on enabling intensive scientific dialogue and interaction between participants to discuss the state of the practice and development of natural-orifice transluminal endoscopic surgery (NOTES) in Europe. Five working groups were...... collaboration and indications, robotics and platforms, and matters related to training and education. This review summarizes consensus statements of the working groups to give an overview of what has been achieved so far and what might be relevant for research related to NOTES in the near future....

  12. Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

    Science.gov (United States)

    Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

    2009-08-01

    Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

  13. A novel semi-automatic snake robot for natural orifice transluminal endoscopic surgery: preclinical tests in animal and human cadaver models (with video).

    Science.gov (United States)

    Son, Jaebum; Cho, Chang Nho; Kim, Kwang Gi; Chang, Tae Young; Jung, Hyunchul; Kim, Sung Chun; Kim, Min-Tae; Yang, Nari; Kim, Tae-Yun; Sohn, Dae Kyung

    2015-06-01

    Natural orifice transluminal endoscopic surgery (NOTES) is an emerging surgical technique. We aimed to design, create, and evaluate a new semi-automatic snake robot for NOTES. The snake robot employs the characteristics of both a manual endoscope and a multi-segment snake robot. This robot is inserted and retracted manually, like a classical endoscope, while its shape is controlled using embedded robot technology. The feasibility of a prototype robot for NOTES was evaluated in animals and human cadavers. The transverse stiffness and maneuverability of the snake robot appeared satisfactory. It could be advanced through the anus as far as the peritoneal cavity without any injury to adjacent organs. Preclinical tests showed that the device could navigate the peritoneal cavity. The snake robot has advantages of high transverse force and intuitive control. This new robot may be clinically superior to conventional tools for transanal NOTES.

  14. Natural orifice transluminal endoscopic surgery gastrotomy closure with an over-the-endoscope clip: a randomized, controlled porcine study (with videos).

    Science.gov (United States)

    von Renteln, Daniel; Schmidt, Arthur; Vassiliou, Melina C; Gieselmann, Maria; Caca, Karel

    2009-10-01

    Secure endoscopic closure of transgastric natural orifice transluminal endoscopic surgery (NOTES) access is of paramount importance. The over-the-scope clip (OTSC) system has previously been shown to be effective for NOTES gastrotomy closure. To compare OTSC gastrotomy closure with surgical closure. Randomized, controlled animal study. Animal facility laboratory. Thirty-six female domestic pigs. Gastrotomies were created by using a needle-knife and an 18-mm balloon. The animals were subsequently randomized to either open surgical repair with interrupted sutures or endoscopic repair with 12-mm OTSCs. In addition, pressurized leak tests were performed in ex vivo specimens of 18-mm scalpel incisions closed with suture (n = 14) and of intact stomachs (n = 10). The mean time for endoscopic closure was 9.8 minutes (range 3-22, SD 5.5). No complications occurred during either type of gastrotomy closure. At necropsy, examination of all OTSC and surgical closures demonstrated complete sealing of gastrotomy sites without evidence of injury to adjacent organs. Pressurized leak tests showed a mean burst pressure of 83 mm Hg (range 30-140, SD 27) for OTSC closures and 67 mm Hg (range 30-130, SD 27.7) for surgical sutures. Ex vivo hand-sewn sutures of 18-mm gastrotomies (n = 14) exhibited a mean burst pressure of 65 mm Hg (range 20-140, SD 31) and intact ex vivo stomachs (n = 10) had a mean burst pressure of 126 mm Hg (range 90-170, SD 28). The burst pressure of ex vivo intact stomachs was significantly higher compared with OTSC closures (P < .01), in vivo surgical closures (P < .01), and ex vivo hand-sewn closures (P < .01). There was a trend toward higher burst pressures in the OTSC closures compared with surgical closures (P = .063) and ex vivo hand-sewn closures (P = .094). In vivo surgical closures demonstrated similar burst pressures compared with ex vivo hand-sewn closures (P = .848). Nonsurvival setting. Endoscopic closure by using the OTSC system is comparable to

  15. Initial evaluation of the "Trauma surgery course"

    Directory of Open Access Journals (Sweden)

    Tugnoli Gregorio

    2006-03-01

    Full Text Available Abstract Background The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course, developed as a model for teaching operative trauma techniques, and assess its efficacy. Method the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. Results All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses.

  16. Patient and physician perception of natural orifice transluminal endoscopic appendectomy

    Czech Academy of Sciences Publication Activity Database

    Hucl, T.; Saglová, A.; Beneš, M.; Kocík, M.; Oliverius, M.; Valenta, Zdeněk; Špičák, J.

    2012-01-01

    Roč. 18, č. 15 (2012), s. 1800-1805 ISSN 1007-9327 Institutional research plan: CEZ:AV0Z10300504 Keywords : natural orifice transluminal endoscopic surgery * patient perception * physician perception * appendectomy * laparoscopy Subject RIV: FJ - Surgery incl. Transplants Impact factor: 2.547, year: 2012

  17. Educational and training aspects of new surgical techniques: experience with the endoscopic–laparoscopic interdisciplinary training entity (ELITE) model in training for a natural orifice translumenal endoscopic surgery (NOTES) approach to appendectomy.

    Science.gov (United States)

    Gillen, Sonja; Gröne, Jörn; Knödgen, Fritz; Wolf, Petra; Meyer, Michael; Friess, Helmut; Buhr, Heinz-Johannes; Ritz, Jörg-Peter; Feussner, Hubertus; Lehmann, Kai S

    2012-08-01

    Natural orifice translumenal endoscopic surgery (NOTES) is a new surgical concept that requires training before it is introduced into clinical practice. The endoscopic–laparoscopic interdisciplinary training entity (ELITE) is a training model for NOTES interventions. The latest research has concentrated on new materials for organs with realistic optical and haptic characteristics and the possibility of high-frequency dissection. This study aimed to assess both the ELITE model in a surgical training course and the construct validity of a newly developed NOTES appendectomy scenario. The 70 attendees of the 2010 Practical Course for Visceral Surgery (Warnemuende, Germany) took part in the study and performed a NOTES appendectomy via a transsigmoidal access. The primary end point was the total time required for the appendectomy, including retrieval of the appendix. Subjective evaluation of the model was performed using a questionnaire. Subgroups were analyzed according to laparoscopic and endoscopic experience. The participants with endoscopic or laparoscopic experience completed the task significantly faster than the inexperienced participants (p = 0.009 and 0.019, respectively). Endoscopic experience was the strongest influencing factor, whereas laparoscopic experience had limited impact on the participants with previous endoscopic experience. As shown by the findings, 87.3% of the participants stated that the ELITE model was suitable for the NOTES training scenario, and 88.7% found the newly developed model anatomically realistic. This study was able to establish face and construct validity for the ELITE model with a large group of surgeons. The ELITE model seems to be well suited for the training of NOTES as a new surgical technique in an established gastrointestinal surgery skills course.

  18. Nurse-Initiated Telephone Follow Up after Ureteroscopic Stone Surgery.

    Science.gov (United States)

    Tackitt, Helen M; Eaton, Samuel H; Lentz, Aaron C

    2016-01-01

    This article presents findings of a quality improvement (QI) project using the DMAIC (define, measure, analyze, improve, and control) model designed to decrease the rate of emergency department (ED) visits and nurse advice line calls after ureteroscopic stone surgery. Results indicated that nurse-initiated follow- up phone calls can decrease ED visits.

  19. [Initial experience in robot-assisted colorectal surgery in Mexico].

    Science.gov (United States)

    Villanueva-Sáenz, Eduardo; Ramírez-Ramírez, Moisés Marino; Zubieta-O'Farrill, Gregorio; García-Hernández, Luis

    Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  20. Cirurgia por orifícios naturais transcolônica: acesso NOTES peri-retal (PNA para excisão mesoretal total Transcolonic natural orifice surgery: peri-rectal NOTES access (PNA for total mesorectal excision

    Directory of Open Access Journals (Sweden)

    Ricardo Zorron

    2010-03-01

    Full Text Available OBJETIVOS: Cirurgia por orifícios naturais tem sido recentemente aplicada em series clínicas para cirurgia abdominal. Apesar de potenciais vantagens do acesso NOTES transcolônico para doenças colorretais, este ainda não havia sido utilizado clinicamente. O presente trabalho descreve a primeira aplicação bem-sucedida de NOTES transcolônico da literatura, em uma nova abordagem de excisão mesoretal total (TME para cancer de reto. MÉTODOS: Foi obtida aprovação de Comitê de Ética em Pesquisa para cirurgias por orifícios naturais, e o paciente assinou termo de consentimento informado. Em um paciente de 54 anos portador de adenocarcinoma de reto, o procedimento de retossigmoidectomia e linfadenectomia, com excisão mesoretal total foi realizada utilizando um acesso posterior transcolônico pouco acima da borda anal. A dissecção mesorretal foi conseguida utilizando um colonoscópio flexível e instrumentos endoscópicos, com assistência laparoscópica. O espécime foi retirado via transanal, e anastomose foi transorificial, com estoma proximal de proteção. RESULTADOS: O tempo operatório foi de 350 min, não ocorrendo complicações operatórias. A evolução pós-operatória foi favorável, e o paciente recebeu alta no sexto dia de pós-operatório com dieta plena. CONCLUSÃO: Este primeiro relato bem sucedido de cirurgia NOTES transcolônica traz potencialmente novas fronteiras de aplicações clínicas na cirurgia minimamente invasiva. O tratamento de doenças colorretais utilizando o novo acesso flexível PNA (Perirectal NOTES Access é uma promissora nova abordagem, paralelamente à laparoscopia e cirurgia aberta, para melhoria do tratamento dos pacientes.OBJECTIVES: Clinical natural orifice surgery has been applied for abdominal surgery in recent years. Despite potential advantages of transcolonic NOTES for colorectal diseases, it was since now not yet clinically applied. The study describes the first successful human

  1. Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE).

    Science.gov (United States)

    Gunkova, P; Gunka, I; Zonca, P; Dostalik, J; Ihnat, P

    2015-01-01

    An experience with laparoscopic sleeve gastrectomy using the natural orifice specimen extraction (NOSE) technique. Bariatric surgery is nowadays the only long term effective obesity treatment method. Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy with the use of natural orifice specimen extraction (NOSE) in the Surgical Clinic of Faculty Hospital Ostrava between May 2012 and August 2012. Inclusion criteria were the body mass index (BMI) higher than 35 kg/m2 or higher than 32 kg/m2 accompanied with relevant comorbidities. Among 21 patients in this series, there were three men (14.3%) and 18 women (85.7%). Their mean age was 40.9±10.2 years. Their mean preoperative BMI was 40.4±4.6 kg/m2. No patient had previous bariatric surgery, one patient had laparoscopic fundoplication. All operations were completed laparoscopically with no conversions to an open procedure. In two cases, laparoscopic cholecystectomy was performed and the gallbladder was extracted along with the gastric specimen by transgastric approach. Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure with low morbidity and mortality. Based on our initial experiences it could be an indication for NOSE with transgastric approach. Obese patients would benefit from this approach due to the elimination of wound complications (Tab. 2, Fig. 3, Ref. 22).

  2. Flow-throttling orifice nozzle

    International Nuclear Information System (INIS)

    Sletten, H.L.

    1975-01-01

    A series-parallel-flow type throttling apparatus to restrict coolant flow to certain fuel assemblies of a nuclear reactor is comprised of an axial extension nozzle of the fuel assembly. The nozzle has a series of concentric tubes with parallel-flow orifice holes in each tube. Flow passes from a high pressure plenum chamber outside the nozzle through the holes in each tube in series to the inside of the innermost tube where the coolant, having dissipated most of its pressure, flows axially to the fuel element. (U.S.)

  3. Factors influencing career choice after initial training in surgery.

    LENUS (Irish Health Repository)

    McHugh, Seamus

    2012-02-01

    INTRODUCTION: Irish general surgery faces a recruitment crisis with only 87 of 145 (60%) basic surgical training (BST) places filled in 2009. We assessed basic surgical trainees to identify objective, and potentially modifiable, factors that influence ultimate recruitment into a general surgical career. METHODS: Candidates commencing BST training during a 5-year period between 2004 and 2008 were included in a quantitative study. In addition a total of 2,536 candidates, representing all those who commenced surgical training in Ireland since 1960 were identified through the Royal College of Surgeons in Ireland (RCSI) database and invited to complete an online survey. Statistical analysis was performed using SPSS version 15, with p < 0.05 considered significant. RESULTS: During the 5-year quantitative study period there were 381 BST trainees. Gender was a significant predictor of career choice with women more likely to ultimately choose a nonsurgical career after initial surgical training (p = 0.049). Passing surgical membership examinations (MRCS) also was predictive of remaining in surgery (p = 0.005). Training region was not a significant predictor of ultimate career choice. There were 418 survey respondents. The influence of role models was most commonly cited as influencing candidates in choosing to commence surgical training. Candidates who rated "academic opportunity" (p = 0.023) and "intellectual challenge" (p = 0.047) as factors that influenced their decision to commence surgical training were more likely to ultimately continue their careers in a surgical speciality. CONCLUSIONS: This study describes the career pathway of surgical trainees and confirms the importance of academic achievement in discriminating between candidates applying for surgical training schemes.

  4. The penetration of aerosols through fine orifices

    International Nuclear Information System (INIS)

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

    1991-07-01

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

  5. Strategic laparoscopic surgery for improved cosmesis in general and bariatric surgery: analysis of initial 127 cases.

    Science.gov (United States)

    Nguyen, Ninh T; Smith, Brian R; Reavis, Kevin M; Nguyen, Xuan-Mai T; Nguyen, Brian; Stamos, Michael J

    2012-05-01

    Strategic laparoscopic surgery for improved cosmesis (SLIC) is a less invasive surgical approach than conventional laparoscopic surgery. The aim of this study was to examine the feasibility and safety of SLIC for general and bariatric surgical operations. Additionally, we compared the outcomes of laparoscopic sleeve gastrectomy with those performed by the SLIC technique. In an academic medical center, from April 2008 to December 2010, 127 patients underwent SLIC procedures: 38 SLIC cholecystectomy, 56 SLIC gastric banding, 26 SLIC sleeve gastrectomy, 1 SLIC gastrojejunostomy, and 6 SLIC appendectomy. SLIC sleeve gastrectomy was initially performed through a single 4.0-cm supraumbilical incision with extraction of the gastric specimen through the same incision. The technique evolved to laparoscopic incisions that were all placed within the umbilicus and suprapubic region. There were no 30-day or in-hospital mortalities or 30-day re-admissions or re-operations. For SLIC cholecystectomy, gastric banding, appendectomy, and gastrojejunostomy, conversion to conventional laparoscopy occurred in 5.3%, 5.4%, 0%, and 0%, respectively; there were no major or minor postoperative complications. For SLIC sleeve gastrectomy, there were no significant differences in mean operative time and length of hospital stay compared with laparoscopic sleeve gastrectomy; 1 (3.8%) of 26 SLIC patients required conversion to five-port laparoscopy. There were no major complications. Minor complications occurred in 7.7% in the SLIC sleeve group versus 8.3% in the laparoscopic sleeve group. SLIC in general and bariatric operations is technically feasible, safe, and associated with a low rate of conversion to conventional laparoscopy. Compared with laparoscopic sleeve gastrectomy, SLIC sleeve gastrectomy can be performed without a prolonged operative time with comparable perioperative outcomes.

  6. Complications in paediatric craniofacial surgery: an initial four year experience.

    Science.gov (United States)

    Jones, B M; Jani, P; Bingham, R M; Mackersie, A M; Hayward, R

    1992-04-01

    107 children undergoing transcranial craniofacial surgery in a paediatric hospital have been reviewed to assess the incidence and type of complications which arose. This represents the first 4 years' experience of the craniofacial team. There were no deaths or permanent adverse sequelae of surgery. A total of 53 complications were seen in 42 patients. In 9.3% of patients they were potentially life-threatening, serious in 12.1% and of a minor nature in 28%. The more serious complications were related either to haemorrhage and/or vasovagal shock at operation or to infection post-operatively. Infants undergoing monoblock frontofacial advancements and those with tracheostomies were at particular risk.

  7. Factors influencing career choice after initial training in surgery.

    LENUS (Irish Health Repository)

    McHugh, Seamus

    2011-03-01

    Irish general surgery faces a recruitment crisis with only 87 of 145 (60%) basic surgical training (BST) places filled in 2009. We assessed basic surgical trainees to identify objective, and potentially modifiable, factors that influence ultimate recruitment into a general surgical career.

  8. Application of robotics in general surgery: initial experience.

    Science.gov (United States)

    Nguyen, Ninh T; Hinojosa, Marcelo W; Finley, David; Stevens, Melinda; Paya, Mahbod

    2004-10-01

    Robotic surgery was recently approved for clinical use in general abdominal surgery. The aim of this study was to review our experience with the da Vinci surgical system during laparoscopic general surgical procedures. Eighteen patients underwent robotically assisted laparoscopic abdominal surgery between June 2002 and March 2003. Main outcome measures were operative time, room setup time, robotic arm-positioning and surgical time, blood loss, conversion to laparoscopy, length of stay, and morbidity. The types of robotically assisted laparoscopic procedures were excision of gastric leiomyoma (n = 1), Heller myotomy (n = 1), cholecystectomy (n = 2), gastric banding (n = 2), Nissen fundoplication (n = 4), and gastric bypass (n = 8). The mean room setup time was 63 +/- 14 minutes, and the mean robotic arm-positioning time was 16 +/- 7 minutes. Conversion to laparoscopy occurred in two (11%) of 18 cases because of equipment difficulty (n = 1) and technical difficulty (n = 1). Estimated blood loss was 91 +/- 71 mL. The mean operative time was 156 +/- 42 minutes, and the robotic operative time was 27% of the total operative time. The mean length of hospital stay was 2.2 +/- 1.5 days. There was one postoperative wound infection and one anastomotic stricture. Robotically assisted laparoscopic abdominal surgery is feasible and safe; however, the theoretical advantages of the da Vinci surgical system were not clinically apparent.

  9. Initial evaluation of a femtosecond laser system in cataract surgery.

    Science.gov (United States)

    Chang, John S M; Chen, Ivan N; Chan, Wai-Man; Ng, Jack C M; Chan, Vincent K C; Law, Antony K P

    2014-01-01

    To report the early experience and complications during cataract surgery with a noncontact femtosecond laser system. Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China. Retrospective case series. All patients had anterior capsulotomy or combined anterior capsulotomy and lens fragmentation using a noncontact femtosecond laser system (Lensar) before phacoemulsification. Chart and video reviews were performed retrospectively to determine the intraoperative complication rate. Risk factors associated with the complications were also analyzed. One hundred seventy eyes were included. Free-floating capsule buttons were found in 151 eyes (88.8%). No suction break occurred in any case. Radial anterior capsule tears occurred in 9 eyes (5.3%); they did not extend to the equator or posterior capsule. One eye (0.6%) had a posterior capsule tear. No capsular block syndrome developed, and no nuclei were dropped during irrigation/aspiration (I/A). Anterior capsule tags and miosis occurred in 4 eyes (2.4%) and 17 eyes (10.0%), respectively. Different severities of subconjunctival hemorrhages developed in 71 (43.8%) of 162 eyes after the laser procedure. The mean surgical time from the beginning to the end of suction was 6.72 minutes ± 4.57 (SD) (range 2 to 28 minutes). Cataract surgery with the noncontact femtosecond laser system was safe. No eye lost vision because of complications. Caution should be taken during phacoemulsification and I/A to avoid radial anterior capsule tears and posterior capsule tears. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  10. Variable orifice using an iris shutter

    International Nuclear Information System (INIS)

    Beeman, R.; Brajkovich, S.J.

    1978-01-01

    A variable orifice forming mechanism is described that utilizes shutter arrangement adapted to control gas flow, conductance in vacuum systems, as a heat shield for furnace windows, as a beam shutter in sputtering operations, and in any other application requiring periodic or continuously-variable control of material, gas, or fluid flow

  11. Hybrid natural orifice transluminal endoscopic cholecystectomy: prospective human series.

    Science.gov (United States)

    Cuadrado-Garcia, Angel; Noguera, Jose F; Olea-Martinez, Jose M; Morales, Rafael; Dolz, Carlos; Lozano, Luis; Vicens, Jose-Carlos; Pujol, Juan José

    2011-01-01

    Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis. The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group. The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure. Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.

  12. Sizing of high-pressure restriction orifices

    International Nuclear Information System (INIS)

    Casado Flores, E.

    1995-01-01

    Constant up-grading of power plants sometimes requires the modification of components which form part of suppliers' packages. In order to protect technology they have developed, however, the suppliers do not supply their calculation criteria. In order to reduce the costs of such improvements, and so as to be able to undertake the modification without having to rely on the original supplier, this paper describes the basic criteria applicable to the study of high-pressure restriction orifices, which can be considered to be representative of the components in question. The restriction orifices discussed are: - Insert - Multiplates in series with one perforation in each plate - Multiplates in series with several perforations in each plate For each type, an explanation of their sizing is given, together with the equations relating the corresponding flow and pressure drop. (Author)

  13. Experimental investigation of hydrodynamic cavitation through orifices of different geometries

    Science.gov (United States)

    Rudolf, Pavel; Kubina, Dávid; Hudec, Martin; Kozák, Jiří; Maršálek, Blahoslav; Maršálková, Eliška; Pochylý, František

    Hydrodynamic cavitation in single and multihole orifices was experimentally investigated to assess their hydraulic characteristics: loss coefficients, inception cavitation number, cavitation number for transition to supercavitation. Significant difference for singlehole and multihole orifices was observed in terms of the measured loss coefficient. It is significantly more effective to use multihole orifices, where energy dissipation is much lower.It was found that using scaling factor given by ratio of orifice thickness suggests linear behaviour of both loss coefficient and inception cavitation number. Orifices seem to be convenient choice as flow constriction devices inducing cavitation due to their simplicity.

  14. Experimental investigation of hydrodynamic cavitation through orifices of different geometries

    Directory of Open Access Journals (Sweden)

    Rudolf Pavel

    2017-01-01

    Full Text Available Hydrodynamic cavitation in single and multihole orifices was experimentally investigated to assess their hydraulic characteristics: loss coefficients, inception cavitation number, cavitation number for transition to supercavitation. Significant difference for singlehole and multihole orifices was observed in terms of the measured loss coefficient. It is significantly more effective to use multihole orifices, where energy dissipation is much lower.It was found that using scaling factor given by ratio of orifice thickness suggests linear behaviour of both loss coefficient and inception cavitation number. Orifices seem to be convenient choice as flow constriction devices inducing cavitation due to their simplicity.

  15. Imaging CT findings in cases of subdural hematoma after cardiovascular surgery. Initial signs of SDH

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Michiyuki; Kuriyama, Yoshihiro; Sawada, Tohru; Ogawa, Makoto; Kaneko, Takaji; Sakamoto, Akira; Kawazoe, Kouhei; Fujita, Tsuyoshi; Omae, Teruo

    1987-12-01

    A characteristic initial sign of CT findings, as seen in cases of subdural hematoma (SDH) after cardiovascular surgery, was reported. Central-nervous-system (CNS) complications after cardiovascular surgery have been thought to be due mainly to the ischemic brain damage caused by both reduced cerebral perfusion pressure and microembolism during extracorporeal circulation. However, we observed 8 cases of SDH in 39 patients suffering from major CNS complications after cardiovascular surgery. In view of these experiences, SDH was thought to be one of the most significant factors causing CNS complications after cardiovascular surgery. In the sequential CT scans of 8 cases of SDH, four exhibited a typical, small, spotty high-density area in the early period of SDH. The clinical courses of these four patients were relatively acute or subacute, and the initial small high-density area progressed to definite SDH findings in that region in the follow-up CT. These initial findings of CT scans were regarded as ''initial signs of SDH-ISS-''. Although there have been many reports concerning the sequential CT changes in SDH, there has been no report describing the above-mentioned finding. It was emphasized that ''ISS'' is of great importance in the early management for SDH.

  16. 78 FR 62506 - TRICARE; Coverage of Care Related to Non-Covered Initial Surgery or Treatment

    Science.gov (United States)

    2013-10-22

    ... Duty member. Additionally, with respect to care that is related to a non-covered initial surgery or... interest; namely, protecting former active duty members who have received private sector care pursuant to a... incorporated by reference for the benefits provided in the civilian health care sector to active duty family...

  17. Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacement.

    Science.gov (United States)

    Florath, Ines; Albert, Alexander; Rosendahl, Ulrich; Ennker, Ina Carolin; Ennker, Jrgen

    2008-06-01

    The impact of valve prosthesis-patient mismatch on long-term outcome after aortic valve replacement estimated by various variables such as projected indexed effective orifice area and internal geometric orifice area obtained from in vivo or in vitro published data is still controversial. The effective orifice area was measured by echocardiography in 533 patients. The mean age of the patients was 71 +/- 9 years; mean follow-up time was 4.7 +/- 2.2 years. The impact of severe (indexed effective orifice area regression. Severe mismatch (hazard ratio: 1.9 [1.08-3.21]) was a significant predictor of survival time after adjustment for age, left ventricular ejection fraction, atrial fibrillation, New York Heart Association class, serum creatinine, and hemoglobin level. The 5- and 7-year survival rates were 71% +/- 4% and 54% +/- 8% for patients with severe mismatch and 83% +/- 4% and 80% +/- 8% for patients with mild mismatch, respectively. The correlation between projected and measured indexed effective orifice area was of medium strength (r = 0.49), and the frequency of observed mismatch depended linearly on the projected indexed effective orifice area. Although projected indexed effective orifice area and indexed internal geometric orifice area were significant predictors of severe mismatch, the sensitivity and specificity for severe prosthesis-patient mismatch were only 75% and 52%, using an optimal threshold of projected indexed effective orifice area defined by the Youden index. Severe prosthesis-patient mismatch estimated by effective orifice area measured within 10 days was an independent risk factor of survival time. Projected indexed effective orifice area determined at surgery does not sufficiently predict mismatch.

  18. Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

    Science.gov (United States)

    Beckwith, Noor; Reisner, Sari L.; Zaslow, Shayne; Mayer, Kenneth H.; Keuroghlian, Alex S.

    2017-01-01

    Abstract Purpose: Gender-affirming surgeries and hormone therapy are medically necessary treatments to alleviate gender dysphoria; however, significant gaps exist in the research and clinical literature on surgery utilization and age of hormone therapy initiation among transgender adults. Methods: We conducted a retrospective review of electronic health record data from a random sample of 201 transgender patients of ages 18–64 years who presented for primary care between July 1, 2010 and June 30, 2015 (inclusive) at an urban community health center in Boston, MA. Fifty percent in our analyses were trans masculine (TM), 50% trans feminine, and 24% reported a genderqueer/nonbinary gender identity. Regression models were fit to assess demographic, gender identity-related, sexual history, and mental health correlates of gender-affirming surgery and of age of hormone therapy initiation. Results: Overall, 95% of patients were prescribed hormones by their primary care provider, and the mean age of initiation of masculinizing or feminizing hormone prescriptions was 31.8 years (SD=11.1). Younger age of initiation of hormone prescriptions was associated with being TM, being a student, identifying as straight/heterosexual, having casual sexual partners, and not having past alcohol use disorder. Approximately one-third (32%) had a documented history of gender-affirming surgery. Factors associated with increased odds of surgery were older age, higher income levels, not identifying as bisexual, and not having a current psychotherapist. Conclusion: This study extends our understanding of prevalence and factors associated with gender-affirming treatments among transgender adults seeking primary care. Findings can inform future interventions to expand delivery of clinical care for transgender patients. PMID:29159310

  19. Left Transperitoneal Adrenalectomy with a Laparoendoscopic Single-Site Surgery Combined Technique: Initial Case Reports

    Directory of Open Access Journals (Sweden)

    Yasuhiro Sumino

    2011-01-01

    Full Text Available Laparoendoscopic single-site surgery (LESS is a step toward the development of minimally invasive surgery. It is initially difficult for surgeons with limited experience to perform the surgery. We describe two cases of left adrenalectomy with a LESS combined with the addition of an accessory port. After a 2.5-cm skin incision was made at the level of the paraumbilicus to insert the primary 12-mm trocar for the laparoscope, a 5-mm nonbladed trocar was placed through the skin incision side-by-side with the primary trocar. A second 3-mm nonbladed trocar was then placed along the anterior axillary line; a multichannel trocar was not used as a single port. Both adrenalectomies were completed successfully. In patients with a minor adrenal tumor, a combined technique using LESS and an additional port is easier than LESS alone and may, therefore, be a bridge between the conventional laparoscopic approach and LESS.

  20. Open and endovascular aneurysm repair in the Society for Vascular Surgery Vascular Quality Initiative.

    Science.gov (United States)

    Spangler, Emily L; Beck, Adam W

    2017-12-01

    The Society for Vascular Surgery Vascular Quality Initiative is a patient safety organization and a collection of procedure-based registries that can be utilized for quality improvement initiatives and clinical outcomes research. The Vascular Quality Initiative consists of voluntary participation by centers to collect data prospectively on all consecutive cases within specific registries which physicians and centers elect to participate. The data capture extends from preoperative demographics and risk factors (including indications for operation), through the perioperative period, to outcomes data at up to 1-year of follow-up. Additionally, longer-term follow-up can be achieved by matching with Medicare claims data, providing long-term longitudinal follow-up for a majority of patients within the Vascular Quality Initiative registries. We present the unique characteristics of the Vascular Quality Initiative registries and highlight important insights gained specific to open and endovascular abdominal aortic aneurysm repair. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. An Interdisciplinary Education Initiative to Promote Blood Conservation in Cardiac Surgery.

    Science.gov (United States)

    Goda, Tamara S; Sherrod, Brad; Kindell, Linda

    Transfusion practices vary extensively for patients undergoing cardiac surgical procedures, leading to high utilization of blood products despite evidence that transfusions negatively impact outcomes. An important factor affecting transfusion practice is recognition of the importance of teams in cardiac surgery care delivery. This article reports an evidenced-based practice (EBP) initiative constructed using the Society of Thoracic Surgery (STS) 2011 Blood Conservation Clinical Practice Guidelines (CPGs) to standardize transfusion practice across the cardiac surgery team at a large academic medical center. Project outcomes included: a) Improvement in clinician knowledge related to the STS Blood Conservation CPGs; and b) Decreased blood product utilization for patients undergoing cardiac surgical procedures. Participants' scores reflected an improvement in the overall knowledge of the STS CPGs noting a 31.1% (p = 0.012) increase in the number of participants whose practice reflected the Blood Conservation CPGs post intervention. Additionally, there was a reduction in overall blood product utilization for all patients undergoing cardiac surgery procedures post intervention (p = 0.005). Interdisciplinary education based on the STS Blood Conservation CPGs is an effective way to reduce transfusion practice variability and decrease utilization of blood products during cardiac surgery.

  2. Motion of a single quantized vortex in an orifice

    International Nuclear Information System (INIS)

    Schwarz, K.W.

    1993-01-01

    Discrete phase-slip events are observed when superfluid 4 He moves through a microscopic orifice. In order to understand such behavior, one must know (a) how a quantized vortex is introduced into the orifice, and (b) how such a vortex evolves fluid dynamically so as to absorb energy from the applied flow field. To begin the study of the latter question, the authors present calculations done with an idealized orifice geometry. It is found that vortex loops larger than a critical size are carried out of the orifice and stretched by the diverging flow. As it stretches, such a vortex will cross the orifice, the energy required to stretch the vortex being absorbed from the flow field. Both a vortex loop introduced directly into the orifice and a remanent vortex extending to infinity will be discussed

  3. Association of Cataract Surgery With Mortality in Older Women: Findings from the Women's Health Initiative.

    Science.gov (United States)

    Tseng, Victoria L; Chlebowski, Rowan T; Yu, Fei; Cauley, Jane A; Li, Wenjun; Thomas, Fridtjof; Virnig, Beth A; Coleman, Anne L

    2018-01-01

    Previous studies have suggested an association between cataract surgery and decreased risk for all-cause mortality potentially through a mechanism of improved health status and functional independence, but the association between cataract surgery and cause-specific mortality has not been previously studied and is not well understood. To examine the association between cataract surgery and total and cause-specific mortality in older women with cataract. This prospective cohort study included nationwide data collected from the Women's Health Initiative (WHI) clinical trial and observational study linked with the Medicare claims database. Participants in the present study were 65 years or older with a diagnosis of cataract in the linked Medicare claims database. The WHI data were collected from January 1, 1993, through December 31, 2015. Data were analyzed for the present study from July 1, 2014, through September 1, 2017. Cataract surgery as determined by Medicare claims codes. The outcomes of interest included all-cause mortality and mortality attributed to vascular, cancer, accidental, neurologic, pulmonary, and infectious causes. Mortality rates were compared by cataract surgery status using the log-rank test and Cox proportional hazards regression models adjusting for demographics, systemic and ocular comorbidities, smoking, alcohol use, body mass index, and physical activity. A total of 74 044 women with cataract in the WHI included 41 735 who underwent cataract surgery. Mean (SD) age was 70.5 (4.6) years; the most common ethnicity was white (64 430 [87.0%]), followed by black (5293 [7.1%]) and Hispanic (1723 [2.3%]). The mortality rate was 2.56 per 100 person-years in both groups. In covariate-adjusted Cox models, cataract surgery was associated with lower all-cause mortality (adjusted hazards ratio [AHR], 0.40; 95% CI, 0.39-0.42) as well as lower mortality specific to vascular (AHR, 0.42; 95% CI, 0.39-0.46), cancer (AHR, 0.31; 95% CI, 0

  4. Gaseous Nitrogen Orifice Mass Flow Calculator

    Science.gov (United States)

    Ritrivi, Charles

    2013-01-01

    The Gaseous Nitrogen (GN2) Orifice Mass Flow Calculator was used to determine Space Shuttle Orbiter Water Spray Boiler (WSB) GN2 high-pressure tank source depletion rates for various leak scenarios, and the ability of the GN2 consumables to support cooling of Auxiliary Power Unit (APU) lubrication during entry. The data was used to support flight rationale concerning loss of an orbiter APU/hydraulic system and mission work-arounds. The GN2 mass flow-rate calculator standardizes a method for rapid assessment of GN2 mass flow through various orifice sizes for various discharge coefficients, delta pressures, and temperatures. The calculator utilizes a 0.9-lb (0.4 kg) GN2 source regulated to 40 psia (.276 kPa). These parameters correspond to the Space Shuttle WSB GN2 Source and Water Tank Bellows, but can be changed in the spreadsheet to accommodate any system parameters. The calculator can be used to analyze a leak source, leak rate, gas consumables depletion time, and puncture diameter that simulates the measured GN2 system pressure drop.

  5. A Mandibular Second Premolar with Three Canals and Atypical Orifices

    Directory of Open Access Journals (Sweden)

    Neha Agarwal

    2013-01-01

    Full Text Available Background: Mandibular second premolars with three canals (Type V, Vertucci and separate foramina are very rare. The anatomy of the pulp chamber floor in these premolars usually reveals one lingual and two buccal orifices at the same level. This case report describes a second premolar with three canals and an unusual pulpal floor anatomy with one mesiobuccal and one distobuccal orifice at the same level and an orifice on the distolingual wall. Very careful examination of the pulpal space with an optical device and preoperative spiral computed tomography is recommended to locate any unusual orifices.

  6. High Pressure Water Stripping Using Multi-Orifice Nozzles

    Science.gov (United States)

    Hoppe, David

    1999-01-01

    The use of multi-orifice rotary nozzles greatly increases the speed and stripping effectiveness of high pressure water blasting systems, but also greatly increases the complexity of selecting and optimizing the operating parameters. The rotational speed of the nozzle must be coupled with its transverse velocity as it passes across the surface of the substrate being stripped. The radial and angular positions of each orifice must be included in the analysis of the nozzle configuration. Orifices at the outer edge of the nozzle head move at a faster rate than the orifices located near the center. The energy transmitted to the surface from the impact force of the water stream from an outer orifice is therefore spread over a larger area than energy from an inner orifice. Utilizing a larger diameter orifice in the outer radial positions increases the total energy transmitted from the outer orifice to compensate for the wider distribution of energy. The total flow rate from the combination of all orifices must be monitored and should be kept below the pump capacity while choosing orifice to insert in each position. The energy distribution from the orifice pattern is further complicated since the rotary path of all the orifices in the nozzle head pass through the center section. All orifices contribute to the stripping in the center of the path while only the outer most orifice contributes to the stripping at the edge of the nozzle. Additional orifices contribute to the stripping from the outer edge toward the center section. With all these parameters to configure and each parameter change affecting the others, a computer model was developed to track and coordinate these parameters. The computer simulation graphically indicates the cumulative affect from each parameter selected. The result from the proper choices in parameters is a well designed, highly efficient stripping system. A poorly chosen set of parameters will cause the nozzle to strip aggressively in some areas

  7. Natural Orifice Translumenal Endoscopic Surgery for Anterior Spinal Procedures

    OpenAIRE

    Magno, Priscilla; Khashab, Mouen A.; Mas, Manuel; Giday, Samuel A.; Buscaglia, Jonathan M.; Shin, Eun Ji; Dray, Xavier; Kalloo, Anthony N.

    2012-01-01

    Background. NOTES techniques allow transesophageal access to the mediastinum. The aim of this study was to assess the feasibility of transesophageal biopsy of thoracic vertebrae. Methods. Nonsurvival experiments on four 50-kg porcine animals were performed. Transesophageal access to the mediastinum was attained using submucosal tunneling technique. Results. The posterior mediastinum was successfully accessed and navigated in all animals. Vertebral bodies and intervertebral spaces were easily ...

  8. International Conference on Natural Orifice Transluminal Endoscopic Surgery (NOTES)

    Science.gov (United States)

    2006-06-01

    hemangiomas, and one simple cyst), five were malignant in five patients (five hepatocarcinoma ). and four patients had an uncertain preoperative diagnosis...In the first three cases [ hepatocarcinoma (HCO of segment II, hydatid cyst of segment VI. and hemangioma of segment II], we used the Kellyclasia...HCC HCC HCC HCC HCC Hemangiomab l-’NH vs adenoma FNH vs adenoma FNH vs adenoma FHN. focal nodular hyperplasia; HCC, hepatocarcinoma 1

  9. [Urethroplasty with transection of urethral orifice and preservation and lengthening of urethral plate: highly applicable to the treatment of hypospadias].

    Science.gov (United States)

    Wang, Wen-Min; Qiu, Wei-Feng; Qian, Chong

    2010-07-01

    To explore the feasibility of urethroplasty with transection of the urethral orifice and preservation and lengthening of the urethral plate in the treatment of hypospadias. Forty-eight patients with hypospadias (18 of the coronal type, 21 the penile type, 8 the penoscrotal type and 1 the perineal type) underwent urethroplasty with transection of the urethral orifice and preservation and lengthening of the urethral plate. The surgical effects were observed by following up the patients for 3-27 months. One-stage surgical success was achieved in 44 of the cases, with satisfactory functional and cosmetic results but no complications. Two cases developed urinary fistula and another 2 urethral stricture, but all cured by the second surgery. Urethroplasty with transection of the urethral orifice and preservation and lengthening of the urethral plate is a simple, safe and effective surgical procedure for the treatment of hypospadias.

  10. The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative.

    Science.gov (United States)

    Chang, Victor; Schwalb, Jason M; Nerenz, David R; Pietrantoni, Lisa; Jones, Sharon; Jankowski, Michelle; Oja-Tebbe, Nancy; Bartol, Stephen; Abdulhak, Muwaffak

    2015-12-01

    OBJECT Given the scrutiny of spine surgery by policy makers, spine surgeons are motivated to demonstrate and improve outcomes, by determining which patients will and will not benefit from surgery, and to reduce costs, often by reducing complications. Insurers are similarly motivated. In 2013, Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) established the Michigan Spine Surgery Improvement Collaborative (MSSIC) as a Collaborative Quality Initiative (CQI). MSSIC is one of the newest of 21 other CQIs that have significantly improved-and continue to improve-the quality of patient care throughout the state of Michigan. METHODS MSSIC focuses on lumbar and cervical spine surgery, specifically indications such as stenosis, disk herniation, and degenerative disease. Surgery for tumors, traumatic fractures, deformity, scoliosis, and acute spinal cord injury are currently not within the scope of MSSIC. Starting in 2014, MSSIC consisted of 7 hospitals and in 2015 included another 15 hospitals, for a total of 22 hospitals statewide. A standardized data set is obtained by data abstractors, who are funded by BCBSM/BCN. Variables of interest include indications for surgery, baseline patient-reported outcome measures, and medical history. These are obtained within 30 days of surgery. Outcome instruments used include the EQ-5D general health state score (0 being worst and 100 being the best health one can imagine) and EQ-5D-3 L. For patients undergoing lumbar surgery, a 0 to 10 numeric rating scale for leg and back pain and the Oswestry Disability Index for back pain are collected. For patients undergoing cervical surgery, a 0 to 10 numeric rating scale for arm and neck pain, Neck Disability Index, and the modified Japanese Orthopaedic Association score are collected. Surgical details, postoperative hospital course, and patient-reported outcome measures are collected at 90-day, 1-year, and 2-year intervals. RESULTS As of July 1, 2015, a total of 6397 cases

  11. Work situation and sickness absence in the initial period after breast cancer surgery.

    Science.gov (United States)

    Petersson, Lena-Marie; Wennman-Larsen, Agneta; Nilsson, Marie; Olsson, Mariann; Alexanderson, Kristina

    2011-02-01

    Breast cancer is the most common cancer diagnosis in women, many of whom are of working age, and the five-year survival rate in Sweden is approaching 90%. Accordingly, aspects of working life and sickness absence are of increasing importance for breast cancer survivors and may have a long-term impact on health and quality of life of these women. The aim was to elucidate the work situation and sickness absence during the initial period after breast cancer surgery and to explore factors associated with sickness absence. This is a cross-sectional questionnaire study 4-6 weeks after breast cancer surgery of women aged 20-63 years, and living in Stockholm. A consecutive sample of 933 women were invited and 756 (81%) accepted to participate. Logistic regression analyses were computed to estimate crude and adjusted odds ratios for associations between sick leave and other variables. Most women (86%) were employed (including self-employed) at diagnosis, and 91% of those worked ≥75% of full-time. At time of survey, 56% were on sick leave, the majority for full-time. Low self-rated health, poorer health than before diagnosis, having a strenuous work posture, and younger age were associated with sick leave during the initial period after breast cancer surgery in both univariate and multivariate analyses. The results of this study is not fully consistent compared to previous studies in this field, often performed in later phases after breast cancer surgery or after other cancer diagnoses. Therefore our results indicate that knowledge is needed during all phases of the breast cancer trajectory to determine factors of importance regarding sick leave and their impact throughout the disease trajectory.

  12. Type A aortic dissection in Marfan syndrome: extent of initial surgery determines long-term outcome.

    Science.gov (United States)

    Rylski, Bartosz; Bavaria, Joseph E; Beyersdorf, Friedhelm; Branchetti, Emanuela; Desai, Nimesh D; Milewski, Rita K; Szeto, Wilson Y; Vallabhajosyula, Prashanth; Siepe, Matthias; Kari, Fabian A

    2014-04-01

    Data on outcomes after Stanford type A aortic dissection in patients with Marfan syndrome are limited. We investigated the primary surgery and long-term results in patients with Marfan syndrome who suffered aortic dissection. Among 1324 consecutive patients with aortic dissection type A, 74 with Marfan syndrome (58% men; median age, 37 years [first and third quartiles, 29 and 48 years]) underwent surgical repair (85% acute dissections; 68% DeBakey I; 55% composite valved graft, 30% supracoronary ascending replacement, 15% valve-sparing aortic root replacement; 12% total arch replacement; 3% in-hospital mortality) at 2 tertiary centers in the United States and Europe over the past 25 years. The rate of aortic reintervention with resternotomy was 24% (18 of 74) and of descending aorta (thoracic+abdominal) intervention was 30% (22 of 74) at a median follow-up of 8.4 years (first and third quartiles, 2.2 and 12.7 years). Freedom from need for aortic root reoperation in patients who underwent primarily a composite valved graft or valve-sparing aortic root replacement procedure was 95±3%, 88±5%, and 79±5% and in patients who underwent supracoronary ascending replacement was 83±9%, 60±13%, 20±16% at 5, 10, and 20 years. Secondary aortic arch surgery was necessary only in patients with initial hemi-arch replacement. Emergency surgery for type A dissection in patients with Marfan syndrome is associated with low in-hospital mortality. Failure to extend the primary surgery to aortic root or arch repair leads to a highly complex clinical course. Aortic root replacement or repair is highly recommended because supracoronary ascending replacement is associated with a high need (>40%) for root reintervention.

  13. Initial incomplete surgery modifies prognosis in advanced ovarian cancer regardless of subsequent management.

    Science.gov (United States)

    Bacalbasa, Nicolae; Balescu, Irina; Dima, Simona; Herlea, Vlad; David, Leonard; Brasoveanu, Vladislav; Popescu, Irinel

    2015-04-01

    Prognosis in ovarian cancer is determined by completeness of cytoreduction and proper management by specialized oncological gynecologists. Incomplete initial debulking surgery in non-specialized Centers is, however, a reality and there is ongoing discussion about the best subsequent management of such patients. Patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics--FIGO FIGO stages IIIC-IV) who had biopsy by laparotomy or incomplete cytoreduction followed or not by chemotherapy further referred to our Institution between January 2002 and May 2014 were included. The two groups of incomplete cytoreduction [followed by upfront surgery or followed by chemotherapy and interval debulking surgery (IDS)] were compared and also compared against a cohort of 197 patients with similar characteristics who underwent upfront maximal surgery according to the standard at our Iinstitution during the same period. A total of 99 eligible patients were identified. Sixty-seven of them underwent biopsies by laparotomy and 32 underwent incomplete cytoreduction in other institutions. Twenty-eight patients underwent direct re-operation while 71 patients underwent neoadjuvant chemotherapy followed by IDS. The mean overall survival duration for patients with upfront reoperation was 31 months and 54 months for patients with neoadjuvant chemotherapy and IDS, considerably lower than the 72 months obtained for the group of 197 patients with maximal up-front complete cytoreduction at our Institution. Primary biopsy or incomplete cytoreduction reduces survival regardless of the subsequent approach. However, if incomplete cytoreduction has occurred, neoadjuvant chemotherapy followed by IDS is preferable to up-front reoperation. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  14. Minimum wall pressure coefficient of orifice plate energy dissipater

    Directory of Open Access Journals (Sweden)

    Wan-zheng Ai

    2015-01-01

    Full Text Available Orifice plate energy dissipaters have been successfully used in large-scale hydropower projects due to their simple structure, convenient construction procedure, and high energy dissipation ratio. The minimum wall pressure coefficient of an orifice plate can indirectly reflect its cavitation characteristics: the lower the minimum wall pressure coefficient is, the better the ability of the orifice plate to resist cavitation damage is. Thus, it is important to study the minimum wall pressure coefficient of the orifice plate. In this study, this coefficient and related parameters, such as the contraction ratio, defined as the ratio of the orifice plate diameter to the flood-discharging tunnel diameter; the relative thickness, defined as the ratio of the orifice plate thickness to the tunnel diameter; and the Reynolds number of the flow through the orifice plate, were theoretically analyzed, and their relationships were obtained through physical model experiments. It can be concluded that the minimum wall pressure coefficient is mainly dominated by the contraction ratio and relative thickness. The lower the contraction ratio and relative thickness are, the larger the minimum wall pressure coefficient is. The effects of the Reynolds number on the minimum wall pressure coefficient can be neglected when it is larger than 105. An empirical expression was presented to calculate the minimum wall pressure coefficient in this study.

  15. Radiotherapy for locally recurrent rectal cancer treated with surgery alone as the initial treatment

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Hidekazu; Yamaguchi, Takahiro; Hachiya, Kae; Okada, Sunaho; Kitahara, Masashi; Matsuyama, Katsuya; Matsuo, Masayuki [Gifu University, Gifu (Japan)

    2017-03-15

    Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.

  16. Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery.

    Science.gov (United States)

    Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric

    2018-02-01

    Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

  17. Patients' perception of physician-initiated prayer prior to elective ophthalmologic surgery.

    Science.gov (United States)

    Siatkowski, R Michael; Cannon, Sterling L; Farris, Bradley K

    2008-02-01

    Prayer is an important part of many patients' and physicians' lives. There is little data in the literature regarding patients' perception of prayer from or with their doctors. To assess in a masked fashion patients' impression of prayer's role in a medical setting, and their perception of being offered and receiving prayer from their physician. Confidential survey of 567 consecutive patients who were offered prayer by their physician before elective eye surgery. Proportion of patients favoring physician-initiated prayer and weighted Likert responses to various positive and negative sentiments regarding their experience. Survey response rate was 53% (300 patients). Ninety-six percent of patients identified themselves as Christian. At least 90% of Christian patients responded favorably toward their prayer experience to each Likert question. Among the non-Christian patients, the proportion of negative impressions to the prayer experience ranged from 0 to 25%. Physician-initiated Christian-based prayer before surgery is well-received by a strong majority of Christian patients. Although the data are few, only a minority of non-Christians felt negatively regarding this experience.

  18. Appendiceal Abscesses Reduced in Size by Drainage of Pus from the Appendiceal Orifice during Colonoscopy: A Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Shinjiro Kobayashi

    2014-11-01

    Full Text Available Interval appendectomy (IA for appendiceal abscesses is useful for avoiding extended surgery and preventing postoperative complications. However, IA has problems in that it takes time before an abscess is reduced in size in some cases and in that elective surgery may result in a delay in treatment in patients with a malignant tumor of the appendix. In order to rule out malignancy, we performed colonoscopy on three patients with an appendiceal abscess that did not decrease in size 5 or more days after IA. After malignancy had been ruled out by examination of the area of the appendiceal orifice, the appendiceal orifice was compressed with a colonoscope, and a catheter was inserted through the orifice. Then, drainage of pus was observed from the appendiceal orifice into the cecal lumen. Computed tomography performed 3 days after colonoscopy revealed a marked reduction in abscess size in all patients. No endoscopy-related complication was noted. Colonoscopy in patients with an appendiceal abscess may not only differentiate malignant tumors, but also accelerate reduction in abscess size.

  19. Orifice design for the control of coupled region flow

    International Nuclear Information System (INIS)

    Atherton, R.; Spadaro, P.R.; Brummerhop, F.G.

    1975-01-01

    A fluid system arrangement for nuclear reactors is described comprising a triplate orifice apparatus which simultaneously controls core flow distribution, flow rate ratio between hydraulically coupled regions of the blanket and radial static pressure gradients entering and leaving the blanket fuel region. The design of the apparatus is based on the parameters of the diameter of the orifice holes, the friction factor, and expansion, contraction and turning pressure loss coefficients of the geometry of each orifice region. These above parameters are properly matched to provide the desired pressure drop, flow split and negligible cross flow at the interface of standard and power-flattened open lattice blanket regions. (U.S.)

  20. Pressure atomizer having multiple orifices and turbulent generation feature

    Science.gov (United States)

    VanBrocklin, Paul G.; Geiger, Gail E.; Moran, Donald James; Fournier, Stephane

    2002-01-01

    A pressure atomizer includes a silicon plate having a top surface and a bottom surface. A portion of the top surface defines a turbulent chamber. The turbulent chamber is peripherally bounded by the top surface of the plate. The turbulent chamber is recessed a predetermined depth relative to the top surface. The silicon plate further defines at least one flow orifice. Each flow orifice extends from the bottom surface of the silicon plate to intersect with and open into the turbulent chamber. Each flow orifice is in fluid communication with the turbulent chamber.

  1. Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases

    DEFF Research Database (Denmark)

    Bulut, Orhan; Nielsen, Claus B; Jespersen, Niels

    2011-01-01

    Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined.......Single-port access laparoscopic surgery is emerging as a method to improve the morbidity and cosmetic benefits of conventional laparoscopic surgery and minimize the surgical trauma. However, the feasibility of this procedure in rectal surgery has not yet been determined....

  2. Periodic cavitation shedding in a cylindrical orifice

    Energy Technology Data Exchange (ETDEWEB)

    Stanley, C.; Barber, T.; Milton, B.; Rosengarten, G. [University of New South Wales, School of Mechanical and Manufacturing Engineering, Sydney (Australia)

    2011-11-15

    Cavitation structures in a large-scale (D = 8.25 mm), plain orifice style nozzle within a unique experimental rig are investigated using high-speed visualisation and digital image processing techniques. Refractive index matching with an acrylic nozzle is achieved using aqueous sodium iodide for the test fluid. Cavitation collapse length, unsteady shedding frequency and spray angles are measured for cavitation conditions from incipient to supercavitation for a range of Reynolds numbers, for a fixed L/D ratio of 4.85. Periodic cavitation shedding was shown to occur with frequencies between 500 and 2,000 Hz for conditions in which cavitation occupied less than 30% of the nozzle length. A discontinuity in collapse length was shown to occur once the cavitation exceeded this length, coinciding with a loss of periodic shedding. A mechanism for this behaviour is discussed. Peak spray angles of approximately {theta} {approx} 14 were recorded for supercavitation conditions indicating the positive influence of cavitation bubble collapse on the jet atomisation process. (orig.)

  3. Evaluation of RF properties by orifice design for IFMIF RFQ

    International Nuclear Information System (INIS)

    Maebara, Sunao; Sugimoto, Masayoshi

    2005-03-01

    Orifices for the IFMIF RFQ have been designed and fabricated, and RF properties have been evaluated by a network analyzer. The designed orifices were installed into a vacuum port of the 1.1m-long RFQ mock-up module, and the resonant frequency and the phase difference between cavities were measured for a quadrupole operation mode of TE 210 . It was found that the RF properties are not affected on condition that slit direction with the same direction of current flow at the RFQ wall. Orifice conductance from 0.22 to 0.25 m 3 /sec by nitrogen conversion at room temperature was designed, and an ultimate pressure level of 5x10 -7 [Pa] was evaluated for the 4.1m-long central module for the IFMIF RFQ. It was concluded that the designed orifices are effective for RF properties and vacuum conductance in the IFMIF RFQ. (author)

  4. Implementing a robotics curriculum at an academic general surgery training program: our initial experience.

    Science.gov (United States)

    Winder, Joshua S; Juza, Ryan M; Sasaki, Jennifer; Rogers, Ann M; Pauli, Eric M; Haluck, Randy S; Estes, Stephanie J; Lyn-Sue, Jerome R

    2016-09-01

    The robotic surgical platform is being utilized by a growing number of hospitals across the country, including academic medical centers. Training programs are tasked with teaching their residents how to utilize this technology. To this end, we have developed and implemented a robotic surgical curriculum, and share our initial experience here. Our curriculum was implemented for all General Surgical residents for the academic year 2014-2015. The curriculum consisted of online training, readings, bedside training, console simulation, participating in ten cases as bedside first assistant, and operating at the console. 20 surgical residents were included. Residents were provided the curriculum and notified the department upon completion. Bedside assistance and operative console training were completed in the operating room through a mix of biliary, foregut, and colorectal cases. During the fiscal years of 2014 and 2015, there were 164 and 263 robot-assisted surgeries performed within the General Surgery Department, respectively. All 20 residents completed the online and bedside instruction portions of the curriculum. Of the 20 residents trained, 13/20 (65 %) sat at the Surgeon console during at least one case. Utilizing this curriculum, we have trained and incorporated residents into robot-assisted cases in an efficient manner. A successful curriculum must be based on didactic learning, reading, bedside training, simulation, and training in the operating room. Each program must examine their caseload and resident class to ensure proper exposure to this platform.

  5. Investigation of wall mass transfer characteristics downstream of an orifice

    International Nuclear Information System (INIS)

    El-Gammal, M.; Ahmed, W.H.; Ching, C.Y.

    2012-01-01

    Highlights: ► Numerical simulations were performed for the mass transfer downstream of an orifice. ► The Low Reynolds Number K-ε turbulence model was used. ► The numerical results were in good agreement with existing experimental results. ► The maximum Sherwood number downstream of the orifice was significantly affected by the Reynolds number. ► The Sherwood number profile was well correlated with the turbulence kinetic energy profile close to the wall. - Abstract: Numerical simulations were performed to determine the effect of Reynolds number and orifice to pipe diameter ratio (d o /d) on the wall mass transfer rate downstream of an orifice. The simulations were performed for d o /d of 0.475 for Reynolds number up to 70,000. The effect of d o /d was determined by performing simulations at a Reynolds number of 70,000 for d o /d of 0.375, 0.475 and 0.575. The momentum and mass transport equations were solved using the Low Reynolds Number (LRN) K-ε turbulence model. The Sherwood number (Sh) profile downstream of the orifice was in relatively good agreement with existing experimental results. The Sh increases sharply downstream of the orifice, reaching a maximum within 1–2 diameters downstream of the orifice, before relaxing back to the fully developed pipe flow value. The Sh number well downstream of the orifice was in good agreement with results for fully developed pipe flow estimated from the correlation of . The peak Sh numbers from the simulations were higher than that predicted from and .

  6. Fabrication of small-orifice fuel injectors for diesel engines.

    Energy Technology Data Exchange (ETDEWEB)

    Woodford, J. B.; Fenske, G. R.

    2005-04-08

    Diesel fuel injector nozzles with spray hole diameters of 50-75 {micro}m have been fabricated via electroless nickel plating of conventionally made nozzles. Thick layers of nickel are deposited onto the orifice interior surfaces, reducing the diameter from {approx}200 {micro}m to the target diameter. The nickel plate is hard, smooth, and adherent, and covers the orifice interior surfaces uniformly.

  7. Calibration and use of filter test facility orifice plates

    Science.gov (United States)

    Fain, D. E.; Selby, T. W.

    1984-07-01

    There are three official DOE filter test facilities. These test facilities are used by the DOE, and others, to test nuclear grade HEPA filters to provide Quality Assurance that the filters meet the required specifications. The filters are tested for both filter efficiency and pressure drop. In the test equipment, standard orifice plates are used to set the specified flow rates for the tests. There has existed a need to calibrate the orifice plates from the three facilities with a common calibration source to assure that the facilities have comparable tests. A project has been undertaken to calibrate these orifice plates. In addition to reporting the results of the calibrations of the orifice plates, the means for using the calibration results will be discussed. A comparison of the orifice discharge coefficients for the orifice plates used at the seven facilities will be given. The pros and cons for the use of mass flow or volume flow rates for testing will be discussed. It is recommended that volume flow rates be used as a more practical and comparable means of testing filters. The rationale for this recommendation will be discussed.

  8. Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

    Science.gov (United States)

    Goh, Brian K P; Low, Tze-Yi; Lee, Ser-Yee; Chan, Chung-Yip; Chung, Alexander Y F; Ooi, London L P J

    2018-05-24

    Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS. This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon. The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions. Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy. © 2018 Royal Australasian College of Surgeons.

  9. Noise generated by cavitating single-hole and multi-hole orifices in a water pipe

    NARCIS (Netherlands)

    Testud, P.; Moussou, P.; Hirschberg, A.; Aurégan, Y.

    2007-01-01

    This paper presents an experimental study of the acoustical effects of cavitation caused by a water flow through an orifice. A circular-centered single-hole orifice and a multi-hole orifice are tested. Experiments are performed under industrial conditions: the pressure drop across the orifice varies

  10. The influence of chamfering and corner radiusing on the discharge coefficient of rotating axial orifices

    International Nuclear Information System (INIS)

    Idris, A; Pullen, K

    2013-01-01

    The effects of chamfering and corner radiusing on the discharge coefficient of rotating axial orifices are presented in this paper. Both experimental and CFD results show that chamfering and corner radiusing improve the discharge coefficient of rotating orifices. For non-inclined rotating orifices, the discharge coefficient reduces with increasing speed, but chamfered and radiused orifices manage to have higher discharge coefficient (C d ) than the straight edge orifices. Comparing between chamfering and corner radiusing, the radiused corner orifice has the highest C d at every rotational speed. This is because the inlet radius helps guiding the flow into the orifice and avoiding flow separation at the inlet.

  11. Initiating statistical process control to improve quality outcomes in colorectal surgery.

    Science.gov (United States)

    Keller, Deborah S; Stulberg, Jonah J; Lawrence, Justin K; Samia, Hoda; Delaney, Conor P

    2015-12-01

    Unexpected variations in postoperative length of stay (LOS) negatively impact resources and patient outcomes. Statistical process control (SPC) measures performance, evaluates productivity, and modifies processes for optimal performance. The goal of this study was to initiate SPC to identify LOS outliers and evaluate its feasibility to improve outcomes in colorectal surgery. Review of a prospective database identified colorectal procedures performed by a single surgeon. Patients were grouped into elective and emergent categories and then stratified by laparoscopic and open approaches. All followed a standardized enhanced recovery protocol. SPC was applied to identify outliers and evaluate causes within each group. A total of 1294 cases were analyzed--83% elective (n = 1074) and 17% emergent (n = 220). Emergent cases were 70.5% open and 29.5% laparoscopic; elective cases were 36.8% open and 63.2% laparoscopic. All groups had a wide range in LOS. LOS outliers ranged from 8.6% (elective laparoscopic) to 10.8% (emergent laparoscopic). Evaluation of outliers demonstrated patient characteristics of higher ASA scores, longer operating times, ICU requirement, and temporary nursing at discharge. Outliers had higher postoperative complication rates in elective open (57.1 vs. 20.0%) and elective lap groups (77.6 vs. 26.1%). Outliers also had higher readmission rates for emergent open (11.4 vs. 5.4%), emergent lap (14.3 vs. 9.2%), and elective lap (32.8 vs. 6.9%). Elective open outliers did not follow trends of longer LOS or higher reoperation rates. SPC is feasible and promising for improving colorectal surgery outcomes. SPC identified patient and process characteristics associated with increased LOS. SPC may allow real-time outlier identification, during quality improvement efforts, and reevaluation of outcomes after introducing process change. SPC has clinical implications for improving patient outcomes and resource utilization.

  12. Effect of benchmarking projects on outcomes of coronary artery bypass graft surgery: challenges and prospects regarding the quality improvement initiative.

    Science.gov (United States)

    Miyata, Hiroaki; Motomura, Noboru; Murakami, Arata; Takamoto, Shinichi

    2012-06-01

    The Japan Cardiovascular Surgery Database (JCVSD) was established in 2000 and initiated a benchmarking project to improve the quality of cardiovascular surgery. Although the importance of quality improvement initiatives has been emphasized, few studies have reported the effects on outcomes. To examine the time-trend effects in initial JCVSD participants (n = 44), we identified 8224 isolated coronary artery bypass graft (CABG) procedures performed between 2004 and 2007. The impact of surgery year was examined using a multiple logistic regression model that set previously identified clinical risk factors and surgery year as fixed effects. To examine the difference in outcomes between initial participants (n = 44) and halfway participants (n = 55), we identified 3882 isolated CABG procedures performed in 2007. The differences between the 2 hospital groups were examined using a multiple logistic regression model that set clinical risk factors, hospital procedure volume, and hospital groups as fixed effects. For operative mortality, the odds ratio of surgery year was 0.88 (P = .083). Observed/expected (OE) ratios for operative mortality were 0.71 in 2004, 0.73 in 2005, 0.63 in 2006, and 0.54 in 2007. As for composite mortality and major morbidities (reoperation, stroke, dialysis, infection, and prolonged ventilation), odds ratio of surgery year was 0.97 (P = .361). OE ratios for composite mortality and morbidities were 1.01 in 2004, 1.04 in 2005, 1.04 in 2006, and 0.94 in 2007. Compared with halfway participants, initial participants had a significantly lower rate of operative mortality (odds ratio = 0.527; P = .008) and composite mortality and major morbidities (odds ratio 0.820; P = .047). This study demonstrated that a quality improvement initiative for cardiovascular surgery has positive impacts on risk-adjusted outcomes. Although the primary target of benchmarking was 30-day mortality in Japan, major morbidities were less affected by those activities. Copyright

  13. Complication related to colostomy orifice: intestinal evisceration

    Directory of Open Access Journals (Sweden)

    Valdemir José Alegre Salles

    2011-12-01

    Full Text Available Intestinal evisceration at the site of a stoma is a rare event, with high morbimortality. Its clinical manifestation often occurs between the sixth and seventh days after surgery. The risk factors most frequently related to evisceration are: increased intra-abdominal pressure, digestive tract cancer surgery, emergency surgery and stomas in the surgical incision. The authors report the case of a male patient, aged 62, suffering from adenocarcinoma of the rectum with obstructive acute abdomen, who underwent loop transversotomy for decompression. On the fourth day after surgery, he had a bronchospasm crisis, with evisceration of ileum and colon through the colostomic hole. The association of some triggering factors, such as emergency surgery, colorectal malignant neoplasm, increased intra-abdominal pressure and technical failure of colostomy were decisive in the development of this rare peri-colostomy complication.A evisceração intestinal desenvolvida no sítio de um estoma é um evento raro, tendo elevada morbimortalidade. Sua manifestação clínica ocorre frequentemente entre o sexto e o sétimo dias de pós-operatório. Os fatores de risco mais frequentemente relacionados à evisceração são: aumento da pressão intra-abdominal, câncer do aparelho digestório, cirurgia de urgência e estomias na incisão cirúrgica. Os autores relatam o caso de um paciente do sexo masculino, com 62 anos, portador de adenocarcinoma do reto médio com abdômen agudo obstrutivo, sendo submetido à transversostomia em alça, com finalidade descompressiva. No quarto dia de pós-operatório com crise de broncoespasmo, apresentou evisceração do cólon e íleo pelo orifício abdominal colostômico. A associação de alguns fatores desencadeantes, como a cirurgia de urgência, a doença neoplásica colorretal maligna, o aumento da pressão intra-abdominal e a falha técnica na confecção da colostomia, foram determinantes para o desenvolvimento desta rara

  14. Energy dissipation characteristics of sharp-edged orifice plate

    Directory of Open Access Journals (Sweden)

    Ai Wanzheng

    2015-08-01

    Full Text Available The energy loss coefficient, relating directly to the energy dissipation ratio, is an important index of this energy dissipater. In this article, this coefficient and its affecting parameters were analyzed by theoretical considerations, and their relationships were obtained by numerical simulations. It could be concluded that the energy loss coefficient of sharp-edged orifice plate and its backflow region length were mainly dominated by the contraction ratio of the orifice plate. Sharp-edged orifice plate’s energy loss coefficient and its backflow region length all increase slightly with the increase in its thickness. When Reynolds number is in the range of 9.00×104–10.3×106, Reynolds number has little impacts on energy loss coefficient and backflow region length. Two empirical expressions, relating to backflow region length and energy loss coefficient, respectively, were presented.

  15. A pulse-tube refrigerator using variable-resistance orifice

    Science.gov (United States)

    Huang, B. J.; Sun, B. W.

    2003-01-01

    In the present study, we propose a new design of orifice pulse-tube refrigerator (VROPT) using a variable-resistance valve to replace the conventional orifice. The variable-resistance orifice (VRO) is basically a high-speed solenoidal valve similar to the fuel jet device widely used in automobile engines. By changing the frequency and periods of ON and OFF of the valve through an electronic device, we can change the flow resistance of the VRO. This thus provides a possibility for an OPT to be controlled on-line during operation. From the results obtained in the present study, we have shown that VROPT is able to achieve on-line control by regulating the duty cycle d or frequency fv of the VRO. We also show that VROPT will not loss its thermal performance as compared to conventional OPT.

  16. Urethral orifice hyaluronic acid injections: a novel animal model of bladder outlet obstruction.

    Science.gov (United States)

    Wang, Yongquan; Xiong, Zhiyong; Gong, Wei; Zhou, Zhansong; Lu, Gensheng

    2015-02-21

    We produced a novel model of bladder outlet obstruction (BOO) by periurethral injection of hyaluronic acid and compared the cystometric features, postoperative complications, and histopathological changes of that model with that of traditional open surgery. Forty female Sprague-Dawley rats were divided into three groups. Fifteen rats were subcutaneously injected with 0.2 ml hyaluronic acid at 5, 7, and 12 o'clock around the urethral orifice. Another fifteen rats underwent traditional open partial proximal urethral obstruction surgery, and 10 normal rats used as controls. After 4 weeks, filling cystometry, postoperative complications, and histopathological features were evaluated in each group. Three rats were also observed for 12 weeks after hyaluronic acid injection to evaluate the long-term effect. Hyaluronic acid periurethral injection caused increased maximum cystometric capacity, maximum bladder pressure, micturition interval, and post-void residual urine volume compared with control (p injection group had significantly shorter operative time, less incidence of incision infection and bladder stone formation compared with the surgery group (p injection and surgery bladders; these were not observed in the control group. Bladder weight and thickness of smooth muscle in the injection and surgery groups were significantly greater than those in the control group (p injection or control groups. Rats periurethrally injected hyaluronic acid were stable the compound was not fully absorbed in any rat after 12 weeks. Hyaluronic acid periurethral injection generates a simple, effective, and persistent animal model of BOO with lower complications, compared with traditional surgery.

  17. Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University

    Science.gov (United States)

    He, Zhehao; Zeng, Liping; Zhang, Chong; Wang, Luming; Wang, Zhitian; Rustam, Azmat; Du, Chengli; Lv, Wang

    2017-01-01

    Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology. PMID:29302429

  18. Setting up pre-admission visits for children undergoing day surgery: a practice development initiative.

    Science.gov (United States)

    O'Shea, Maria; Cummins, Ann; Kelleher, Ann

    2010-06-01

    The hospital experience can bring about a range of negative emotions for children. The literature clearly states that children who are prepared for surgery recover faster and have fewer negative effects. Pre-admission programmes seek to prepare children (and their parents) for surgery. This paper describes in detail how a pre-admission programme was established for children and their families who were scheduled for day case surgery.

  19. Effect of plate shapes in orifice plate type flowmeters

    International Nuclear Information System (INIS)

    Moeller, S.V.

    1984-01-01

    The study of unusual plate shapes in orifice plate type flowmeters is presented, with a view to providing data for the substitution of the plate with one centered circular orifice in those applications where its use is not possible. For this purpose, six pairs of plates with different forms, with and without chamfered edges, were made and tested in a closed water loop. Results show that, generally, the use of chamfers improves the results and, in the case of perforated and slotlike orificed plates, the narrow-ness of the fluid passage tends to make unnecessary its use. (Author) [pt

  20. Design and analysis of throttle orifice applying to small space with large pressure drop

    International Nuclear Information System (INIS)

    Li Yan; Lu Daogang; Zeng Xiaokang

    2013-01-01

    Throttle orifices are widely used in various pipe systems of nuclear power plants. Improper placement of orifices would aggravate the vibration of the pipe with strong noise, damaging the structure of the pipe and the completeness of the system. In this paper, effects of orifice diameter, thickness, eccentric distance and chamfering on the throttling are analyzed applying CFD software. Based on that, we propose the throttle orifices which apply to small space with large pressure drop are multiple eccentric orifices. The results show that the multiple eccentric orifices can effectively restrain the cavitation and flash distillation, while generating a large pressure drop. (authors)

  1. Cavitating Orifice: Flow regime transitions and low frequency sound production

    NARCIS (Netherlands)

    Testud, P.; Moussou, P.; Hirschberg, A.; Aurégan, Y.

    2005-01-01

    Detailed data are provided for the broadband noise in a cavitating pipe flow through a circular orifice in water. Experiments are performed under industrial conditions, i.e., with a pressure drop varying from 3 to 30 bars and a cavitation number in the range 0.10 = s = 0.77. The speed of sound

  2. New trends in minimally invasive urological surgery

    Directory of Open Access Journals (Sweden)

    Prabhakar Rajan

    2009-10-01

    Full Text Available Purpose: The perceived benefits of minimally-invasive surgery include less postoperative pain, shorter hospitalization, reduced morbidity and better cosmesis while maintaining diagnostic accuracy and therapeutic outcome. We review the new trends in minimally-invasive urological surgery. Materials and method: We reviewed the English language literature using the National Library of Medicine database to identify the latest technological advances in minimally-invasive surgery with particular reference to urology. Results: Amongst other advances, studies incorporating needlescopic surgery, laparoendoscopic single-site surgery , magnetic anchoring and guidance systems, natural orifice transluminal endoscopic surgery and flexible robots were considered of interest. The results from initial animal and human studies are also outlined. Conclusion: Minimally-invasive surgery continues to evolve to meet the demands of the operators and patients. Many novel technologies are still in the testing phase, whilst others have entered clinical practice. Further evaluation is required to confirm the safety and efficacy of these techniques and validate the published reports.

  3. Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

    Directory of Open Access Journals (Sweden)

    Ahmet Kale

    Full Text Available ABSTRACT Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.

  4. Two cases of laparoscopic total colectomy with natural orifice specimen extraction and review of the literature.

    Science.gov (United States)

    Gundogan, Ersin; Aktas, Aydin; Kayaalp, Cuneyt; Gonultas, Fatih; Sumer, Fatih

    2017-09-01

    We present two cases of natural orifice specimen extraction (NOSE) after laparoscopic total colectomy and ileorectal anastomosis (TC-IRA), and we also review all of the previously reported cases. Our aim was to focus on patient selection for NOSE after TC-IRA. The PubMed and Google Scholar databases were scanned. Demographic features, surgical indications, and techniques were analyzed. Basic calculations were used for statistical analysis. A total of 13 cases were detected in addition to our 2 cases. All of the specimens were removed through the natural orifices successfully. No case required a diverting ileostomy. No patients were converted to open surgery or to conventional laparoscopy. Complications were reported in three patients. Transanal extractions were performed in 12 cases (10 colonic inertia, 2 polyposis), and transvaginal extractions were performed in 3 cases (2 malignancy, 1 colonic inertia). Both transanal and transvaginal specimen extractions after laparoscopic TC-IRA can be preferred. However, transanal extraction seems to be feasible in cases of TC for benign disease with a limited mesenteric-omental resection. If the indication is a malignancy requiring a mesenteric-omental resection, a transvaginal route should be preferred for a voluminous specimen.

  5. [The beginnings and the development of heart surgery in Debrecen; the consequence of Professor József Schnitzler's initiative].

    Science.gov (United States)

    Péterffy, Arpád

    2009-10-04

    In the early 1960s, cardiac surgery was founded in Debrecen in the department of thoracic surgery, on Professor József Schnitzler's initiative with the cooperation of the head surgeon Arpád Eisert from Nyíregyháza. During the first 5 years, between 1963-1968, 44 closed cardiac surgical procedures were performed (closure of patent ductus arteriosus, pulmonal and mitral stenosis, pericardectomy). The first open heart surgery was performed by Gábor Kovács visiting professor from Szeged in 1968, after the Pemco heart-lung machine, a donation by Béla Köteles and the Presbyterian Church in Cleveland had arrived. The cardiac surgical activity was led by Professor András Gömöry (1972-1983). During the first 20 years 310 open, 220 closed cardiac surgical, and 612 pacemaker operations were performed. After Professor Schnitzler's retirement in 1983, Arpád Péterffy was appointed the head of the entire department (general and cardio-thoracic surgery). In the last 25 years, 18,000 open, 1500 closed and 8500 pacemaker procedures altogether 32,000 were performed. In 2008 associate professor Tamás Szerafin became the head of the department of cardiac surgery.

  6. Disinfection of Escherichia coli bacteria using hybrid method of ozonation and hydrodynamic cavitation with orifice plate

    Science.gov (United States)

    Karamah, Eva F.; Ghaudenson, Rioneli; Amalia, Fitri; Bismo, Setijo

    2017-11-01

    This research aims to evaluate the performance of hybrid method of ozonation and hydrodynamic cavitation with orifice plate on E.coli bacteria disinfection. In this research, ozone dose, circulation flowrate, and disinfection method were varied. Ozone was produced by commercial ozonator with ozone dose of 64.83 mg/hour, 108.18 mg/hour, and 135.04 mg/hour. Meanwhile, hydrodynamic cavitation was generated by an orifice plate. The disinfection method compared in this research were: hydrodynamic cavitation, ozonation, and the combination of both. The best result on each method was achieved on the 60th minutes and with a circulation flowrate of 7 L/min. The hybrid method attained final concentration of 0 CFU/mL from the initial concentration of 2.10 × 105 CFU/mL. The ozonation method attained final concentration of 0 CFU/mL from the initial concentration of 1.32 × 105 CFU/mL. Cavitation method gives the least disinfection with final concentration of 5.20 × 104 CFU/mL from the initial concentration of 2.17 × 105 CFU/mL. In conclusion, hybrid method gives a faster and better disinfection of E.coli than each method on its own.

  7. Energy Efficiency for Biodiesel Production by Combining Two Orifices in Hydrodynamic Cavitation Reactor

    OpenAIRE

    Mahlinda, Mahlinda; Djafar, Fitriana

    2014-01-01

    Research of energy efficiency for biodiesel production process by combining two orifices on  hydrodynamic cavitation reactor had been carried out. The aim of this reseach was to studied effect of the number of orifices toward increasing temperature without using external energy source to produce biodiesel that generated by cavitation effects on orifices. The results of preliminary research showed by combining two orifices arranged in series can produce the highest thermal energy reached 48oC....

  8. Transanal minimally-invasive surgery (TAMIS: Technique and results from an initial experience

    Directory of Open Access Journals (Sweden)

    Carlos Ramon Silveira Mendes

    2013-10-01

    Full Text Available Transanal endoscopic microsurgery is a minimally-invasive approach for rectal lesions. Superior exposure and access to the entire rectum result in lesser risk of compromised margins and lower recurrence rates, when compared to conventional transanal excision. The aim of this study was to describe a single institution's initial experience with transanal minimally invasive surgery (TAMIS. This was a prospective review of our database. Elev- en procedures from January 2012 to June 2013 were analyzed. Results: eleven operations were completed. Five men were evaluated. Mean age was 62.9 (40-86. Mean follow-up was 9.3 (2-17 months. Average tumor size was 3.8 (1.8-8 cm. Mean distance from anal verge was 6.3 (3-12 cm. Mean operating time was 53.73 (28-118 min. Postoperative complica- tion rate was 9.1%. There were no readmissions. Mortality was null. Operative pathology disclosed the presence of adenoma in four patients, invasive adenocarcinoma in two, neu- roendocrine carcinoma in three, and no residual lesion in one case. TAMIS is a minimally- invasive procedure with low postoperative morbidity at the initial experience. TAMIS is a curative procedure for benign lesions and for selected early cancers. It is useful after neoadjuvant therapy for strictly selected cancers, pending the results of multi-institutional trials. Resumo: Microcirurgia endoscópica transanal é uma abordagem minimamente invasiva para lesões retais. Apresenta menor risco de margem comprometida e menores taxas de recorrência em comparação com excisão transanal convencional. Objetivou-se descrever a experiência inicial, de uma única instituição, com cirurgia minimamente invasiva transanal (TAMIS. Avaliação prospectiva de nosso banco de dados. Onze procedimentos de janeiro de 2012 a junho de 2013, foram analisados. Resultados: onze operações foram concluídas. Havia cinco homens. A média de idade foi de 62,9 (40-86. O acompanhamento médio foi de ww9,3 (2-17 meses. O

  9. Minimal access surgery in children: An initial experience of 28 months

    Directory of Open Access Journals (Sweden)

    Gupta Abhaya

    2009-01-01

    Full Text Available Background : This study reports our 28 months experience with minimal access surgery (MAS in children. Materials and Methods : This was a review of all children who underwent MAS between December 2004 and March 2007 at the Departments of Paediatric Surgery, Seth Gordhandas Sunderdas Medical College (GSMC and King Edward the VII Memorial (KEM Hospital, India. Results and observations were tabulated and analysed, comparing with observations by various other authors regarding variety of indications such as, operative time, hospital stay, conversion rate, complications, safety, and feasibilty of MAS in neonates, in the appropriate operative groups. Results : A total of 199 procedures were performed in 193 children aged between 10 days and 12 years (average age: 5.7 years. One case of each, adrenal mass, retroperitoneoscopic nephrectomy, laparoscopic congenital diaphragmatic hernia (CDH repair, and abdominoperineal pull-through for anorectal malformation, were converted to open surgeries due to technical difficulty. The overall conversion rate was 3%. Morbidity and mortality were very minimal and the procedures were well tolerated in majority of cases. Conclusion : We concluded that MAS procedures appear to be safe for a wide range of indications in neonates and children. Further development and expansion of its indications in neonatal and paediatric surgery requires further multi-institutional studies and larger cohort of patients, to compare with standards of open surgery.

  10. Feasibility of single-incision laparoscopic surgery for appendicitis in abnormal anatomical locations: A single surgeon′s initial experience

    Directory of Open Access Journals (Sweden)

    Sanoop K Zachariah

    2013-01-01

    Full Text Available Background: Single-incision laparoscopic surgery is considered as a more technically demanding procedure than the standard laparoscopic surgery. Based on an initial and early experience, single-incision laparoscopic appendectomy (LA was found to be technically advantageous for dealing with appendicitis in unusual anatomical locations. This study aims to highlight the technical advantages of single-incision laparoscopic surgery in dealing with the abnormally located appendixes and furthermore report a case of acute appendicitis occurring in a sub-gastric position, which is probably the first such case to be reported in English literature. Materials and Methods: A retrospective analysis of the first 10 cases of single-incision LA which were performed by a single surgeon is presented here. Results: There were seven females and three males. The mean age of the patients was 30.6 (range 18-52 years, mean BMI was 22.7 (range 17-28 kg/m 2 and the mean operative time was 85.5 (range 45-150 min. The mean postoperative stay was 3.6 (range 1-7 days. The commonest position of the appendix was retro-caecal (50% followed by pelvic (30%. In three cases the appendix was found to be in abnormal locations namely sub-hepatic, sub-gastric and deep pelvic or para-vesical or para-rectal. All these cases could be managed with this technique without any conversions Conclusion: Single-incision laparoscopic surgery appears to be a feasible and safe technique for dealing with appendicitis in rare anatomical locations. Appendectomy may be a suitable procedure for the initial training in single-incision laparoscopic surgery.

  11. A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit.

    Science.gov (United States)

    Pearse, Bronwyn Louise; Rickard, Claire M; Keogh, Samantha; Lin Fung, Yoke

    2018-03-09

    Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost. Given the success of the initiative, we sought to answer the question; "How and why was the process of implementing a bleeding management quality initiative in the cardiac surgery unit successful, and sustainable?" A retrospective explanatory case study design was chosen to explore the quality initiative. Analysis of the evidence was reviewed through phases of the 'Knowledgeto Action' planned change model. Data was derived from: (1) document analysis, (2) direct observation of the local environment, (3) clinical narratives from interviews, and analysed with a triangulation approach. The study period extended from 10/2011 to 6/2013. Results demonstrated the complexity of changing practice, as well as the significant amount of dedicated time and effort required to support individual, department and system wide change. Results suggest that while many clinicians were aware of the potential to apply improved practice, numerous barriers and challenges needed to be overcome to implement change across multiple disciplines and departments. The key successful components of the QI were revealed through the case study analysis as: (1) an appropriately skilled project manager to facilitate the implementation process; (2) tools to support changes in workflow and decision making including a bleeding management treatment algorithm with POCCTs; (3) strong clinical leadership from the multidisciplinary team and; (4) the evolution of the project

  12. Consecutive operative procedures in patients with Marfan syndrome up to 28 years after initial aortic root surgery.

    Science.gov (United States)

    Puluca, Nazan; Burri, Melchior; Cleuziou, Julie; Krane, Markus; Lange, Rüdiger

    2018-02-28

    Most patients (75%) with Marfan syndrome present with aortic root dilatation that may require surgical intervention. However, associated cardiovascular disorders are not limited to the aortic root. These patients frequently require consecutive operations on the remaining thoracic aorta or the heart valves. Our intent was to characterize the spectrum of such procedures. Data from all patients with Marfan syndrome undergoing aortic root surgery at our centre between 1988 and 2016 were analysed retrospectively. Overall, 73 patients (26 women) were selected for the study. The median age at 1st operation was 30 years (3-68 years). Indications for aortic root surgery were aneurysm (78%) and dissection (22%). Initially, 33 Bentall procedures and 40 valve-sparing root replacement procedures were performed, with a 97% rate of follow-up completion. The median follow up was 8 years (0-28 years). Survival at 1, 10 and 15 years was 100%, 85% and 82%, respectively. During follow-up monitoring, 48 subsequent procedures were performed in 33 patients (aorta, 23; aortic valve, 11; mitral valve, 7 and combined procedures, 7). The 30-day mortality rate after subsequent procedures was 4.2%. Freedom from subsequent operation and death (combined end-point) after 5, 10 and 15 years was 70%, 53% and 34%, respectively. After the initial surgery, subsequent procedures required in the setting of Marfan syndrome most often involve the remaining native aorta, followed by the aortic and mitral valves. The continued need for additional operative procedures remains high, even decades after the initial surgeries are undertaken. Therefore, long-term patient monitoring at specialized centres is imperative.

  13. Mast cell degranulation during abdominal surgery initiates postoperative ileus in mice

    NARCIS (Netherlands)

    de Jonge, Wouter J.; The, Frans O.; van der Coelen, Dennis; Bennink, Roelof J.; Reitsma, Pieter H.; van Deventer, Sander J.; van den Wijngaard, René M.; Boeckxstaens, Guy E.

    2004-01-01

    Background & Aims: Inflammation of the intestinal muscularis following manipulation during surgery plays a crucial role in the pathogenesis of postoperative ileus. Here, we evaluate the role of mast cell activation in the recruitment of infiltrates in a murine model. Methods: Twenty-four hours after

  14. Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy.

    Science.gov (United States)

    Deura, Imari; Shimada, Muneaki; Hirashita, Keiko; Sugimura, Maki; Sato, Seiya; Sato, Shinya; Oishi, Tetsuro; Itamochi, Hiroaki; Harada, Tasuku; Kigawa, Junzo

    2015-06-01

    Lower limb lymphedema (LLL) is one of the most frequent postoperative complications of retroperitoneal lymphadenectomy for gynecologic cancer. LLL often impairs quality of life, activities of daily living, sleep, and sex in patients with gynecologic cancer. We conducted this study to evaluate the incidence and risk factors for LLL after gynecologic cancer surgery in patients who received assessment and periodic complex decongestive physiotherapy (CDP). We retrospectively reviewed 126 cases of gynecologic cancer that underwent surgery involving retroperitoneal lymphadenectomy at Tottori University Hospital between 2009 and 2012. All patients received physical examinations to detect LLL and underwent CDP by nurse specialists within several months after surgery. The International Society of Lymphology staging of lymphedema severity was used as the diagnostic criteria. Of 126 patients, 57 (45.2%) had LLL, comprising 45 and 12 patients with stage 1 and stage 2 LLL, respectively. No patient had stage 3 LLL. LLL was present in 37 (29.4%) patients at the initial physical examination. Multivariate analysis revealed that adjuvant concurrent chemoradiotherapy and age ≥ 55 years were independent risk factors for ≥ stage 2 LLL. To minimize the incidence of ≥ stage 2 LLL, gynecologic oncologists should be vigilant for this condition in patients who are ≥ 55 years and in those who undergo adjuvant chemoradiotherapy. Patients should be advised to have a physical assessment for LLL and to receive education about CDP immediately after surgery involving retroperitoneal lymphadenectomy for gynecologic cancer.

  15. Laboratory evaluation of a vibrating orifice monodisperse aerosol generator

    International Nuclear Information System (INIS)

    Everitt, N.M.; Snelling, K.W.

    1985-02-01

    The Berglund-Liu vibrating orifice aerosol generator is capable of producing monodisperse particles in the diameter range 5 to 50 μm. Experiments have been carried out to set up and evaluate such a generator for the preparation of standard liquid (olive oil) and solid (methylene blue) aerosols in the size range 8 to 13 μm. Modifications have been made to the apparatus to improve its performance and increase its particle output. (author)

  16. Preparation of spherical particles by vibrating orifice technique

    Science.gov (United States)

    Shibata, Shuichi; Tomizawa, Atsushi; Yoshikawa, Hidemi; Yano, Tetsuji; Yamane, Masayuki

    2000-05-01

    Preparation of micrometer-sized spherical particles containing Rhodamine 6G (R6G) has been investigated for the spherical cavity micro-laser. Using phenyl triethoxy silane (PTES) as a starting material, R6G-doped monodisperse spherical particles were prepared by the vibrating orifice technique. Processing consists of two major processes: (1) Hydrolysis and polymerization of PTES and (2) Droplet formation from PTES oligomers by vibrating orifice technique. A cylindrical liquid jet passing through the orifice of 10 and 20 micrometers in diameter breaks up into equal- sized droplets by mechanical vibration. Alcohol solvent of these droplets was evaporated during flying with carrier gas and subsequently solidified in ammonium water trap. For making smooth surface and god shaped particles, control of molecular weight of PTES oligomer was essential. R6G-doped hybrid spherical particles of 4 to 10 micrometers size of cavity structure were successfully obtained. The spherical particles were pumped by a second harmonic pulse of Q- switched Nd:YAG laser and laser emission peaks were observed at wavelengths which correspond to the resonance modes.

  17. Killing rate of colony count by hydrodynamic cavitation due to square multi-orifice plates

    Science.gov (United States)

    Dong, Zhiyong; Zhao, Wenqian

    2018-02-01

    Currently,in water supply engineering, the conventional technique of disinfection by chlorination is employed to kill pathogenic microorganisms in raw water. However, chlorine reacts with organic compounds in water and generates disinfection byproducts (DBPs), such as trihalomethanes (THMs), haloacetic acids (HAAs) etc. These byproducts are of carcinogenic, teratogenic and mutagenic effects, which seriously threaten human health. Hydrodynamic cavitation is a novel technique of drinking water disinfection without DBPs. Effects of orifice size, orifice number and orifice layout of multi-orifice plate, cavitation number, cavitation time and orifice velocity on killing pathogenic microorganisms by cavitation were investigated experimentally in a self-developed square multi-orifice plate-type hydrodynamic cavitation device. The experimental results showed that cavitation effects increased with decrease in orifice size and increase in orifice number, cavitation time and orifice velocity. Along with lowering in cavitation number, there was an increase in Reynolds shear stress,thus enhancing the killing rate of pathogenic microorganism in raw water. In addition, the killing rate by staggered orifice layout was greater than that by checkerboard-type orifice layout.

  18. Online and smartphone based cognitive behavioral therapy for bariatric surgery patients: Initial pilot study.

    Science.gov (United States)

    Zhang, Melvyn W B; Ho, Roger C M; Cassin, Stephanie E; Hawa, Raed; Sockalingam, Sanjeev

    2015-01-01

    The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Despite the success of Bariatric surgery, studies have proposed that it has neglected the contributions of other factors, such as psychological factors in the causation as well as the maintenance of obesity amongst individuals. Cognitive behavioral therapy (CBT) is largely a psychosocial intervention that has been shown to be efficacious, as studies have demonstrated that even brief CBT interventions could help in the reduction of binge eating and maintenance of weight loss. Previously identified problems with regards to the integration and the provision of such interventions include that of geographical barriers. In order to overcome the geographical barriers, telephone-based CBT has been conceptualized. Over the past decade, there has been massive advancement and development in Internet, Web-based and smartphone technologies, but there is still a paucity of applications in this area. Our current research objective is to determine if bariatric surgery patients will be receptive towards an online and smartphone based CBT intervention. The Bariatric Surgery Online CBT portal and Smartphone companion application was developed between July 2013 and December 2013. A low-cost methodology of developing the online portal was adopted. In terms of development, 4 core development phases were adopted. These included that of: a) Formulation of users' requirements, b) System design and development, c) System evaluation and d) System deployment and pilot application. The bariatric surgery workgroup from the Toronto Western Hospital helped with the recruitment of the subjects from the outpatient specialist service. Links to the web-portal was provided to each of the participants recruited. Since the inception of the online portal to date, in terms of usage rates, there

  19. Close Contact Casting vs Surgery for Initial Treatment of Unstable Ankle Fractures in Older Adults: A Randomized Clinical Trial.

    Science.gov (United States)

    Willett, Keith; Keene, David J; Mistry, Dipesh; Nam, Julian; Tutton, Elizabeth; Handley, Robert; Morgan, Lesley; Roberts, Emma; Briggs, Andrew; Lall, Ranjit; Chesser, Timothy J S; Pallister, Ian; Lamb, Sarah E

    2016-10-11

    Ankle fractures cause substantial morbidity in older persons. Surgical fixation is the contemporary intervention but is associated with infection and other healing complications. To determine whether initial fracture treatment with close contact casting, a molded below-knee cast with minimal padding, offers outcome equivalent to that with immediate surgery, with fewer complications and less health resource use. This was a pragmatic, equivalence, randomized clinical trial with blinded outcome assessors. A pilot study commenced in May 2004, followed by multicenter recruitment from July 2010 to November 2013; follow-up was completed May 2014. Recruitment was from 24 UK major trauma centers and general hospitals. Participants were 620 adults older than 60 years with acute, overtly unstable ankle fracture. Exclusions were serious limb or concomitant disease or substantial cognitive impairment. Participants were randomly assigned to surgery (n = 309) or casting (n = 311). Casts were applied in the operating room under general or spinal anesthesia by a trained surgeon. The primary 6-month, per-protocol outcome was the Olerud-Molander Ankle Score at 6 months (OMAS; range, 0-100; higher scores indicate better outcomes and fewer symptoms), equivalence prespecified as ±6 points. Secondary outcomes were quality of life, pain, ankle motion, mobility, complications, health resource use, and patient satisfaction. Among 620 adults (mean age, 71 years; 460 [74%] women) who were randomized, 593 (96%) completed the study. Nearly all participants (579/620; 93%) received allocated treatment; 52 of 275 (19%) who initially received casting later converted to surgery, which was allowable in the casting treatment pathway to manage early loss of fracture reduction. At 6 months, casting resulted in ankle function equivalent to that with surgery (OMAS score, 66.0 [95% CI, 63.6-68.5] for surgery vs 64.5 [95% CI, 61.8-67.2] for casting; mean difference, -0.6 [95% CI, -3.9 to 2.6]; P

  20. Initial Experiments with the Leap Motion as a User Interface in Robotic Endonasal Surgery.

    Science.gov (United States)

    Travaglini, T A; Swaney, P J; Weaver, Kyle D; Webster, R J

    The Leap Motion controller is a low-cost, optically-based hand tracking system that has recently been introduced on the consumer market. Prior studies have investigated its precision and accuracy, toward evaluating its usefulness as a surgical robot master interface. Yet due to the diversity of potential slave robots and surgical procedures, as well as the dynamic nature of surgery, it is challenging to make general conclusions from published accuracy and precision data. Thus, our goal in this paper is to explore the use of the Leap in the specific scenario of endonasal pituitary surgery. We use it to control a concentric tube continuum robot in a phantom study, and compare user performance using the Leap to previously published results using the Phantom Omni. We find that the users were able to achieve nearly identical average resection percentage and overall surgical duration with the Leap.

  1. Initial Experiments with the Leap Motion as a User Interface in Robotic Endonasal Surgery

    Science.gov (United States)

    Travaglini, T. A.; Swaney, P. J.; Weaver, Kyle D.; Webster, R. J.

    2016-01-01

    The Leap Motion controller is a low-cost, optically-based hand tracking system that has recently been introduced on the consumer market. Prior studies have investigated its precision and accuracy, toward evaluating its usefulness as a surgical robot master interface. Yet due to the diversity of potential slave robots and surgical procedures, as well as the dynamic nature of surgery, it is challenging to make general conclusions from published accuracy and precision data. Thus, our goal in this paper is to explore the use of the Leap in the specific scenario of endonasal pituitary surgery. We use it to control a concentric tube continuum robot in a phantom study, and compare user performance using the Leap to previously published results using the Phantom Omni. We find that the users were able to achieve nearly identical average resection percentage and overall surgical duration with the Leap. PMID:26752501

  2. Development of honeycomb type orifices for flow zoning in PFBR

    Energy Technology Data Exchange (ETDEWEB)

    Pandey, G.K., E-mail: gkpandey@igcar.gov.in; Ramdasu, D.; Padmakumar, G.; Prakash, V.; Rajan, K.K.

    2013-09-15

    Highlights: • Cavitation free flow zoning devices are developed for reactor core in PFBR. • These devices are experimentally investigated for their hydraulic characteristics. • Pressure drop and cavitation are two main characteristics to be investigated. • Various configurations of devices utilized in different zones are discussed. • Loss coefficient for each configuration is compared and reported. -- Abstract: The prototype fast breeder reactor (PFBR) is in its advanced phase of construction at Kalpakkam, India. It is a sodium cooled, pool type reactor with two loop concept where each loop have one primary sodium pump (PSP), one secondary sodium pump (SSP) and two intermediate heat exchangers (IHX). PFBR core subassemblies (SA) are supported vertically inside the sleeves provided in the grid plate (GP). The GP acts as a coolant header through which flow is distributed among the SA to remove fission heat. Since the power profile of the reactor core is not uniform, it is necessary to distribute the coolant flow (called flow zoning) to each subassembly according to their power levels to get maximum mean outlet temperature of sodium at core outlet. To achieve this, PFBR core is divided into 15 zones such as fuel, blanket, reflector, storage, etc. according to their respective power levels. The flow zoning in the different SAs of the reactor core is achieved by installing permanent pressure dropping devices in the foot of the subassembly. Orifices having honey-comb type geometry were developed to meet the flow zoning requirements of fuel zone. These orifices being of very complex geometry requires precision methods of manufacturing to achieve the desired shape under specified tolerances. Investment casting method was optimized to manufacture this orifice plate successfully. Hydraulics of these orifices is important in achieving the required pressure drop without cavitation. The pressure drop across these orifice geometries depends mainly on geometrical

  3. The Impact of Manifold-to-Orifice Turning Angle on Sharp-Edge Orifice Flow Characteristics in both Cavitation and Non-Cavitation Turbulent Flow Regimes (Preprint)

    Science.gov (United States)

    2007-06-01

    varies as the cavitation number is lowered. The third is supercavitation where the vapor pocket attachment has moved to the orifice exit and beyond but...the flow still acts as attached. For this study only the 90 degree orifice angle configuration experienced supercavitation . For all other angles

  4. Overview of robotic colorectal surgery: Current and future practical developments

    Science.gov (United States)

    Roy, Sudipta; Evans, Charles

    2016-01-01

    Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete. PMID:26981188

  5. Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

    Energy Technology Data Exchange (ETDEWEB)

    Krammer, Julia [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Price, Elissa R. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, Division of Women' s Imaging, San Francisco, CA (United States); Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A. [Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Murray, Melissa P. [Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, NY (United States); Schoenberg, Stefan O. [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

    2017-11-15

    To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

  6. Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

    International Nuclear Information System (INIS)

    Krammer, Julia; Price, Elissa R.; Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A.; Murray, Melissa P.; Schoenberg, Stefan O.

    2017-01-01

    To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

  7. Long-term survival in children with atrioventricular septal defect and common atrioventricular valvar orifice in Sweden.

    Science.gov (United States)

    Frid, Christina; Björkhem, Gudrun; Jonzon, Anders; Sunnegårdh, Jan; Annerén, Göran; Lundell, Bo

    2004-02-01

    The survival for patients with atrioventricular septal defect has improved markedly over the last decades and, during the same period, the survival of children with Down's syndrome has also increased. The aim of our study was to investigate long-term survival in patients having atrioventricular septal defect with common valvar orifice, but without associated significant congenital heart defects, in the setting of Down's syndrome, comparing the findings to those in chromosomally normal children with the same malformation. In a population-based retrospective study, we scrutinised the medical records from 801 liveborn children with atrioventricular septal defect born in Sweden during the period 1973 through 1997. Data on gender, presence or absence of Down's syndrome, associated congenital heart defects, date of birth, operation and death were recorded and followed up until 2001. An isolated atrioventricular septal defect with common atrioventricular valvar orifice was present in 502 children, of whom 86% had Down's syndrome. We found a significant reduc tion over time in age at operation, and in postoperative mortality at 30 days, from 28 to 1%. Using a multiple logistic regression model, we found no significant differences in mortality between genders, nor between those with or without Down's syndrome. Early corrective surgery could not be identified as a significant independent factor for survival. The 5-year postoperative survival in patients with Down's syndrome increased from 65% over the period from 1973 through 1977, to about 90% in the period 1993 through 1997, and the same trend was observed in chromosomally normal patients. Survival in uncomplicated atrioventricular septal defect with common atrioventricular valvar orifice has greatly increased, and surgical correction is now equally successful in patients with Down's syndrome and chromosomally normal patients, and for both genders. Death in connection with surgery is no longer the major threat, and focus

  8. Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative.

    Science.gov (United States)

    Slinger, Gillian; Trautvetter, Lilli; Browning, Andrew; Rane, Ajay

    2018-06-01

    Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000. © 2018 International Federation of Gynecology and Obstetrics.

  9. Pressure heat pumping in the orifice pulse-tube refrigerator

    International Nuclear Information System (INIS)

    Boer, P.C.T. de

    1996-01-01

    The mechanism by which heat is pumped as a result of pressure changes in an orifice pulse-tube refrigerator (OPTR) is analyzed thermodynamically. The thermodynamic cycle considered consists of four steps: (1) the pressure is increased by a factor π 1 due to motion of a piston in the heat exchanger at the warm end of the regenerator; (2) the pressure is decreased by a factor π 2 due to leakage out of the orifice; (3) the pressure is further decreased due to motion of the piston back to its original position; (4) the pressure is increased to its value at the start of the cycle due to leakage through the orifice back into the pulse tube. The regenerator and the heat exchangers are taken to be perfect. The pressure is assumed to be uniform during the entire cycle. The temperature profiles of the gas in the pulse tube after each step are derived analytically. Knowledge of the temperature at which gas enters the cold heat exchanger during steps 3 and 4 provides the heat removed per cycle from this exchanger. Knowledge of the pressure as a function of piston position provides the work done per cycle by the piston. The pressure heat pumping mechanism considered is effective only in the presence of a regenerator. Detailed results are presented for the heat removed per cycle, for the coefficient of performance, and for the refrigeration efficiency as a function of the compression ratio π 1 and the expansion ratio π 2 . Results are also given for the influence on performance of the ratio of specific heats. The results obtained are compared with corresponding results for the basic pulse-tube refrigerator (BPTR) operating by surface heat pumping

  10. Risk stratification for the development of respiratory adverse events following vascular surgery using the Society of Vascular Surgery's Vascular Quality Initiative.

    Science.gov (United States)

    Genovese, Elizabeth A; Fish, Larry; Chaer, Rabih A; Makaroun, Michel S; Baril, Donald T

    2017-02-01

    Postoperative respiratory adverse events (RAEs) are associated with high rates of morbidity and mortality in general surgery, however, little is known about these complications in the vascular surgery population, a frail subset with multiple comorbidities. The objective of this study was to describe the contemporary incidence of RAEs in vascular surgery patients, the risk factors for this complication, and the overall impact of RAEs on patient outcomes. The Vascular Quality Initiative was queried (2003-2014) for patients who underwent endovascular abdominal aortic repair, open abdominal aortic aneurysm repair, thoracic endovascular aortic repair, suprainguinal bypass, or infrainguinal bypass. A mixed-effects logistic regression model determined the independent risk factors for RAEs. Using a random 85% of the cohort, a risk prediction score for RAEs was created, and the score was validated using the remaining 15% of the cohort, comparing the predicted to the actual incidence of RAE and determining the area under the receiver operating characteristic curve. The independent risk of in-hospital mortality and discharge to a nursing facility associated with RAEs was determined using a mixed-effects logistic regression to control for baseline patient characteristics, operative variables, and other postoperative adverse events. The cohort consisted of 52,562 patients, with a 5.4% incidence of RAEs. The highest rates of RAEs were seen in current smokers (6.1%), recent acute myocardial infarction (10.1%), symptomatic congestive heart failure (9.9%), chronic obstructive pulmonary disease requiring oxygen therapy (11.0%), urgent and emergent procedures (6.4% and 25.9%, respectively), open abdominal aortic aneurysm repairs (17.6%), in situ suprainguinal bypasses (9.68%), and thoracic endovascular aortic repairs (9.6%). The variables included in the risk prediction score were age, body mass index, smoking status, congestive heart failure severity, chronic obstructive pulmonary

  11. Characterization of surface position in a liquid dispensing orifice

    Energy Technology Data Exchange (ETDEWEB)

    Farahi, R H [ORNL; Passian, Ali [ORNL; Thundat, Thomas George [ORNL; Lereu, Aude L [ORNL; Tetard, Laurene [University of Tennessee, Knoxville (UTK) & Oak Ridge National Laboratory (ORNL); Jones, Yolanda [ORNL

    2009-01-01

    Precision microdispencing technology delivers picoliter amounts of fluid for printing, electronic, optical, chemical and biomedical applications. In particular, microjetting is capable of accurate, flexible, and non-contact coating with polymers, thus allowing the functionalization of delicate microsensors such as microcantilevers. Information on various phases of droplet formation are important to control volume, uniformity, velocity and rate. One such aspect is the ringing of the meniscus after droplet breakoff which can affect subsequent drop formation. We present analysis of an optical characterization technique and experimental results on the behaviour of menisus oscillations in an orifice of a piezoelectric microjet.

  12. Numerical simulation of progressive BWR fuel inlet orifices

    International Nuclear Information System (INIS)

    Sara Lundgren; Hernan Tinoco; Aleksander Pohl; Wiktor Frid

    2005-01-01

    Full text of publication follows: A 'progressive' orifice is characterized by an edge-shaped hole that gives a Reynolds number dependent resistance coefficient. For Reynolds numbers smaller than a critical one, the resistance coefficient has a high constant value that drops to a much lower value for Reynolds numbers greater than this critical value. A similar effect is widely known for external flows around bodies of different shapes, i. e. spheres, cylinders, etc., and the sudden drop in drag coefficient is due to the shift from laminar to turbulent boundary-layer flow. Experimentally, progressive orifices have been investigated under high-pressure and high-temperature conditions by Akiba et al. (2001) for a reduced set of geometrical parameters. Using the sparse experimental data, a core stability study was carried out by Forsmaks Kraftgrupp AB that showed an improvement in core stability but without the expected reduction in pump power at normal operation. The reason for this partial success was the impossibility of optimizing the fuel inlet pressure drop owing to the limited amount of available data. Due to the high costs associated with the experimental generation of high-pressure, high-temperature data, it was considered that, if possible, the lacking data could be generated numerically at much lower cost. Therefore, the present work deals with the possibility of numerically simulate the flow through progressive orifices, and with the conditions under which to reproduce and generate resistance coefficient data by means of a commercial CFD-code. The results obtained with a two-dimensional, axisymmetric approximation show that Reynolds Averaged Navier-Stokes (RANS) turbulence models are able to qualitatively capture the physics of the phenomenon but with an earlier transition to turbulent boundary-layer flow and with an underestimation of the resistance coefficient by approximately 20 %. This underestimation of the resistance coefficient is related to the two

  13. Numerical simulation of progressive BWR fuel inlet orifices

    Energy Technology Data Exchange (ETDEWEB)

    Sara Lundgren; Hernan Tinoco [Forsmarks Kraftgrupp AB, 742 03 Oesthammar (Sweden); Aleksander Pohl; Wiktor Frid [The Royal Institute of Technology, Dept. Energy Technology, SE-100 44 Stockholm (Sweden)

    2005-07-01

    Full text of publication follows: A 'progressive' orifice is characterized by an edge-shaped hole that gives a Reynolds number dependent resistance coefficient. For Reynolds numbers smaller than a critical one, the resistance coefficient has a high constant value that drops to a much lower value for Reynolds numbers greater than this critical value. A similar effect is widely known for external flows around bodies of different shapes, i. e. spheres, cylinders, etc., and the sudden drop in drag coefficient is due to the shift from laminar to turbulent boundary-layer flow. Experimentally, progressive orifices have been investigated under high-pressure and high-temperature conditions by Akiba et al. (2001) for a reduced set of geometrical parameters. Using the sparse experimental data, a core stability study was carried out by Forsmaks Kraftgrupp AB that showed an improvement in core stability but without the expected reduction in pump power at normal operation. The reason for this partial success was the impossibility of optimizing the fuel inlet pressure drop owing to the limited amount of available data. Due to the high costs associated with the experimental generation of high-pressure, high-temperature data, it was considered that, if possible, the lacking data could be generated numerically at much lower cost. Therefore, the present work deals with the possibility of numerically simulate the flow through progressive orifices, and with the conditions under which to reproduce and generate resistance coefficient data by means of a commercial CFD-code. The results obtained with a two-dimensional, axisymmetric approximation show that Reynolds Averaged Navier-Stokes (RANS) turbulence models are able to qualitatively capture the physics of the phenomenon but with an earlier transition to turbulent boundary-layer flow and with an underestimation of the resistance coefficient by approximately 20 %. This underestimation of the resistance coefficient is related to

  14. Return to axi-symmetry for pipe flows generated after a fractal orifice

    Energy Technology Data Exchange (ETDEWEB)

    Nicolleau, F C G A, E-mail: F.Nicolleau@Sheffield.ac.uk [SFMG, Department of Mechanical Engineering, University of Sheffield, Mappin Street, Sheffield S1 3JD (United Kingdom)

    2013-12-15

    We present experimental results obtained from pipe flows generated by fractal shaped orifices or openings. We compare different fractal orifices and their efficiencies to re-generate axi-symmetric flows and to return to the standard flow generated by a perforated plate or a circular orifice plate. We consider two families of fractal openings: mono-orifice and complex orifice and emphasize the differences between the two fractal families. For the Reynolds number we used, we found that there is an optimum iteration for the fractal level above which no improvement for practical applications such as flowmetering is to be expected. The main parameters we propose for the characterization of the fractal orifice are the connexity parameter, the symmetry angle and the gap to the wall {delta}*{sub g}. The results presented here are among the first for flows forced through fractal openings and will serve as a reference for future studies and benchmarks for numerical applications. (paper)

  15. Return to axi-symmetry for pipe flows generated after a fractal orifice

    International Nuclear Information System (INIS)

    Nicolleau, F C G A

    2013-01-01

    We present experimental results obtained from pipe flows generated by fractal shaped orifices or openings. We compare different fractal orifices and their efficiencies to re-generate axi-symmetric flows and to return to the standard flow generated by a perforated plate or a circular orifice plate. We consider two families of fractal openings: mono-orifice and complex orifice and emphasize the differences between the two fractal families. For the Reynolds number we used, we found that there is an optimum iteration for the fractal level above which no improvement for practical applications such as flowmetering is to be expected. The main parameters we propose for the characterization of the fractal orifice are the connexity parameter, the symmetry angle and the gap to the wall δ* g . The results presented here are among the first for flows forced through fractal openings and will serve as a reference for future studies and benchmarks for numerical applications. (paper)

  16. Numerical analysis for the flow field past a two-staged conical orifice

    International Nuclear Information System (INIS)

    Kim, Yeon Soo; Kim, You Gon

    2001-01-01

    The objective of the paper was to measure the pressure drop and to investigate the recirculation region of the conical orifices used in Kwang-yang Iron and Steel Company. The flow field with water used as a working fluid was the turbulent flow for Reynolds number of 2x10 4 . The effective parameters for the pressure drop and the recirculation region were the conical orifice's inclined angle (θ) against the wall, the interval(L) between orifices, the relative angle of rotation(α) of the orifices, the shape of the orifice's hole(circle, rectangle, triangle) having the same area. It was found that the shape of the orifice's hold affected the pressure drop and the flow field a lot. But the other parameters did not make much differences to the pressure drop. The PISO algorithm with FLUENT code was employed

  17. Endoscopic endonasal transsphenoidal surgery using the iArmS operation support robot: initial experience in 43 patients.

    Science.gov (United States)

    Ogiwara, Toshihiro; Goto, Tetsuya; Nagm, Alhusain; Hongo, Kazuhiro

    2017-05-01

    Objective The intelligent arm-support system, iArmS, which follows the surgeon's arm and automatically fixes it at an adequate position, was developed as an operation support robot. iArmS was designed to support the surgeon's forearm to prevent hand trembling and to alleviate fatigue during surgery with a microscope. In this study, the authors report on application of this robotic device to endoscopic endonasal transsphenoidal surgery (ETSS) and evaluate their initial experiences. Methods The study population consisted of 43 patients: 29 with pituitary adenoma, 3 with meningioma, 3 with Rathke's cleft cyst, 2 with craniopharyngioma, 2 with chordoma, and 4 with other conditions. All patients underwent surgery via the endonasal transsphenoidal approach using a rigid endoscope. During the nasal and sphenoid phases, iArmS was used to support the surgeon's nondominant arm, which held the endoscope. The details of the iArmS and clinical results were collected. Results iArmS followed the surgeon's arm movement automatically. It reduced the surgeon's fatigue and stabilized the surgeon's hand during ETSS. Shaking of the video image decreased due to the steadying of the surgeon's scope-holding hand with iArmS. There were no complications related to use of the device. Conclusions The intelligent armrest, iArmS, seems to be safe and effective during ETSS. iArmS is helpful for improving the precision and safety not only for microscopic neurosurgery, but also for ETSS. Ongoing advances in robotics ensure the continued evolution of neurosurgery.

  18. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations.

    Science.gov (United States)

    Pascual, Marta; Salvans, Silvia; Pera, Miguel

    2016-01-14

    The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients' characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.

  19. Quality Assurance and Improvement in Head and Neck Cancer Surgery: From Clinical Trials to National Healthcare Initiatives.

    Science.gov (United States)

    Simon, Christian; Caballero, Carmela

    2018-05-24

    It is without question in the best interest of our patients, if we can identify ways to improve the quality of care we deliver to them. Great progress has been made within the last 25 years in terms of development and implementation of quality-assurance (QA) platforms and quality improvement programs for surgery in general, and within this context for head and neck surgery. As of now, we have successfully identified process indicators that impact outcome of our patients and the quality of care we deliver as surgeons. We have developed risk calculators to determine the risk for complications of individual surgical patients. We have created perioperative guidelines for complex head and neck procedures. We have in Europe and North America created audit registries that can gather and analyze data from institutions across the world to better understand which processes need change to obtain good outcomes and improve quality of care. QA platforms can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit directly from such initiatives on a global level.

  20. Giant cell tumor of the bone: aggressive case initially treated with denosumab and intralesional surgery

    Energy Technology Data Exchange (ETDEWEB)

    Von Borstel, Donald; Strle, Nicholas A. [Oklahoma State University Medical Center, Department of Radiology, Tulsa, OK (United States); Taguibao, Roberto A. [University of California, Irvine, UCI Medical Center, Department of Pathology, Orange, CA (United States); Burns, Joseph E. [University of California, Irvine, UCI Medical Center, Department of Radiological Sciences, Orange, CA (United States)

    2017-04-15

    Giant cell tumor of the bone (GCTB) is a locally aggressive benign tumor, which has historically been treated with wide surgical excision. We report a case of a 29-year-old male with histology-proven GCTB of the distal ulna. The initial imaging study was a contrast-enhanced magnetic resonance imaging (MRI) examination of the left wrist, which was from an outside facility performed before presenting to our institution. On the initial MRI, the lesion had homogenous T2-hyperintense and T1-hypointense signal with expansive remodeling of the osseous contour. A radiographic study performed upon presentation to our institution 1 month later showed progression of the lesion with atypical imaging characteristics. After confirming the diagnosis, denosumab therapy was implemented allowing for reconstitution of bone and intralesional treatment. The patient was treated with five doses of denosumab over the duration of 7 weeks. Therapeutic changes of the GCTB were evaluated by radiography and a post-treatment MRI. This MRI was interpreted as suspicious for worsening disease due to the imaging appearance of intralesional signal heterogeneity, increased perilesional fluid-like signal, and circumferential cortical irregularity. However, on subsequent intralesional curettage and bone autografting 6 weeks later, no giant cells were seen on the specimen. Thus, the appearance on the MRI, rather than representing a manifestation of lesion aggressiveness or a non-responding tumor, conversely represented the imaging appearance of a positive response to denosumab therapy. On follow-up evaluation, 5 months after intralesional treatment, the patient had recurrent disease and is now scheduled for wide-excision with joint prosthesis. (orig.)

  1. The Quality Initiative in Rectal Cancer (QIRC trial: study protocol of a cluster randomized controlled trial in surgery

    Directory of Open Access Journals (Sweden)

    Thabane Lehana

    2008-02-01

    Full Text Available Abstract Background Two unfortunate outcomes for patients treated surgically for rectal cancer are placement of a permanent colostomy and local tumor recurrence. Total mesorectal excision is a new technique for rectal cancer surgery that can lead to improved patient outcomes. We describe a cluster randomized controlled trial that is testing if the above patient outcomes can be improved through a knowledge translation strategy called the Quality Initiative in Rectal Cancer (QIRC strategy. The strategy is designed to optimize the use of total mesorectal excision techniques. Methods and Design Hospitals were randomized to the QIRC strategy (experimental group versus normal practice environment (control group. Participating hospitals, and the respective surgeon group operating in them, are from Ontario, Canada and have an annual procedure volume for major rectal cancer resections of 15 or greater. Patients were eligible if they underwent major rectal surgery for a diagnosis of primary rectal cancer. The surgeon-directed QIRC interventions included a workshop, use of opinion leaders, operative demonstrations, a post-operative questionnaire, and, audit and feedback. For an operative demonstration participating surgeons invited a study team surgeon to assist them with a case of rectal cancer surgery. The intent was to demonstrate total mesorectal excision techniques. Control arm surgeons received no intervention. Sample size calculations were two-sided, considered the clustering of data at the hospital level, and were driven by requirements for the outcome local recurrence. To detect an improvement in local recurrence from 20% to 8% with confidence we required 16 hospitals and 672 patients – 8 hospitals and 336 patients in each arm. Outcomes data are collected via chart review for at least 30 months after surgery. Analyses will use an intention-to-treat principle and will consider the clustering of data. Data collection will be complete by the end of

  2. Collection of process data after cardiac surgery: initial implementation with a Java-based intranet applet.

    Science.gov (United States)

    Ratcliffe, M B; Khan, J H; Magee, K M; McElhinney, D B; Hubner, C

    2000-06-01

    Using a Java-based intranet program (applet), we collected postoperative process data after coronary artery bypass grafting. A Java-based applet was developed and deployed on a hospital intranet. Briefly, the nurse entered patient process data using a point and click interface. The applet generated a nursing note, and process data were saved in a Microsoft Access database. In 10 patients, this method was validated by comparison with a retrospective chart review. In 45 consecutive patients, weekly control charts were generated from the data. When aberrations from the pathway occurred, feedback was initiated to restore the goals of the critical pathway. The intranet process data collection method was verified by a manual chart review with 98% sensitivity. The control charts for time to extubation, intensive care unit stay, and hospital stay showed a deviation from critical pathway goals after the first 20 patients. Feedback modulation was associated with a return to critical pathway goals. Java-based applets are inexpensive and can collect accurate postoperative process data, identify critical pathway deviations, and allow timely feedback of process data.

  3. Effect of mitral orifice shape on intra-ventricular filling fluid dynamics

    Science.gov (United States)

    Okafor, Ikechukwu; Angirish, Yagna; Yoganathan, Ajit; Santhanakrishnan, Arvind

    2013-11-01

    The natural geometry of the mitral orifice is D-shaped. However, most current designs of prosthetic valves employ O-shaped orifice geometry. The goal of this study was to compare the effect of geometrical modification between the D and O orifice on the intra-ventricular fluid dynamics during diastolic filling. The different mitral orifice geometries were incorporated into an in vitro left heart simulator consisting of a flexible-walled anatomical left ventricle (LV) physical model enclosed in an acrylic housing. Physiological flow rates and pressures were obtained via tuning systemic resistance and compliance elements in the flow loop. A programmable piston pump was used to generate the LV model wall motion. 2D Particle image velocimetry measurements were conducted along multiple longitudinal planes perpendicular to the annulus plane. During peak diastole, the incoming jet width at the LV central plane was smaller for the D-orifice than that of the O-orifice. Further, the core of the vortex ring in the D-orifice was reduced in size compared to that of the O-orifice. The spatiotemporal spreading of the inflow jet as well as the propagation of the vortex ring will be discussed. This study was funded by a grant from the National Heart, Lung and Blood Institute (RO1HL70262).

  4. Efficiency Analysis of Direct Video-Assisted Thoracoscopic Surgery in Elderly Patients with Blunt Traumatic Hemothorax without an Initial Thoracostomy

    Directory of Open Access Journals (Sweden)

    Wen-Yen Huang

    2016-01-01

    Full Text Available Hemothorax is common in elderly patients following blunt chest trauma. Traditionally, tube thoracostomy is the first choice for managing this complication. The goal of this study was to determine the benefits of this approach in elderly patients with and without an initial tube thoracostomy. Seventy-eight patients aged >65 years with blunt chest trauma and stable vital signs were included. All of them had more than 300 mL of hemothorax, indicating that a tube thoracostomy was necessary. The basic demographic data and clinical outcomes of patients with hemothorax who underwent direct video-assisted thoracoscopic surgery without a tube thoracostomy were compared with those who received an initial tube thoracostomy. Patients who did not receive a thoracostomy had lower posttrauma infection rates (28.6% versus 56.3%, P=0.061 and a significantly shorter length of stay in the intensive care unit (3.13 versus 8.27, P=0.029 and in the hospital (15.93 versus 23.17, P=0.01 compared with those who received a thoracostomy. The clinical outcomes in the patients who received direct VATS were more favorable compared with those of the patients who did not receive direct VATS.

  5. Transport phenomena of macro and micro flows behind orifice and flow accelerated corrosion

    International Nuclear Information System (INIS)

    Fujisawa, Nobuyuki; Hayase, Toshiyuki; Ohara, Taku; Ikohagi, Toshiaki

    2008-01-01

    This paper describes experiment and numerical simulations for macro and micro flows behind an orifice model in a square pipe, which are carried from the viewpoint of flow accelerated corrosion (FAC). The measurements of velocity field behind the orifice model were carried out using particle image velocimetry, and the variations of velocity field with respect to the accuracy of the orifice position were studied. It is found that the reattachment behavior of the flow is highly influenced by the orifice position, which is a critical problem for predicting the pipe thinning phenomena by FAC. The DNS simulation was also conducted for calculating the macro flow behind the orifice. The result suggests that the DNS simulation is applicable to the prediction of pipe thinning macro flow for highly aged nuclear plant. The micro flow simulation can predict the pipe thinning phenomena near the wall. (author)

  6. SPIDER ® sleeve gastrectomy--a new concept in single-trocar bariatric surgery: initial experience and technical details.

    Science.gov (United States)

    Noel, P; Nedelcu, M; Gagner, M

    2014-04-01

    Single port instrument delivery extended reach (SPIDER(®)) surgical system is a revolutionary surgical platform that allows triangulation of the surgical instruments while eliminating the crossing of instruments, the problematic characteristic of single access laparoscopic surgery. The purpose of this study was to analyze our initial experience with SPIDER(®) sleeve gastrectomy and to present the technical details of this new minimally invasive approach, performed in ten patients at the La Casamance Private Hospital between November 2012 and April 2013. All patients were reviewed at scheduled post-operative consultations at 1, 3 and 6 months. In addition to clinical examination, the post-operative consultation at one month also included a satisfaction survey using the Moorehead-Ardelt questionnaire. An initial series of ten sleeve gastrectomies were performed in female patients with a mean age of 41.5 years (range: 2-52). The mean BMI was 40.11 (range: 37.25-44.3). The intervention was performed through a single trocar in all patients with no "conversion" to classic laparoscopy or open surgery. The mean operative time was 61 ± 15.22 minutes (SD=standard deviation) (range: 43-96 min). The mean BMI at one month was 35.5 (SD:± 3.58, SEM: ± 1.13) (SEM=standard error of mean) with an average percentage of excess weight loss (%EWL) of 32.9% (SD:± 8.56%, SEM:± 2.71%). The mean BMI at three months was 32.4 (SD: ± 2.78, SEM: ± 0.88) with an average %EWL of 52.7% (SD: ± 8.64%, SEM: ± 2.73%). The mean BMI at six months was 29.9 (SD:± 2.60, SEM: ± 0.98) with a mean %EWL of 68.8% (SD: ± 8.38%, SEM:± 3.17%). Complete remission of co-morbid conditions was observed in four patients, improvement in three others, and no change in a single patient. The mean duration of hospitalization was 3.1 days. The mean follow-up period was 161 days (SD:± 57.4 days, range: 90-243 days). There was no mortality and no intra-operative and post-operative complications were noted. The

  7. Occurrence and prevention of enhanced oxide deposition in boiler flow control orifices

    International Nuclear Information System (INIS)

    Woolsey, I.S.; Thomas, D.M.; Garbett, K.; Bignold, G.J.

    1989-10-01

    Once-through boilers, such as those of the AGRs, incorporate flow control orifices at the boiler inlet to ensure a satisfactory flow distribution and stability in the parallel flow paths of the boiler. Deposition of corrosion products in the flow control orifice leads to changes in the orifice pressure loss characteristics, which could lead to problems of flow maldistribution within the boiler, and any adverse consequences resulting from this, such as tube overheating. To date, AGR boiler inlet orifices have not suffered significant fouling due to corrosion products in the boiler feedwater. However, oxide deposition in orifices has been observed in other plants, and in experimental loops operating under conditions very similar to those at inlet to AGR boilers. The lack of deposition in AGR flow control orifices is therefore somewhat surprising. This Report describes studies carried out to examine the factors controlling oxide deposition in flow control orifices, the intention of the work being to explain why deposition has not occurred in AGR boilers to date, and to provide means of preventing deposition in the future should this prove necessary. (author)

  8. Inactivation of Heterosigma akashiwo in ballast water by circular orifice plate-generated hydrodynamic cavitation.

    Science.gov (United States)

    Feng, Daolun; Zhao, Jie; Liu, Tian

    2016-01-01

    The discharge of alien ballast water is a well-known, major reason for marine species invasion. Here, circular orifice plate-generated hydrodynamic cavitation was used to inactivate Heterosigma akashiwo in ballast water. In comparison with single- and multihole orifice plates, the conical-hole orifice plate yielded the highest inactivation percentage, 51.12%, and consumed only 6.84% energy (based on a 50% inactivation percentage). Repeating treatment, either using double series-connection or circling inactivation, elevated the inactivation percentage, yet consumed much more energy. The results indicate that conical-hole-generated hydrodynamic cavitation shows great potential as a pre-inactivation method for ballast water treatment.

  9. CFD study of a simple orifice pulse tube cooler

    Science.gov (United States)

    Zhang, X. B.; Qiu, L. M.; Gan, Z. H.; He, Y. L.

    2007-05-01

    Pulse tube cooler (PTC) has the advantages of long-life and low vibration over the conventional cryocoolers, such as G-M and Stirling coolers because of the absence of moving parts in low temperature. This paper performs a two-dimensional axis-symmetric computational fluid dynamic (CFD) simulation of a GM-type simple orifice PTC (OPTC). The detailed modeling process and the general results such as the phase difference between velocity and pressure at cold end, the temperature profiles along the wall as well as the temperature oscillations at cold end with different heat loads are presented. Emphases are put on analyzing the complicated phenomena of multi-dimensional flow and heat transfer in the pulse tube under conditions of oscillating pressure. Swirling flow pattern in the pulse tube is observed and the mechanism of formation is analyzed in details, which is further validated by modeling a basic PTC. The swirl causes undesirable mixing in the thermally stratified fluid and is partially responsible for the poor overall performance of the cooler, such as unsteady cold-end temperature.

  10. Estimation of the measurement error of eccentrically installed orifice plates

    Energy Technology Data Exchange (ETDEWEB)

    Barton, Neil; Hodgkinson, Edwin; Reader-Harris, Michael

    2005-07-01

    The presentation discusses methods for simulation and estimation of flow measurement errors. The main conclusions are: Computational Fluid Dynamics (CFD) simulation methods and published test measurements have been used to estimate the error of a metering system over a period when its orifice plates were eccentric and when leaking O-rings allowed some gas to bypass the meter. It was found that plate eccentricity effects would result in errors of between -2% and -3% for individual meters. Validation against test data suggests that these estimates of error should be within 1% of the actual error, but it is unclear whether the simulations over-estimate or under-estimate the error. Simulations were also run to assess how leakage at the periphery affects the metering error. Various alternative leakage scenarios were modelled and it was found that the leakage rate has an effect on the error, but that the leakage distribution does not. Correction factors, based on the CFD results, were then used to predict the system's mis-measurement over a three-year period (tk)

  11. Surgery with cooperative robots.

    Science.gov (United States)

    Lehman, Amy C; Berg, Kyle A; Dumpert, Jason; Wood, Nathan A; Visty, Abigail Q; Rentschler, Mark E; Platt, Stephen R; Farritor, Shane M; Oleynikov, Dmitry

    2008-03-01

    Advances in endoscopic techniques for abdominal procedures continue to reduce the invasiveness of surgery. Gaining access to the peritoneal cavity through small incisions prompted the first significant shift in general surgery. The complete elimination of external incisions through natural orifice access is potentially the next step in reducing patient trauma. While minimally invasive techniques offer significant patient advantages, the procedures are surgically challenging. Robotic surgical systems are being developed that address the visualization and manipulation limitations, but many of these systems remain constrained by the entry incisions. Alternatively, miniature in vivo robots are being developed that are completely inserted into the peritoneal cavity for laparoscopic and natural orifice procedures. These robots can provide vision and task assistance without the constraints of the entry incision, and can reduce the number of incisions required for laparoscopic procedures. In this study, a series of minimally invasive animal-model surgeries were performed using multiple miniature in vivo robots in cooperation with existing laparoscopy and endoscopy tools as well as the da Vinci Surgical System. These procedures demonstrate that miniature in vivo robots can address the visualization constraints of minimally invasive surgery by providing video feedback and task assistance from arbitrary orientations within the peritoneal cavity.

  12. [Fourth branchial cleft deformity with skin orifice: a series of 10 cases].

    Science.gov (United States)

    Huang, S L; Zhang, B; Chen, L S; Liang, L; Luo, X N; Lu, Z M; Zhang, S Y

    2016-10-07

    Objective: To report rare cases of congenital neck cutaneous sinus with an orifice near the sternoclavicular joint and to investigate their origins and managements. Methods: A total of ten patients with congenital neck cutaneous sinus having an orifice near the sternoclavicular joint treated in the Guangdong General Hospital from January 2010 to June 2015 were retrospectively analyzed. Results: There four boys and six girls, aging from 11 months to 96 months with an average of 33.4 months, and they had a common feature showing a congenital cutaneous sinus with an orifice near sternoclavicular joint. Discharge of pus from the orifice or abscess formation was commonly seen soon after infection. With bacteriological study, staphylococcus aureus was positive in five cases and klebsiella pneumonia in a case. Another orifice of fistula/sinus was not depicted in pyriform with barium swallow X-ray in five cases Ultrasound studies of three cases demonstrated anechoic (i.e., nearly black) and solid-cystic lesion near sternoclavicular joint with posterior acoustic enhancement. Magnetic resonance imaging (MRI) showed isointensity of the lesion on T1 and T2 weighted images with heterogeneous enhancement and a close relationship with sternoclavicular joint. All patients underwent laryngoscopic examination, which showed no orifice of sinus in pyriform at same side. Surgical resection of fistula/sinus was performed in all cases. The lengths of the fistula varied from 5 mm to 22 mm with an average of 11 mm. Postoperative pathological examination showed all specimens were accordance with fistula. No complications were noticed. Recurrence was not observed in the cases by following-up of 6 months to 70 months (median: 33 months). Conclusion: Congenital neck cutaneous sinus with orifice near the sternoclavicular joint maybe a special clinical phenotype of the fourth branchial cleft sinus with skin orifice in cervicothoracic junction. Differential diagnoses between low cervical diseases

  13. The impact assessment of eccentric installation and roughness change in piping on the orifice flow measurement

    International Nuclear Information System (INIS)

    Nishi, Y.; Eguchi, Y.; Nishihara, T.; Kanai, T.; Kondo, M.

    2012-01-01

    In orifice flowmeters used in nuclear power plants, requirements for the inner surface roughness of upstream piping and eccentric installation exist depending on certain standards. If these cannot be satisfied based on the installation condition, an appropriate error margin must be considered, although this remains to be clarified. In this research, quantitative data concerning the relative error of orifice flowmeters were obtained during experiments with the parameters of the inner surface roughness of upstream piping and the installation eccentricity of the orifice hole. The maximum Reynolds number of the experimental facility is about 1.6x10 6 . In orifice flowmeters, the flow rate is calculated based on the differential pressure between upstream and downstream orifices and the peculiar discharge coefficient C. The latter value shows an upward trend with increasing roughness of piping, while change of 0.3% of C was observed in terms of roughness (case 2), which approaches the limits of the JIS standard. With significant roughness (Case 3) that exceeds five times the JIS standard, C is shown to have increased by about 1%. No influence was observed by varying the direction of eccentric installation, hence this was fixed and the amount of eccentricity was considered. Change in C of about 0.25% was observed when around twice the standard level of eccentricity was applied. The error margin data under conditions exceeding the JIS standard for the orifice flowmeter was obtained. (authors)

  14. Choked flow mechanism of HFC-134a flowing through short-tube orifices

    Energy Technology Data Exchange (ETDEWEB)

    Nilpueng, Kitti; Wongwises, Somchai [Fluid Mechanics, Thermal Engineering and Multiphase Flow Research Lab (FUTURE), Department of Mechanical Engineering, King Mongkut' s University of Technology Thonburi, Bangmod, Bangkok (Thailand)

    2011-02-15

    This paper is a continuation of the author's previous work. New experimental data on the occurrence of choked flow phenomenon and mass flow rate of HFC-134a inside short-tube orifices under choked flow condition are presented. Short-tube orifices diameters ranging from 0.406 mm to 0.686 mm with lengths ranging from 1 mm to 3 mm which can be applied to a miniature vapour-compression refrigeration system are examined. The experimental results indicated that the occurrence of choked flow phenomena inside short-tube orifices is different from that obtained from short-tube orifice diameters of greater than 1 mm, which are typically used in air-conditioner. The beginning of choked flow is dependent on the downstream pressure, degree of subcooling, and length-to-diameter ratio. Under choked flow condition, the mass flow rate is greatly varied with the short-tube orifice dimension, but it is slightly affected by the operating conditions. A correlation of mass flow rate through short-tube orifices is proposed in terms of the dimensionless parameters. The predicted results show good agreement with experimental data with a mean deviation of 4.69%. (author) transfer coefficient was also proposed. (author)

  15. Orifice Mass Flow Calculation in NASA's W-8 Single Stage Axial Compressor Facility

    Science.gov (United States)

    Bozak, Richard F.

    2018-01-01

    Updates to the orifice mass flow calculation for the W-8 Single Stage Axial Compressor Facility at NASA Glenn Research Center are provided to include the effect of humidity and incorporate ISO 5167. A methodology for including the effect of humidity into the inlet orifice mass flow calculation is provided. Orifice mass flow calculations provided by ASME PTC-19.5-2004, ASME MFC-3M-2004, ASME Fluid Meters, and ISO 5167 are compared for W-8's atmospheric inlet orifice plate. Differences in expansion factor and discharge coefficient given by these standards give a variation of about +/- 75% mass flow except for a few cases. A comparison of the calculations with an inlet static pressure mass flow correlation and a fan exit mass flow integration using test data from a 2017 turbofan rotor test in W-8 show good agreement between the inlet static pressure mass flow correlation, ISO 5167, and ASME Fluid Meters. While W-8's atmospheric inlet orifice plate violates the pipe diameter limit defined by each of the standards, the ISO 5167 is chosen to be the primary orifice mass flow calculation to use in the W-8 facility.

  16. A Study of System Pressure Transients Generated by Isolation Valve Open/Closure in Orifice Manifold

    Energy Technology Data Exchange (ETDEWEB)

    Kim, M. [KEPCO, Daejeon (Korea, Republic of); Bae, S. W.; Kim, J. I.; Park, S. J. [KHNP, Abu Dhabi (United Arab Emirates)

    2016-05-15

    In this study, we explore the effects of pressure transients on peak and minimal pressures caused by the actuation of isolation valve and control valve reacting to the combined orifice operation of orifice manifold with motor-operated valve installed in the rear of the orifice. We then use the collected data to direct our effort towards cause analysis and propose improvements to efficiency and safety of operation. This formation is used to by domestic and foreign nuclear power plants as a mean to control flow rate, producing required flow rate jointly together by combination of the orifices. No significant impacts on the internals of manifold orifice due to peak pressure has been observed, although chance of cavitation at the outlet of control valve is significant. Considering the peak pressure, as well as minimum pressure occurs in low flow rate conditions, the pressure transient is more so affected by the characteristics (modified equal percentage) of control valve. Isolation valve of the orifice and control valve operate organically, therefore stroke time for valves need to be applied in order for both valves to cooperatively formulate an optimized operation.

  17. Outcomes of secondary self-expandable metal stents versus surgery after delayed initial palliative stent failure in malignant colorectal obstruction.

    Science.gov (United States)

    Yoon, Jin Young; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

    2013-01-01

    When re-intervention is required due to an occluded first colorectal self-expanding metal stent for malignant colorectal obstruction, serious controversies exist regarding whether to use endoscopic re-stenting or surgery. To compare the clinical outcomes in patients who underwent stent re-insertion versus palliative surgery as a second intervention. A total of 115 patients who received either self-expandable metal stent (SEMS) insertion or palliative surgery for treatment of a second occurrence of malignant colorectal obstruction after the first SEMS placement were retrospectively studied between July 2005 and December 2009. The median overall survival (8.2 vs. 15.5 months) and progression-free survival (4.0 vs. 2.7 months) were not significantly different between the stent and surgery groups (p = 0.895 and 0.650, respectively). The median lumen patency in the stent group was 3.4 months and that in the surgery group was 7.9 months (p = 0.003). The immediate complication rate after second stent insertion was 13.9% and late complication rate was observed in 12 of 79 (15.2%) patients. There was no mortality related to the SEMS procedure. The complication and mortality rates associated with palliative surgery were 3.5% (2/57) and 12.3% (7/57), respectively. Although there is no significant difference in the overall survival between stenting and surgery, a secondary stent insertion had a lower mortality rate despite a shorter duration of temporary colorectal decompression compared to that of palliative surgery.

  18. Hip Replacement Surgery

    Science.gov (United States)

    ... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

  19. A Pilot Review of Gradual Versus Goal Re-initiation of Enteral Nutrition after Burn Surgery in the Hemodynamically Stable Patient

    Science.gov (United States)

    2014-01-01

    nutrition after burn surgery in the hemodynamically stable patient 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Shields...specific recommendations on the rate of delivery at initiation [6]. Once a patient is considered hemodynamically stable (HDS), common practice is to...differences in these practices were largely due to new residents and/or nursing staff. GRVs were monitored every 4 h. When GRVs were greater than 500 mL with EN

  20. Natural orifice transluminal endoscopic surgery for patients with perforated peptic ulcer.

    Science.gov (United States)

    Bonin, Eduardo A; Moran, Erica; Gostout, Christopher J; McConico, Andrea L; Zielinski, Martin; Bingener, Juliane

    2012-06-01

    Perforation accounts for 70% of deaths attributed to peptic ulcers. Laparoscopic repair is effective but infrequently used. Our aim was to assess how many patients with perforated peptic ulcer could be candidates for a transluminal endoscopic omental patch closure. This retrospective study reviewed patients with perforated peptic ulcer from 2005 to 2010. Demographics, ulcer characteristics, operative procedure, and outcomes were recorded. Candidates for endoscopic transluminal repair were defined as those having undergone omental patch closure of an ulcer of appropriate size and no contraindications to laparoscopy or endoscopy. In the retrospective review, a total of 104 patients were identified; 62% female, mean age = 68 years, mean ASA of 3, and 63% medication-related ulcers. Fifty-nine (63%) had an omental patch (80% open), and 35 (37%) had other procedures. Ten patients had nonoperative management. Thirty-day mortality was 14% and 1 year mortality was 35%. Forty-nine patients (52%) were considered potential candidates for transluminal repair. Sixty-three percent of our patients sustained a medication-related perforation with 1 year mortality of 35%. The majority of patients were treated using open omental patch repair. Transluminal endoscopic repair may provide an additional situation for a minimally invasive approach for a number of these patients.

  1. Localization of root canal orifices in mandibular second molars in relation to occlusal dimension.

    Science.gov (United States)

    Gorduysus, O; Nagas, E; Cehreli, Z C; Gorduysus, M; Yilmaz, Z

    2009-11-01

    To evaluate the localization and distribution of canal orifices of mandibular second molar teeth in relation to the mesio-distal and bucco-lingual dimensions of coronal tissue. Fifty extracted mandibular second molar teeth were embedded into plaster blocks with their vertical axes aligned perpendicular to the horizontal plane. The teeth were photographed digitally from the occlusal aspect under 12 x magnification. Thereafter, the occlusal halves of crowns were sectioned off to expose the root canal orifices. The teeth were than photographed under the same magnification, after which the pre- and post-sectioning images of each specimen were stacked into a single file. To plot the coordinate of each canal orifice, a 0.5-mm grid analytical plane was mounted digitally on the stack so that the x- and y-axes of the plane were superimposed on the mesiodistal and buccolingual axes (bisectors) of the tooth crowns. Localization and distribution of the coordinates of the canal orifices were evaluated using the chi-square test (P = 0.05). Only one tooth displayed a single root canal orifice, located in the mesiobuccal-distolingual 'centre' of the occlusal surface. The majority of mandibular second molars had three orifices (72%), followed by those with two (16%) and four (10%). The distal canal was located lingual to the centre of the occlusal plane. The distal canal was located lingual to the centre of the occlusal plane of mandibular second molars. The possibility of observing more divergent localizations and orifice numbers should not be overlooked in clinical practice.

  2. Optimization of Orifice Geometry for Cross-Flow Mixing in a Cylindrical Duct

    Science.gov (United States)

    Kroll, J. T.; Sowa, W. A.; Samuelsen, G. S.

    1996-01-01

    Mixing of gaseous jets in a cross-flow has significant applications in engineering, one example of which is the dilution zone of a gas turbine combustor. Despite years of study, the design of the jet injection in combustors is largely based on practical experience. The emergence of NO(x) regulations for stationary gas turbines and the anticipation of aero-engine regulations requires an improved understanding of jet mixing as new combustor concepts are introduced. For example, the success of the staged combustor to reduce the emission of NO(x) is almost entirely dependent upon the rapid and complete dilution of the rich zone products within the mixing section. It is these mixing challenges to which the present study is directed. A series of experiments was undertaken to delineate the optimal mixer orifice geometry. A cross-flow to core-flow momentum-flux ratio of 40 and a mass flow ratio of 2.5 were selected as representative of a conventional design. An experimental test matrix was designed around three variables: the number of orifices, the orifice length-to- width ratio, and the orifice angle. A regression analysis was performed on the data to arrive at an interpolating equation that predicted the mixing performance of orifice geometry combinations within the range of the test matrix parameters. Results indicate that the best mixing orifice geometry tested involves eight orifices with a long-to-short side aspect ratio of 3.5 at a twenty-three degree inclination from the center-line of the mixing section.

  3. Clinical outcomes of radiotherapy as initial local therapy for Graves’ ophthalmopathy and predictors of the need for post-radiotherapy decompressive surgery

    International Nuclear Information System (INIS)

    Prabhu, Roshan S; Liebman, Lang; Wojno, Ted; Hayek, Brent; Hall, William A; Crocker, Ian

    2012-01-01

    The optimal initial local treatment for patients with Graves’ ophthalmopathy (GO) is not fully characterized. The purpose of this retrospective study is to describe the clinical outcomes of RT as initial local therapy for GO and define predictors of the need for post-RT salvage bony decompressive surgery. 91 patients with active GO and without prior surgery were treated with RT as initial local therapy between 01/1999 and 12/2010, with a median follow-up period of 18.3 months (range 3.7 - 142 months). RT dose was 24 Gy in 12 fractions. 44 patients (48.4%) had prior use of steroids, with 31 (34.1%) being on steroids at the initiation of RT. The most common presenting symptoms were diplopia (79%), proptosis (71%) and soft tissue signs (62%). 84 patients (92.3%) experienced stabilization or improvement of GO symptoms. 58 patients (64%) experienced improvement in their symptoms. 19 patients (20.9%) underwent salvage post-RT bony decompressive surgery. Smoking status and total symptom score at 4 months were independent predictors of post-RT bony decompression with odds ratios of 3.23 (95% CI 1.03 – 10.2) and 1.59 (95% CI 1.06 – 2.4), respectively. Persistent objective vision loss at 4 months post-RT was the most important symptom type in predicting salvage decompression. Chronic dry eye occurred in 9 patients (9.9%) and cataracts developed in 4 patients (4.4%). RT is effective and well tolerated as initial local therapy for active GO, with only 21% of patients requiring decompressive surgery post RT. Most patients experience stabilization or improvement of GO symptoms, but moderate to significant response occurs in the minority of patients. Smoking status and total symptom severity at 4 months, primarily persistent objective vision loss, are the primary determinants of the need for post-RT salvage bony decompression. Patients who smoke or present with predominantly vision loss symptoms should be advised as to their lower likelihood of symptomatic response to RT

  4. Neuroprotective Anesthesia Regimen and Intensive Management for Pediatric Cardiac Surgery with Cardiopulmonary Bypass: a Review and Initial Experience

    Directory of Open Access Journals (Sweden)

    Jyrson Guilherme Klamt

    Full Text Available Abstract This article describes our proposal for routine anesthesia, intraoperative medical management, cerebral and physiological monitoring during pediatric cardiac surgery with cardiopulmonary bypass that intend to provide appropriate anesthesia (analgesia, hypnosis, neuroprotection, adequate cerebral and systemic oxygen supply, and preventing against drugs neurotoxicity. A concise retrospective data is presented.

  5. Increasing medical student exposure to musculoskeletal medicine: the initial impact of the Orthopaedic Surgery and Sports Medicine Interest Group

    Directory of Open Access Journals (Sweden)

    Mickelson DT

    2017-07-01

    Full Text Available Dayne T Mickelson,1 Philip K Louie,2 Kenneth R Gundle,3 Alex W Farnand,4 Douglas P Hanel5 1Department of Orthopedic Surgery and Sports Medicine, Duke University, Durham, NC, USA; 2Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; 3Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA; 4Department of General Surgery, Presence Saint Joseph Hospital – Chicago, Chicago, IL, USA; 5Department of Orthopedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA Purpose: To investigate the impact of the Orthopaedic Surgery and Sports Medicine Interest Group (OSSMIG on medical student interest and confidence in core musculoskeletal (MSK concepts through supplemental education and experiences at a single tertiary, academic institution.Methods: Medical student OSSMIG members at various levels of training were anonymously surveyed at the beginning and end of the 2014–2015 academic year.Results: Eighteen (N=18 medical student interest group members completed the survey. Significant improvement in their level of training was observed with regard to respondents’ self-assessed competence and confidence in MSK medicine (p<0.05. Additionally, respondents’ attitudes toward exposure and support from the interest group were significantly higher than those provided by the institution (p<0.05. Members believed OSSMIG increased interest in MSK medicine, improved confidence in their ability to perform orthopedics-related physical exams, strengthened mentorship with residents and attendings, and developed a connection with the Department of Orthopedic Surgery and its residents (median “Strongly Agree”, interquartile range one and two scale items.Conclusion: Since its inception 8 years ago, OSSMIG has been well received and has positively impacted University of Washington School of Medicine students through various interventions

  6. Neutron Imaging study of bubble behaviors in Nanofluid Through Engineered Orifices

    International Nuclear Information System (INIS)

    Seo, Seok Bin; Bang, In Cheol; Kim, Tae Joo

    2014-01-01

    Most studies focused on the change of surface parameters through deposited nanoparticles, while Vafaei and Wen firstly discussed modification of bubble dynamics by dispersed nanoparticles in fluid as well as deposited ones. The boiling mechanism, as an effective heat transfer mode, includes bubble generation, growth, departure, and coalescence. Therefore the change of bubble dynamics can lead to the change of boiling heat transfer condition. That is, not only surface characteristics but the dispersed nanoparticles would be the essential parameters of boiling mechanism in terms of bubble dynamics. For advanced visualization of opaque fluids, the neutron imaging technique is introduced. In the present study, the bubble dynamics in nanofluid through engineered orifices was studied. The main parameters of engineered orifices are size and geometry. Photographic analysis of bubble departure frequency and averaged bubble departure volume provides as follows: With increasing orifice diameter, averaged bubble departure volume increases, while bubble departure frequency decreases. The results are attributed to enhanced capillary force by increasing contact perimeter. Averaged bubble departure volume and bubble departure frequency remain similar for three different types of orifices. But edges of the triangle and square orifice produce small bubbles which interrupts bubble generation. The converged triple contact line due to the edge may be a reason for the emerged baby bubbles. Nanofluid shows less averaged bubble departure volume and higher bubble departure frequency. Considering little change in physical properties of the fluid, interaction between bubble interface and nanoparticles may be in charge of the results

  7. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery.

    Science.gov (United States)

    Hedrick, Traci L; McEvoy, Matthew D; Mythen, Michael Monty G; Bergamaschi, Roberto; Gupta, Ruchir; Holubar, Stefan D; Senagore, Anthony J; Gan, Tong Joo; Shaw, Andrew D; Thacker, Julie K M; Miller, Timothy E; Wischmeyer, Paul E; Carli, Franco; Evans, David C; Guilbert, Sarah; Kozar, Rosemary; Pryor, Aurora; Thiele, Robert H; Everett, Sotiria; Grocott, Mike; Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; Fiore, Julio F

    2018-06-01

    The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable consequence of surgery, but this has been shown to be false in the modern era owing to the proliferation of enhanced recovery protocols. However, impaired GI function is still common after colorectal surgery, and the current literature is ambiguous with regard to the definition of postoperative GI dysfunction (POGD), or what is typically referred to as ileus. This persistent ambiguity has impeded the ability to ascertain the true incidence of the condition and study it properly within a research setting. Furthermore, a rational and standardized approach to prevention and treatment of POGD is needed. The second Perioperative Quality Initiative brought together a group of international experts to review the published literature and provide consensus recommendations on this important topic with the goal to (1) develop a rational definition for POGD that can serve as a framework for clinical and research efforts; (2) critically review the evidence behind current prevention strategies and provide consensus recommendations; and (3) develop rational treatment strategies that take into account the wide spectrum of impaired GI function in the postoperative period.

  8. Initial investigation of 18F-NaF PET/CT for identification of vertebral sites amenable to surgical revision after spinal fusion surgery

    International Nuclear Information System (INIS)

    Quon, Andrew; Iagaru, Andrei; Dodd, Robert; Abreu, Marcelo Rodrigues de; Sprinz, Clarice; Hennemann, Sergio; Alves Neto, Jose Maria

    2012-01-01

    A pilot study was performed in patients with recurrent back pain after spinal fusion surgery to evaluate the ability of 18 F-NaF PET/CT imaging to correctly identify those requiring surgical intervention and to locate a site amenable to surgical intervention. In this prospective study 22 patients with recurrent back pain after spinal surgery and with equivocal findings on physical examination and CT were enrolled for evaluation with 18 F-NaF PET/CT. All PET/CT images were prospectively reviewed with the primary objective of identifying or ruling out the presence of lesions amenable to surgical intervention. The PET/CT results were then validated during surgical exploration or clinical follow-up of at least 15 months. Abnormal 18 F-NaF foci were found in 16 of the 22 patients, and surgical intervention was recommended. These foci were located at various sites: screws, cages, rods, fixation hardware, and bone grafts. In 6 of the 22 patients no foci requiring surgical intervention were found. Validation of the results by surgery (15 patients) or on clinical follow-up (7 patients) showed that 18 F-NaF PET/CT correctly predicted the presence of an abnormality requiring surgical intervention in 15 of 16 patients and was falsely positive in 1 of 16. In this initial investigation, 18 F-NaF PET/CT imaging showed potential utility for evaluation of recurrent symptoms after spinal fusion surgery by identifying those patients requiring surgical management. (orig.)

  9. Robotic Laparoendoscopic Single-site Retroperitioneal Renal Surgery: Initial Investigation of a Purpose-built Single-port Surgical System.

    Science.gov (United States)

    Maurice, Matthew J; Ramirez, Daniel; Kaouk, Jihad H

    2017-04-01

    Robotic single-site retroperitoneal renal surgery has the potential to minimize the morbidity of standard transperitoneal and multiport approaches. Traditionally, technological limitations of non-purpose-built robotic platforms have hindered the application of this approach. To assess the feasibility of retroperitoneal renal surgery using a new purpose-built robotic single-port surgical system. This was a preclinical study using three male cadavers to assess the feasibility of the da Vinci SP1098 surgical system for robotic laparoendoscopic single-site (R-LESS) retroperitoneal renal surgery. We used the SP1098 to perform retroperitoneal R-LESS radical nephrectomy (n=1) and bilateral partial nephrectomy (n=4) on the anterior and posterior surfaces of the kidney. Improvements unique to this system include enhanced optics and intelligent instrument arm control. Access was obtained 2cm anterior and inferior to the tip of the 12th rib using a novel 2.5-cm robotic single-port system that accommodates three double-jointed articulating robotic instruments, an articulating camera, and an assistant port. The primary outcome was the technical feasibility of the procedures, as measured by the need for conversion to standard techniques, intraoperative complications, and operative times. All cases were completed without the need for conversion. There were no intraoperative complications. The operative time was 100min for radical nephrectomy, and the mean operative time was 91.8±18.5min for partial nephrectomy. Limitations include the preclinical model, the small sample size, and the lack of a control group. Single-site retroperitoneal renal surgery is feasible using the latest-generation SP1098 robotic platform. While the potential of the SP1098 appears promising, further study is needed for clinical evaluation of this investigational technology. In an experimental model, we used a new robotic system to successfully perform major surgery on the kidney through a single small

  10. Comparison of turbulent flow through hexagram and hexagon orifices in circular pipes using large-eddy simulation

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Wei; Nicolleau, Franck C G A; Qin, Ning, E-mail: n.qin@sheffield.ac.uk [Department of Mechanical Engineering, The University of Sheffield, Sheffield, S1 3JD (United Kingdom)

    2016-04-15

    Characteristics of turbulent flow through a circular, a hexagon and a hexagram orifice with the same flow area in circular pipes are investigated using wall-modelled large-eddy simulation. Good agreements to available experimental data were obtained in both the mean velocity and turbulent kinetic energy. The hexagram orifice with alternating convex and concave corners introduces outwards radial velocity around the concave corners downstream of the orifice plate stronger than the hexagon orifice. The stronger outwards radial velocity transfers high momentum from the pipe centre towards the pipe wall to energize the orifice-forced vortex sheet rolling-up and leads to a delayed vortex break-down. Correspondingly, the hexagram has a more gradual flow recovery to a pipe flow and a reduced pressure drop than the hexagon orifice. Both the hexagon and hexagram orifices show an axis-switching phenomenon, which is observed from both the streamwise velocity and turbulent kinetic energy contours. To the best knowledge of the authors, this is the first comparison of orifice-forced turbulence development, mixing and flow dynamics between a regular and a fractal-based polygonal orifice. (paper)

  11. Microcomputed tomography analysis of mesiobuccal orifices and major apical foramen in first maxillary molars.

    Science.gov (United States)

    Spagnuolo, Gianrico; Ametrano, Gianluca; D'Antò, Vincenzo; Formisano, Anna; Simeone, Michele; Riccitiello, Francesco; Amato, Massimo; Rengo, Sandro

    2012-01-01

    Aim of the study was to determined by microcomputed tomography (µCT) the horizontal distance between the main (MB1) and the second mesiobuccal canal (MB2) orifices, the vertical distance between the MB1 and MB2 orifices planes, and the distance between the anatomic apex and major apical foramen (AF). Furthermore, we characterized the entire internal and external anatomy of the MB, distalbuccal (DB) and palatal (P) maxillary first molars roots. Twenty-two intact extracted first maxillary molars were scanned by X-ray computed transaxial µCT and then 2D and 3D images were processed and analyzed. The results showed that 77.27% of the mesiobuccal (MB) roots presented a second MB canal, and 29.41% of the MB2 were independent from the MB1 canals. In 15 teeth, there were three root canal orifices on the chamber floor, and 10 of these teeth presented MB2 canals. The mean vertical distance between the MB1 and MB2 planes was 1.68 ± 0.83 mm. Seven teeth had four orifices. The mean horizontal interorificial distance between the MB1 and MB2 orifices was 1.21 ± 0.5 mm. Accessory canals were observed in 33.33% of the roots, loops in 6.06%, while isthmuses were found in 15 of the 22 MB roots. Of the total roots, 74.24% presented one foramen, while all of the roots showed a major apical foramen that was not coincident with the anatomic apex. Our µCT analysis provided interesting features on the horizontal and vertical distance between the MB1 and MB2 orifices and on the distance of AF and anatomic apex. These results have an important clinical value because might support the endodontist in the recruitment, negotiation and obturation of maxillary first molar canal system.

  12. MR imaging of the entry, the abdominal communicating orifice, and the retrograde dissection in aortic dissections

    International Nuclear Information System (INIS)

    Yoshida, Y.; Mukohara, N.; Nakamura, K.; Sugimura, K.; Kono, M.

    1986-01-01

    MR imaging (1.5 T) was performed on 41 patients with aortic dissection. Entries were clearly visualized on the MR images as partial defects of the intimal flap in 18 of 21 patients (85.7%). In eight of ten patients, the locations of abdominal communicating orifices corresponded to the lowest signal intensities of the false lumina. Retrograde disections were diagnosed in all six patients from gradual increases in signal intensities of the false lumina toward the heart. MR imaging was very useful in diagnosing entries of the thoracic aorta, abdominal communicating orifices between true and false lumina, and retrograde dissections

  13. Initial experiences in embedding core competency education in entry-level surgery residents through a nonclinical rotation.

    Science.gov (United States)

    Kahol, Kanav; Huston, Carrie; Hamann, Jessica; Ferrara, John J

    2011-03-01

    Health care continues to expand in scope and in complexity. In this changing environment, residents are challenged with understanding its intricacies and the impact it will have on their professional activities and careers. Embedding each of the competency elements in residents in a meaningful way remains a challenge for many surgery residency program directors. We established a nonclinical rotation to provide surgery postgraduate year-1 (PGY-1) residents with a structured, multifaceted, largely self-directed curriculum into which each of the 6 core competencies are woven. Posttesting strategies were established for most curricular experiences to ensure to the greatest possible extent that each resident will have achieved an acceptable level of understanding of each of the competency areas before being given credit for the rotation. By uniformly exceeding satisfactory scores on respective objective analyses, residents demonstrated an increased (at least short-term) understanding of each of the assessed competency areas. Our project sought to address a prior lack of opportunity for our residents to develop a sound foundation for our residents in systems-based practice. Our new rotation addresses systems-based practice in several different learning environments, including emergency medical service ride-along, sentinel event participation, and hospice visits. Several research projects have enhanced the overall learning program. Our experience shows that a rotation dedicated to competency training can provide an innovative and engaging means of teaching residents the value of each element.

  14. Detectability of Middle Mesial Root Canal Orifices by Troughing Technique in Mandibular Molars: A Micro-computed Tomographic Study.

    Science.gov (United States)

    Keleş, Ali; Keskin, Cangül

    2017-08-01

    The objective of the present study was to measure the orifice depth of middle mesial canals (MMCs) and evaluate the detectability of orifices using troughing preparation. For this study, 85 mandibular molar teeth with MMCs were selected from the scanned micro-computed tomographic images. The MMCs were categorized, and the distances between the MMC orifices and the cementoenamel junctions (CEJ) were recorded as the depth of the orifice. Data were evaluated with frequency analysis and a chi-square test using SPSS (SPSS Inc, Chicago, IL), and the results indicated a 5% significance level. It was found that 77.41% of the MMC orifices were at the CEJ level, whereas 5.38% and 9.69% of the MMC orifices were detectable within 1-mm and 2-mm depths from the CEJ, respectively. Of the specimens, 7.52% had MMC orifices deeper than 2 mm from the CEJ. Confluent anatomy was the most frequent configuration. No significant relation was detected between the orifice depth and MMC configuration (P > .05). It was concluded that 77.41% of the specimens did not require troughing preparation, the remaining 15.07% would require troughing, and 7.52% could not be accessed even with the troughing preparation. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. Requirements for Vertically Installed Runoff Control Boards for the “Paddy Field Dam” and Appropriate Orifice Shapes

    Science.gov (United States)

    Natsuki, Yoshikawa; Hideyuki, Koide; Shin-Ichi, Misawa

    While the “Paddy Field Dam” project has been recognized as an effective flood control measure, there are some cases in which the runoff control boards are vertically installed on the opening of the drainage boxes without careful consideration of the orifice shape and size. The important criteria for the runoff control boards to be satisfied are: 1. to maintain a sufficient peak runoff control function, 2. to avoid excessive ponding causing overflow, 3. to minimize the influence to the ordinary water management, and 4. to reserve sufficient orifice area to avoid blockage of the orifice with floating litters. The purpose of this study is to examine proper shapes and sizes of the orifice to satisfy the criteria for the vertically installed runoff control boards through experiments and simulations. Given the condition that the orifice has sufficient area to avoid overflow with 10 and 20 year return period rainfall event (criteria 2), the simulation results show that the orifice with horizontally wider shapes has advantages over the square or circular shapes in terms of the criteria 1 and 3. The disadvantage of the horizontally wider shapes is the blockage of the orifice with floating litters (criteria 4). In conclusion, we proposed to secure sufficient vertical distance to avoid this problem by setting a lower limit on the vertical distance and then determine the widest horizontal distance to optimize all the criteria. In addition, we have constructed the “Orifice Design Assist Tool” on the basis of the examinations in this study.

  16. Cavitation in flow through a micro-orifice inside a silicon microchannel

    Science.gov (United States)

    Mishra, Chandan; Peles, Yoav

    2005-01-01

    Hydrodynamic cavitation in flows through a micro-orifice entrenched in a microchannel has been detected and experimentally investigated. Microfabrication techniques have been employed to design and develop a microfluidic device containing an 11.5μm wide micro-orifice inside a 100.2μm wide and 101.3μm deep microchannel. The flow of de-ionized water through the micro-orifice reveals the presence of multifarious cavitating flow regimes. This investigation divulges both similarities and differences between cavitation in micro-orifices and cavitation in their macroscale counterparts. The low incipient cavitation number obtained from the current experiments suggests a dominant size scale effect. Choking cavitation is observed to be independent of any pressure or velocity scale effects. However, choking is significantly influenced by the small stream nuclei residence time at such scales. Flow rate choking leads to the establishment of a stationary cavity. Large flow and cavitation hysteresis have been detected at the microscale leading to very high desinent cavitation numbers. The rapid transition from incipient bubbles to choking cavitation and subsequent supercavitation suggests the presence of radically different flow patterns at the microscale. Supercavitation results in a thick cavity, which extends throughout the microchannel, and is encompassed by the liquid. Cavitation at the microscale is expected to considerably influence the design of innovative high-speed microfluidic systems.

  17. A double parameters measurement of steam-water two-phase flow with single orifice

    International Nuclear Information System (INIS)

    Zhong Shuoping; Tong Yunxian; Yu Meiying

    1992-08-01

    A double parameters measurement of steam-water two-phase flow with single orifice is described. An on-line measurement device based on micro-computer has been developed. The measured r.m.s error of steam quality is less than 6.5% and the measured relative r.m.s. error of mass flow rate is less than 9%

  18. Orifice microreactor for the production of an organic peroxide – non-reactive and reactive characterization

    NARCIS (Netherlands)

    Illg, T.; Hessel, V.; Löb, P.; Schouten, J.C.

    2012-01-01

    In this article, the transfer of a two-step, biphasic, and exothermic peroxide synthesis into a microreactor assisted process is discussed as well as the non-reactive and reactive characterization of the developed orifice microreactor. Residence time distribution measurements showed nearly ideal

  19. A case of ectopic ureteral orifice with hypoplastic kidney diagnosed by enhanced computed tomography

    International Nuclear Information System (INIS)

    Kishi, Mikio; Yoshimoto, Jun; Matsumura, Yosuke; Ohmori, Hiroyuki

    1983-01-01

    A case of ectopic ureteral orifice, 6 year old girl with urinary incontinece, is herein reported. Cystoscopy and excretory urogram showed absense of right half of trigone and non visualizing kidney. By enhanced computed tomography, right hypoplastic kidney was found and right nephrectomy was performed. We emphasize that enhanced computed tomography is very usefull for diagnosis of localization of hypoplastic kidney. (author)

  20. Flow through a cylindrical pipe with a periodic array of fractal orifices

    NARCIS (Netherlands)

    van Melick, P.A.J.; Geurts, Bernardus J.

    2013-01-01

    We apply direct numerical simulation (DNS) of the incompressible Navier–Stokes equations to predict flow through a cylindrical pipe in which a periodic array of orifice plates with a fractal perimeter is mounted. The flow is simulated using a volume penalization immersed boundary method with which

  1. Flow through a cylindrical pipe with a periodic array of fractal orifices

    NARCIS (Netherlands)

    van Melick, P.A.J.; Geurts, B.J.

    2013-01-01

    We apply direct numerical simulation (DNS) of the incompressible Navier-Stokes equations to predict flow through a cylindrical pipe in which a periodic array of orifice plates with a fractal perimeter is mounted. The flow is simulated using a volume penalization immersed boundary method with which

  2. Energy Efficiency for Biodiesel Production by Combining Two Orifices in Hydrodynamic Cavitation Reactor

    Directory of Open Access Journals (Sweden)

    Mahlinda Mahlinda

    2014-12-01

    Full Text Available Research of energy efficiency for biodiesel production process by combining two orifices on  hydrodynamic cavitation reactor had been carried out. The aim of this reseach was to studied effect of the number of orifices toward increasing temperature without using external energy source to produce biodiesel that generated by cavitation effects on orifices. The results of preliminary research showed by combining two orifices arranged in series can produce the highest thermal energy reached 48oC. Result of biodiesel production showed that yield of the highest biodiesel was 96.34% using molar ratio a methanol:oil with comparison 6:1, KOH as catalyst (1% for 50 minutes processing time. For biodiesel quality testing showed all selected parameter met the requirements of the Indonesian National Standard (SNI 04-7182:2006. Identification of biodiesel compound using GCMS showed the biodiesel compounds consisted of methyl oleate, methyl palmitate, acid linoleid, methyl stearate, palmitic acid and oleic acid with the total contents 98.39%.

  3. Experiment of cavitation erosion at the exit of a long orifice

    Energy Technology Data Exchange (ETDEWEB)

    Yagi, Yoshinori; Murase, Michio [Inst. of Nuclear Safety System Inc., Mihama, Fukui (Japan)

    2002-09-01

    We performed experiments to clarify mechanism of cavitation erosion and to predict cavitation erosion rate at the exit of a long orifice equipped at the chemical and volume control system in a pressurized water reactor (PWR). In order to find this mechanism, we used a high speed video camera. As the result, we observed bubble collapses near the exit of the orifice when flow condition was oscillating. So the bubble collapses due to the oscillation might cause the first stage erosion at the exit of the orifice. Using the orifice which had the cone-shaped exit, we observed that bubbles collapsed near the exit and then they collapsed at the upstream like a chain reaction. So this bubble collapse mechanism could be explained as follows: shock wave was generated by the bubble collapse near the exit, then it propagated upwards, consequently it caused the bubble collapse at the upstream. And we predicted erosion rate by evaluating the effect of the velocity and comparing the erosion resistance between the test speciment (aluminum) and the plant material (stainless steel) by means of vibratory tests. We compared the predicted erosion rate with that of the average value estimated from plant investigation, then we examined the applicability of these method to the plant evaluations. (author)

  4. A comphrehensive model for the amplification of acoustic pressure waves by single hole orifices

    NARCIS (Netherlands)

    Moussou, P.; Testud, Ph.; Auregan, Y.; Hirschberg, A.

    2008-01-01

    Using a parallel flow approximation, a simple model of hydrodynamic instability is proposed for describing the behavior of an orifice as an acoustic amplifier. It is shown that the growing of perturbations in the vena contracta can generate negative damping for Strouhal numbers of the order of

  5. The whistling potentiality of an orifice in a confined flow using an energetic criterion

    NARCIS (Netherlands)

    Testud, P.; Aurégan, Y.; Moussou, P.; Hirschberg, A.

    2009-01-01

    Using a two-source method, the scattering matrices of 10 sharp-edged thin orifices are measured under different subsonic flow conditions. The data are analysed in terms of net acoustical energy balance: the potential whistling frequency range is defined as the one associated with acoustical energy

  6. Not All Clefts Are Created Equal: Patterns of Hospital-Based Care Use among Children with Cleft Lip and Palate within 4 Years of Initial Surgery.

    Science.gov (United States)

    Ligh, Cassandra A; Fox, Justin P; Swanson, Jordan; Yu, Jason W; Taylor, Jesse A

    2016-06-01

    This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges. The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care-emergency, outpatient, inpatient-within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges. The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p cleft palate were most likely to return to the hospital (p cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges. Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.

  7. Fabrication and Characterization of Device Pressure Regulation System Orifice of Manufacturing Process Gel Uranium Column Gelation External

    International Nuclear Information System (INIS)

    Triyono; Sutarni; Indra Suryawan

    2009-01-01

    The device pressure regulation orifice system of manufacturing process gel uranium on external column gelation has been made and characterized. The device consists : compressor 5.75-6.75 kg / cm 2 , air container tank, power supply 24 volts dc, solenoid valve 24 volts dc, pressure indicator 0-100 mbar, pressure indicator 0-250 mbar, mechanical valve and power electric 380 volts 50 Hz. The activity includes: installation device system and characterization with pressure variation orifice 5-75 mbar on the compressor 5.75-6.5 kg/cm 2 continuously for 1 minute. The method of installation i.e: wiring and piping to first component and support component (compressor and pressure air indicator, air container tank and pressure air indicator, solenoid valve, power supply 220 volts / 24 volts dc and orifice). After apparatus installed has been tested by the characterization without feed under air pressure varied to orifice of 5-75 mbar and device characterization with variation diameter orifice of 0.5-1 mm and orifice pressure of 5-75 mbar. The result in the characterization an every component good function, can be operation by input pressure range of 15-185 mbar orifice pressure range of 5-75 mbar. The characterization result device pressure regulation orifice system showed that: the system can be good operation of air pressure regulation orifice between 5-75 mbar with diameter orifice 0.5 mm to result gelation range of 10-25 piece / minute with variation air pressure input between 15-185 mbar of air pressure compressor 5.75-6.5 kg cm 2 . (author)

  8. EMR of laterally spreading lesions around or involving the appendiceal orifice: technique, risk factors for failure, and outcomes of a tertiary referral cohort (with video).

    Science.gov (United States)

    Tate, David J; Desomer, Lobke; Awadie, Halim; Goodrick, Kathleen; Hourigan, Luke; Singh, Rajvinder; Williams, Stephen J; Bourke, Michael J

    2018-05-01

    EMR of sessile periappendiceal laterally spreading lesions (PA-LSLs) is technically demanding because of poor endoscopic access to the appendiceal lumen and the thin colonic wall at the base of the cecum. We aimed to assess the feasibility and safety of EMR for PA-LSLs. Consecutive LSLs ≥20 mm and PA-LSLs ≥10 mm detected at 3 academic endoscopy centers from September 2008 until January 2017 were eligible. Prospective patient, procedural, and lesion data were collected. PA-LSLs were compared with LSLs in other colonic locations. Thirty-eight PA-LSLs were compared with 1721 LSLs. Referral for surgery without an attempt at EMR was more likely with PA-LSLs (28.9% vs 5.1%, P < .001), and those that involved a greater percentage of the appendiceal orifice (AO) were less likely to be attempted (P = .038). Most PA-LSLs (10/11) were not attempted because of deep extension into the appendiceal lumen; 2 of 11 of these surgical specimens contained invasive cancer. Once attempted, complete clearance of visible adenoma (92.6% PA-LSLs vs 97.6% LSLs, P = .14), adverse events, and rates of adenoma recurrence did not vary significantly between PA-LSLs and LSLs. All 7 patients with prior appendicectomy achieved complete adenoma clearance. There were no cases of post-EMR appendicitis. Twenty of 22 PA-LSLs (91%) eligible for surveillance avoided surgery to longest follow-up. EMR is a safe, effective, and durable treatment for PA-LSLs when specific criteria are fulfilled. If the distal margin of the PA-LSL within the AO cannot be visualized or if more than 50% of the circumference of the orifice is involved, surgery should be considered. (Clinical trial registration number: NTC01368289.). Copyright © 2018. Published by Elsevier Inc.

  9. Taking NOTES: translumenal flexible endoscopy and endoscopic surgery.

    Science.gov (United States)

    Willingham, Field F; Brugge, William R

    2007-09-01

    To review the current state of natural orifice surgery and examine the concerns, challenges, and opportunities presented by translumenal research. Translumenal endoscopic procedures have been the focus of extensive research. Researchers have reported natural orifice translumenal endoscopic surgery in a swine model in several areas involving the abdominal cavity. Diagnostic procedures have included endoscopic peritoneoscopy, liver biopsy, lymphadenectomy, and abdominal exploration. Several gynecologic procedures including tubal ligation, oophorectomy, and partial hysterectomy have been demonstrated using current commercial endoscopes. Gastrointestinal surgical procedures, including gastrojejunostomy, cholecystectomy, splenectomy, and distal pancreatectomy have been performed successfully via transgastric and/or transcolonic approaches. There have been no studies of natural orifice translumenal endoscopic surgery procedures published in humans. While fundamental questions about the emerging technology have not been scrutinized, limitations of the large animal model will pose a challenge to the development of large randomized trials. While natural orifice translumenal endoscopic surgery may represent a paradigm shift and may offer significant benefits to patients, rigorous testing of the techniques is lacking and current data have been drawn from case series.

  10. [Management of recurrent urethrocutaneous fistula after hypospadias surgery in pediatric patients: initial experience with dermal regeneration sheet Integra].

    Science.gov (United States)

    Casal-Beloy, I; Somoza Argibay, I; García-González, M; García-Novoa, A M; Míguez Fortes, L; Blanco, C; Dargallo Carbonell, T

    2017-10-25

    To present our initial experience using a dermal regeneration sheet as an urethral cover in the repair of recurrent urethrocutaneous fistulae in pediatric patients. Since May 2016 to March a total of 8 fistulaes were repaired using this new technique. We performed the ddissection of the fistulous tract and posterior closure of the urethral defect. A dermal regeneration sheet was used to cover the urethral suture. Finally a rotational flap was performed to avoid overlap sutures. During the follow-up (average 6 months), one patient presented in the immediate postoperative period infection of the surgical wound. This patient presented recurrence of the fistula. 88% of the patients included presented a good evolution with no other complications. In our initial experience the new technique seems easy, safe and effective in the management of the recurrent urethrocutaneous fistulae in pediatric patients. More studies are needed to prove these results.

  11. The Double-Orifice Valve Technique to Treat Tricuspid Valve Incompetence.

    Science.gov (United States)

    Hetzer, Roland; Javier, Mariano; Delmo Walter, Eva Maria

    2016-01-01

    A straightforward tricuspid valve (TV) repair technique was used to treat either moderate or severe functional (normal valve with dilated annulus) or for primary/organic (Ebstein's anomaly, leaflet retraction/tethering and chordal malposition/tethering, with annular dilatation) TV incompetence, and its long-term outcome assessed. A double-orifice valve technique was employed in 91 patients (mean age 52.6 ± 23.2 years; median age 56 years; range: 0.6-82 years) with severe tricuspid regurgitation. Among the patients, three had post-transplant iatrogenic chordal rupture, five had infective endocarditis, 11 had mitral valve insufficiency, 23 had Ebstein's anomaly, and 47 had isolated severe TV incompetence. The basic principle was to reduce the distance between the coapting leaflets, wherein the most mobile leaflet could coapt to the opposite leaflet, by creating two orifices, ensuring valve competence. The TV repair was performed through a median sternotomy or right anterior thoracotomy in the fifth intercostal space under cardiopulmonary bypass. The degree and extent of creating a double-valve orifice was determined by considering the minimal body surface area (BSA)-related acceptable TV diameter. Repair was accomplished by passing pledgeted mattress sutures from the middle of the true anterior annulus to a spot on the opposite septal annulus, located approximately two-thirds of the length of the septal annulus to avoid injury to the bundle of His. The annular apposition divides the TV into a larger anterior and a smaller posterior orifices, enabling valve closure, on both sides. In adults, the diameter of the anterior valve orifice should be 23-25 mm, and the posterior orifice 15-18 mm; thus, the total valve orifice area is 5-6 cm2. In children, the total valve orifice should be a standard deviation of 1.7 mm for a BSA of 1.0m2. During a mean follow up of 8.7 ± 1.34 years (median 10 years; range: 1.5-25.9 years) there have been no reoperations for TV insufficiency

  12. Early reconstruction of bone defect created after initial surgery of a large keratocystic odontogenic tumor: A case report

    Directory of Open Access Journals (Sweden)

    Matijević Stevo

    2013-01-01

    Full Text Available Introduction. Keratocystic odontogenic tumor (KCOT is defined as a benign cystic neoplasm of the jaws of odontogenic origin with a high rate of recurrence. The most lesions occur in the posterior part of the mandible. Treatment of KCOT remains controversial, but the goals of treatment should involve eliminating the potential for recurrence while minimizing surgical morbidity. However, another significant therapeutic problem related to the management of KCOT is an adequate and early reconstruction of the existing jaw defect, as well as appropriate aesthetic and functional rehabilitation of a patient, especially in cases of a very large destruction of the jaws bone. Case report. We presented a 65-year-old female patient with very large KCOT of the mandible. Orthopantomographic radiography showed a very large elliptical multilocular radiolucency, located on the right side of the mandible body and the ascending ramus of the mandible, with radiographic evidence of cortical perforation at the anterior border of the mandibular ramus and the superior border of the alveolar part of the mandible. The surgical treatment included two phases. In the first phase, the tumor was removed by enucleation and additional use of Carnoy solution, performing peripheral ostectomy and excision of the affected overlying mucosa, while in the second phase, restorative surgery of the existing mandibular defect was performed 6 months later. Postoperatively, we did not register any of postoperative complications, nor recurrence within 2 years of the follow-up. Conclusion. Adequate and early reconstruction of the existing jaw defect and appropriate aesthetic and functional rehabilitation of the patient should be the primary goal in the treatment of KCOT, having in mind the need for a long-term post-surgical follow-up.

  13. Flow and mass transfer downstream of an orifice under flow accelerated corrosion conditions

    International Nuclear Information System (INIS)

    Ahmed, Wael H.; Bello, Mufatiu M.; El Nakla, Meamer; Al Sarkhi, Abdelsalam

    2012-01-01

    Highlights: ► Mass transfer downstream of orifices was numerically and experimentally investigated. ► The surface wear pattern is measured and used to validate the present numerical results. ► The maximum mass transfer coefficient found to occur at approximately 2–3 pipe diameters downstream of the orifice. ► The FAC wear rates were correlated with the turbulence kinetic energy and wall mass transfer in terms of Sherwood number. ► The current study offered very useful information for FAC engineers for better preparation of nuclear plant inspection scope. - Abstract: Local flow parameters play an important role in characterizing flow accelerated corrosion (FAC) downstream of sudden area change in power plant piping systems. Accurate prediction of the highest FAC wear rate locations enables the mitigation of sudden and catastrophic failures, and the improvement of the plant capacity factor. The objective of the present study is to evaluate the effect of the local flow and mass transfer parameters on flow accelerated corrosion downstream of an orifice. In the present study, orifice to pipe diameter ratios of 0.25, 0.5 and 0.74 were investigated numerically by solving the continuity and momentum equations at Reynolds number of Re = 20,000. Laboratory experiments, using test sections made of hydrocal (CaSO 4 ·½H 2 O) were carried out in order to determine the surface wear pattern and validate the present numerical results. The numerical results were compared to the plants data as well as to the present experiments. The maximum mass transfer coefficient found to occur at approximately 2–3 pipe diameters downstream of the orifice. This location was also found to correspond to the location of elevated turbulent kinetic energy generated within the flow separation vortices downstream of the orifice. The FAC wear rates were correlated with the turbulence kinetic energy and wall mass transfer in terms of Sherwood number. The current study found to offer very

  14. High Viscosity Liquid Flow through the Round Orifices at Small Reynold’s Numbe rs

    Directory of Open Access Journals (Sweden)

    V. N. Pil'gunov

    2015-01-01

    Full Text Available The paper presents research results of the mineral oil flow process with viscosity of 30 cSt through a round orifice with the sharp inlet edge of 0.9 mm in diameter. Pilot studies were conducted using a module from the transparent plexiglas that allowed to visualize hydrodynamic processes. The intake and off-take channels of the module with their sufficient extension had diameter of 20 mm (24 diameters of an orifice that allows us to consider compression of a stream as perfect. Drawing the enameled nichrome wire with a mark as a stripping isolation of 0.1 mm width enabled sounding of electric processes in the stream sections. Intensive high- frequency electric processes were revealed in cavitation stream. The paper gives experimental values of coefficientsof volumetric and mass flow at low (150 orifice. Free jet at a speed exceeding 50 m/s strikes a wall, barrier, installed at a distance of 100 diameters of the orifice: the reflection from walls, barriers shot blast, which caused intense foaming and conversion of oil into the two-phase mixture "fluid- combined air." We investigate the "life cycle" of a two-phase mixture: flotation bubbles in a viscous medium, and there was no air passes completely evolved in the dissolved state in a time not exceeding 30 minutes. Volumetric analysis of the foam allowed us to estimate the percentage of volumetric gas content of oil, which was 9% at 240С and atmospheric pressure of 97.5 kPa. An explanation of the possible cause cavitation edge at the end of a viscous fluid through an orifice with a sharp edge - appearance in fluid large tensile forces due to the centrifugal force on the particles of the fluid streams in passing peripheral sharp edge. Experimental research data flow of a viscous fluid in the annular orifice formed sharp edge and the surface of the string. Detected failure mode expiration free jet and conversion shareware transparent

  15. Organic compounds generated after the flow of water through micro-orifices: Were they synthesized?

    Directory of Open Access Journals (Sweden)

    Tomiichi Hasegawa

    2017-08-01

    Full Text Available Micro-fluid mechanics is an important area of research in modern fluid mechanics because of its many potential industrial and biological applications. However, the field is not fully understood yet. In previous work, when passing ultrapure water (UPW in which air was dissolved (UPW* through micro-orifices, we found that the flow velocity decreased and stopped over time, and membranes were frequently formed in the orifice when the flow stopped. The membrane came from the dissolved air in UPW*, and membrane formation was closely related to electric charges generated in orifices by the flow. In the present paper, we clarified the components of the membrane and suggested a mechanism for membrane formation. We examined the effect of contaminants on the membrane formation and confirmed our previous results. We identified the chemical components of the membrane and those present in the UPW* itself by using an electron probe microanalyzer and found that the proportion of each element differed between the membrane and UPW*. Raman and infrared (IR spectroscopy showed that the membrane consisted of organic substances such as carotenoids, amides, esters, and sugars. We irradiated UPW* with ultraviolet light to cut organic chains that may be left in UPW* as contaminants. We found a similar membrane and organic compounds as in nonirradiated UPW*. Furthermore, although the UPW that was kept from contact with air after it was supplied from the UPW maker (UPW0 and bubbled with Ar gas (UPW0 bubbled with Ar formed no membrane, the UPW0 bubbled with CO2 formed thin membranes, and Raman and IR analysis showed that this membrane contained carboxylic acid salts, carotenoids, or a mixture of both. We found that electric grounding of the orifice reduces the probability of membrane formation and that the jets issuing from an aperture bear negative charges, and we assumed that the micro-orifices possess positive charges generated by flows. Consequently, we suggest that

  16. Do We Need to Clamp the Renal Hilum Liberally during the Initial Phase of the Learning Curve of Robot-Assisted Nephron-Sparing Surgery?

    Directory of Open Access Journals (Sweden)

    Ömer Acar

    2014-01-01

    Full Text Available Objective. We aimed to compare the results of our initial robot-assisted nephron-sparing surgeries (RANSS performed with or without hilar clamping. Material and Method. Charts of the initial RANSSs (n=44, which were performed by a single surgeon, were retrospectively reviewed. R.E.N.A.L. nephrometry system, modified Clavien classification, and M.D.R.D. equation were used to record tumoral complexity, complications, and estimated glomerular filtration rate (eGFR, respectively. Outcomes of the clamped (group 1, n=14 versus off-clamp (group 2, n=30 RANSSs were compared. Results. The difference between the two groups was insignificant regarding mean patient age, mean tumor size, and mean R.E.N.A.L. nephrometry score. Mean operative time, mean estimated blood loss amount, and mean length of hospitalization were similar between groups. A total of 4 patients in each group suffered 11 Clavien grade ≥2 complications early postoperatively. Open conversion rates were similar. The difference between the 2 groups in terms of the mean postoperative change in eGFR was insignificant. We did not encounter any local recurrence after a mean follow-up of 18.9 months. Conclusions. Creating warm-ischemic conditions during RANSS should not be a liberal decision, even in the initial phases of the learning curve for a highly experienced open surgeon.

  17. Per-oral endoscopic myotomy: Major advance in achalasia treatment and in endoscopic surgery

    Science.gov (United States)

    Friedel, David; Modayil, Rani; Stavropoulos, Stavros N

    2014-01-01

    Per-oral endoscopic myotomy (POEM) represents a natural orifice endoscopic surgery (NOTES) approach to laparoscopy Heller myotomy (LHM). POEM is arguably the most successful clinical application of NOTES. The growth of POEM from a single center in 2008 to approximately 60 centers worldwide in 2014 with several thousand procedures having been performed attests to the success of POEM. Initial efficacy, safety and acid reflux data suggest at least equivalence of POEM to LHM, the previous gold standard for achalasia therapy. Adjunctive techniques used in the West include impedance planimetry for real-time intraprocedural luminal assessment and endoscopic suturing for challenging mucosal defect closures during POEM. The impact of POEM extends beyond the realm of esophageal motility disorders as it is rapidly popularizing endoscopic submucosal dissection in the West and spawning offshoots that use the submucosal tunnel technique for a host of new indications ranging from resection of tumors to pyloromyotomy for gastroparesis. PMID:25548473

  18. Repair of Double Orifice Left AV Valve (DOLAVV with Endocardial Cushion Defect in Adult

    Directory of Open Access Journals (Sweden)

    Vivek Velayudhan Pillai

    Full Text Available Abstract Double orifice left atrioventricular valve (DOLAVV or double orifice mitral valve (DOMV is a rare congenital cardiac anomaly manifesting either as an isolated lesion (mitral stenosis or mitral insufficiency or in association with other congenital cardiac defects. Signs of mitral valve disease are usually present along with the symptoms of associated coexistent congenital heart diseases. Mitral insufficiency due to annular dilatation is seen when DOLAVV is associated with endocardial cushion defects. Surgical intervention like mitral valve repair or replacement is required in 50% of patients and yields good results. We report a case of a 56-year-old lady who successfully underwent surgical correction of DOLAVV with partial atrioventricular canal defect.

  19. Burnout experiments in freon 12 using different types of orifices to simulate the core grids

    International Nuclear Information System (INIS)

    Ladeira, L.; Katsaounis, A.; Orlowski, R.; Fulfs, H.; Hofmann, K.

    1978-01-01

    This paper will report on burnout experiments carried out in freon 12 mainly at steady state and further at mass flow or power transient conditions with annular test sections axially uniformly heating either the inside or both the inside and outside rod. The runs are performed without orifice and using three different types of orifices simulating the reactor spacer grid. An important influence of the flow restriction on burnout position and value is measured. Furthermore, the comparison between the burnout correlations W2, W3, B and W2 and GE and experimental results from the literature using simple test section geometries in water and freon 12 demonstrate, that the accuracy is more or less comparable for both fluids. (orig.) [de

  20. Method for generating small and ultra small apertures, slits, nozzles and orifices

    Science.gov (United States)

    Khounsary, Ali M [Hinsdale, IL

    2012-05-22

    A method and device for one or more small apertures, slits, nozzles and orifices, preferably having a high aspect ratio. In one embodiment, one or more alternating layers of sacrificial layers and blocking layers are deposited onto a substrate. Each sacrificial layer is made of a material which preferably allows a radiation to substantially pass through. Each blocking layer is made of a material which substantially blocks the radiation.

  1. Coronal microleakage of three different dental biomaterials as intra-orifice barrier during nonvital bleaching

    Directory of Open Access Journals (Sweden)

    Nafiseh Zarenejad

    2015-01-01

    Full Text Available Background: This study was designed to assess the microleakage of glass-ionomer (GI, mineral trioxide aggregate (MTA, and calcium-enriched mixture (CEM cement as coronal orifice barrier during walking bleaching. Materials and Methods: In this experimental study, endodontic treatment was done for 70 extracted human incisors without canal calcification, caries, restoration, resorption, or cracks. The teeth were then divided into three experimental using "Simple randomization allocation" (n = 20 and two control groups (n = 5. The three cements were applied as 3-mm intra-orifice barrier in test groups, and bleaching process was then conducted using a mixture of sodium perborate powder and distilled water, for 9 days. For leakage evaluation, bovine serum albumin marker was traced in a dual-chamber technique with Bradford indicator. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis. Results: The mean ± standard deviation leakage of samples from negative control, positive control, GI, MTA, and CEM cement groups were 0.0, 8.9 ± 0.03, 0.47 ± 0.02, 0.48 ± 0.02, and 0.49 ± 0.02 mg/mL, respectively. Statistical analysis showed no significant difference between three experimental groups (P > 0.05. Conclusion: It is concluded that GI, MTA, and CEM cements are considered as suitable intra-orifice barrier to provide coronal seal during walking bleaching.

  2. Performance of an Orifice Compensated Two-Lobe Hole-Entry Hybrid Journal Bearing

    Directory of Open Access Journals (Sweden)

    J. Sharana Basavaraja

    2008-01-01

    Full Text Available The work presented in this paper aims to study the performance of a two-lobe hole-entry hybrid journal bearing system compensated by orifice restrictors. The Reynolds equation governing the flow of lubricant in the clearance space between the journal and bearing together with the equation of flow through an orifice restrictor has been solved using FEM and Galerkin's method. The bearing performance characteristics results have been simulated for an orifice compensated nonrecessed two-lobe hole-entry hybrid journal bearing symmetric configuration for the various values of offset factor (, restrictor design parameter (2, and the value of external load (0. Further, a comparative study of the performance of a two-lobe hole-entry hybrid journal bearing system with a circular hole-entry symmetric hybrid journal bearing system has also been carried out so that a designer has a better flexibility in choosing a suitable bearing configuration. The simulated numerical results indicate that for the two-lobe symmetric hole-entry hybrid journal bearing system with an offset factor ( greater than one provides 30 to 50 percent larger values of direct stiffness and direct damping coefficients as compared to a circular symmetric hole-entry hybrid journal bearing system.

  3. Evaluation of the flow-accelerated corrosion downstream of an orifice. 1. Measurements and numerical analysis of flow field

    International Nuclear Information System (INIS)

    Utanohara, Yoichi; Nagaya, Yukinori; Nakamura, Akira; Murase, Michio

    2008-01-01

    In this study, in order to evaluate the effects of flow field on corrosion rate due to flow accelerated corrosion (FAC), an orifice flow was measured and calculated. The diameter of pipe is 50 mm and that of the orifice is 24.3 mm, and flow velocity in a water loop was set at 2.41 m/s. Flow field was measured by laser Doppler velocimetry (LDV) and particle image velocimetry (PIV), and compared with a calculation for the same flow conditions. Measurements of wall shear stress downstream of the orifice was also planed. The calculated velocity distribution of standard k-□ agreed qualitatively with PIV data and quantitatively with LDV data. Instantaneous flow field measured by PIV showed vortices around the jet from the orifice and some of them reached near the pipe wall. (author)

  4. Impact of L/D on 90 Degree Sharp-Edge Orifice Flow with Manifold Passage Cross Flow (Preprint)

    Science.gov (United States)

    2007-04-30

    that are observed by measurement as the flow transitions from non-cavitation to cavitation (turbulent flow), supercavitation , and finally separation in...include inception of cavitation, supercavitation , and separation. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...cavitation to cavitation (turbulent flow), supercavitation , and finally separation in sharp-edge 90 degree orifices. This study includes orifice L/D from

  5. Fast-track video-assisted thoracoscopic surgery

    DEFF Research Database (Denmark)

    Holbek, Bo Laksafoss; Petersen, René Horsleben; Kehlet, Henrik

    2016-01-01

    Objectives To provide a short overview of fast-track video-assisted thoracoscopic surgery (VATS) and to identify areas requiring further research. Design A literature search was made using key words including: fast-track, enhanced recovery, video-assisted thoracoscopic surgery, robot......-assisted thoracoscopic surgery (RATS), robotic, thoracotomy, single-incision, uniportal, natural orifice transluminal endoscopic surgery (NOTES), chest tube, air-leak, digital drainage, pain management, analgesia, perioperative management, anaesthesia and non-intubated. References from articles were screened for further...

  6. Numerical simulation of progressive inlet orifices in boiling water reactor fuel

    International Nuclear Information System (INIS)

    Lundgren, Sara

    2004-07-01

    This thesis was carried out at Forsmark Nuclear Power Plant. The power plant in Forsmark consists of three boiling water reactors (BWR) which produce about 17% of Swedish electricity. In a BWR the nuclear reactions are used to boil water inside the reactor vessel. The water works both as a coolant and as a moderator and the resulting steam is used directly to run the turbines. A problem when running a BWR at low flow conditions is the density wave oscillations that might occur to the water flow inside the fuel assemblies. These oscillations arise due to the connection between power and flow rate in a heated channel with two-phase flow. In order to improve the stability performance of the channel an orifice plate is placed at the inlet of each fuel assembly. Today these orifice plates have sharp edges and a constant resistance coefficient. Experimental work has been done with progressive orifices, the edge of which is half-oval in shape. The advantage of progressive orifices is the lower pressure losses with an increase of the Reynolds number, a similar phenomenon that appears in external flow around curved bodies. Since there are high costs associated with experimental generation of high- temperature and high-pressure data, it is of some interest to be able to reproduce and generate data using Computational Fluid Dynamics (CFD). This work deals with the possibility to use the CFD-code Fluent to do numerical simulations of the flow through progressive orifices. The following conclusions may be drawn from the numerical results: All simulations using Reynolds-Averaged Navier-Stokes (RANS) turbulence models, two-dimensional and three-dimensional, capture an abrupt decrease of the resistance coefficient at higher Reynolds numbers. Two-equation models seem to under-predict the critical Reynolds number. The five-equation Reynolds Stress Model (RSM) gives a critical Reynolds number of the same order of magnitude of that measured in experiments. No major differences have

  7. Mass transfer coefficient in disturbed flow due to orifice for flow accelerated corrosion in nuclear power plant

    International Nuclear Information System (INIS)

    Prasad, Mahendra; Gaikwad, Avinash J.; Sridharan, Arunkumar; Parida, Smrutiranjan

    2015-01-01

    The flow of fluid in pipes cause corrosion wherein the inner surface of pipe becomes progressively thinner and susceptible to failure. This form of corrosion dependent on flow dynamics is called Flow Accelerated Corrosion (FAC) and has been observed in Nuclear Power Plants (NPPs). Mass transfer coefficient (MTC) is related to extent of wall thinning and it changes from its value in a straight pipe (with same fluid parameters) for flow in orifices, bends, junctions etc. due to gross disturbance of the velocity profile. This paper presents two-dimensional computational fluid dynamics (CFD) simulations for an orifice configuration in a straight pipe. Turbulent model K- ω with shear stress transport and transition flow was the model used for simulation studies. The mass transfer boundary layer (MTBL) thickness δ mtbl is related to the Schmidt number (Sc) and hydrodynamic boundary layer thickness δ h , as δ mtbl ~ δh/(Sc 1/3 ). MTBL is significantly smaller than δ h and hence boundary layer meshing was carried out deep into δ mtbl . Uniform velocity profile was applied at the inlet. Post orifice fluid shows large recirculating flows on the upper and lower wall. At various locations after orifice, mass transfer coefficient is calculated and compared with the value in straight pipe with fully developed turbulent flow. The MTC due to the orifice increases and it is correlated with enhanced FAC in region after orifice. (author)

  8. Risk Stratification for the Development of Respiratory Adverse Events Following Vascular Surgery Using the Society of Vascular Surgery’s Vascular Quality Initiative

    Science.gov (United States)

    Genovese, Elizabeth A; Fish, Larry; Chaer, Rabih A; Makaroun, Michel S; Baril, Donald T

    2017-01-01

    Objective Post-operative respiratory adverse events (RAEs) are associated with high rates of morbidity and mortality in general surgery, however little is known about these complications in the vascular surgery population, a frail subset with multiple comorbidities. The objective of this study was to describe the contemporary incidence of RAEs in vascular surgery patients, the risk factors for this complication and the overall impact of RAEs on patient outcomes. Methods The Vascular Quality Initiative was queried (2003–2014) for patients who underwent endovascular abdominal aortic repair, open abdominal aortic aneurysm (AAA) repair, thoracic endovascular aortic repair (TEVAR), suprainguinal bypass or infrainguinal bypass. A mixed-effects logistic regression model determined the independent risk factors for RAEs. Using a random 85% of the cohort, a risk prediction score for RAEs was created and the score was validated using the remaining 15% of the cohort, comparing the predicted to the actual incidence of RAE and determining the area under the receiver operating characteristic curve. The independent risk of in-hospital mortality and discharge to a nursing facility associated with RAEs was determined using a mixed-effects logistic regression to control for baseline patient characteristics, operative variables and other post-operative adverse events. Results The cohort consisted of 52,562 patients, with a 5.4% incidence of RAEs. The highest rates of RAEs were seen in current smokers (6.1%), recent acute myocardial infarction (10.1%), symptomatic congestive heart failure (CHF) (9.9%), chronic obstructive pulmonary disease (COPD) requiring oxygen therapy (11.0%), urgent and emergent procedures (6.4% and 25.9%, respectively), open AAA repairs (17.6%), in-situ suprainguinal bypasses (9.68%) and TEVARs (9.6%). The variables included in the risk prediction score were age, body mass index, smoking status, CHF severity, COPD severity, degree of renal insufficiency

  9. The Performance Test for Reactor Coolant Pump (RCP) adopting Variable Restriction Orifice Type Control Valve

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S.; Bae, B. U.; Cho, Y. J. and others

    2014-05-15

    The design values of the RCPTF are 17.2 MPa, 343 .deg. C, 11.7 m{sup 3}/s, and 13 MW in the maximum pressure, temperature, flow rate, and electrical power, respectively. In the RCPTF, various types of tests can be performed including a hydraulic performance test to acquire a H-Q curve as well seal transient tests, thrust bearing transient test, cost down test, NPSHR verification test, and so on. After a commissioning startup test was successfully perfomed, mechanical structures are improved including a flow stabilizer and variable restriction orifice. Two- branch pipe (Y-branch) was installed to regulate the flow rate in the range of performance tests. In the main pipe, a flow restrictor (RO: Restriction Orifice) for limiting the maximum flow rate was installed. In the branch pipe line, a globe valve and a butterfly valves for regulating the flow rate was located on the each branch line. When the pressure loss of the valve side is smaller than that of the RO side, the flow rate of valve side was increasing and the flow disturbance was occurred in the lower pipe line. Due to flow disturbnace, it is to cause an error when measuring RCP head and flow measurement of the venturi flow meter installed in the lower main pipe line, and thus leading to a decrease in measurement accuracy as a result. To increase the efficiency of the flow control availability of the test facility, the variable restriction orifice (VRO) type flow control valve was designed and manufactured. In the RCPTF in KAERI, the performance tests and various kinds of transient tests of the RCP were successfully performed. In this study, H-Q curve of the pump using the VRO revealed a similar trend to the result from two ROs. The VRO was confirmed to effectively cover the full test range of the flow rate.

  10. Numerical simulation of trans-critical carbon dioxide (R744) flow through short tube orifices

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Valladares, O. [Centro de Investigacion en Energia de la Universidad Nacional Autonoma de Mexico, Privada Xochicalco S/N, Apdo. Postal 34, 62580 Temixco, Morelos (Mexico)

    2006-02-01

    A detailed one-dimensional numerical simulation of the fluid-dynamic behaviour of short tube orifices expansion devices working with trans-critical carbon dioxide (CO{sub 2} or R744) has been developed. The discretized governing equations are coupled using an implicit step by step method. A special treatment has been implemented in order to consider transitions (subcooled liquid region and equilibrium two-phase region). The numerical model allows analysis of aspects such as geometry, different working conditions, critical or non-critical flow conditions, etc. Comparison of the numerical simulation with experimental data presented in the technical literature will be shown in the present article. (author)

  11. Short-term results of microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery in Japanese eyes: initial case series.

    Science.gov (United States)

    Tanito, Masaki; Sano, Ichiya; Ikeda, Yoshifumi; Fujihara, Etsuko

    2017-08-01

    To report the first early postoperative results and safety profile after microhook ab interno trabeculotomy (μLOT). This initial retrospective observational case series included 24 consecutive glaucomatous eyes of 17 Japanese patients (7 men, 10 women; mean age ± standard deviation, 66.7 ± 17.9 years) who underwent μLOT. The trabeculotomy extent, surgical time, perioperative complications, interventions for complications and additional glaucoma surgeries during the follow-up for more than 3 months were collected by reviewing the medical and surgical records. The intraocular pressure (IOP), numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare and corneal endothelial cell density (CECD) were compared preoperatively and postoperatively. The trabecular meshwork was incised for a mean of 3.6 ± 0.5 clock hours temporally, 3.7 ± 0.5 clock hours nasally and total 7.3 ± 0.6 clock hours during the 6.2 ± 1.6-min surgery. The mean preoperative IOP of 25.9 ± 14.3 mmHg and number of antiglaucoma medication of 3.3 ± 1.0 decreased significantly (p = 0.0002 and p = 0.005, respectively) to 14.7 ± 3.6 mmHg and 2.8 ± 0.8 at the final visit at 188.6 ± 68.8 days postoperatively. Compared with preoperatively, the final VA, AC flare and CECD did not change significantly. Hyphema with niveau formation (nine eyes, 38%) and washout of hyphema (two eyes, 8%) were the most common postoperative complication and intervention, respectively. At the final visit, 19 eyes (79%) achieved successful IOP control of 18 mmHg or less and a 15% reduction or greater. Microhook trabeculotomy normalizes the IOP during the early postoperative period in patients with glaucoma. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  12. Effect of Timing of Initial Cataract Surgery, Compliance to Amblyopia Therapy on Outcomes of Secondary Intraocular Lens Implantation in Chinese Children: A Retrospective Case Series

    Directory of Open Access Journals (Sweden)

    Liuyang Li

    2018-01-01

    Full Text Available Purpose. As a secondary analysis, we reassess the association of initial congenital cataract surgery times, compliance to amblyopia therapy, and visual outcomes for a long-term follow-up in a secondary IOL implantation. Methods. Retrospective review of records of all infants with congenital cataracts who underwent secondary IOL implantation in the Eye and ENT Hospital of Fudan University from January 1, 2001, to December 31, 2007, and the minimum follow-up period was 5 years. Multiple regression analysis was used and the possible confounding factors were also analyzed to assess the effect on visual outcome. Results. A total of 110 patients (male: 59.1% were included. The median (min–max age at cataract extraction and IOL implantation was 7.5 (3.0–15.0 and 35.0 (22.0–184.0 months, respectively, and the average follow-up period was 99.3 ± 23.6 months. The median (min–max BCVA at final follow-up was 0.20 (0.01–1.00. Compliance to amblyopia therapy was none, poor, and good in 21.8%, 24.5%, and 53.6%, respectively. Postoperative BCVA [logMAR, median (min–max 0.70 (0.00–2.00] linearly decreased with increasing cataract extraction time (per month (β=0.04, 95% CI: 0.03–0.06, p<0.0001 in multivariable models with laterality and compliance to amblyopia therapy adjusted. Good compliance to amblyopia therapy was associated with better BCVA (logMAR at last follow-up (β=−0.40, 95% CI = −0.53 to −0.27, p<0.0001 with laterality, opacity type, and extraction time adjusted. Conclusions. For Chinese infants with congenital cataract, an earlier primary congenital cataract surgery at an age of 3 to 15 months is associated with a better visual outcome. Good compliance to amblyopia therapy was also significant to visual outcome.

  13. The Relationship Between Preoperative and Primary Care Blood Pressure Among Veterans Presenting from Home for Surgery. Is There Evidence for Anesthesiologist-Initiated Blood Pressure Referral?

    Science.gov (United States)

    Schonberger, Robert B.; Burg, Matthew M.; Holt, Natalie; Lukens, Carrie L.; Dai, Feng; Brandt, Cynthia

    2011-01-01

    Background American College of Cardiology/American Heart Association guidelines describe the perioperative evaluation as “a unique opportunity to identify patients with hypertension,” however factors such as anticipatory stress or medication noncompliance may induce a bias toward higher blood pressure, leaving clinicians unsure about how to interpret preoperative hypertension. Information describing the relationship between preoperative intake blood pressure and primary care measurements could help anesthesiologists make primary care referrals for improved blood pressure control in an evidence-based fashion. We hypothesized that the preoperative examination provides a useful basis for initiating primary care blood pressure referral. Methods We analyzed retrospective data on 2807 patients who arrived from home for surgery and who were subsequently evaluated within 6 months after surgery in the primary care center of the same institution. After descriptive analysis, we conducted multiple linear regression analysis to identify day-of-surgery (DOS) factors associated with subsequent primary care blood pressure. We calculated the sensitivity, specificity, and positive and negative predictive value of different blood pressure referral thresholds using both a single-measurement and a two-stage screen incorporating recent preoperative and DOS measurements for identifying patients with subsequently elevated primary care blood pressure. Results DOS systolic blood pressure (SBP) was higher than subsequent primary care SBP by a mean bias of 5.5mmHg (95% limits of agreement +43.8 to −32.8). DOS diastolic blood pressure (DBP) was higher than subsequent primary care DBP by a mean bias of 1.5mmHg (95% limits of agreement +13.0 to −10.0). Linear regression of DOS factors explained 19% of the variability in primary care SBP and 29% of the variability in DBP. Accounting for the observed bias, a two-stage SBP referral screen requiring preoperative clinic SBP≥140mmHg and DOS

  14. Dual discharge from a stratified two-phase region through side orifices oriented horizontally

    Energy Technology Data Exchange (ETDEWEB)

    Hassan, I G; Soliman, H M; Sims, G E [Manitoba Univ., Winnipeg, MB (Canada). Dept. of Mechanical Engineering; Kowalski, J E [Atomic Energy of Canada Ltd., Pinawa, MB (Canada). Whiteshell Labs.

    1996-12-31

    Experimental data are presented for the mass flow rate and quality of two-phase (air-water) discharge from a stratified region through two side orifices (6.35 mm i.d.) with their parallel centre lines located in a horizontal plane. These data correspond to different values of the interface level between the onsets of gas and liquid entrainments for test-section pressures of 316 and 517 kPa, test-section-to-separators pressure difference ranging from 40 to 235 kPa, orifice separating distance to diameter ratio ranging from 1.5 to 8 and different hydraulic resistances of the lines connecting the test section to the separators. Influences of these independent variables on the deviation between the present results (of mass flow rate and quality) and those corresponding to a single discharge are presented and discussed. Normalized plots are presented showing that the present data of dual discharge and those of a single discharge can be collapsed for the whole test range when specific definition for the dimensionless height of the interface and mass flow rate are used. Excellent agreement is demonstrated between single-discharge correlations and the present data using these dimensionless quantities. (author). 12 refs., 1 tab., 16 figs.

  15. Dual discharge from a stratified two-phase region through side orifices oriented horizontally

    International Nuclear Information System (INIS)

    Hassan, I.G.; Soliman, H.M.; Sims, G.E.; Kowalski, J.E.

    1995-01-01

    Experimental data are presented for the mass flow rate and quality of two-phase (air-water) discharge from a stratified region through two side orifices (6.35 mm i.d.) with their parallel centre lines located in a horizontal plane. These data correspond to different values of the interface level between the onsets of gas and liquid entrainments for test-section pressures of 316 and 517 kPa, test-section-to-separators pressure difference ranging from 40 to 235 kPa, orifice separating distance to diameter ratio ranging from 1.5 to 8 and different hydraulic resistances of the lines connecting the test section to the separators. Influences of these independent variables on the deviation between the present results (of mass flow rate and quality) and those corresponding to a single discharge are presented and discussed. Normalized plots are presented showing that the present data of dual discharge and those of a single discharge can be collapsed for the whole test range when specific definition for the dimensionless height of the interface and mass flow rate are used. Excellent agreement is demonstrated between single-discharge correlations and the present data using these dimensionless quantities. (author). 12 refs., 1 tab., 16 figs

  16. Experimental study of cooling performance of pneumatic synthetic jet with singular slot rectangular orifice

    Science.gov (United States)

    Yu, Roger Ho Zhen; Ismail, Mohd Azmi bin; Ramdan, Muhammad Iftishah; Mustaffa, Nur Musfirah binti

    2017-03-01

    Synthetic Jet generates turbulence flow in cooling the microelectronic devices. In this paper, the experiment investigation of the cooling performance of pneumatic synthetic jet with single slot rectangular orifices at low frequency motion is presented. The velocity profile at the end of the orifice was measured and used as characteristic performance of synthetic jet in the present study. Frequencies of synthetic jet and the compressed air pressure supplied to the pneumatic cylinder (1bar to 5bar) were the parameters of the flow measurement. The air velocity of the synthetic jet was measured by using anemometer air flow meter. The maximum air velocity was 0.5 m/s and it occurred at frequency motion of 8 Hz. The optimum compressed air supplied pressure of the synthetic jet study was 4 bar. The cooling performance of synthetic jet at several driven frequencies from 0 Hz to 8 Hz and heat dissipation between 2.5W and 9W were also investigate in the present study. The results showed that the Nusselt number increased and thermal resistance decreased with both frequency and Reynolds number. The lowest thermal resistance was 5.25°C/W and the highest Nusselt number was 13.39 at heat dissipation of 9W and driven frequency of 8Hz.

  17. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad

    2014-01-01

    BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... and distributed electronically via e-mail to a total of 1253 members of The Danish Society of Surgeons and The Danish Society of Young Surgeons. RESULTS: In total, 352 (approximately 30%) surgeons completed the questionnaire, 54.4% were over 50 years of age, and 76.6% were men. When choosing surgery, the most...

  18. Flow resistance of orifices and spacers of BWR thermal-hydraulic and neutronic coupling loop

    International Nuclear Information System (INIS)

    Iguchi, Tadashi; Asaka, Hideaki; Nakamura, Hideo

    2002-03-01

    Authors are performing THYNC experiments to study thermal-hydraulic instability under neutronic and thermal-hydraulic coupling. In THYNC experiments, the orifices are installed at the exit of the test section and the spacers are installed in the test section, in order to properly simulate in-core thermal-hydraulics in the reactor core. It is necessary to know the flow resistance of the orifices and spacers for the analysis of THYNC experimental results. Consequently, authors measured the flow resistance of orifice and spacer under single-phase and two-phase flows. Using the experimental results, authors investigated the dependency of the flow resistances on the parameters, such as pressure, mass flux, an geometries. Furthermore, authors investigated the applicability of the basic two-phase flow models, for example the separate flow model, to the two-phase flow multiplier. As the result of the investigation on the single-phase flow experiment, it was found (1) that the effects of pressure and mass flux flow resistance are described by a function of Reynolds number, and (2) that flow resistances of the orifice and the spacer are calculated with the previous prediction methods. However, it was necessary to introduce an empirical coefficient, since it was difficult to predict accurately the flow resistance only with the previous prediction method due to the complicated geometry dependency, for example a flow area blockage ratio. On the other hand, according to the investigation on two-phase flow experiment, the followings were found. (1) Relation between the two-phase flow multiplier and the quality is regarded to be linear under pressure of 2MPa - 7MPa. The relation is dependent on pressure and geometry, and is little dependent on mass flux. (2) Relation between the two-phase flow multiplier and void fraction is little dependent on pressure, mass flux, and geometry under pressure of 0.2MPa - 7MPa and void fraction less than 0.6. The relation is less dependent on

  19. Novel challenges of multi-society investigator-initiated studies: a paradigm shift for technique and technology evaluation.

    Science.gov (United States)

    Schwaitzberg, Steven D; Hawes, Robert H; Rattner, David W; Kochman, Michael L

    2013-08-01

    The introduction of innovative techniques and novel technologies into clinical practice is a challenge that confronts all aspects of healthcare delivery. Upheaval from shrinking research funding and declining healthcare reimbursements now forces patients, doctors, hospitals, payers, regulators, and even health systems into conflict as new therapies struggle to find a place in the therapeutic armamentarium. The escalating costs of healthcare force all parties to consider both the medical risks/benefits as well as the economic efficiency of proposed tools and therapies. We highlight these challenges by examining the process of initiating and conducting a "society-as-investigator" clinical trial to assess the safety of the natural orifice translumenal endoscopic surgery (NOTES) approach to cholecystectomy in the context of the issues that confront technology diffusion today.

  20. Effect of Orifice Nozzle Design and Input Power on Two-Phase Flow and Mass Transfer Characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Hei Cheon [Chonnam Nat’l Univ., Gwangju (Korea, Republic of)

    2016-04-15

    It is necessary to investigate the input power as well as the mass transfer characteristics of the aeration process in order to improve the energy efficiency of an aerobic water treatment. The objective of this study is to experimentally investigate the effect of orifice nozzle design and input power on the flow and mass transfer characteristics of a vertical two-phase flow. The mass ratio, input power, volumetric mass transfer coefficient, and mass transfer efficiency were calculated using the measured data. It was found that as the input power increases the volumetric mass transfer coefficient increases, while the mass ratio and mass transfer efficiency decrease. The mass ratio, volumetric mass transfer coefficient, and mass transfer efficiency were higher for the orifice configuration with a smaller orifice nozzle area ratio. An empirical correlation was proposed to estimate the effect of mass ratio, input power, and Froude number on the volumetric mass transfer coefficient.

  1. Fabrication and Application of Mono-sized Spherical Micro Particles by Pulsated Orifice Ejection Method

    Directory of Open Access Journals (Sweden)

    DONG Wei

    2018-02-01

    Full Text Available A novel technology called pulsated orifice ejection method(POEM and used for preparing mono-sized and high-precision spherical micro particles was introduced in this article. The working principle of the technique was illustrated and it was in two modes:low-melting point diaphragm mode and high-melting point rod mode, depending on the different melting points of materials. The particles prepared by POEM have the advantages of mono-sized, uniform and controllable particle size, high sphericity, and consistent thermal history. By introducing the application of particles prepared by this method, showing the huge application prospects of this technology in electronic packaging, bioengineering, micro-fabrication, rapid solidification analysis of metal droplets, additive manufacturing and so on.With the development of POEM, this technology is predicted to have wider prospects due to its unique characteristics.

  2. Restenosis after stenting in symptomatic vertebral arterial orifice disease and considerations for better outcome

    Science.gov (United States)

    Chang, Jun Young; Park, Hyun; Kwon, Oki

    2017-01-01

    We have performed stenting in 11 patients with symptomatic vertebral arterial orifice stenosis refractory to medical treatment or impairment in anterior circulation. Three of the 11 patients experienced asymptomatic severe in-stent restenosis or occlusion. Bare metal stents were used in those three patients, two of whom received revascularization therapy. Development of sufficient cervical collateral channels reconstituting the distal vertebral artery was the common feature in patients with asymptomatic in-stent restenosis. In selecting appropriate stents, consideration of mechanical strength and drug-eluting properties of a stent according to characteristics of the target vessel is important to reduce the risk of in-stent restenosis. Any decision to perform revascularization should be based on the presence of abundant cervical collaterals as well as clinical symptoms of vertebrobasilar ischemia. PMID:28304206

  3. Evaluation of effective regurgitant orifice area of mitral valvular regurgitation by multislice cardiac computed tomography

    International Nuclear Information System (INIS)

    Vural, M.; Ucar, O.; Celebi, O.O.; Cicekcioglu, H.; Durmaz, H.A.; Selvi, N.A.; Koparal, S.; Aydogdu, S.

    2010-01-01

    The purpose of our study was to assess the diagnostic accuracy of multislice computed tomography (MSCT) for the identification and quantification of mitral valve regurgitation in comparison with transthoracic echocardiography (TTE). Twenty-six patients (15 females, 11 males with a mean age of 44.6±14.1 years) who were in follow-up with the diagnosis of mitral regurgitation and those who were referred for MSCT were enrolled. MSCT results were compared with TTE measurements. The mean effective mitral regurgitant orifice area at MSCT was 23.1±13.0 mm 2 and at echocardiography was 24.4±16.0mm 2 . Bland-Altman analysis showed good agreement between the two imaging methods. MSCT provides reliable and good results for the evaluation of mitral regurgitation. (author)

  4. A mathematical model for erosion-corrosion downstream of an orifice

    International Nuclear Information System (INIS)

    Thomas, R.M.

    1989-08-01

    In certain types of nuclear plant, the internal surfaces of the steel high-pressure boiler tubes become covered with magnetite. This normal growth of protective magnetite may, in unfavourable circumstances, be replaced by rapid attack on the tube wall. Particularly at risk are the regions downstream of the orifice plates commonly fitted near the boiler inlet. An attempt is made to construct a mathematical model for this erosion-corrosion which is considerably more complete than those available hitherto. A systematic synthesis is developed of the various aspects of the phenomenon, namely the mechanism of the topotactic oxidation at the interface between magnetite and metal, the kinetics of the electrode reactions at the magnetite/solution interface, the thermodynamics of magnetite solubility and the calculation of mass transfer in solution. With one choice of parameters and some simplification, the treatment reduces to the original theory of Bignold. (author)

  5. The counter-current flooding limit in vertical tubes with and without orifices

    International Nuclear Information System (INIS)

    Tye, P.; Davidson, M.; Teyssedou, A.; Tapucu, A.; Matuszkiewicz, A.; Midvidy, W.

    1993-01-01

    For hypothetical loss of coolant accidents in nuclear reactors, rapid reflooding of the core is desirable. In CANDU reactors the cooling water is injected into the headers which are connected to the fuel channels by the feeder pipes. These pipes consist of vertical and horizontal runs; in some feeders, orifices and/or venturi flow meters are installed for flow adjustments and measurements respectively. For certain postulated accident scenarios, steam coming from the fuel channels and/or generated in the hot feeders may flow in the direction opposite to that of the cooling water thereby, creating a vertical or horizontal counter-current two-phase flow. Under these conditions, the rate at which cooling water can enter the fuel channels may be limited by the flooding phenomena. This phenomena is greatly affected by the geometry of the feeder pips, shape and number of fittings, and the flow area restrictions located in the feeders. In this paper the influence that orifice type flow area restrictions have on the counter-current flooding limit (CCFL) in a vertical tube is examined. air and water at close to atmospheric conditions are used as the working fluids. The data collected on the counter-current flooding limit in a vertical tube both with and without flow area restrictions is compared against some of the most commonly used correlations that are available in the open literature. Data on the two-phase counter-current pressure drop below the flooding point are also presented. 12 refs., 10 figs., 1 tab

  6. Flexible single-incision surgery: a fusion technique.

    Science.gov (United States)

    Noguera, José F; Dolz, Carlos; Cuadrado, Angel; Olea, José; García, Juan

    2013-06-01

    The development of natural orifice transluminal endoscopic surgery has led to other techniques, such as single-incision surgery. The use of the flexible endoscope for single-incision surgery paves the way for further refinement of both surgical methods. To describe a new, single-incision surgical technique, namely, flexible single-incision surgery. Assessment of the safety and effectiveness of endoscopic cholecystectomy in a series of 30 patients. This technique consists of a single umbilical incision through which a flexible endoscope is introduced and consists of 2 parallel entry ports that provide access to nonarticulated laparoscopic instruments. The technique was applied in all patients for whom it was prescribed. No general or surgical wound complications were noted. Surgical time was no longer than usual for single-port surgery. Flexible single-incision surgery is a new single-site surgical technique offering the same level of patient safety, with additional advantages for the surgeon at minimal cost.

  7. The effect of orifice plate insertion on low NOx radial swirl burner performances (simulated variable area burner)

    International Nuclear Information System (INIS)

    Mohammad Nazri Mohd Jaafar

    2000-01-01

    The effect of inserting an outlet orifice plate of different sizes at the exit plane of the swirler outlet were studied for small radial swirler with fixed curves vanes. Tests were carried out using two different sizes flame tubes of 76 mm and 140 mm inside diameter, respectively and 330 mm in length. The system was fuelled via eight vane passage fuel nozzles of 3.5 mm diameter hole. This type of fuel injection helps in mixing the fuel and air better prior to ignition. Tests were carried out at 20 mm W.G. pressure loss which is representative of gas burners for domestic central heating system operating conditions. Tests were also carried out at 400 K preheated inlet air temperature and using only natural gas as fuel. The aim of the insertion of orifice plate was to create the swirler pressure loss at the swirler outlet phase so that the swirler outlet shear layer turbulence was maximize to assist with fuel/air mixing. For the present work, the smallest orifice plate exhibited a very low NO x emissions even at 0.7 equivalence ratio were NO x is well below 10 ppm corrected at 0% oxygen at dry basis. Other emissions such as carbon monoxide and unburned hydrocarbon were below 10 ppm and 100 ppm, respectively, over a wide range of operating equivalence ratios. The implies that good combustion was achieved using the smallest orifice plate. (Author)

  8. Continuous synthesis of tert.-butyl peroxypivalate using a single channel micro reactor equipped with orifices as emulsification units

    NARCIS (Netherlands)

    Illg, T.; Hessel, V.; Löb, P.; Schouten, J.C.

    2011-01-01

    The two-step synthesis of tert-butyl peroxypivalate is performed in a single-channel microreactor. The first step, the deprotonation of tert-butyl hydroperoxide, is done in a simple mixer tube setup. The residence time section for the second reaction step is equipped with orifices for interfacial

  9. Shear flow over a plane wall with an axisymmetric cavity or a circular orifice of finite thickness

    International Nuclear Information System (INIS)

    Pozrikidis, C.

    1994-01-01

    Shear flow over a plane wall that contains an axisymmetric depression or pore is studied using a new boundary integral method which is suitable for computing three-dimensional Stokes flow within axisymmetric domains. Numerical results are presented for cavities in the shape of a section of a sphere or a circular cylinder of finite length, and for a family of pores or orifices with finite thickness. The results illustrate the distribution of shear stresses over the plane wall and inside the cavities or pores. It is found that in most cases, the distribution of shear stresses over the plane wall, around the depressions, is well approximated with that for flow over an orifice of infinitesimal thickness for which an exact solution is available. The kinematic structure of the flow is discussed with reference to eddy formation and three-dimensional flow reversal. It is shown that the thickness of a circular orifice or depth of a pore play an important role in determining the kinematical structure of the flow underneath the orifice in the lower half-space

  10. Experimental investigation on the effect of liquid injection by multiple orifices in the formation of droplets in a Venturi scrubber

    Energy Technology Data Exchange (ETDEWEB)

    Guerra, V.G.; Goncalves, J.A.S. [Department of Chemical Engineering, Federal University of Sao Carlos, Via Washington Luiz, Km. 235, 13565-905 Sao Carlos, SP (Brazil); Coury, J.R. [Department of Chemical Engineering, Federal University of Sao Carlos, Via Washington Luiz, Km. 235, 13565-905 Sao Carlos, SP (Brazil)], E-mail: jcoury@ufscar.br

    2009-01-15

    Venturi scrubbers are widely utilized in gas cleaning. The cleansing elements in these scrubbers are droplets formed from the atomization of a liquid into a dust-laden gas. In industrial scrubbers, this liquid is injected through several orifices so that the cloud of droplets can be evenly distributed throughout the duct. The interaction between droplets when injected through many orifices, where opposite clouds of atomized liquid can reach each other, is to be expected. This work presents experimental measurements of droplet size measured in situ and the evidence of cloud interaction within a Venturi scrubber operating with multi-orifice jet injection. The influence of gas velocity, liquid flow rate and droplet size variation in the axial position after the point of the injection of the liquid were also evaluated for the different injection configurations. The experimental results showed that an increase in the liquid flow rate generated greater interaction between jets. The number of orifices had a significant influence on droplet size. In general, the increase in the velocity of the liquid jet and in the gas velocity favored the atomization process by reducing the size of the droplets.

  11. Experimental investigation on the effect of liquid injection by multiple orifices in the formation of droplets in a Venturi scrubber

    International Nuclear Information System (INIS)

    Guerra, V.G.; Goncalves, J.A.S.; Coury, J.R.

    2009-01-01

    Venturi scrubbers are widely utilized in gas cleaning. The cleansing elements in these scrubbers are droplets formed from the atomization of a liquid into a dust-laden gas. In industrial scrubbers, this liquid is injected through several orifices so that the cloud of droplets can be evenly distributed throughout the duct. The interaction between droplets when injected through many orifices, where opposite clouds of atomized liquid can reach each other, is to be expected. This work presents experimental measurements of droplet size measured in situ and the evidence of cloud interaction within a Venturi scrubber operating with multi-orifice jet injection. The influence of gas velocity, liquid flow rate and droplet size variation in the axial position after the point of the injection of the liquid were also evaluated for the different injection configurations. The experimental results showed that an increase in the liquid flow rate generated greater interaction between jets. The number of orifices had a significant influence on droplet size. In general, the increase in the velocity of the liquid jet and in the gas velocity favored the atomization process by reducing the size of the droplets

  12. Experimental investigation on the effect of liquid injection by multiple orifices in the formation of droplets in a Venturi scrubber.

    Science.gov (United States)

    Guerra, V G; Gonçalves, J A S; Coury, J R

    2009-01-15

    Venturi scrubbers are widely utilized in gas cleaning. The cleansing elements in these scrubbers are droplets formed from the atomization of a liquid into a dust-laden gas. In industrial scrubbers, this liquid is injected through several orifices so that the cloud of droplets can be evenly distributed throughout the duct. The interaction between droplets when injected through many orifices, where opposite clouds of atomized liquid can reach each other, is to be expected. This work presents experimental measurements of droplet size measured in situ and the evidence of cloud interaction within a Venturi scrubber operating with multi-orifice jet injection. The influence of gas velocity, liquid flow rate and droplet size variation in the axial position after the point of the injection of the liquid were also evaluated for the different injection configurations. The experimental results showed that an increase in the liquid flow rate generated greater interaction between jets. The number of orifices had a significant influence on droplet size. In general, the increase in the velocity of the liquid jet and in the gas velocity favored the atomization process by reducing the size of the droplets.

  13. Simplified one-orifice venoplasty for middle hepatic vein reconstruction in adult living donor liver transplantation using right lobe grafts.

    Science.gov (United States)

    Kim, Joo Dong; Choi, Dong Lak; Han, Young Seok

    2014-05-01

    Middle hepatic vein (MHV) reconstruction is often essential to avoid hepatic congestion and serious graft dysfunction in living donor liver transplantation (LDLT). The aim of this report was to introduce evolution of our MHV reconstruction technique and excellent outcomes of simplified one-orifice venoplasty. We compared clinical outcomes with two reconstruction techniques through retrospective review of 95 recipients who underwent LDLT using right lobe grafts at our institution from January 2008 to April 2012; group 1 received separate outflow reconstruction and group 2 received new one-orifice technique. The early patency rates of MHV in group 2 were higher than those in group 1; 98.4% vs. 88.2% on postoperative day 7 (p = 0.054) and 96.7% vs. 82.4% on postoperative day 14, respectively (p = 0.023). Right hepatic vein (RHV) stenosis developed in three cases in group 1, but no RHV stenosis developed because we adopted one-orifice technique (p = 0.043). The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in group 2 were significantly lower than those in group 1 during the early post-transplant period. In conclusion, our simplified one-orifice venoplasty technique could secure venous outflow and improve graft function during right lobe LDLT. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Years Versus Days Between Successive Surgeries, After an Initial Outpatient Procedure, for the Median Patient Versus the Median Surgeon in the State of Iowa.

    Science.gov (United States)

    Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

    2018-03-01

    Previously, we studied the relative importance of different institutional interventions that the largest hospital in Iowa could take to grow the anesthesia department's outpatient surgical care. Most (>50%) patients having elective surgery had not previously had surgery at the hospital. Patient perioperative experience was unimportant for influencing total anesthesia workload and numbers of patients. More important was the availability of surgical clinic appointments within several days. These results would be generalizable if the median time from surgery to a patient's next surgical procedure was large (eg, >2 years), among all hospitals in Iowa with outpatient surgery, and without regard to the hospital where the next procedure was performed. There were 37,172 surgical cases at hospital outpatient departments of any of the 117 hospitals in Iowa from July 1, 2013, to September 30, 2013. Data extracted about each case included its intraoperative work relative value units. The 37,172 cases were matched to all inpatient and outpatient records for the next 2 years statewide using patient linkage identifiers; from these were determined whether the patient had surgery again within 2 years. Furthermore, the cases' 1820 surgeons were matched to the surgeon's next outpatient or inpatient case, both including and excluding other cases performed on the date of the original case. By patient, the median time to their next surgical case, either outpatient or inpatient, exceeded 2 years, tested with weighting by intraoperative relative value units and repeated when unweighted (both P 2 years for patients versus 1 day for surgeons. Thus, although patients' experiences are an important attribute of quality of care, surgeons' experiences are orders of magnitude more important from the vantage point of marketing and growth of an anesthesia practice.

  15. Transcatheter pledget-assisted suture tricuspid annuloplasty (PASTA) to create a double-orifice valve.

    Science.gov (United States)

    Khan, Jaffar M; Rogers, Toby; Schenke, William H; Greenbaum, Adam B; Babaliaros, Vasilis C; Paone, Gaetano; Ramasawmy, Rajiv; Chen, Marcus Y; Herzka, Daniel A; Lederman, Robert J

    2018-02-06

    Pledget-assisted suture tricuspid valve annuloplasty (PASTA) is a novel technique using marketed equipment to deliver percutaneous trans-annular sutures to create a double-orifice tricuspid valve. Tricuspid regurgitation is a malignant disease with high surgical mortality and no commercially available transcatheter solution in the US. Two iterations of PASTA were tested using trans-apical or trans-jugular access in swine. Catheters directed paired coronary guidewires to septal and lateral targets on the tricuspid annulus under fluoroscopic and echocardiographic guidance. Guidewires were electrified to traverse the annular targets and exchanged for pledgeted sutures. The sutures were drawn together and knotted, apposing septal and lateral targets, creating a double orifice tricuspid valve. Twenty-two pigs underwent PASTA. Annular and chamber dimensions were reduced (annular area, 10.1 ± 0.8 cm 2 to 3.8 ± 1.5 cm 2 (naïve) and 13.1 ± 1.5 cm 2 to 6.2 ± 1.0 cm 2 (diseased); septal-lateral diameter, 3.9 ± 0.3 mm to 1.4 ± 0.6 mm (naïve) and 4.4 ± 0.4 mm to 1.7 ± 1.0 mm (diseased); and right ventricular end-diastolic volume, 94 ± 13 ml to 85 ± 14 ml (naïve) and 157 ± 25 ml to 143 ± 20 ml (diseased)). MRI derived tricuspid regurgitation fraction fell from 32 ± 12% to 4 ± 5%. Results were sustained at 30 days. Pledget pull-through force was five-fold higher (40.6 ± 11.7N vs 8.0 ± 2.6N, P PASTA reduces annular dimensions and tricuspid regurgitation in pigs. It may be cautiously applied to selected patients with severe tricuspid regurgitation and no options. This is the first transcatheter procedure, to our knowledge, to deliver standard pledgeted sutures to repair cardiac pathology. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

  16. Effectiveness and safety of combined cataract surgery and microhook ab interno trabeculotomy in Japanese eyes with glaucoma: report of an initial case series.

    Science.gov (United States)

    Tanito, Masaki; Ikeda, Yoshifumi; Fujihara, Etsuko

    2017-11-01

    To report the early postoperative results and safety profile of ab interno microhook trabeculotomy (μLOT) combined with cataract surgery. This retrospective observational case series included 68 consecutive glaucomatous eyes of 23 Japanese men and 25 Japanese women [mean (SD) age, 76.0 ± 8.5 years] who underwent μLOT for intraocular pressure (IOP) and visually relevant cataracts. The LOT site/extent, perioperative complications, and complication treatments were collected from the medical and surgical records. The preoperative and postoperative IOP, numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare, and corneal endothelial cell density (CECD) were compared. After small incisional cataract surgery, the trabecular meshwork was incised in the nasal (6 eyes, 3.6 ± 0.5 clock hours), temporal (6 eyes, 3.8 ± 0.8 clock hours), or both nasal and temporal (56 eyes, 6.5 ± 0.6 clock hours) angles. The mean preoperative IOP (16.4 ± 2.9 mmHg) and number of antiglaucoma medications (2.4 ± 1.2) decreased significantly (P control of 15 mmHg or less and IOP reduction of 15% or greater. Combined μLOT and cataract surgery improves IOP and VA during the early postoperative period in patients with glaucoma and cataract.

  17. Investigation on Hydrodynamic Cavitation of a Restriction Orifice and Static Mixer on Crud-like Deposits

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Man; Lee, Seung Won; Park, Seong Dae; Kang, Sa Rah; Seo, Han; Bang, In Cheol [Ulsan National Institute of Science and Technology, Ulsan (Korea, Republic of)

    2012-05-15

    Axial Offset Anomaly (AOA) referring to an unexpected neutron flux depression is also known as Crud Induced Power Shift (CIPS). Fuel assemblies removed from an AOA core have shown a thick porous deposition layer of crud on fuel clad surface. The deposition layer was induced by precipitation reactions of both boron species and crud during sub-cooled nucleate boiling. Therefore, to resolve the AOA issues, a fuel cleaning technology using ultrasonic cavitation has been developed by EPRI and applied to the domestic NPPs by KNF. However, the performance of crud removal during maintenance of NPPs is known to be not enough. Hydrodynamic cavitation is the process of vaporization, bubble generation and bubble implosion which occurs in a flowing liquid as a result of decrease and subsequent increase in pressure. Hydrodynamic cavitation generates shock pressure of a few tens MPa due to bubble collapse like the cavitation generated by Ultrasonics. It is well known that the cavitation can erode the metal surface. The idea of the current study is that such energetic cavitation bubble collapses could help to remove the crud from the fuel assembly. Therefore, the current study first investigates effects of hydrodynamic cavitation occurred from a single hole orifice and static mixer fundamentally

  18. Effects of Hydrodynamic Cavitation of a Restriction Orifice on Crud-like Deposits

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Man; Lee, Seung Won; Park, Sung Dae; Kang, Sarah; Seo, Han; Bang, In Cheol [Ulsan National Institute of Science and Technology, Ulsan (Korea, Republic of)

    2011-10-15

    Axial Offset Anomaly (AOA) referring to an unexpected neutron flux depression is also known as Crud Induced Power Shift (CIPS). Fuel assemblies removed from an AOA core has shown a thick porous deposition layer of crud on fuel clad surface. The deposition layer was induced by precipitation reactions of both boron species and crud during sub-cooled nucleate boiling. Therefore, to resolve the AOA issues, a fuel cleaning technology using ultrasonic cavitation has been developed by EPRI and applied to the domestic NPPs by KNF. However, the performance of crud removal during maintenance of NPPs is known to be not enough. Hydrodynamic cavitation is the process of vaporization, bubble generation and bubble implosion which occurs in a flowing liquid as a result of decrease and subsequent increase in pressure. Hydrodynamic cavitation generates shock pressure of a few tens MPa due to bubble collapse like the cavitation generated by Ultrasonics. It is well known that the cavitation can erode the metal surface. The idea of the current study is that such energetic cavitation bubble collapses could help to remove the crud from the fuel assembly. Therefore, the current study first investigates effects of hydrodynamic cavitation occurred from a single hole orifice fundamentally

  19. Investigation on Hydrodynamic Cavitation of a Restriction Orifice and Static Mixer on Crud-like Deposits

    International Nuclear Information System (INIS)

    Kim, Seong Man; Lee, Seung Won; Park, Seong Dae; Kang, Sa Rah; Seo, Han; Bang, In Cheol

    2012-01-01

    Axial Offset Anomaly (AOA) referring to an unexpected neutron flux depression is also known as Crud Induced Power Shift (CIPS). Fuel assemblies removed from an AOA core have shown a thick porous deposition layer of crud on fuel clad surface. The deposition layer was induced by precipitation reactions of both boron species and crud during sub-cooled nucleate boiling. Therefore, to resolve the AOA issues, a fuel cleaning technology using ultrasonic cavitation has been developed by EPRI and applied to the domestic NPPs by KNF. However, the performance of crud removal during maintenance of NPPs is known to be not enough. Hydrodynamic cavitation is the process of vaporization, bubble generation and bubble implosion which occurs in a flowing liquid as a result of decrease and subsequent increase in pressure. Hydrodynamic cavitation generates shock pressure of a few tens MPa due to bubble collapse like the cavitation generated by Ultrasonics. It is well known that the cavitation can erode the metal surface. The idea of the current study is that such energetic cavitation bubble collapses could help to remove the crud from the fuel assembly. Therefore, the current study first investigates effects of hydrodynamic cavitation occurred from a single hole orifice and static mixer fundamentally

  20. Effects of Hydrodynamic Cavitation of a Restriction Orifice on Crud-like Deposits

    International Nuclear Information System (INIS)

    Kim, Seong Man; Lee, Seung Won; Park, Sung Dae; Kang, Sarah; Seo, Han; Bang, In Cheol

    2011-01-01

    Axial Offset Anomaly (AOA) referring to an unexpected neutron flux depression is also known as Crud Induced Power Shift (CIPS). Fuel assemblies removed from an AOA core has shown a thick porous deposition layer of crud on fuel clad surface. The deposition layer was induced by precipitation reactions of both boron species and crud during sub-cooled nucleate boiling. Therefore, to resolve the AOA issues, a fuel cleaning technology using ultrasonic cavitation has been developed by EPRI and applied to the domestic NPPs by KNF. However, the performance of crud removal during maintenance of NPPs is known to be not enough. Hydrodynamic cavitation is the process of vaporization, bubble generation and bubble implosion which occurs in a flowing liquid as a result of decrease and subsequent increase in pressure. Hydrodynamic cavitation generates shock pressure of a few tens MPa due to bubble collapse like the cavitation generated by Ultrasonics. It is well known that the cavitation can erode the metal surface. The idea of the current study is that such energetic cavitation bubble collapses could help to remove the crud from the fuel assembly. Therefore, the current study first investigates effects of hydrodynamic cavitation occurred from a single hole orifice fundamentally

  1. THE PERFORMANCE ANALYSIS OF A PACKED COLUMN : CALIBRATION OF AN ORIFICE

    Directory of Open Access Journals (Sweden)

    Aynur ŞENOL

    2003-01-01

    Full Text Available Investigations to develop data for this study were made using a pilot scale glass column of 9 cm inside diameter randomly filled to a depth of 1.90 cm with a Raschig type ring at a slightly modified geometry. The geometrical characteristics of packing are: the total area of a single particle ad = 2.3 cm2; specific area ap = 10.37 cm2/cm3; voidage ? = 0.545 m3/m3. The efficiency tests were run using trichloroethylene/n-heptane system under total reflux conditions. Using the modified versions of the Eckert flooding model and the Bravo effective area (ae approach, as well as the Onda wetted area (aw and individual mass transfer coefficient models, it has been attempted to estimate the packing efficiency theoretically. This article also deals with the design strategies attributed to a randomly packed column. Emphasis is mainly placed on the way to formulate an algorithm of designing a pilot scale column through the models being attributed to the film theory. Using the column dry pressure drop properties based on the air flowing it has been achieved a generalized flow rate approach for calibrating of an orifice through which the air passes.

  2. Oxide deposition in the orifices of AGR boiler inlet ferrule assemblies

    International Nuclear Information System (INIS)

    Thomas, D.M.

    1988-08-01

    In experiments designed to study the erosion-corrosion behaviour of AGR boiler inlet ferrules using the CERL high velocity circulating isothermal water rig, oxide deposition was frequently found within the flow control orifices. The present investigation was carried out as a preliminary to a programme of experiments addressed specifically to this problem. Analysis shows the deposits to be predominantly magnetite (or possible maghemite) with traces of α-haematite. Calculations indicate that the maximum rate of magnetite deposition is mass transfer limited, although in some experiments no deposition occurred in cases where mass transfer would have allowed substantial deposition. Thus the occurrence of deposition is thought to depend on the rig potential as this varies with experimental conditions. In these experiments the surface potential is not found to be governed by the hydrogen level. Metallographic cross-sections through the ferrule control bores show the deposits to be found in regions of separated flow, and the flow markings in the deposits show that the flow is turbulent in these zones. The exact morphology is thought to be influenced by machining marks within the control bore. (author)

  3. Does bladder outlet obstruction affect distance between the ureteric orifices in patients with benign prostate hyperplasia?

    Directory of Open Access Journals (Sweden)

    Cüneyt Özden

    2009-01-01

    Full Text Available Objectives: Many morphological changes occur in the bladder due to bladder outlet obstruction (BOO in pa-tients with benign prostate hyperplasia (BPH. In the present study we evaluated the relationship between in-terureteric distance (IUD of the orifices and BOO in BPH patients.Materials and methods: Thirty-seven consecutive pa-tients with lower urinary tract symptoms at the urology polyclinic included in the study. Patients divided into 2 groups according to maximal flow rate (Qmax. The first group constituted of 18 patients with Qmax 15ml/s. The IUD measurement was performed with Doppler ultrasonography.Results: There was no significant difference between the groups regarding mean age and prostate volume. Mean IUD in the first group was 32.7±5.4 mm and mean IUD in the second group was 31.5±5.1 mm. There was no statistically significant difference between the groups regarding the IUD.Conclusions: Data obtained from the study revealed that measurement of IUD with Doppler ultrasonography not significantly related to BOO.

  4. Liquid hydrogen mass flow through a multiple orifice Joule-Thomson device

    International Nuclear Information System (INIS)

    Papell, S.S.; Nyland, T.W.; Saiyed, N.H.

    1992-07-01

    Liquid hydrogen mass flow rate, pressure drop, and temperature drop data were obtained for a number of multiple orifice Joule-Thomson devices known as visco jets. The present investigation continues a study to develop an equation for predicting two phase flow of cryogens through these devices. The test apparatus design allowed isenthalpic expansion of the cryogen through the visco jets. The data covered a range of inlet and outlet operating conditions. The mass flow rate range single phase or two phase was 0.015 to 0.98 lbm/hr. The manufacturer's equation was found to overpredict the single phase hydrogen data by 10 percent and the two phase data by as much as 27 percent. Two modifications of the equation resulted in a data correlation that predicts both the single and two phase flow across the visco jet. The first modification was of a theoretical nature, and the second strictly empirical. The former reduced the spread in the two phase data. It was a multiplication factor of 1-X applied to the manufacturer's equation. The parameter X is the flow quality downstream of the visco jet based on isenthalpic expansion across the device. The latter modification was a 10 percent correction term that correlated 90 percent of the single and two phase data to within +/- 10 percent scatter band. 3 refs

  5. Experimental study of mixed convection flow through a horizontal orifice or vent linking two compartments

    International Nuclear Information System (INIS)

    Varrall, Kevin

    2016-01-01

    To answer building issues and fire safety challenges, this thesis deals with the mixed convection flow through a horizontal orifice or vent linking two compartments. The aim is to improve the understanding and the modeling of the exchange of gas through the opening. A small scale experimental study and a theoretical approach are proposed. The study focuses first on the influence of the geometrical ratio L/D of the opening on the flow rate at the vent for free convection regime. Non-intrusive measurements, via the tracking of the interface between two non miscible liquids in an isothermal approach, and thanks to the SPIV in a thermal approach, permit to describe the bidirectional exchange process and to consolidate existing correlations. Experiments for mixed convection regime aim to study the impact of mechanical ventilation (in blowing and extracting modes) on the exchanged flow rates. The comparison between existing correlations and experimental data shows large differences. A modification of the correlation of Cooper is proposed. A theoretical approach from the simplified Navier Stokes equations and with the Boussinesq approximation permits to discuss the construction of existing correlations. From this theory, a more accurate model than those available in the literature is proposed thanks to an adjustment of discharge coefficients from experimental data. (author)

  6. Minimally invasive single-site surgery for the digestive system: A technological review

    Directory of Open Access Journals (Sweden)

    Dhumane Parag

    2011-01-01

    Full Text Available Minimally Invasive Single Site (MISS surgery is a better terminology to explain the novel concept of scarless surgery, which is increasingly making its way into clinical practice. But, there are some difficulties. We review the existing technologies for MISS surgery with regards to single-port devices, endoscope and camera, instruments, retractors and also the future perspectives for the evolution of MISS surgery. While we need to move ahead cautiously and wait for the development of appropriate technology, we believe that the "Ultimate form of Minimally Invasive Surgery" will be a hybrid form of MISS surgery and Natural Orifice Transluminal Endoscopic Surgery, complimented by technological innovations from the fields of robotics and computer-assisted surgery.

  7. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  8. Bariatric Surgery

    Science.gov (United States)

    ... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

  9. Lung surgery

    Science.gov (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  10. Plastic Surgery

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  11. [Alternative approaches in thyroid surgery].

    Science.gov (United States)

    Maurer, E; Wächter, S; Bartsch, D K

    2017-08-01

    In thyroid surgery multiple different cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed in the last 20 years. The aim of all these alternative approaches to the thyroid gland is optimization of the cosmetic result. The indications for the use of alternative and conventional approaches are principally the same. Important requirements for the use of alternative methods are nevertheless a broad experience in conventional thyroid operations of the thyroid and adequate patient selection under consideration of the size of the thyroid and the underlying pathology. Contraindications for the use of alternative approaches are a large size of the thyroid gland including local symptoms, advanced carcinomas, reoperations and previous radiations of the anterior neck. The current article gives an overview of the clinically implemented alternative approaches for thyroid surgery. Of those the majority must still be considered as experimental. The alternative approaches to the thyroid gland can be divided in cervical minimally invasive, extracervical endosopic (robot-assisted) and transoral operations (natural orifice transluminal endoscopic surgery, NOTES). Since conventional thyroid operations are standardized procedures with low complication rates, alternative approaches to the thyroid gland are considered critically in Germany. The request for a perfect cosmetic result should not overweigh patients' safety. Only a few alternative approaches (e. g. MIVAT, RAT) can yet be considered as a safe addition in experienced hands in highly selected patients.

  12. Combined robotic transanal total mesorectal excision (R-taTME) and single-site plus one-port (R-SSPO) technique for ultra-low rectal surgery-initial experience with a new operation approach.

    Science.gov (United States)

    Kuo, Li-Jen; Ngu, James Chi-Yong; Tong, Yiu-Shun; Chen, Chia-Che

    2017-02-01

    Robot-assisted rectal surgery is gaining popularity, and robotic single-site surgery is also being explored clinically. We report our initial experience with robotic transanal total mesorectal excision (R-taTME) and radical proctectomy using the robotic single-site plus one-port (R-SSPO) technique for low rectal surgery. Between July 2015 and March 2016, 15 consecutive patients with ultra-low rectal lesions underwent R-taTME followed by radical proctectomy using the R-SSPO technique by a single surgeon. The clinical and pathological results were retrospectively analyzed. The median operative time was 473 (range, 335-569) min, and the estimated blood loss was 33 (range, 30-50) mL. The median number of lymph nodes harvested was 12 (range, 8-18). The median distal resection margin was 1.4 (range, 0.4-3.5) cm, and all patients had clear circumferential resection margins. We encountered a left ureteric transection intraoperatively in one patient, and another patient required reoperation for postoperative adhesive intestinal obstruction. There was no 30-day mortality. R-taTME followed by radical proctectomy using the R-SSPO technique for patients with low rectal lesions is technically feasible and safe without compromising oncologic outcomes. However, there were considerable limitations and a steep learning curve using current robotic technology.

  13. Evaluation of the flow-accelerated corrosion downstream of an orifice. 2. Measurement of corrosion rate and evaluation on the effects of the flow field

    International Nuclear Information System (INIS)

    Nagaya, Yukinori; Utanohara, Yoichi; Nakamura, Akira; Murase, Michio

    2008-01-01

    In this study, in order to evaluate the effects of flow field on corrosion rate due to flow accelerated corrosion (FAC), a corrosion rate downstream of an orifice was measured using the electric resistance method. The diameter of the pipe is 50 mm and that of the orifice is 24.3 mm, and flow velocity of the experimental loop was set at 5m/s, and the temperature of water was controlled within ±1 at 150deg-C. There were no significant circumferential difference in measured corrosion rate, and the maximum corrosion rate was observed at 1D or 2D downstream from the orifice. The ratios of the measured corrosion rate and the calculated wall shear stress at the 1D downstream from the orifice to the value at upstream under well developed flow agreed well. (author)

  14. Initial laboratory experience with a novel ultrasound probe for standard and single-port robotic kidney surgery: increasing console surgeon autonomy and minimizing instrument clashing.

    Science.gov (United States)

    Yakoubi, Rachid; Autorino, Riccardo; Laydner, Humberto; Guillotreau, Julien; White, Michael A; Hillyer, Shahab; Spana, Gregory; Khanna, Rakesh; Isaac, Wahib; Haber, Georges-Pascal; Stein, Robert J; Kaouk, Jihad H

    2012-06-01

    The aim of this study was to evaluate a novel ultrasound probe specifically developed for robotic surgery by determining its efficiency in identifying renal tumors. The study was carried out using the Da Vinci™ surgical system in one female pig. Renal tumor targets were created by percutaneous injection of a tumor mimic mixture. Single-port and standard robotic partial nephrectomy were performed. Intraoperative ultrasound was performed using both standard laparoscopic probe and the new ProART™ Robotic probe. Probe maneuverability and ease of handling for tumor localization were recorded. The standard laparoscopic probe was guided by the assistant. Significant clashing with robotic arms was noted during the single-port procedure. The novel robotic probe was easily introduced through the assistant trocar, and held by the console surgeon using the robotic Prograsp™ with no registered clashing in the external operative field. The average time for grasping the new robotic probe was less than 10 s. Once inserted and grasped, no limitation was found in terms of instrument clashing during the single-port procedure. This novel ultrasound probe developed for robotic surgery was noted to be user-friendly when performing porcine standard and especially single-port robotic partial nephrectomy. Copyright © 2011 John Wiley & Sons, Ltd.

  15. Robotic laparoendoscopic single-site surgery: From present to future

    Directory of Open Access Journals (Sweden)

    Ayhan Verit

    2012-01-01

    Full Text Available The continued effort of improving cosmesis and reducing morbidity in urologic surgery has given rise to novel alternatives to traditional minimally invasive techniques: Laparoendoscopic Single-site Surgery (LESS and Natural Orifice Transluminal Endoscopic Surgery (NOTES. Despite the development of specialized access devices and instruments, the performance of complex procedures using LESS has been challenging due to loss of triangulation and instrument clashing. A robotic interface may represent the key factor in overcoming the critical restrictions related to NOTES and LESS. Although encouraging, current clinical evidence related to R-LESS remains limited as the current da Vinci® robotic platform has not been specifically designed for LESS. Robotic innovations are imminent and are likely to govern major changes to the current landscape of scarless surgery.

  16. Decolorization of Acid Orange 7 by an electric field-assisted modified orifice plate hydrodynamic cavitation system: Optimization of operational parameters.

    Science.gov (United States)

    Jung, Kyung-Won; Park, Dae-Seon; Hwang, Min-Jin; Ahn, Kyu-Hong

    2015-09-01

    In this study, the decolorization of Acid Orange 7 (AO-7) with intensified performance was obtained using hydrodynamic cavitation (HC) combined with an electric field (graphite electrodes). As a preliminary step, various HC systems were compared in terms of decolorization, and, among them, the electric field-assisted modified orifice plate HC (EFM-HC) system exhibited perfect decolorization performance within 40 min of reaction time. Interestingly, when H2O2 was injected into the EFM-HC system as an additional oxidant, the reactor performance gradually decreased as the dosing ratio increased; thus, the remaining experiments were performed without H2O2. Subsequently, an optimization process was conducted using response surface methodology with a Box-Behnken design. The inlet pressure, initial pH, applied voltage, and reaction time were chosen as operational key factors, while decolorization was selected as the response variable. The overall performance revealed that the selected parameters were either slightly interdependent, or had significant interactive effects on the decolorization. In the verification test, complete decolorization was observed under statistically optimized conditions. This study suggests that EFM-HC is a useful method for pretreatment of dye wastewater with positive economic and commercial benefits. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  18. A New Era of Minimally Invasive Surgery: Progress and Development of Major Technical Innovations in General Surgery Over the Last Decade.

    Science.gov (United States)

    Siddaiah-Subramanya, Manjunath; Tiang, Kor Woi; Nyandowe, Masimba

    2017-10-01

    Minimally invasive surgery (MIS) continues to play an important role in general surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation have seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We look at the differences in new developments and advancement in the different techniques in the last 10 years. We also aim to explain these differences as well as the implications in general surgery for the future.

  19. Natural orifice transgastric endoscopic wedge hepatic resection in an experimental model using an intuitively controlled master and slave transluminal endoscopic robot (MASTER).

    Science.gov (United States)

    Phee, S J; Ho, K Y; Lomanto, D; Low, S C; Huynh, V A; Kencana, A P; Yang, K; Sun, Z L; Chung, S C Sydney

    2010-09-01

    The lack of triangulation of standard endoscopic devices limits the degree of freedom for surgical maneuvers during natural orifice transluminal endoscopic surgery (NOTES). This study explored the feasibility of adapting an intuitively controlled master and slave transluminal endoscopic robot (MASTER) the authors developed to facilitate wedge hepatic resection in NOTES. The MASTER consists of a master controller, a telesurgical workstation, and a slave manipulator that holds two end-effectors: a grasper, and a monopolar electrocautery hook. The master controller is attached to the wrist and fingers of the operator and connected to the manipulator by electrical and wire cables. Movements of the operator are detected and converted into control signals driving the slave manipulator via a tendon-sheath power transmission mechanism allowing nine degrees of freedom. Using this system, wedge hepatic resection was performed through the transgastric route on two female pigs under general anesthesia. Entry into the peritoneal cavity was via a 10-mm incision made on the anterior wall of the stomach by the electrocautery hook. Wedge hepatic resection was performed using the robotic grasper and hook. Hemostasis was achieved with the electrocautery hook. After the procedure, the resected liver tissue was retrieved through the mouth using the grasper. Using the MASTER, transgastric wedge hepatic resection was successfully performed on two pigs with no laparoscopic assistance. The entire procedure took 9.4 min (range, 8.5-10.2 min), with 7.1 min (range, 6-8.2 min) spent on excision of the liver tissue. The robotics-controlled device was able to grasp, retract, and excise the liver specimen successfully in the desired plane. This study demonstrated for the first time that the MASTER could effectively mitigate the technical constraints normally encountered in NOTES procedures. With it, the triangulation of surgical tools and the manipulation of tissue became easy, and wedge hepatic

  20. A computational investigation on the influence of the use of elliptical orifices on the inner nozzle flow and cavitation development in diesel injector nozzles

    International Nuclear Information System (INIS)

    Molina, S.; Salvador, F.J.; Carreres, M.; Jaramillo, D.

    2014-01-01

    Highlights: • The influence of elliptical orifices on the inner nozzle flow is compared. • Five nozzles with different elliptical and circular orifices are simulated. • Differences in the flow coefficients and cavitation morphology are observed. • Horizontal axis orifices are ease to cavitate, with a higher discharge coefficient. • A better mixing process quality is expected for the horizontal major axis nozzles. - Abstract: In this paper a computational study was carried out in order to investigate the influence of the use of elliptical orifices on the inner nozzle flow and cavitation development. With this aim, a large number of injection conditions have been simulated and analysed for 5 different nozzles: four nozzles with different elliptical orifices and one standard nozzle with circular orifices. The four elliptical nozzles differ from each other in the orientation of the major axis (vertical or horizontal) and in the eccentricity value, but keeping the same outlet section in all cases. The comparison has been made in terms of mass flow, momentum flux and other important non-dimensional parameters which help to describe the behaviour of the inner nozzle flow: discharge coefficient (C d ), area coefficient (C a ) and velocity coefficient (C v ). The simulations have been done with a code able to simulate the flow under either cavitating or non-cavitating conditions. This code has been previously validated using experimental measurements over the standard nozzle with circular orifices. The main results of the investigation have shown how the different geometries modify the critical cavitation conditions as well as the discharge coefficient and the effective velocity. In particular, elliptical geometries with vertically oriented major axis are less prone to cavitate and have a lower discharge coefficient, whereas elliptical geometries with horizontally oriented major axis are more prone to cavitate and show a higher discharge coefficient

  1. Evaluation of native hyaline cartilage and repair tissue after two cartilage repair surgery techniques with 23Na MR imaging at 7 T: initial experience.

    Science.gov (United States)

    Zbýň, S; Stelzeneder, D; Welsch, G H; Negrin, L L; Juras, V; Mayerhoefer, M E; Szomolanyi, P; Bogner, W; Domayer, S E; Weber, M; Trattnig, S

    2012-08-01

    To compare the sodium normalized mean signal intensity (NMSI) values between patients after bone marrow stimulation (BMS) and matrix-associated autologous chondrocyte transplantation (MACT) cartilage repair procedures. Nine BMS and nine MACT patients were included. Each BMS patient was matched with one MACT patient according to age [BMS 36.7 ± 10.7 (mean ± standard deviation) years; MACT 36.9 ± 10.0 years], postoperative interval (BMS 33.5 ± 25.3 months; MACT 33.2 ± 25.7 months), and defect location. All magnetic resonance imaging (MRI) measurements were performed on a 7 T system. Proton images served for morphological evaluation of repair tissue using the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system. Sodium NMSI values in the repair area and morphologically normal cartilage were calculated. Clinical outcome was assessed right after MRI. Analysis of covariance, t-tests, and Pearson correlation coefficients were evaluated. Sodium NMSI was significantly lower in BMS (P = 0.004) and MACT (P = 0.006) repair tissue, compared to reference cartilage. Sodium NMSI was not different between the reference cartilage in MACT and BMS patients (P = 0.664), however it was significantly higher in MACT than in BMS repair tissue (P = 0.028). Better clinical outcome was observed in BMS than in MACT patients. There was no difference between MOCART scores for MACT and BMS patients (P = 0.915). We did not observe any significant correlation between MOCART score and sodium repair tissue NMSI (r = -0.001; P = 0.996). Our results suggest higher glycosaminoglycan (GAG) content, and therefore, repair tissue of better quality in MACT than in BMS patients. Sodium imaging might be beneficial in non-invasive evaluation of cartilage repair surgery efficacy. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  2. Pressure drop calculation using a one-dimensional mathematical model for two-phase flow through an orifice

    DEFF Research Database (Denmark)

    Petkov, K.P.; Puton, M; Madsen, Søren Peder

    2014-01-01

    are accounted for through both friction and acceleration as in a conventional formulation. However, in this analysis the acceleration term is both attributed geometrical effects through the area change and fluid dynamic effects through the expansion of the two-phase flow. The comparison of numerical...... is a one dimensional formulation in space and the equations incorporates the change in tubes and orifice diameter as formulated in (S. Madsen et.al., Dynamic Modeling of Phase Crossings in Two-Phase Flow, Communications in Computational Physics 12 (4), 1129-1147). The pressure changes in the flow...

  3. Robotic surgery

    Science.gov (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  4. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2018. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  5. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  6. Thyroid Surgery

    Science.gov (United States)

    ... Hypothyroidism in Children and Adolescents Pediatric Differentiated Thyroid Cancer Thyroid Nodules in Children and Adolescents Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery FAQs PDF En Español Cirugia De La Tiroides El folleto de Cirugia De La Tiroides Search Thyroid ...

  7. Experimental otitis media with effusion induced by electron beam irradiation to pharyngeal orifice of auditory tube in guinea pig

    International Nuclear Information System (INIS)

    Kokubu, Michiyo; Amatsu, Mutsuo

    1984-01-01

    The purpose of the present study was to obtain a more natural tubal insufficiency than that obtained by the conventional methods to clarify the middle ear pathology associated with tubal dysfunction. For this purpose, the pharyngeal orifice of the auditory tube in the guinea pigs was irradiated with electron beam with a dose of 2,000 rad following the preliminary experiments to determine the appropriate dose. The guinea pigs with intact drum and normal Pryer reflex were used for the present experiment series. A specially devised apparatus was used for avoiding the dipersing beam. Histopathological changes of the middle ear and auditory tube were observed in a series of single specimen with H-E staining 1, 2, 3, 6, 12 months after irradiation. In this study, middle ear with effusion was used to clarify the dynamic process of the pathological changes between the auditory tube and the middle ear. In summary, the present study revealed that the electron beam irradiation to the pharyngeal orifice caused various grades of otitis media with effusion which could be classified into three groups. Of these groups 1) and 2), 3) were likely to be corresponding with so-called serous and purulent otitis media with effusion in human respectively. Infection due to the malfunction caused by the epithelial damage of the auditory tube was an important promoting factor to change the serous type effusion for the purulent type effusion. (J.P.N.)

  8. Quantitative characterization of near-field fuel sprays by multi-orifice direct injection using ultrafast x-tomography technique

    International Nuclear Information System (INIS)

    Liu, X.; Im, K.S.; Wang, Y.; Wang, J.; Hung, D.L.S.; Winkelman, J.R.; Tate, M.W.; Ercan, A.; Koerner, L.J.; Caswell, T.; Chamberlain, D.; Schuette, D.R.; Philipp, H.; Smilgies, D.M.; Gruner, S.M.

    2006-01-01

    A low-pressure direct injection fuel system for spark ignition direct injection engines has been developed, in which a high-turbulence nozzle technology was employed to achieve fine fuel droplet size at a low injection pressure around 2 MPa. It is particularly important to study spray characteristics in the near-nozzle region due to the immediate liquid breakup at the nozzle exit. By using an ultrafast x-ray area detector and intense synchrotron x-ray beams, the interior structure and dynamics of the direct injection gasoline sprays from a multi-orifice turbulence-assisted nozzle were elucidated for the first time in a highly quantitative manner with μs-temporal resolution. Revealed by a newly developed, ultrafast computed x-microtomography technique, many detailed features associated with the transient liquid flows are readily observable in the reconstructed spray. Furthermore, an accurate 3-dimensional fuel density distribution, in the form of fuel volume fraction, was obtained by the time-resolved computed tomography. The time-dependent fuel density distribution revealed that the fuel jet is well broken up immediately at the nozzle exits. These results not only reveal the near-field characteristics of the partial atomized fuel sprays with unprecedented detail, but also facilitate the development of an advanced multi-orifice direct injector. This ultrafast tomography capability also will facilitate the realistic computational fluid dynamic simulations in highly transient and multiphase fuel spray systems.

  9. New Developments in Robotics and Single-site Gynecologic Surgery.

    Science.gov (United States)

    Matthews, Catherine A

    2017-06-01

    Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience. Single-port hysterectomy has not improved postoperative pain or subjective cosmetic results. Emerging platforms with flexible, articulating instruments may increase the uptake of single-port procedures including natural orifice transluminal endoscopic cases.

  10. Technological advances in robotic-assisted laparoscopic surgery.

    Science.gov (United States)

    Tan, Gerald Y; Goel, Raj K; Kaouk, Jihad H; Tewari, Ashutosh K

    2009-05-01

    In this article, the authors describe the evolution of urologic robotic systems and the current state-of-the-art features and existing limitations of the da Vinci S HD System (Intuitive Surgical, Inc.). They then review promising innovations in scaling down the footprint of robotic platforms, the early experience with mobile miniaturized in vivo robots, advances in endoscopic navigation systems using augmented reality technologies and tracking devices, the emergence of technologies for robotic natural orifice transluminal endoscopic surgery and single-port surgery, advances in flexible robotics and haptics, the development of new virtual reality simulator training platforms compatible with the existing da Vinci system, and recent experiences with remote robotic surgery and telestration.

  11. Wall-resolved Large Eddy Simulation of a flow through a square-edged orifice in a round pipe at Re = 25,000

    Energy Technology Data Exchange (ETDEWEB)

    Benhamadouche, S., E-mail: sofiane.benhamadouche@edf.fr; Arenas, M.; Malouf, W.J.

    2017-02-15

    Highlights: • Wall-resolved LES can predict the flow through a square-edged orifice at Re = 25,000. • LES results are compared with the available experimental data and ISO 5167-2. • Pressure loss and discharge coefficients are in very good agreement with ISO 5167-2. • The present wall-resolved LES could be used as reference data for RANS validation. - Abstract: The orifice plate is a pressure differential device frequently used for flow measurements in pipes across different industries. The present study demonstrates the accuracy obtainable using a wall-resolved Large Eddy Simulation (LES) approach to predict the velocity, the Reynolds stresses, the pressure loss and the discharge coefficient for a flow through a square-edged orifice in a round pipe at a Reynolds number of 25,000. The ratio of the orifice diameter to the pipe diameter is β = 0.62, and the ratio of the orifice thickness to the pipe diameter is 0.11. The mesh is sized using refinement criteria at the wall and preliminary RANS results to ensure that the solution is resolved beyond an estimated Taylor micro-scale. The inlet condition is simulated using a recycling method, and the LES is run with a dynamic Smagorinsky sub-grid scale (SGS) model. The sensitivity to the SGS model and to the pressure–velocity coupling is shown to be small in the present study. The LES is compared with the available experimental data and ISO 5167-2. In general, the LES shows good agreement with the velocity from the experimental data. The profiles of the Reynolds stresses are similar, but an offset is observed in the diagonal stresses. The pressure loss and discharge coefficients are shown to be in very good agreement with the predictions of ISO 5167-2. Therefore, the wall-resolved LES is shown to be highly accurate in simulating the flow across a square-edged orifice.

  12. Quantitative analysis of the side-branch orifice after bifurcation stenting using en-face processing of OCT images: a comparison between Xience V and Resolute Integrity stents.

    Science.gov (United States)

    Minami, Yoshiyasu; Wang, Zhao; Aguirre, Aaron D; Lee, Stephen; Uemura, Shiro; Soeda, Tsunenari; Vergallo, Rocco; Raffel, Owen C; Barlis, Peter; Itoh, Tomonori; Lee, Hang; Fujimoto, James; Jang, Ik-Kyung

    2016-01-01

    Methods for intravascular assessment of the side-branch (SB) orifice after stenting are not readily available. The aim of this study was to assess the utility of an en-face projection processing for optical coherence tomography (OCT) images for SB evaluation. Measurements of the SB orifice obtained using en-face OCT images were validated using a phantom model. Linear regression modeling was applied to estimated area measurements made on the en-face images. The SB orifice was then analyzed in 88 patients with bifurcation lesions treated with either Xience V (everolimus-eluting stent) or Resolute Integrity [zotarolimus-eluting stent (ZES)]. The SB orifice area (A) and the area obstructed by struts (B) were calculated, and the %open area was evaluated as (A-B)/A*100. Linear regression modeling demonstrated that the observed departures of the intercept and slope were not significantly different from 0 (-0.12 ± 0.22, P=0.59) and 1 (1.01 ± 0.06, R(2)=0.88, P=0.87), respectively. In cases without SB dilatation, the %open area was significantly larger in the everolimus-eluting stent group (n=25) than in the ZES group [n=32; 89.2% (83.7-91.3) vs. 84.3% (78.9-87.8), P=0.04]. A significant difference in %open area between cases with and those without SB dilatation was demonstrated in the ZES group [91.4% (86.1-94.0) vs. 84.3% (78.9-87.8), P=0.04]. The accuracy of SB orifice measurement on an en-face OCT image was validated using a phantom model. This novel approach enables quantitative evaluation of the differences in SB orifice area free from struts among different stent types and different treatment strategies in vivo.

  13. Wall-resolved Large Eddy Simulation of a flow through a square-edged orifice in a round pipe at Re = 25,000

    International Nuclear Information System (INIS)

    Benhamadouche, S.; Arenas, M.; Malouf, W.J.

    2017-01-01

    Highlights: • Wall-resolved LES can predict the flow through a square-edged orifice at Re = 25,000. • LES results are compared with the available experimental data and ISO 5167-2. • Pressure loss and discharge coefficients are in very good agreement with ISO 5167-2. • The present wall-resolved LES could be used as reference data for RANS validation. - Abstract: The orifice plate is a pressure differential device frequently used for flow measurements in pipes across different industries. The present study demonstrates the accuracy obtainable using a wall-resolved Large Eddy Simulation (LES) approach to predict the velocity, the Reynolds stresses, the pressure loss and the discharge coefficient for a flow through a square-edged orifice in a round pipe at a Reynolds number of 25,000. The ratio of the orifice diameter to the pipe diameter is β = 0.62, and the ratio of the orifice thickness to the pipe diameter is 0.11. The mesh is sized using refinement criteria at the wall and preliminary RANS results to ensure that the solution is resolved beyond an estimated Taylor micro-scale. The inlet condition is simulated using a recycling method, and the LES is run with a dynamic Smagorinsky sub-grid scale (SGS) model. The sensitivity to the SGS model and to the pressure–velocity coupling is shown to be small in the present study. The LES is compared with the available experimental data and ISO 5167-2. In general, the LES shows good agreement with the velocity from the experimental data. The profiles of the Reynolds stresses are similar, but an offset is observed in the diagonal stresses. The pressure loss and discharge coefficients are shown to be in very good agreement with the predictions of ISO 5167-2. Therefore, the wall-resolved LES is shown to be highly accurate in simulating the flow across a square-edged orifice.

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  15. Simulation of Micro-Channel and Micro-Orifice Flow Using Lattice Boltzmann Method with Langmuir Slip Model

    Directory of Open Access Journals (Sweden)

    A. R. Rahmati

    2016-12-01

    Full Text Available Because of its kinetic nature and computational advantages, the Lattice Boltzmann method (LBM has been well accepted as a useful tool to simulate micro-scale flows. The slip boundary model plays a crucial role in the accuracy of solutions for micro-channel flow simulations. The most used slip boundary condition is the Maxwell slip model. The results of Maxwell slip model are affected by the accommodation coefficient significantly, but there is not an explicitly relationship between properties at wall and accommodation coefficient. In the present wok, Langmuir slip model is used beside LBM to simulate micro-channel and micro-orifice flows. Slip velocity and nonlinear pressure drop profiles are presented as two major effects in such flows. The results are in good agreement with existing results in the literature.

  16. Prediction of flow rates through an orifice at pressures corresponding to the transition between molecular and isentropic flow

    International Nuclear Information System (INIS)

    DeMuth, S.F.; Watson, J.S.

    1985-01-01

    A model of compressible flow through an orifice, in the region of transition from free molecular to isentropic expansion flow, has been developed and tested for accuracy. The transitional or slip regime is defined as the conditions where molecular interactions are too many for free molecular flow modeling, yet not great enough for isentropic expansion flow modeling. Due to a lack of literature establishing a well-accepted model for predicting transitional flow, it was felt such work would be beneficial. The model is nonlinear and cannot be satisfactorily linearized for a linear regression analysis. Consequently, a computer routine was developed which minimized the sum of the squares of the residual flow for the nonlinear model. The results indicate an average accuracy within 15% of the measured flow throughout the range of test conditions. Furthermore, the results of the regression analysis indicate that the transitional regime lies between Knudsen numbers of approximately 2 and 45. 4 refs., 3 figs., 1 tab

  17. Office hysteroscopic treatment of a vanishing external uterine orifice in a postmenopausal woman with an obstetrical history of 44 abortions

    Directory of Open Access Journals (Sweden)

    Maurizio Guida

    2015-11-01

    Full Text Available Cervical stenosis, defined as cervical scarring of variable degree, represents a significant anatomical impediment to hysteroscopic procedures. Acquired cervical stenoses are more common than congenital forms and they are mainly associated with aging, estrogen–progesteron drugs, cervical trauma or carcinoma. The overcoming of cervical stenosis at office hysteroscopy is challenging and it often fails requiring the scheduling of the patient for an in-patient treatment under general anesthesia. We report the office hysteroscopy treatment of a vanishing external uterine orifice in a postmenopausal woman with an ultrasonographic report of a heterogeneous and thick endometrium suggestive of endometrial pathology, focusing on the main surgical steps to perform an adequate management.

  18. Endoscopic Urinary Diversion As Initial Management of Symptomatic Obstructive Ectopic Ureter in Infants

    Directory of Open Access Journals (Sweden)

    Ruben Ortiz

    2017-09-01

    Full Text Available AimDefinitive surgery of ectopic ureter in infants is challenging. We propose an endoscopic urinary diversion (EUD as a novel surgical technique in the initial management of symptomatic obstructive ectopic ureter.Patients and methodsSixteen obstructive ectopic ureters (14 patients were initially treated by EUD between 2006 and 2015. All patients had urinary tract dilatation worsening at preoperative US scans and at least two febrile urinary tract infection (UTI or urinary sepsis despite antibiotic prophylaxis. Ectopic ureter was confirmed by cystoscopy. When ectopic meatus was not found, EUD consisted in the creation of a transurethral neo-orifice (TUNO performed by needle puncturing of the ureterovesical wall, under fluoroscopic and ultrasound control. If ectopic meatus was identified in the posterior urethra, “intravesicalization procedure” was done opening the urethral–ureteral wall to create a new ureteral outlet into the bladder.ResultsEUD was done at a median age of 3.5 months (0.5–7 with median follow-up of 48 months (24–136. TUNO was performed in six patients and “intravesicalization” in eight patients. Significant differences were observed in ureteral diameter and anteroposterior pelvis diameter before and after endoscopic treatment (p < 0.005. Initial renal function was preserved in all cases. Postoperative complications were UTI in four patients and TUNO stenosis in one patient, treated by endoscopic balloon dilation. Definitive treatment was further individualized in each patient after 1 year of life.ConclusionEUD is a feasible and safe less-invasive technique in the initial management of symptomatic obstructive ectopic ureter. It allows an adequate ureteral drainage preserving renal function until definitive repair if necessary and does not invalidate other surgical options in case of failure or future definitive treatments.

  19. GENERAL SURGERY

    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

  20. GENERAL SURGERY

    African Journals Online (AJOL)

    mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

  1. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  2. Bariatric surgery insurance requirements independently predict surgery dropout.

    Science.gov (United States)

    Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

    2017-05-01

    Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  3. Exploring the umbilical and vaginal port during minimally invasive surgery.

    Science.gov (United States)

    Tinelli, Andrea; Tsin, Daniel A; Forgione, Antonello; Zorron, Ricardo; Dapri, Giovanni; Malvasi, Antonio; Benhidjeb, Tahar; Sparic, Radmila; Nezhat, Farr

    2017-09-01

    This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site. The vaginal route requires prophylactic antibiotics, a Foley catheter, and a period of postoperative sexual abstinence. Removal of large specimens is a challenge in traditional laparoscopy. Recently, there has been increased interest in going beyond traditional laparoscopy by using the navel in single-incision and port-reduction techniques. The benefits for removal of surgical specimens by colpotomy are not new. There is increasing interest in techniques that use vaginotomy in multifunctional ways, as described under the names of culdolaparoscopy, minilaparoscopy-assisted natural orifice surgery, and natural orifice transluminal endoscopic surgery. Both the navel and the transvaginal accesses are safe and convenient to use in the hands of experienced laparoscopic surgeons. The umbilical site has been successfully used in laparoscopy as an entry and extraction port. Vaginal entry and extraction is associated with a lower risk of incisional hernias, less postoperative pain, and excellent cosmetic results.

  4. Cataract Surgery

    Science.gov (United States)

    ... Oncology Oculoplastics/Orbit Refractive Management/Intervention Retina/Vitreous Uveitis Focus On Pediatric Ophthalmology ... Are Cataracts? Pediatric Cataracts Cataract Diagnosis and Treatment Cataract Surgery IOL Implants: Lens Replacement After Cataracts ...

  5. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  6. Foot Surgery

    Science.gov (United States)

    ... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

  7. Hemorrhoid surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002939.htm Hemorrhoid surgery To use the sharing features on this page, please enable JavaScript. Hemorrhoids are swollen veins around the anus. They may ...

  8. PLASTIC SURGERY

    African Journals Online (AJOL)

    Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.

  9. GENERAL SURGERY

    African Journals Online (AJOL)

    influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.

  10. GENERAL SURGERY

    African Journals Online (AJOL)

    1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.

  11. Sinus Surgery

    Science.gov (United States)

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  12. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  13. CT after transsphenoidal surgery

    International Nuclear Information System (INIS)

    Tazawa, Satoru

    1991-01-01

    Two hundred and ten CT studies of 95 patients after transsphenoidal surgery were reviewed. Spheno-ethmoid opacificaiton, intrasellar hematoma and gas bubbles were noted within 2 weeks after surgery. Bone defect of the sellar floor and bone stent were seen on coronal scans in most cases. The packing material frequently disappeared on follow-up studies. Hormonal assessment of the functioning tumor, according to which the effect of treatment was evaluated, was correlated with CT findings. Because differentiation between postoperative changes and residual mass was difficult, there was no definite CT criteria to indicate residual functioning tumor except upward convexity of the diaphragma sellae on CT more than 3 months after surgery. Initial follow up CT study is recommended to be performed at about 3 months after surgery, at which time the immediate postoperative inflammatory changes have been disappeared. The incidence of recurrence was 3/47 (6%), which was shown on follow-up CT from 4 to 10 years after surgery. Therefore, subsequent CT study should be done in every year or two, taking the clinical symptoms and hormonal data into consideration. (author)

  14. CT after transsphenoidal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tazawa, Satoru [Tohoku Univ., Sendai (Japan). School of Medicine

    1991-03-01

    Two hundred and ten CT studies of 95 patients after transsphenoidal surgery were reviewed. Spheno-ethmoid opacificaiton, intrasellar hematoma and gas bubbles were noted within 2 weeks after surgery. Bone defect of the sellar floor and bone stent were seen on coronal scans in most cases. The packing material frequently disappeared on follow-up studies. Hormonal assessment of the functioning tumor, according to which the effect of treatment was evaluated, was correlated with CT findings. Because differentiation between postoperative changes and residual mass was difficult, there was no definite CT criteria to indicate residual functioning tumor except upward convexity of the diaphragma sellae on CT more than 3 months after surgery. Initial follow up CT study is recommended to be performed at about 3 months after surgery, at which time the immediate postoperative inflammatory changes have been disappeared. The incidence of recurrence was 3/47 (6%), which was shown on follow-up CT from 4 to 10 years after surgery. Therefore, subsequent CT study should be done in every year or two, taking the clinical symptoms and hormonal data into consideration. (author).

  15. Tennis elbow surgery

    Science.gov (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  17. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  18. Retrospective Methods Analysis of Semiautomated Intracerebral Hemorrhage Volume Quantification From a Selection of the STICH II Cohort (Early Surgery Versus Initial Conservative Treatment in Patients With Spontaneous Supratentorial Lobar Intracerebral Haematomas).

    Science.gov (United States)

    Haley, Mark D; Gregson, Barbara A; Mould, W Andrew; Hanley, Daniel F; Mendelow, Alexander David

    2018-02-01

    The ABC/2 method for calculating intracerebral hemorrhage (ICH) volume has been well validated. However, the formula, derived from the volume of an ellipse, assumes the shape of ICH is elliptical. We sought to compare the agreement of the ABC/2 formula with other methods through retrospective analysis of a selection of the STICH II cohort (Early Surgery Versus Initial Conservative Treatment in Patients With Spontaneous Supratentorial Lobar Intracerebral Haematomas). From 390 patients, 739 scans were selected from the STICH II image archive based on the availability of a CT scan compatible with OsiriX DICOM viewer. ICH volumes were calculated by the reference standard semiautomatic segmentation in OsiriX software and compared with calculated arithmetic methods (ABC/2, ABC/2.4, ABC/3, and 2/3SC) volumes. Volumes were compared by difference plots for specific groups: randomization ICH (n=374), 3- to 7-day postsurgical ICH (n=206), antithrombotic-associated ICH (n=79), irregular-shape ICH (n=703) and irregular-density ICH (n=650). Density and shape were measured by the Barras ordinal shape and density groups (1-5). The ABC/2.4 method had the closest agreement to the semiautomatic segmentation volume in all groups, except for the 3- to 7-day postsurgical ICH group where the ABC/3 method was superior. Although the ABC/2 formula for calculating elliptical ICH is well validated, it must be used with caution in ICH scans where the elliptical shape of ICH is a false assumption. We validated the adjustment of the ABC/2.4 method in randomization, antithrombotic-associated, heterogeneous-density, and irregular-shape ICH. URL: http://www.isrctn.com/ISRCTN22153967. Unique identifier: ISRCTN22153967. © 2018 American Heart Association, Inc.

  19. Next-generation robotic surgery--from the aspect of surgical robots developed by industry.

    Science.gov (United States)

    Nakadate, Ryu; Arata, Jumpei; Hashizume, Makoto

    2015-02-01

    At present, much of the research conducted worldwide focuses on extending the ability of surgical robots. One approach is to extend robotic dexterity. For instance, accessibility and dexterity of the surgical instruments remains the largest issue for reduced port surgery such as single port surgery or natural orifice surgery. To solve this problem, a great deal of research is currently conducted in the field of robotics. Enhancing the surgeon's perception is an approach that uses advanced sensor technology. The real-time data acquired through the robotic system combined with the data stored in the robot (such as the robot's location) provide a major advantage. This paper aims at introducing state-of-the-art products and pre-market products in this technological advancement, namely the robotic challenge in extending dexterity and hopefully providing the path to robotic surgery in the near future.

  20. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  1. A three-dimensional semi-analytical solution for predicting drug release through the orifice of a spherical device.

    Science.gov (United States)

    Simon, Laurent; Ospina, Juan

    2016-07-25

    Three-dimensional solute transport was investigated for a spherical device with a release hole. The governing equation was derived using the Fick's second law. A mixed Neumann-Dirichlet condition was imposed at the boundary to represent diffusion through a small region on the surface of the device. The cumulative percentage of drug released was calculated in the Laplace domain and represented by the first term of an infinite series of Legendre and modified Bessel functions of the first kind. Application of the Zakian algorithm yielded the time-domain closed-form expression. The first-order solution closely matched a numerical solution generated by Mathematica(®). The proposed method allowed computation of the characteristic time. A larger surface pore resulted in a smaller effective time constant. The agreement between the numerical solution and the semi-analytical method improved noticeably as the size of the orifice increased. It took four time constants for the device to release approximately ninety-eight of its drug content. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. An Assessment on Temperature Profile of Jet-A/Biodiesel Mixture in a Simple Combustion Chamber with Plain Orifice Atomiser

    Science.gov (United States)

    Ng, W. X.; Mazlan, N. M.; Ismail, M. A.; Rajendran, P.

    2018-05-01

    The preliminary study to evaluate influence of biodiesel/kerosene mixtures on combustion temperature profile is explored. A simple cylindrical combustion chamber configuration with plain orifice atomiser is used for the evaluation. The evaluation is performed under stoichiometric air to fuel ratio. Six samples of fuels are used: 100BD (pure biodiesel), 100KE (pure Jet-A), 20KE80BD (20% Jet-A/80% Biodiesel), 40KE60BD (40% Jet-A/60% Biodiesel), 60KE40BD (60% Jet-A/40% Biodiesel), and 80KE20BD (80% Jet-A/20% Biodiesel). Results showed that the oxygen content, viscosity, and lower heating value are key parameters in affecting the temperature profile inside the chamber. Biodiesel is known to have higher energy content, higher viscosity and lower heating value compared to kerosene. Mixing biodiesel with kerosene improves viscosity and caloric value but reduces oxygen content of the fuel. High oxygen content of the biodiesel resulted to the highest flame temperature. However the flame temperature reduce as the percentage of biodiesel in the fuel mixture reduces.

  3. Intestinal Surgery.

    Science.gov (United States)

    Desrochers, André; Anderson, David E

    2016-11-01

    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Burnout experiments in freon 12 using different types of orifices to simulate the core grids - comparision between measured and predicted burnout values

    International Nuclear Information System (INIS)

    Katsaounis, A.; Orlowski, R.; Fulfs, H.; Hofmann, K.; Ladeira, L.C.D.

    1978-06-01

    This paper will report on burnout experiments carried out in freon 12 mainly at steady state and further at mass flow or power transient conditions with annular test sections axially uniformly heating either the inside or both the inside and outside rod. The runs are performed without orifice and using three different types of orifices simulating the reactor spacer grid. An important influence of the flow restriction on burnout position and value is measured. Furthermore, the comparison between the burnout correlations W2, W3, BandW2 and GE and experimental results from the literature using simple test section geometries in water and freon 12 demonstrate, that the accuracy is more or less comparable for both fluids

  5. The Influence of Swirl Brakes and a Tip Discharge Orifice on the Rotordynamic Forces Generated by Discharge-to-Suction Leakage Flows in Shrouded Centrifugal Pumps

    Science.gov (United States)

    Sivo, Joseph M.; Acosta, A. J.; Brennen, C. E.; Caughey, T. K.

    1993-01-01

    Recent experiments conducted in the Rotor Force Test Facility at the California Institute of Technology have examined the effects of a tip leakage restriction and swirl brakes on the rotordynamic forces due to leakage flows on an impeller undergoing a prescribed circular whirl. The experiments simulate the leakage flow conditions and geometry of the Alternate Turbopump Design (ATD) of the Space Shuttle High Pressure Oxygen Turbopump and are critical to evaluating the pump's rotordynamic instability problems. Previous experimental and analytical results have shown that discharge-to-suction leakage flows in the annulus of a shrouded centrifugal pump contribute substantially to the fluid induced rotordynamic forces. Also, previous experiments have shown that leakage inlet (pump discharge) swirl can increase the cross-coupled stiffness coefficient and hence increase the range of positive whirl for which the tangential force is destabilizing. In recent experimental work, the present authors demonstrated that when the swirl velocity within the leakage path is reduced by the introduction of ribs or swirl brakes, then a substantial decrease in both the destabilizing normal and tangential forces could be achieved. Motivation for the present research is that previous experiments have shown that restrictions such as wear rings or orifices at pump inlets affect the leakage forces. Recent pump designs such as the Space Shuttle Alternate Turbopump Design (ATD) utilize tip orifices at discharge for the purpose of establishing axial thrust balance. The ATD has experienced rotordynamic instability problems and one may surmise that these tip discharge orifices may also have an important effect on the normal and tangential forces in the plane of impeller rotation. The present study determines if such tip leakage restrictions contribute to undesirable rotordynamic forces. Additional motivation for the present study is that the widening of the leakage path annular clearance and the

  6. Comparative Performance of a Non-recessed Hole-entry Hybrid/Hydrostatic Conical Journal Bearing Compensated with Capillary and Orifice Restrictors

    Directory of Open Access Journals (Sweden)

    P.G. Khakse

    2016-06-01

    Full Text Available This research paper deals with the theoretical study of comparison of capillary and orifice compensated non-recess hole-entry hydrostatic/ hybrid conical journal bearing. Modified Reynolds equation governing the flow of lubricant in the clearance space of conical journal and bearing has been solved using FEM, Newton-Raphson method and Gauss elimination method. Spherical coordinate system has been employed to obtain the results. The results have been computed for uniform distribution of holes in the circumferential direction with the range of restrictor design parameter C ̅_s2 = 0.02 - 0.1. The numerically simulated result shows, the use of orifice restrictor is to increase bearing stiffness, threshold speed and maximum pressure compared to capillary restrictor for applied radial load.

  7. GENERAL SURGERY

    African Journals Online (AJOL)

    surgery. Since the first laparoscopic treatment of hydatid disease was described in 1992,14 there has been a steady growth in reports of the laparoscopic treatment of hydatid cysts of liver. Although early reported laparoscopic treatment of liver hydatid disease was confined to simple drainage, more advanced laparoscopic ...

  8. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  9. TRAUMA SURGERY

    African Journals Online (AJOL)

    meet the criteria for damage control surgery, and ligation of the AVC is a .... There were two vertebral body fractures, one penetrating brain injury from a gunshot wound to the head, one ... two hand fractures, three haemothoraces, one pelvic fracture, .... One patient with an intimal flap injury to his left common iliac artery ...

  10. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  11. Rodding Surgery

    Science.gov (United States)

    ... Physical activity prior to surgery,  Length of the operation; anesthesia issues,  Reason for the choice of rod,  Time in the hospital,  Length of recovery time at home,  Pain management including control of muscle spasms,  The rehabilitation plan. ...

  12. Combined experimental and computational investigation of the cavitating flow in an orifice plate with special emphasis on surrogate-based optimization method

    International Nuclear Information System (INIS)

    Li, XianLin; Huang, Biao; Chen, Tairan; Liu, Ying; Qiu, Si Cong; Zhao, Jing

    2017-01-01

    We investigated the influence of geometrical parameters of the orifice plate on the cavitation structures, and optimized these parameters by using a surrogate-based model with special emphasis on the concentration of hydroxyl radical released. The results show that for the orifice plate of the hydrodynamic cavitation system, the possible location of the inception of the cavity spreads to throat and divergent section of the venturi geometry. Based on the surrogate model and global sensitivity assessment, the diameter of throat Dt and diameter of inlet Din significantly influenced the size of the cavity, while the length of throat Lt had little effect on both cavitation intensity and flow rate. It should be noted that when Lt is decreased, the size of cavity would be slightly decreased but the flow rate increased clearly. The increase of the diverging section is in favor of the size of cavity. By comparing the experimental measurements on the concentration of Methylene blue, the optimum geometry of the orifice plate for best cavitational activity is proposed

  13. Combined experimental and computational investigation of the cavitating flow in an orifice plate with special emphasis on surrogate-based optimization method

    Energy Technology Data Exchange (ETDEWEB)

    Li, XianLin; Huang, Biao; Chen, Tairan; Liu, Ying; Qiu, Si Cong [School of Mechanical and Vehicular Engineering, Beijing Institute of Technology, Beijing (China); Zhao, Jing [China Academy of Launch Vehicle Technology, Beijing (China)

    2017-01-15

    We investigated the influence of geometrical parameters of the orifice plate on the cavitation structures, and optimized these parameters by using a surrogate-based model with special emphasis on the concentration of hydroxyl radical released. The results show that for the orifice plate of the hydrodynamic cavitation system, the possible location of the inception of the cavity spreads to throat and divergent section of the venturi geometry. Based on the surrogate model and global sensitivity assessment, the diameter of throat Dt and diameter of inlet Din significantly influenced the size of the cavity, while the length of throat Lt had little effect on both cavitation intensity and flow rate. It should be noted that when Lt is decreased, the size of cavity would be slightly decreased but the flow rate increased clearly. The increase of the diverging section is in favor of the size of cavity. By comparing the experimental measurements on the concentration of Methylene blue, the optimum geometry of the orifice plate for best cavitational activity is proposed.

  14. Characterization of Gatewell Orifice Lighting at the Bonneville Dam Second Powerhouse and Compendium of Research on Light Guidance with Juvenile Salmonids

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, Robert P.; Simmons, Mary Ann

    2007-12-29

    The goal of the study described in this report is to provide U.S. Army Corps of Engineers (USACE) biologists and engineers with general design guidelines for using artificial lighting to enhance the passage of juvenile salmonids into the collection channel at the Bonneville Dam second powerhouse (B2). During fall 2007, Pacific Northwest National Laboratory (PNNL) researchers measured light levels in the field at one powerhouse orifice through which fish must pass to reach the collection channel. Two light types were evaluated—light-emitting diode (LED) lights and halogen spot lights. Additional measurements with mercury lamps were made at the PNNL Aquatic Research Laboratory to determine baseline intensity of the current lighting. A separate chapter synthesizes the relevant literature related to light and fish guidance for both field and laboratory studies. PNNL will also review the Corps plans for existing lighting protocol at all of the Portland District projects and help develop a uniform lighting scheme which could be implemented. The specific objectives for this study are to 1. Create a synthesis report of existing lighting data for juvenile salmonid attraction and deterrence and how the data are used at fish bypass facilities. 2. Evaluate current B2 orifice lighting conditions with both LED and halogen sources. 3. Make recommendations as to what lighting intensity, source, and configuration would improve passage at the B2 orifices. 4. Review USACE plans for retrofit of existing systems (to be assessed at a later date).

  15. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  16. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown...... the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity....... Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further...

  17. Preparing for Surgery

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Preparing for Surgery Home For Patients Search FAQs Preparing for Surgery ... Surgery FAQ080, August 2011 PDF Format Preparing for Surgery Gynecologic Problems What is the difference between outpatient ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  19. Corrective Jaw Surgery

    Science.gov (United States)

    ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  20. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  1. Facial Cosmetic Surgery

    Science.gov (United States)

    ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  2. Heart bypass surgery

    Science.gov (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  3. Joint Replacement Surgery: Health Information Basics for You and Your Family

    Science.gov (United States)

    ... Initiative Breadcrumb Home Health Topics English Español Joint Replacement Surgery Basics In-Depth Download Download EPUB Download ... What is it? Points To Remember About Joint Replacement Surgery Joint replacement surgery removes damaged or diseased ...

  4. Robotic Applications in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alan P. Kypson

    2008-11-01

    Full Text Available Traditionally, cardiac surgery has been performed through a median sternotomy, which allows the surgeon generous access to the heart and surrounding great vessels. As a paradigm shift in the size and location of incisions occurs in cardiac surgery, new methods have been developed to allow the surgeon the same amount of dexterity and accessibility to the heart in confined spaces and in a less invasive manner. Initially, long instruments without pivot points were used, however, more recent robotic telemanipulation systems have been applied that allow for improved dexterity, enabling the surgeon to perform cardiac surgery from a distance not previously possible. In this rapidly evolving field, we review the recent history and clinical results of using robotics in cardiac surgery.

  5. Robotics in reproductive surgery: strengths and limitations.

    Science.gov (United States)

    Catenacci, M; Flyckt, R L; Falcone, T

    2011-09-01

    Minimally invasive surgical techniques are becoming increasingly common in gynecologic surgery. However, traditional laparoscopy can be challenging. A robotic surgical system gives several advantages over traditional laparoscopy and has been incorporated into reproductive gynecological surgeries. The objective of this article is to review recent publications on robotically-assisted laparoscopy for reproductive surgery. Recent clinical research supports robotic surgery as resulting in less post-operative pain, shorter hospital stays, faster return to normal activities, and decreased blood loss. Reproductive outcomes appear similar to alternative approaches. Drawbacks of robotic surgery include longer operating room times, the need for specialized training, and increased cost. Larger prospective studies comparing robotic approaches with laparoscopy and conventional open surgery have been initiated and information regarding long-term outcomes after robotic surgery will be important in determining the ultimate utility of these procedures. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. PLASTIC SURGERY

    African Journals Online (AJOL)

    fixation of fractures, wound debridement and reconstruction of soft tissue ... Soft tissue coverage of lower limb wounds may include one or the ... The recovery is lengthy, and the outcome dependent on the initial injury, the surgical procedures.

  7. Achalasia: Dilation, Injection or Surgery?

    OpenAIRE

    Peracchia, Alberto; Bonavina, Luigi

    2000-01-01

    Achalasia results from irreversible alterations of the esophageal myenteric plexus. The target of treatment in this setting is to reduce lower esophageal sphincter resistance to passage of the bolus. Definitive treatment of the disease requires pneumatic dilation or Heller myotomy. Although no controlled studies comparing modern endoscopic and surgical techniques are available, laparoscopic surgery is emerging as the initial intervention of choice.

  8. Gamma surgery for hemangiopericytomas

    International Nuclear Information System (INIS)

    Payne, B.R.; Prasad, D.; Steiner, M.; Steiner, L.

    2000-01-01

    A retrospective analysis of a consecutive series of 12 patients with 15 intracranial hemangiopericytomas treated at the University of Virginia using gamma surgery is presented. Clinical and radiographic follow up of 3 to 56 months is available for 10 patients with 12 tumors. There was one tumor present at the time of initial gamma surgery in each patient. Two new tumors occurred in patients previously treated. Nine of the tumors decreased in volume and three remained stable. Four of the nine tumors that shrank later progressed at an average of 22 months after treatment. Of the tumors that decreased in volume and have not progressed, the response has been for an average of 11 months. The follow-up for two tumors that remained unchanged was 10 and 34 months (average 22 months). A third tumor was unchanged at 42 months but the patient died of new disease adjacent to the treated area in the anterior skull base. There were no complications and the quality of life following the procedure was maintained or improved in every case. Gamma surgery is effective in palliating the patients by decreasing tumor volume and delaying recurrence. (author)

  9. Experimental study of the core grid by-pass orifices inlet pressure drop of the new core of the R A 6 reactor

    International Nuclear Information System (INIS)

    Masson, V. P; Garcia, J. C; Delmastro, D. F

    2006-01-01

    In this work the core grid by-pass orifices inlet pressure drop of the new core of the R A6 reactor are experimentally studied.The experiments are performed using a 1:1 scale mock-up of an external fuel element cell.Different gaps between fuel elements are considered in order to take into account the design allowances. Different flows are considered to take into account the normal operation flow range.Measurement uncertainties are included.The results will be used to calculate the core flow distribution [es

  10. Pemodelan Dan Analisis Pengaruh Variasi Oli dan Diameter Orifice terhadap Gaya Redam Shock Absorber Dan Respon Dinamis Sepeda Motor Yamaha Jupiter Z 2008

    Directory of Open Access Journals (Sweden)

    Newanda Asa Wahid

    2017-03-01

    Full Text Available Sepeda motor merupakan moda transportasi yang paling banyak diminati oleh masyarakat Indonesia. Dalam hal kenyamanan, maka komponen sepeda motor yang berperan penting adalah sistem suspensi. Sistem suspensi berfungsi menyerap getaran berlebih akibat profil permukaan jalan, sehingga meningkatkan kenyamanan dan keamanan. Oleh karena itu, perlu dilakukan penelitian untuk mendapatkan sistem suspensi yang terbaik. Dalam tugas akhir ini dilakukan pemodelan dan analisis pengaruh perubahan parameter sistem suspensi sepeda motor Yamaha Jupiter Z 2008 khususnya pada komponen monotube hydraulic shock absorber yang didasarkan pada pemodelan setengah kendaraan. Parameter yang divariasikan adalah tipe oli dan diameter orifice, dimana terdapat 5 macam tipe oli dengan rentang nilai massa jenis (ρ sebesar 845 – 874 kg/m3, dan viskositas (ν sebesar 11,3 – 46 mm2/s, sementara untuk diameter orifice yaitu saat kompresi (Docomp sebesar 1,2 – 1,5 mm, saat ekspansi (Doexp sebesar 0,8 – 1 mm. Input yang digunakan pada simulasi adalah input sinusoidal dan input bump modified. Dari penelitian ini didapatkan hasil bahwa sistem suspensi modifikasi monotube hydraulic shock absorber yang menghasilkan gaya redam optimal memiliki nilai parameter viskositas kinematis oli 46 mm2/s, massa jenis oli 845 kg/m3, diameter orifice kompresi 0,00135 m, dan diameter orifice ekspansi 0,0009 m. Nilai gaya redam optimal yang dihasilkan sistem suspensi modifikasi adalah sebesar 1171,3 N, lebih tinggi hingga 546,44 N dibandingkan dengan gaya redam sistem supensi asli yang bernilai 624,86 N pada frekuensi 2 Hz. Pada sistem setengah kendaraan motor dengan penggunaan sistem suspensi asli maupun modifikasi, untuk input bump, respon kendaraan dan penumpang mencapai steady state kurang dari 2 detik dan 5 detik, sedangkan untuk input sinusoidal responnya mencapai steady state kurang dari 2 detik dan 3 detik. Penggunaan suspensi asli maupun modifikasi menghasilkan nilai perpindahan RMS yang

  11. Cell response to surgery.

    LENUS (Irish Health Repository)

    Ni Choileain, Niamh

    2012-02-03

    OBJECTIVES: To describe the profound alterations in host immunity that are produced by major surgery as demonstrated by experimental and clinical studies, and to evaluate the benefits of therapeutic strategies aimed at attenuating perioperative immune dysfunction. DATA SOURCES: A review of the English-language literature was conducted, incorporating searches of the MEDLINE, EMBASE, and Cochrane collaboration databases to identify laboratory and clinical studies investigating the cellular response to surgery. STUDY SELECTION: Original articles and case reports describing immune dysfunction secondary to surgical trauma were included. DATA EXTRACTION: The results were compiled to show outcomes of different studies and were compared. DATA SYNTHESIS: Current evidence indicates that the early systemic inflammatory response syndrome observed after major surgery that is characterized by proinflammatory cytokine release, microcirculatory disturbance, and cell-mediated immune dysfunction is followed by a compensatory anti-inflammatory response syndrome, which predisposes the patient to opportunistic infection, multiple organ dysfunction syndrome, and death. Because there are currently no effective treatment options for multiple organ dysfunction syndrome, measures to prevent its onset should be initiated at an early stage. Accumulating experimental evidence suggests that targeted therapeutic strategies involving immunomodulatory agents such as interferon gamma, granulocyte colony-stimulating factor, the prostaglandin E(2) antagonist, indomethacin, and pentoxifylline may be used for the treatment of systemic inflammatory response syndrome to prevent the onset of multiple organ dysfunction syndrome. CONCLUSIONS: Surgical trauma produces profound immunological dysfunction. Therapeutic strategies directed at restoring immune homeostasis should aim to redress the physiological proinflammatory-anti-inflammatory cell imbalance associated with major surgery.

  12. Perioperative smoking cessation in vascular surgery

    DEFF Research Database (Denmark)

    Kehlet, M.; Heesemann, Sabine; Tonnesen, H.

    2015-01-01

    Background: The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods: A single-blinded randomized clinical trial conducted at two vascular surgery...... departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments' standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According...

  13. [Advantages and disadvantages of minimally invasive surgery in colorectal cancer surgery].

    Science.gov (United States)

    Zheng, Minhua; Ma, Junjun

    2017-06-25

    Since the emergence of minimally invasive technology twenty years ago, as a surgical concept and surgical technique for colorectal cancer surgery, its obvious advantages have been recognized. Laparoscopic technology, as one of the most important technology platform, has got a lot of evidence-based support for the oncological safety and effectiveness in colorectal cancer surgery Laparoscopic technique has advantages in terms of identification of anatomic plane and autonomic nerve, protection of pelvic structure, and fine dissection of vessels. But because of the limitation of laparoscopic technology there are still some deficiencies and shortcomings, including lack of touch and lack of stereo vision problems, in addition to the low rectal cancer, especially male, obese, narrow pelvis, larger tumors, it is difficult to get better view and manipulating triangle in laparoscopy. However, the emergence of a series of new minimally invasive technology platform is to make up for the defects and deficiencies. The robotic surgical system possesses advantages, such as stereo vision, higher magnification, manipulator wrist with high freedom degree, filtering of tremor and higher stability, but still has disadvantages, such as lack of haptic feedback, longer operation time, high operation cost and expensive price. 3D system of laparoscopic surgery has similar visual experience and feelings as robotic surgery in the 3D view, the same operating skills as 2D laparoscopy and a short learning curve. The price of 3D laparoscopy is also moderate, which makes the 3D laparoscopy more popular in China. Transanal total mesorectal excision (taTME) by changing the traditional laparoscopic pelvic surgery approach, may have certain advantages for male cases with narrow pelvic and patients with large tumor, and it is in accordance with the technical concept of natural orifice, with less minimally invasive and better cosmetics, which can be regarded as a supplemental technique of the

  14. A study on the root cause identification of local wall thinning caused by deflected turbulent flow inside orifice of carbon steel components

    International Nuclear Information System (INIS)

    Park, S. H.; Kim, K. H.; Hwang, K. M.

    2010-01-01

    When components made of carbon steel in nuclear, fossil, and industry plants are exposed to flowing fluid, wall thinning caused by FAC (flow accelerated corrosion) can be generated and eventually ruptured at the portion of pressure boundary. A study to identify the locations generating local wall thinning and to disclose turbulence coefficients related to the local wall thinning was performed. Experiments and numerical analyses for orifice of down-scaled piping components were performed and the results were compared. Based on the results that the flow behaviors inside piping components can be simulated by numerical analysis, numerical analyses for magnified models to actual size of plants were performed. To disclose the relationship between turbulence coefficients and local thinning rate, numerical analyses were preformed for orifice components included in the main feedwater systems. The turbulence coefficients based on the numerical analyses were compared with the local wear rate based on the measured data. From the comparison of the results, the vertical flow velocity component (Vr) flowing to the wall after separating in the wall due to the geometrical configuration and colliding with the wall directly at an angle of some degree was analogous to the configuration of local wall thinning. (authors)

  15. Tennis elbow surgery - discharge

    Science.gov (United States)

    ... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

  16. Lung surgery - discharge

    Science.gov (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  17. Gastric Sleeve Surgery

    Science.gov (United States)

    ... Videos for Educators Search English Español Gastric Sleeve Surgery KidsHealth / For Teens / Gastric Sleeve Surgery What's in ... or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...

  18. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  20. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  1. Breast Reduction Surgery

    Science.gov (United States)

    ... considering breast reduction surgery, consult a board-certified plastic surgeon. It's important to understand what breast reduction surgery entails — including possible risks and complications — as ...

  2. [The role of antiarrhythmic surgery in 2004].

    Science.gov (United States)

    Guiraudon, G M

    2004-11-01

    In 2004, surgery for cardiac arrhythmias addresses essentially atrial fibrillation. Surgery is only a rare alternative for other cardiac arrhythmias in center that still have the surgical skill. Surgery for atrial fibrillation has the definite advantage of concomitant exclusion of the left atrial appendage which is the predominant site of intra-atrial thrombi with the associated risk of severe thrombo-embolic events. Our experience with surgery for lone atrial fibrillation, using the Corridor III operation, shows that surgery is associated with high efficacy and long term control of arrhythmia when the surgical technique is well performed. Failures were associated with incomplete line of block or exclusion. This experience shows the necessity of postoperative EP testing. Initially performed using open heart technique, surger for atrial fibrillation is now performed using mini-invasive technique. Indications for surgery for lone atrial fibrillation will decreased while other strategies are developing. To remain competitive surgery must have high efficacy and use mini-invasive techniques. i.e.: closed off pump beating heart via port access. Surgery for atrial fibrillation concomitant with other cardiac surgical repairs yields remarkable results, without increased surgical risk. Their indications go beyond mitral valve pathology. Future developments imply the following conditions: atrial surgery must not increase morbidity, and its cost-effectiveness must be documented. Combined surgery must be testable and tested to gain valid pathophysiological data to improve surgical rationales. Its impact in terms of survival, prevention of thrombo-embolic events and quality of life will be documented by clinical trials.

  3. The ongoing emergence of robotics in plastic and reconstructive surgery.

    Science.gov (United States)

    Struk, S; Qassemyar, Q; Leymarie, N; Honart, J-F; Alkhashnam, H; De Fremicourt, K; Conversano, A; Schaff, J-B; Rimareix, F; Kolb, F; Sarfati, B

    2018-04-01

    Robot-assisted surgery is more and more widely used in urology, general surgery and gynecological surgery. The interest of robotics in plastic and reconstructive surgery, a discipline that operates primarily on surfaces, has yet to be conclusively proved. However, the initial applications of robotic surgery in plastic and reconstructive surgery have been emerging in a number of fields including transoral reconstruction of posterior oropharyngeal defects, nipple-sparing mastectomy with immediate breast reconstruction, microsurgery, muscle harvesting for pelvic reconstruction and coverage of the scalp or the extremities. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  4. Stent valve implantation in conventional redo aortic valve surgery to prevent patient-prosthesis mismatch.

    Science.gov (United States)

    Ferrari, Enrico; Franciosi, Giorgio; Clivio, Sara; Faletra, Francesco; Moccetti, Marco; Moccetti, Tiziano; Pedrazzini, Giovanni; Demertzis, Stefanos

    2017-03-01

    The goal was to show the technical details, feasibility and clinical results of balloon-expandable stent valve implantation in the aortic position during conventional redo open-heart surgery in selected obese patients with a small aortic prosthesis and severe patient-prosthesis mismatch. Two symptomatic overweight patients (body mass index of 31 and 38), each with a small aortic prosthesis (a 4-year-old, 21-mm Hancock II biological valve and a 29-year-old, 23-mm Duromedic mechanical valve), increased transvalvular gradients (59/31 and 74/44 mmHg) and a reduced indexed effective orifice area (0.50 and 0.43 cm 2 /m 2 ) underwent implantation of two 26-mm balloon-expandable Sapien 3 valves during standard on-pump redo valve surgery. Using full re-sternotomy, cardiopulmonary bypass and cardioplegic arrest, the two balloon-expandable stent valves were implanted under direct view using a standard aortotomy, after prosthesis removal and without annulus enlargement. Aortic cross-clamp times were 162 and 126 min; cardiopulmonary bypass times were 178 and 180 min; total surgical times were 360 and 318 min. At discharge, echocardiograms showed transvalvular peak and mean gradients of 13/9 and 23/13 mmHg and indexed effective orifice areas of 0.64 and 1.08 cm 2 /m 2 . The 3-month echocardiographic follow-up showed transvalvular peak and mean gradients of 18/9 and 19/11 mmHg and indexed effective orifice areas of 0.78 cm 2 /m 2 and 0.84 cm 2 /m 2 , with improved symptoms (New York Heart Association class 1). Implantation of a balloon-expandable stent valve during redo aortic valve surgery is feasible in selected cases and prevents patient-prosthesis mismatch in obese patients without need for aortic annulus enlargement. Moreover, in the case of stent valve degeneration, this approach permits additional valve-in-valve procedures with large stent valves and prevents re-redo surgery. © The Author 2016. Published by Oxford University Press on behalf of the

  5. Injection and spray characteristics of a variable orifice nozzle applied the jerk type fuel injection pump for DI diesel engine; Jerk shiki nenryo funsha pump wo mochiita kahen funko nozzle no funsha funmu tokusei

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, T; Matsui, K; Iwasaki, T; Kobayashi, T [Zexel Corp., Tokyo (Japan); Matsumoto, Y [The University of Tokyo, Tokyo (Japan)

    1997-10-01

    A Variable Orifice Nozzle (VON) by changing a cross-sectional area of the nozzle injection hole, for improving a rate of injection and injection duration, has been developed to study its injection and spray characteristics. The nozzle geometry was optimized to analyze a nozzle internal flow by computational method. Results show that, injection and spray pattern responded to the nozzle orifice cross-sectional area which is changing larger to smaller in the part load range. This results suggest to contribute a combustion improvement which decreasing NOx and soot. 14 refs., 10 figs.

  6. Hand-held transendoscopic robotic manipulators: A transurethral laser prostate surgery case study.

    Science.gov (United States)

    Hendrick, Richard J; Mitchell, Christopher R; Herrell, S Duke; Webster, Robert J

    2015-11-01

    Natural orifice endoscopic surgery can enable incisionless approaches, but a major challenge is the lack of small and dexterous instrumentation. Surgical robots have the potential to meet this need yet often disrupt the clinical workflow. Hand-held robots that combine thin manipulators and endoscopes have the potential to address this by integrating seamlessly into the clinical workflow and enhancing dexterity. As a case study illustrating the potential of this approach, we describe a hand-held robotic system that passes two concentric tube manipulators through a 5 mm port in a rigid endoscope for transurethral laser prostate surgery. This system is intended to catalyze the use of a clinically superior, yet rarely attempted, procedure for benign prostatic hyperplasia. This paper describes system design and experiments to evaluate the surgeon's functional workspace and accuracy using the robot. Phantom and cadaver experiments demonstrate successful completion of the target procedure via prostate lobe resection.

  7. Early recovery following lower limb arthroplasty: Qualitative interviews with patients undergoing elective hip and knee replacement surgery. Initial phase in the development of a patient-reported outcome measure.

    Science.gov (United States)

    Strickland, Louise H; Kelly, Laura; Hamilton, Thomas W; Murray, David W; Pandit, Hemant G; Jenkinson, Crispin

    2017-09-27

    To explore the patients' perspective of surgery and early recovery when undergoing lower limb (hip or knee) arthroplasty. Lower limb arthroplasty is a commonly performed procedure for symptomatic arthritis, which has not responded to conservative medical treatment. Each patient's perspective of the surgical process and early recovery period impacts on their quality of life. Open, semistructured qualitative interviews were used to allow for a deeper understanding of the patient perspective when undergoing a hip or knee arthroplasty. Following ethical approval, 30 patients were interviewed between August and November 2016 during the perioperative period while undergoing an elective hip or knee arthroplasty (n = 30). The interviews were performed between the day of surgery and a nine-week postoperative clinic appointment. Data were analysed using an in-depth narrative thematic analysis method. NVivo qualitative data analysis software was used. Seven main themes evolved from the interviews: "improving function and mobility", "pain", "experiences of health care", "support from others", "involvement and understanding of care decisions", "behaviour and coping" and "fatigue and sleeping". The early postoperative recovery period is of vital importance to all surgical patients. This is no different for the orthopaedic patient. However, identifying key self-reported areas of importance from patients can guide clinical focus for healthcare professionals. To have specific patient-reported information regarding key areas of importance during the perioperative phase is invaluable when caring for the orthopaedic surgical patient. It gives insight and understanding in to this increasing population group. This study has also served as a starting point in the development of a questionnaire which could be used to assess interventions in the lower limb arthroplasty population. These results will influence both items and content of the questionnaire. © 2017 John Wiley & Sons Ltd.

  8. Manufacturing Initiative

    Data.gov (United States)

    National Aeronautics and Space Administration — The Advanced Manufacturing Technologies (AMT) Project supports multiple activities within the Administration's National Manufacturing Initiative. A key component of...

  9. Bariatric Surgery vs. Conventional Dieting in the Morbidly Obese.

    Science.gov (United States)

    Greenstein; Rabner; Taler

    1994-02-01

    Weight loss and psychosocial events have been compared between low calorie conventional diet (n = 11) or following obesity surgery (n = 17). Interviews were >/= 9 months following initiation of treatment. After surgery significantly less hunger was experienced (surgery 76% [13/17] vs diet 18% [2/11] p employed (surgery 76% [13/17] vs diet 18% [2/11) p appearance improvements (surgery 94% [15/16] vs diet 50% [5/10] p Physical activity improved (surgery 73% [11/15] vs diet 18% [2/11] p Physical activity increases, and satisfaction with weight loss method is greater, after surgery. Employment is greater (probably self selection) in the post-surgical group. We found that comparing >/= 9 months following surgery or beginning a conventional diet, the morbidly obese have a more positive response to surgery.

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  11. Bariatric surgery in hypothalamic obesity

    Directory of Open Access Journals (Sweden)

    Nathan eBingham

    2012-02-01

    Full Text Available Craniopharyngiomas (CP are epithelial neoplasms generally found in the area of the pituitary and hypothalamus. Despite benign histology, these tumors and/or their treatment often result in significant, debilitating disorders of endocrine, neurological, behavioral, and metabolic systems. Severe obesity is observed in a high percentage of patients with CP resulting in significant comorbidities and negatively impacting quality of life. Obesity occurs as a result of hypothalamic damage and disruption of normal homeostatic mechanisms regulating energy balance. Such pathological weight gain, termed hypothalamic obesity (HyOb, is often severe and refractory to therapy.Unfortunately, neither lifestyle intervention nor pharmacotherapy has proven truly effective in the treatment of CP-HyOb. Given the limited choices and poor results of these treatments, several groups have examined bariatric surgery as a treatment alternative for patients with CP-HyOb. While a large body of evidence exists supporting the use of bariatric surgery in the treatment of exogenous obesity and its comorbidities, its role in the treatment of HyOb has yet to be well defined. To date, the existing literature on bariatric surgery in CP-HyOb is largely limited to case reports and series with short term follow-up. Here we review the current reports on the use of bariatric surgery in the treatment of CP-HyOb. We also compare these results to those reported for other populations of HyOb, including Prader-Willi Syndrome and patients with melanocortin signaling defects. While initial reports of bariatric surgery in CP-HyOb are promising, their limited scope makes it difficult to draw any substantial conclusions as to the long term safety and efficacy of bariatric surgery in CP-HyOb. There continues to be a need for more robust, controlled, prospective trials with long term follow-up in order to better define the role of bariatric surgery in the treatment of all types of hypothalamic

  12. Endoscopic surgery of nasopharyngeal angiofibroma

    Directory of Open Access Journals (Sweden)

    Machado, Silvio

    2010-06-01

    Full Text Available Introduction: Juvenile nasopharyngeal angiofibroma (NAJ is a tumor with vascular component, slow growing, benign but very aggressive because of its local invasiveness. The NAJ is rare, accounting for 0.05% of all head and neck cancers. The classic triad of epistaxis, unilateral nasal obstruction and a mass in the nasopharynx suggests the diagnosis of NAJ and is then supplemented by imaging. Over the past 10 years the treatment of this disease has been discussed with the aim of designing a management protocol. Currently, surgery appears to be the best treatment of the NAJ. Other methods such as hormone therapy, radiotherapy and chemotherapy treatment modalities are now used occasionally as complementary treatments. Objective: To present the cases of this disease in the Hospital Infantil between October 2007 and August 2008. Methods: A retrospective case study of five cases of NAJ underwent surgery solely with endoscopic technique of two surgeons. Classifieds between IIA and IIIA. All patients underwent angiography with embolization of the tumor 3-4 days before surgery. Follow-up after surgery to detect recurrence. Results: There were two relapses in the following two years after surgery. Conclusion: Given the short period of patient follow-up, there were only two relapses in one year. So there is need for further action to claim that this technique has a low recurrence rate, since the recurrence is probably related to incomplete resection the initial tumor.

  13. Robotic systems in spine surgery.

    Science.gov (United States)

    Onen, Mehmet Resid; Naderi, Sait

    2014-01-01

    Surgical robotic systems have been available for almost twenty years. The first surgical robotic systems were designed as supportive systems for laparoscopic approaches in general surgery (the first procedure was a cholecystectomy in 1987). The da Vinci Robotic System is the most common system used for robotic surgery today. This system is widely used in urology, gynecology and other surgical disciplines, and recently there have been initial reports of its use in spine surgery, for transoral access and anterior approaches for lumbar inter-body fusion interventions. SpineAssist, which is widely used in spine surgery, and Renaissance Robotic Systems, which are considered the next generation of robotic systems, are now FDA approved. These robotic systems are designed for use as guidance systems in spine instrumentation, cement augmentations and biopsies. The aim is to increase surgical accuracy while reducing the intra-operative exposure to harmful radiation to the patient and operating team personnel during the intervention. We offer a review of the published literature related to the use of robotic systems in spine surgery and provide information on using robotic systems.

  14. Experience with day stay surgery.

    Science.gov (United States)

    Cohen, D; Keneally, J; Black, A; Gaffney, S; Johnson, A

    1980-02-01

    Potential advantages of day stay surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and his family. The successful program requires careful case selection, full operating and anesthetic facilities and good follow-up. Day stay surgery was initiated at Royal Alexandra Hospital for Children in 1974. Experience is reviewed in relation to the total number and nature of surgical admissions and the daily utilisation of the facility. Utilization has markedly increased in the past 2 yr. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. Parental attitudes towards day stay surgery were evaluated indicating both the advantages and the problems encountered. These related mainly to insufficient information, transport difficulties and afternoon operations. Recommendations for improving the day stay service are discussed with special reference to: (1) communication with the parents as to adequate pre-operative explanation, revision of the day stay information pamphlet and improved distribution, and clear postoperative instructions, (2) the timing of operations, and (3) transport and parking facilities.

  15. Future of robotic surgery.

    Science.gov (United States)

    Lendvay, Thomas Sean; Hannaford, Blake; Satava, Richard M

    2013-01-01

    In just over a decade, robotic surgery has penetrated almost every surgical subspecialty and has even replaced some of the most commonly performed open oncologic procedures. The initial reports on patient outcomes yielded mixed results, but as more medical centers develop high-volume robotics programs, outcomes appear comparable if not improved for some applications. There are limitations to the current commercially available system, and new robotic platforms, some designed to compete in the current market and some to address niche surgical considerations, are being developed that will change the robotic landscape in the next decade. Adoption of these new systems will be dependent on overcoming barriers to true telesurgery that range from legal to logistical. As additional surgical disciplines embrace robotics and open surgery continues to be replaced by robotic approaches, it will be imperative that adequate education and training keep pace with technology. Methods to enhance surgical performance in robotics through the use of simulation and telementoring promise to accelerate learning curves and perhaps even improve surgical readiness through brief virtual-reality warm-ups and presurgical rehearsal. All these advances will need to be carefully and rigorously validated through not only patient outcomes, but also cost efficiency.

  16. Surgery for achalasia: 1998.

    Science.gov (United States)

    Shiino, Y; Filipi, C J; Awad, Z T; Tomonaga, T; Marsh, R E

    1999-01-01

    Technical controversies abound regarding the surgical treatment of achalasia. To determine the value of a concomitant antireflux procedure, the best antireflux procedure, the correct length for gastric myotomy, the optimal surgical approach (thoracic or abdominal), and the equivalency of minimally invasive surgery, a literature review was carried out. The review is based on 23 articles on open transabdominal or transthoracic myotomy, 14 articles on laparoscopic myotomy, and four articles on thoracoscopic myotomy. Postoperative results of traditional open thoracic or transabdominal myotomy as determined by symptomatology were better with fundoplication than without fundoplication. The incidence of postoperative reflux as proved by pH monitoring was high in patients who had an open transabdominal myotomy without fundoplication. The type of antireflux procedure used and the length of gastric myotomy had little effect on results. The results of transthoracic Heller myotomy do not require a concomitant fundoplication. Laparoscopic and thoracoscopic myotomy had excellent results at short-term follow-up. A fundoplication must be added if the myotomy is performed transabdominally. A randomized prospective study is required to determine the best fundoplication and the extent of gastric myotomy. Although minimally invasive surgery for achalasia has excellent initial results, longer follow-up in a larger population of patients is needed.

  17. Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

    OpenAIRE

    Lee, Seung-Hwan; Kim, Ji-Sup; Jeong, Yoo-Chul; Kwak, Dae-Kyung; Chun, Ja-Hae; Lee, Hwan-Mo

    2013-01-01

    Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your sit...

  18. NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program.

    Science.gov (United States)

    Kavic, Michael S; Mirza, Brian; Horne, Walter; Moskowitz, Jesse B

    2008-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) is a development of recent origin. In 2004, Kalloo et al first described NOTES investigation in an animal model. Since then, several investigators have pursued NOTES study in animal survival and nonsurvival models. Our objectives for this project included studying NOTES intervention in a laboratory environment using large animal (swine) models and learning to do so in a safe, controlled manner. Ultimately, we intend to introduce NOTES methodology into our surgical residency training program. The expertise of an experienced laparoscopic surgeon, fellowship-trained laparoendoscopic surgeon, and veterinarian along with a senior surgical resident was utilized to bring the input of several disciplines to this study. The Institutional Animal Care and Use Committee (IACUC) of Northeastern Ohio Universities College of Medicine and Pharmacy (NEOUCOM/COP) approved this study. A series of 5 laboratory sessions using mixed breed farm swine varying in weight from 37 kg to 43.1 kg was planned for the initial phase of NOTES introduction into our residency program. Animals were not kept alive in this investigation. All animals were anesthetized using a standard swine protocol and euthanized following guidelines issued by the American Veterinary Medical Association Panel on Euthanasia. Equipment included a Fujinon EVE endoscope 0.8 cm in diameter with a suction/irrigation channel and one working channel. Initially, a US Endoscopy gastric overtube, 19.5 mm OD and 50 cm in length, was used to facilitate passage of the endoscope. However, this device was found to have insufficient length. Subsequently, commercially available 5/8" diameter clear plastic tubing, 70 cm to 80 cm in length, was adapted for use as an overtube. Standard endoscopic instruments included Boston Scientific biopsy forceps, needle-knife, papillotome, endoscopic clip applier, and Valley Lab electrosurgical unit. A Karl Storz laparoscope and tower were used for

  19. Triple-orifice valve repair in severe Barlow disease with multiple-jet mitral regurgitation: report of mid-term experience.

    Science.gov (United States)

    Fucci, Carlo; Faggiano, Pompilio; Nardi, Matilde; D'Aloia, Antonio; Coletti, Giuseppe; De Cicco, Giuseppe; Latini, Leonardo; Vizzardi, Enrico; Lorusso, Roberto

    2013-09-10

    Barlow disease represents a surgical challenge for mitral valve repair (MR) in the presence of mitral insufficiency (MI) with multiple regurgitant jets. We hereby present our mid-term experience using a modified edge-to-edge technique to address this peculiar MI. From March 2003 till December 2010, 25 consecutive patients (mean age 54 ± 7 years, 14 males) affected by severe Barlow disease with multiple regurgitant jets were submitted to MR. Preoperative transesophageal echo (TEE) in all the cases showed at least 2 regurgitant jets, involving one or both leaflets in more than one segment. In all the patients, a triple orifice valve (TOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the TOV repair. There was no in-hospital death and one late death (non-cardiac related). At intra-operative TEE, the three orifices showed a mean total valve area of 2.9 ± 0.1cm(2) (range 2.5-3.3 cm(2)) with no residual regurgitation (2 cases of trivial MI) and no sign of valve stenosis (mean transvalvular gradient 4.6 ± 1.5 mmHg). At follow up (mean 38 ± 22 months), TTE showed favourable MR and no recurrence of significant MI (6 cases of trivial and 1 of mild MI). Stress TTE was performed in 5 cases showing persistent effective valve function (2 cases of trivial MI at peak exercise). All the patients showed significant NYHA functional class improvement. This report indicates that the TOV technique is effective in correcting complex Barlow mitral valves with multiple jets. Further studies are required to confirm long-term applicability and durability in more numerous clinical cases. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. Achalasia: Dilation, Injection or Surgery?

    Directory of Open Access Journals (Sweden)

    Alberto Peracchia

    2000-01-01

    Full Text Available Achalasia results from irreversible alterations of the esophageal myenteric plexus. The target of treatment in this setting is to reduce lower esophageal sphincter resistance to passage of the bolus. Definitive treatment of the disease requires pneumatic dilation or Heller myotomy. Although no controlled studies comparing modern endoscopic and surgical techniques are available, laparoscopic surgery is emerging as the initial intervention of choice.

  1. Unilateral initiatives

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

  2. Ports Initiative

    Science.gov (United States)

    EPA's Ports Initiative works in collaboration with the port industry, communities, and government to improve environmental performance and increase economic prosperity. This effort helps people near ports breath cleaner air and live better lives.

  3. Software development for a orifice plate characterization used in the oil and gas industry; Desenvolvimento de um 'software' para caracterizacao de placas de orificio utilizadas na industria do petroleo

    Energy Technology Data Exchange (ETDEWEB)

    Andreas, N. Andreas [Universidade Federal de Itajuba (UNIFEI), MG (Brazil)

    2008-07-01

    The petroleum industry is an economic area that has a strong impact, because this, the information precision is one of the most important facts and it is able to be defined with software simulation. The knowledge of the exactly quantify of petroleum is fundamental, and then the instrumentation is essential for this measurement. There are many mechanisms to measure the volume flow, and one of the most used is the Orifice Plates, which has been more common in the Natural Gas Industry. The software development goal is the characterization of these Orifice Plates, allowing that the constant, which characterizes certain Plate, to be determined without Labor instruments, for that the software has an actualized database. But, the software needs some variables, that are responsible for the environment characteristics and the used material, to calculate the constant of the Orifice Plate, for example, fluid viscosity, environment temperature and kind of the Orifice Plate. The utilized equations in this software are based on the Stolz II equations. This tool is able to facilitate the work in petroleum industry, besides it is done for mobile applications, allowing analyses in real time. (author)

  4. Fast track surgery at the University Teaching Hospital of Kigali: a ...

    African Journals Online (AJOL)

    Background: Fast Track Surgery is synonymous with Enhanced Recovery after Surgery. It was started in the 1990's initially for colorectal surgery, but later became applicable to other aspects of surgery. Its core elements include epidural or regional anaesthesia, perioperative fluid management, minimally invasive surgical ...

  5. Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art.

    Science.gov (United States)

    Boudissa, Mehdi; Courvoisier, Aurélien; Chabanas, Matthieu; Tonetti, Jérôme

    2018-01-01

    The development of imaging modalities and computer technology provides a new approach in acetabular surgery. Areas covered: This review describes the role of computer-assisted surgery (CAS) in understanding of the fracture patterns, in the virtual preoperative planning of the surgery and in the use of custom-made plates in acetabular fractures with or without 3D printing technologies. A Pubmed internet research of the English literature of the last 20 years was carried out about studies concerning computer-assisted surgery in acetabular fractures. The several steps for CAS in acetabular fracture surgery are presented and commented by the main author regarding to his personal experience. Expert commentary: Computer-assisted surgery in acetabular fractures is still initial experiences with promising results. Patient-specific biomechanical models considering soft tissues should be developed to allow a more realistic planning.

  6. Complications After Cosmetic Surgery Tourism.

    Science.gov (United States)

    Klein, Holger J; Simic, Dario; Fuchs, Nina; Schweizer, Riccardo; Mehra, Tarun; Giovanoli, Pietro; Plock, Jan A

    2017-04-01

    Cosmetic surgery tourism characterizes a phenomenon of people traveling abroad for aesthetic surgery treatment. Problems arise when patients return with complications or need of follow-up care. To investigate the complications of cosmetic surgery tourism treated at our hospital as well as to analyze arising costs for the health system. Between 2010 and 2014, we retrospectively included all patients presenting with complications arising from cosmetic surgery abroad. We reviewed medical records for patients' characteristics including performed operations, complications, and treatment. Associated cost expenditure and Diagnose Related Groups (DRG)-related reimbursement were analyzed. In total 109 patients were identified. All patients were female with a mean age of 38.5 ± 11.3 years. Most procedures were performed in South America (43%) and Southeast (29.4%) or central Europe (24.8%), respectively. Favored procedures were breast augmentation (39.4%), abdominoplasty (11%), and breast reduction (7.3%). Median time between the initial procedure abroad and presentation was 15 days (interquartile range [IQR], 9) for early, 81.5 days (IQR, 69.5) for midterm, and 4.9 years (IQR, 9.4) for late complications. Main complications were infections (25.7%), wound breakdown (19.3%), and pain/discomfort (14.7%). The majority of patients (63.3%) were treated conservatively; 34.8% became inpatients with a mean hospital stay of 5.2 ± 3.8 days. Overall DRG-related reimbursement premiums approximately covered the total costs. Despite warnings regarding associated risks, cosmetic surgery tourism has become increasingly popular. Efficient patients' referral to secondary/tertiary care centers with standardized evaluation and treatment can limit arising costs without imposing a too large burden on the social healthcare system. 4. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  7. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  8. Future of uniportal video-assisted thoracoscopic surgery-emerging technology.

    Science.gov (United States)

    Li, Zheng; Ng, Calvin S H

    2016-03-01

    Uniportal VATS poses unique difficulties to the surgeon, mainly as a consequence of operating through a small single incision. The instruments in uniportal VATS have limited movement through the small incision. In addition, the approach to the surgical operating site is unidirectional, which may restrict vision and retraction, and unavoidably suffers from instrument fencing. Recent thoracoscopic technology in the form of a wide variable angled lens has to some extent improved these shortcomings. The development of an extendable flexible thoracoscope and wireless steerable endoscope (WSE) systems can further improve the visualization for surgery and reduce or even remove fencing between endoscope and instruments. New single incision access platforms both derived from Natural orifice transluminal endoscopic surgery (NOTES) and robotic surgery approaches are on the horizon. These may allow uniportal VATS to be performed through an even smaller ultra-minimally invasive incision, with improved vision, more freedom of movement of the instruments and greater precision. However, a number of problems remain to be resolved, including provision of a stable platform and payload, applied force limitations and equipment sterilization. Advances in uniportal VATS major lung resection techniques have not only challenged the surgeon to acquire new skills and knowledge, but at the same time have rekindled the collaborative spirit between industry and clinician in developing novel equipment and technology to push the boundaries of minimally invasive surgery. These technological improvements and innovations may improve operating efficiency and safety during uniportal VATS surgery.

  9. Nutrition Following Pancreatic Surgery

    Science.gov (United States)

    ... BACK Contact Us DONATE NOW GENERAL DONATION PURPLESTRIDE Nutrition Following Pancreatic Surgery Home Facing Pancreatic Cancer Living with Pancreatic Cancer Diet and Nutrition Nutrition Following Pancreatic Surgery Ver esta página en ...

  10. Blood donation before surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000367.htm Blood donation before surgery To use the sharing features on ... team. Related MedlinePlus Health Topics Blood Transfusion and Donation Surgery Browse the Encyclopedia A.D.A.M., ...

  11. Cosmetic ear surgery

    Science.gov (United States)

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  12. Open heart surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002950.htm Open heart surgery To use the sharing features on this ... large arteries connected to the heart. The term "open heart surgery" means that you are connected to a ...

  13. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may ... indicate the need for corrective jaw surgery: Difficulty chewing, or biting food Difficulty swallowing Chronic jaw or ...

  15. Refractive corneal surgery - discharge

    Science.gov (United States)

    ... surgery. Avoid contact sports (such as boxing and football) for the first 4 weeks after surgery. DO ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  18. Surgery for pancreatic cancer

    Science.gov (United States)

    ... laparoscopically (using a tiny video camera) or using robotic surgery depends on: The extent of the surgery ... by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is ...

  19. Anti-reflux surgery

    Science.gov (United States)

    ... surgery. You may need another surgery in the future if you develop new reflux symptoms or swallowing ... Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  20. Blepharoplasty (Eyelid Surgery)

    Science.gov (United States)

    ... Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that repairs droopy eyelids and may involve ... tobacco and drugs. Your expectations. An honest discussion of your hopes and motivation for surgery will help set the stage for ...

  1. Smoking and surgery

    Science.gov (United States)

    Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking ... Tar, nicotine, and other chemicals from smoking can increase your risk of many health problems. These include heart and blood vessel problems, such as: Blood clots and aneurysms in ...

  2. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

  3. Cosmetic breast surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000273.htm Cosmetic breast surgery - discharge To use the sharing features on this page, please enable JavaScript. You had cosmetic breast surgery to change the size or shape ...

  4. Shoulder surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000179.htm Shoulder surgery - discharge To use the sharing features on this page, please enable JavaScript. You had shoulder surgery to repair the tissues inside or around your ...

  5. Weight Loss Surgery

    Science.gov (United States)

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight ... obesity. There are different types of weight loss surgery. They often limit the amount of food you ...

  6. Robotic liver surgery

    Science.gov (United States)

    Leung, Universe

    2014-01-01

    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  7. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian

    2009-01-01

    increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes...

  8. Breast Cancer Surgery

    Science.gov (United States)

    FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the whole tumor from the breast. Some lymph nodes ... might still be in the body. Types of breast cancer surgery There are two types of breast cancer ...

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may ... front, or side Facial injury Birth defects Receding lower jaw and ...

  10. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  11. The effect of initial temperature on flame acceleration and deflagration-to-detonation transition phenomenon

    International Nuclear Information System (INIS)

    Ciccarelli, G.; Boccio, J.L.; Ginsberg, T.; Finfrock, C.; Gerlach, L.; Tagawa, H.; Malliakos, A.

    1998-05-01

    The High-Temperature Combustion Facility at BNL was used to conduct deflagration-to-detonation transition (DDT) experiments. Periodic orifice plates were installed inside the entire length of the detonation tube in order to promote flame acceleration. The orifice plates are 27.3-cm-outer diameter, which is equivalent to the inner diameter of the tube, and 20.6-cm-inner diameter. The detonation tube length is 21.3-meters long, and the spacing of the orifice plates is one tube diameter. A standard automobile diesel engine glow plug was used to ignite the test mixture at one end of the tube. Hydrogen-air-steam mixtures were tested at a range of temperatures up to 650K and at an initial pressure of 0.1 MPa. In most cases, the limiting hydrogen mole fraction which resulted in DDT corresponded to the mixture whose detonation cell size, λ, was equal to the inner diameter of the orifice plate, d (e.g., d/λ=1). The only exception was in the dry hydrogen-air mixtures at 650K where the DDT limit was observed to be 11 percent hydrogen, corresponding to a value of d/λ equal to 5.5. For a 10.5 percent hydrogen mixture at 650K, the flame accelerated to a maximum velocity of about 120 mIs and then decelerated to below 2 mIs. By maintaining the first 6.1 meters of the vessel at the ignition end at 400K, and the rest of the vessel at 650K, the DDT limit was reduced to 9.5 percent hydrogen (d/λ=4.2). This observation indicates that the d/λ=1 DDT limit criteria provides a necessary condition but not a sufficient one for the onset of DDT in obstacle laden ducts. In this particular case, the mixture initial condition (i.e., temperature) resulted in the inability of the mixture to sustain flame acceleration to the point where DDT could occur. It was also observed that the distance required for the flame to accelerate to the point of detonation initiation, referred to as the run-up distance, was found to be a function of both the hydrogen mole fraction and the mixture initial

  12. Robot-assisted general surgery.

    Science.gov (United States)

    Hazey, Jeffrey W; Melvin, W Scott

    2004-06-01

    With the initiation of laparoscopic techniques in general surgery, we have seen a significant expansion of minimally invasive techniques in the last 16 years. More recently, robotic-assisted laparoscopy has moved into the general surgeon's armamentarium to address some of the shortcomings of laparoscopic surgery. AESOP (Computer Motion, Goleta, CA) addressed the issue of visualization as a robotic camera holder. With the introduction of the ZEUS robotic surgical system (Computer Motion), the ability to remotely operate laparoscopic instruments became a reality. US Food and Drug Administration approval in July 2000 of the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) further defined the ability of a robotic-assist device to address limitations in laparoscopy. This includes a significant improvement in instrument dexterity, dampening of natural hand tremors, three-dimensional visualization, ergonomics, and camera stability. As experience with robotic technology increased and its applications to advanced laparoscopic procedures have become more understood, more procedures have been performed with robotic assistance. Numerous studies have shown equivalent or improved patient outcomes when robotic-assist devices are used. Initially, robotic-assisted laparoscopic cholecystectomy was deemed safe, and now robotics has been shown to be safe in foregut procedures, including Nissen fundoplication, Heller myotomy, gastric banding procedures, and Roux-en-Y gastric bypass. These techniques have been extrapolated to solid-organ procedures (splenectomy, adrenalectomy, and pancreatic surgery) as well as robotic-assisted laparoscopic colectomy. In this chapter, we review the evolution of robotic technology and its applications in general surgical procedures.

  13. Using your shoulder after surgery

    Science.gov (United States)

    Shoulder surgery - using your shoulder; Shoulder surgery - after ... rotator cuff surgery or other ligament or labral surgery, you need to be careful with your shoulder. Ask the surgeon what arm movements are safe ...

  14. Orifice diseases project - experience of the "Hospital das Clínicas" University of São Paulo Medical Center in day-hospital of anorectal disease Projeto doenças orificiais experiência do HCFMUSP em hospital-dia e doenças anorretais

    Directory of Open Access Journals (Sweden)

    Sergio Carlos Nahas

    1999-06-01

    Full Text Available The treatment of malignant or benign colorectal pathologies that require more complex management are priorities in tertiary hospitals such as "Hospital das Clínicas" University of São Paulo Medical Center (HCFMUSP. Therefore, benign, uncomplicated orifice conditions are relegated to second place. The number of patients with hemorrhoids, perianal fistulas, fissures, condylomas and pilonidal cysts who seek treatment at the HFMUSP is very great, resulting in over-crowding in the outpatient clinics and a long waiting list for recommended surgical treatment (at times over 18 months. The authors describe the experience of the HCFMUSP over an eight-day period with day-hospital surgery in which 140 patients underwent surgery. Data was prospectively taken on the patients undergoing surgery for benign orifice pathologies including age, sex, diagnosis, surgery performed, immediate and late postoperative complications, and follow-up. 140 patients operated on over eight days were studied. 68 were males (48.75% with ages ranging from 25 to 62 (mean 35.2 yrs.. Hemorrhoids was the most frequent condition encountered (82 hemorrhoidectomies, 58.6%, followed by perineal fistula (28 fistula repairs, 20.0%. The most common complication was headache secondary to rachianesthesia occurring in 9 patients (6.4%. One patient (0.7% developed bleeding immediately PO that required reoperation. Mean follow-up was 104 days. Day-surgery characterized by quality care and low morbidity is feasible in tertiary public hospitals, permitting surgery for benign orifice pathologies on many patients within a short period of time.O tratamento das patologias colorretais malignas ou benignas, que necessitam tratamento com maior grau de complexidade são prioridades em hospitais terciários, como é o Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP, permanecendo assim as patologias orificiais benignas em um segundo plano. Todavia devido à sua

  15. Surgery versus physiotherapy for stress urinary incontinence.

    Science.gov (United States)

    Labrie, Julien; Berghmans, Bary L C M; Fischer, Kathelijn; Milani, Alfredo L; van der Wijk, Ileana; Smalbraak, Dina J C; Vollebregt, Astrid; Schellart, René P; Graziosi, Giuseppe C M; van der Ploeg, J Marinus; Brouns, Joseph F G M; Tiersma, E Stella M; Groenendijk, Annette G; Scholten, Piet; Mol, Ben Willem; Blokhuis, Elisabeth E; Adriaanse, Albert H; Schram, Aaltje; Roovers, Jan-Paul W R; Lagro-Janssen, Antoine L M; van der Vaart, Carl H

    2013-09-19

    Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial therapy. We performed a multicenter, randomized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence. Crossover between groups was allowed. The primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement at 12 months. We randomly assigned 230 women to the surgery group and 230 women to the physiotherapy group. A total of 49.0% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. In an intention-to-treat analysis, subjective improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference, 26.4 percentage points; 95% confidence interval [CI], 18.1 to 34.5). The rates of subjective cure were 85.2% in the surgery group and 53.4% in the physiotherapy group (absolute difference, 31.8 percentage points; 95% CI, 22.6 to 40.3); rates of objective cure were 76.5% and 58.8%, respectively (absolute difference, 17.8 percentage points; 95% CI, 7.9 to 27.3). A post hoc per-protocol analysis showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery and that both these groups had outcomes superior to those of women who did not cross over to surgery. For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year. (Funded by ZonMw, the Netherlands Organization for Health Research and Development; Dutch Trial Register number, NTR1248.).

  16. DEVELOPMENT OF PLASTIC SURGERY.

    Science.gov (United States)

    Pećanac, Marija Đ

    2015-01-01

    Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.

  17. Global patient outcomes after elective surgery

    DEFF Research Database (Denmark)

    2016-01-01

    BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective...... adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration...... to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low...

  18. Prosthetic valve obstruction: Redo surgery or fibrinolysis?

    Directory of Open Access Journals (Sweden)

    Avinash Inamdar

    2017-01-01

    Full Text Available Objective: The aim of this study was to compare the efficacy and safety of surgery versus fibrinolytic therapy in patients with prosthetic valve obstruction. Materials and Methods: We compared 15 patients of prosthetic valve thrombosis treated by surgical line of management and another 15 patients treated by thrombolysis. All patients were initially assessed by clinical evaluation and diagnosis confirmed by transthoracic and transesophageal two-dimensional echocardiography. Depending on hemodynamic stability, pannus, or thrombus on transesophageal echocardiography, the patients were assigned surgical or medical line of management. Results: Patients mortality rate was 40% in fibrinolytic group and 13.33% in surgical group. Recurrence was 40% in fibrinolytic group while there was no recurrence till date in surgery group. Complications were more in fibrinolytic group as opposed to surgery group patient. Conclusion: From our experience, we conclude that redo surgery is effective and definitive treatment, especially in patients with stable hemodynamic conditions.

  19. Surgery of Primary Melanomas

    Directory of Open Access Journals (Sweden)

    Piotr Rutkowski

    2010-05-01

    Full Text Available Surgery remains the mainstay of melanoma therapy, regardless of the tumor site. Only the early diagnosis combined with proper surgical therapy currently gives patients affected by this malignancy the chance for a full cure. The main goal of surgical therapy is to provide the local control of the disease and to secure long-term survival of the patient without reasonable functional and esthetic impairment. The recommended method of biopsy—excisional biopsy, as an initial diagnostic and, to some extent, therapeutic procedure—is performed under local anesthesia as an elliptical incision with visual clear margins of 1–3 mm and with some mm of subcutaneous tissue. The extent of radical excision of the primary tumor (or scar after excisional biopsy is based on the histopathologic characteristics of the primary tumor and usually consists of 1–2 cm margins with primary closure. The philosophy behind conducted randomized clinical trials has been to find the most conservative surgical approach that is able to guarantee the same results as more demolitive treatment. This has been the background of the trials designed to define the correct margins of excision around a primary cutaneous melanoma. Much less definition can be dedicated to the surgical management of patients with non-cutaneous melanomas.

  20. Surgery of Primary Melanomas

    Energy Technology Data Exchange (ETDEWEB)

    Rutkowski, Piotr, E-mail: rutkowskip@coi.waw.pl; Zdzienicki, Marcin; Nowecki, Zbigniew I. [Soft Tissue/Bone Sarcoma and Melanoma Department, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Akkooi, Alexander C. J. van [Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2010-05-11

    Surgery remains the mainstay of melanoma therapy, regardless of the tumor site. Only the early diagnosis combined with proper surgical therapy currently gives patients affected by this malignancy the chance for a full cure. The main goal of surgical therapy is to provide the local control of the disease and to secure long-term survival of the patient without reasonable functional and esthetic impairment. The recommended method of biopsy—excisional biopsy, as an initial diagnostic and, to some extent, therapeutic procedure—is performed under local anesthesia as an elliptical incision with visual clear margins of 1–3 mm and with some mm of subcutaneous tissue. The extent of radical excision of the primary tumor (or scar after excisional biopsy) is based on the histopathologic characteristics of the primary tumor and usually consists of 1–2 cm margins with primary closure. The philosophy behind conducted randomized clinical trials has been to find the most conservative surgical approach that is able to guarantee the same results as more demolitive treatment. This has been the background of the trials designed to define the correct margins of excision around a primary cutaneous melanoma. Much less definition can be dedicated to the surgical management of patients with non-cutaneous melanomas.

  1. Surgery of Primary Melanomas

    International Nuclear Information System (INIS)

    Rutkowski, Piotr; Zdzienicki, Marcin; Nowecki, Zbigniew I.; Akkooi, Alexander C. J. van

    2010-01-01

    Surgery remains the mainstay of melanoma therapy, regardless of the tumor site. Only the early diagnosis combined with proper surgical therapy currently gives patients affected by this malignancy the chance for a full cure. The main goal of surgical therapy is to provide the local control of the disease and to secure long-term survival of the patient without reasonable functional and esthetic impairment. The recommended method of biopsy—excisional biopsy, as an initial diagnostic and, to some extent, therapeutic procedure—is performed under local anesthesia as an elliptical incision with visual clear margins of 1–3 mm and with some mm of subcutaneous tissue. The extent of radical excision of the primary tumor (or scar after excisional biopsy) is based on the histopathologic characteristics of the primary tumor and usually consists of 1–2 cm margins with primary closure. The philosophy behind conducted randomized clinical trials has been to find the most conservative surgical approach that is able to guarantee the same results as more demolitive treatment. This has been the background of the trials designed to define the correct margins of excision around a primary cutaneous melanoma. Much less definition can be dedicated to the surgical management of patients with non-cutaneous melanomas

  2. A Population-Based Analysis of Time to Surgery and Travel Distances for Brachial Plexus Surgery.

    Science.gov (United States)

    Dy, Christopher J; Baty, Jack; Saeed, Mohammed J; Olsen, Margaret A; Osei, Daniel A

    2016-09-01

    Despite the importance of timely evaluation for patients with brachial plexus injuries (BPIs), in clinical practice we have noted delays in referral. Because the published BPI experience is largely from individual centers, we used a population-based approach to evaluate the delivery of care for patients with BPI. We used statewide administrative databases from Florida (2007-2013), New York (2008-2012), and North Carolina (2009-2010) to create a cohort of patients who underwent surgery for BPI (exploration, repair, neurolysis, grafting, or nerve transfer). Emergency department and inpatient records were used to determine the time interval between the injury and surgical treatment. Distances between treating hospitals and between the patient's home ZIP code and the surgical hospital were recorded. A multivariable logistic regression model was used to determine predictors for time from injury to surgery exceeding 365 days. Within the 222 patients in our cohort, median time from injury to surgery was 7.6 months and exceeded 365 days in 29% (64 of 222 patients) of cases. Treatment at a smaller hospital for the initial injury was significantly associated with surgery beyond 365 days after injury. Patient insurance type, travel distance for surgery, distance between the 2 treating hospitals, and changing hospitals between injury and surgery did not significantly influence time to surgery. Nearly one third of patients in Florida, New York, and North Carolina underwent BPI surgery more than 1 year after the injury. Patients initially treated at smaller hospitals are at risk for undergoing delayed BPI surgery. These findings can inform administrative and policy efforts to expedite timely referral of patients with BPI to experienced centers. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Analysis of Simultaneous Gas-Liquid Flow Through an Orifice and Its Application to Flow Metering Etude de l'écoulement simultané d'un mélange gaz-liquide à travers un orifice et son application à la mesure du débit

    Directory of Open Access Journals (Sweden)

    Pascal H.

    2006-11-01

    Full Text Available The purpose of this article is to show a more accurate orifice equation for a two-phase flow, such a compressible mixture of gas and liquid. The orifice equation given here con be used for the measurement of a gas-liquid mixture of fine emulsions by the orificemeter method. From the thermodynamic point of view, an equation of state has been formulated which provides the relationship between the specific mass of the mixture and pressure, under conditions of adiabatic expansion. The results obtained enable the mass flow rates of gas and liquid ta be determined without separation of the phases, provided thot the gas liquid mass ratio is known. The critical pressure ratio corresponding ta sonic velocity is also determined. Cet article présente une relation plus précise pour l'écoulement d'un système à deux phases, tel qu'un mélange compressible gaz-liquide, à travers un diaphragme. Cette relation peut être utilisée pour des mesures de mélanges gaz-liquide très finement divisés, c'est-à-dire des émulsions ou brouillards, par la méthode du diaphragme en paroi mince. Du point de vue thermodynamique, on a formulé une équation d'état donnant la relation entre la masse spécifique du mélange et la pression dans des conditions d'expansion adiabatique. Les résultats obtenus per-mettent de déterminer le débit massique du gaz et du liquide, sans séparation des deux phases, à condition que le rapport de masse gaz-liquide soit connu. On détermine également le rapport de pression critique correspondantà la vitesse du son.

  4. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Mrkobrada, Marko; Sessler, Daniel I

    2014-01-01

    BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10......,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before...... the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum...

  5. Modelling of fluid flow through short tube orifices under metastable conditions: A new numerical validation approach for evaluating the mass flow rate with refrigerant mixtures (HFC-407C and HFC-410A)

    International Nuclear Information System (INIS)

    García-Valladares, O.; Santoyo, E.

    2014-01-01

    In a previous work, one-dimensional numerical modelling of fluid-flow inside short tube orifices was performed, and successfully validated against a wide range of mass flow rate measurements reported for the refrigerant HFC-134a. Governing equations of continuity, momentum, energy and entropy were solved for describing the fluid flow under a wide variety of thermodynamic transitions (e.g., subcooled liquid region, metastable liquid region, metastable two-phase region and equilibrium two-phase region), including sudden contraction and enlargement. In this new study, a comprehensive comparison analysis between numerical simulation data and experimental measurements obtained for HFC-407C and HFC-410A refrigerants (N o  = 241) to extend the applicability of the same mathematical model was carried out. Using a widespread statistical analysis, based on weighted linear regressions with an outlier detection/rejection module at 95% of confidence level, the prediction performance of the mathematical model was again assessed. Linear regressions between predicted mass flow rate data and experimental measurements were computed, and used them as a statistical comparison criterion. A statistical comparison between predicted simulation results and mass flow rate experimental data are reported. Average deviation errors of ±11.1% (for the refrigerant HFC-407C) and ±7.3% (for refrigerant HFC-410A) were found between numerical model and experimental data. These results demonstrate a new and robust application of the model to predict reliably the mass flow rate through short tube orifices under metastable conditions, which enable this tool to be reliably used for the design of short tube orifices. - Highlights: •A modelling for evaluating short tube orifice was developed for refrigerant mixtures. •The numerical model applied considered metastable regions and choke flow. •The model was validated against experimental data for HFC-407C and HFC-410A. •Statistical analysis based

  6. Predictors of incident depression after hip fracture surgery.

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Banerjee, S.; Horan, M.; Baldwin, R.; Pendleton, N.; Proctor, R.; Tarrier, N.; Woodward, Y.; Burns, A.

    2007-01-01

    OBJECTIVE: Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery

  7. Ergonomics in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Supe Avinash

    2010-01-01

    Full Text Available Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comfortable in the operating room but also reduce physical strains on surgeon.

  8. Gastric and intestinal surgery.

    Science.gov (United States)

    Fossum, Theresa W; Hedlund, Cheryl S

    2003-09-01

    Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.

  9. Surgery: a risky business.

    Science.gov (United States)

    Vats, Amit; Nagpal, Kamal; Moorthy, Krishna

    2009-10-01

    The advancement of surgical technology has made surgery an increasingly suitable management option for an increasing number of medical conditions. Yet there is also a growing concern about the number of patients coming to harm as a result of surgery. Studies show that this harm can be prevented by better teamwork and communication in operating theatres. This article discusses the extent of adverse events in surgery and how effective teamwork and communication can improve patient safety. It also highlights the role checklists and briefing in improving teamwork and reducing human error in surgery.

  10. Heart valve surgery

    Science.gov (United States)

    ... replacement; Valve repair; Heart valve prosthesis; Mechanical valves; Prosthetic valves ... surgery. Your heart valve has been damaged by infection ( endocarditis ). You have received a new heart valve ...

  11. Surgery versus physiotherapy for stress urinary incontinence

    NARCIS (Netherlands)

    Labrie, J.; Berghmans, B.L.; Fischer, K.; Milani, A.L.; Wijk, I. van; Smalbraak, D.J.; Vollebregt, A.; Schellart, R.P.; Graziosi, G.C.; Ploeg, J.M. van der; Brouns, J.F.; Tiersma, E.S.; Groenendijk, A.G.; Scholten, P.; Mol, B.W.; Blokhuis, E.E.; Adriaanse, A.H.; Schram, A.; Roovers, J.P.; Lagro-Janssen, A.L.M.; Vaart, C.H. van der

    2013-01-01

    BACKGROUND: Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial

  12. Surgery versus Physiotherapy for Stress Urinary Incontinence

    NARCIS (Netherlands)

    Labrie, Julien; Berghmans, Bary L. C. M.; Fischer, Kathelijn; Milani, Alfredo L.; van der Wijk, Ileana; Smalbraak, Dina J. C.; Vollebregt, Astrid; Schellart, Rene P.; Graziosi, Giuseppe C. M.; van der Ploeg, J. Marinus; Brouns, Joseph F. G. M.; Tiersma, E. Stella M.; Groenendijk, Annette G.; Scholten, Piet; Mol, Ben Willem; Blokhuis, Elisabeth E.; Adriaanse, Albert H.; Schram, Aaltje; Roovers, Jan-Paul W. R.; Lagro-Janssen, Antoine L. M.; van der Vaart, Carl H.

    2013-01-01

    BackgroundPhysiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial

  13. Metabolic and oncological consequences of laparoscopic surgery

    NARCIS (Netherlands)

    N.D. Kannekens-Bouvy (Nicole)

    1997-01-01

    textabstractIn 1986, Philip Mouret and his colleagues performed the first laparoscopic cholecystectomy. They initiated the most revolutionary change in traditional surgery, since the introduction of anaesthesia, asepsis, antibiotics and blood-transfusion. At the same time, industry propelled this

  14. [From the French Society of Plastic and Reconstructive Surgery to the French Society of Plastic Reconstructive and Aesthetic Surgery].

    Science.gov (United States)

    Glicenstein, J

    2004-04-01

    (The) 3rd December 1952, 11 surgeons and other specialists found the French Society of Plastic and Reconstructive Surgery (SFCPR) which was officially published on (the) 28 September 1953. The first congress was during October 1953 and the first president as Maurice Aubry. The first secretary was Daniel Morel Fatio. The symposiums were after about three of four times each year and the thematic subjects were initially according the reconstructive surgery. The review "Annales de chirurgie plastique" was free in 1956. The members of the Society were about 30 initially, but their plastic surgery in the big hospitals at Paris and other big towns in France. The "specialty" of plastic surgery was created in 1971. On "syndicate", one French board of plastic reconstructive and aesthetic surgery, the increasing of departments of plastic surgery were the front of increasing of the plastic surgery in French and of the number of the French Society of Plastic Reconstructive surgery (580 in 2003). The French Society organized the International Congress of Plastic Surgery in 1975. The society SFCPR became the French Society of plastic reconstruction and Aesthetic Surgery (SFCPRE) in 1983 and the "logo" (front view) was in the 1994 SOF.CPRE.

  15. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid C; Neumann, Gudrun

    2014-01-01

    -up by hospital data files, general practitioner, death certificate, and autopsy report. Revision of histopathology by a single pathologist. Main outcome measures: Survival and relapse by clinical data, stage, and type of surgery. RESULTS: The incidence of AGCT was 1.37 per year per 100,000 women (95% CI: 1.08, 1.......68). The median follow-up time was 15 years and for the 79 surviving women 22 years. Stage I was found in 94% of cases. Relapse occurred in 24% of women in stage I and 100% of the other stages. Survival in stage I was 95%, 89% and 84% after 5, 10 and 20 years respectively. Increased survival of stage I......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...

  16. Gut permeability and myocardial damage in paediatric cardiac surgery

    NARCIS (Netherlands)

    Malagon, Ignacio

    2005-01-01

    Cardiopulmonary bypass (CPB) induces a systemic inflammatory response syndrome (SIRS) in patients following cardiac surgery that can lead to major organ injury and postoperative morbidity. Initiation of CPB sets in motion an extremely complex and multifaceted response involving complement

  17. Openness initiative

    International Nuclear Information System (INIS)

    Duncan, S.S.

    1995-01-01

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: open-quotes Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?close quotes To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts

  18. Openness initiative

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, S.S. [Los Alamos National Lab., NM (United States)

    1995-12-31

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  19. Jet array impingement flow distributions and heat transfer characteristics. Effects of initial crossflow and nonuniform array geometry. [gas turbine engine component cooling

    Science.gov (United States)

    Florschuetz, L. W.; Metzger, D. E.; Su, C. C.; Isoda, Y.; Tseng, H. H.

    1982-01-01

    Two-dimensional arrays of circular air jets impinging on a heat transfer surface parallel to the jet orifice plate are considered. The jet flow, after impingement, is constrained to exit in a single direction along the channel formed by the jet orifice plate and the heat transfer surface. The configurations considered are intended to model those of interest in current and contemplated gas turbine airfoil midchord cooling applications. The effects of an initial crossflow which approaches the array through an upstream extension of the channel are considered. Flow distributions as well as heat transfer coefficients and adiabatic wall temperatures resolved to one streamwise hole spacing were measured as a function of the initial crossflow rate and temperature relative to the jet flow rate and temperature. Both Nusselt number profiles and dimensionless adiabatic wall temperature (effectiveness) profiles are presented and discussed. Special test results which show a significant reduction of jet orifice discharge coefficients owing to the effect of a confined crossflow are also presented, along with a flow distribution model which incorporates those effects. A nonuniform array flow distribution model is developed and validated.

  20. Initiative hard coal; Initiative Steinkohle

    Energy Technology Data Exchange (ETDEWEB)

    Leonhardt, J.

    2007-08-02

    In order to decrease the import dependence of hard coal in the European Union, the author has submitted suggestions to the director of conventional sources of energy (directorate general for energy and transport) of the European community, which found a positive resonance. These suggestions are summarized in an elaboration 'Initiative Hard Coal'. After clarifying the starting situation and defining the target the presupposition for a better use of hard coal deposits as raw material in the European Union are pointed out. On that basis concrete suggestions for measures are made. Apart from the conditions of the deposits it concerns thereby also new mining techniques and mining-economical developments, connected with tasks for the mining-machine industry. (orig.)

  1. Performance Indicators in Spine Surgery.

    Science.gov (United States)

    St-Pierre, Godefroy Hardy; Yang, Michael H; Bourget-Murray, Jonathan; Thomas, Ken C; Hurlbert, Robin John; Matthes, Nikolas

    2018-02-15

    Systematic review. To elucidate how performance indicators are currently used in spine surgery. The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators. MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator. The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery. The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance. 1.

  2. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. The Annals of Pediatric Surgery has the responsibility to serve not only pediatric surgeons in the Middle East and North Africa but also should be an important conduit for scientific ...

  3. Safety in cardiac surgery

    NARCIS (Netherlands)

    Siregar, S.

    2013-01-01

    The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for

  4. What Is Heart Surgery?

    Science.gov (United States)

    ... kidneys, liver, and lungs. Stroke , which may cause short-term or permanent damage. Death. (Heart surgery is more likely to be life threatening in people who are very sick before the surgery.) Memory loss and other issues, such as problems concentrating or ...

  5. Annals of African Surgery

    African Journals Online (AJOL)

    The goal of the Annals of African Surgery is to provide a medium for the exchange of current information between surgeons in the African region. The journal embraces surgery in all its aspects; basic science, clinical research, experimental research, surgical education. It will assist surgeons in the region to keep abreast of ...

  6. About Hand Surgery

    Science.gov (United States)

    ... Find a hand surgeon near you. © 2009 American Society for Surgery of the Hand. Definition developed by ASSH Council. Other Links CME Mission Statement and Disclaimer Policies and Technical Requirements Exhibits and Partners ASSH 822 W. Washington Blvd. ... 2018 by American Society for Surgery of the Hand × Search Tips Tip ...

  7. Lasik eye surgery - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100206.htm Lasik eye surgery - series—Normal anatomy To use the ... A.M. Editorial team. Related MedlinePlus Health Topics Laser Eye Surgery A.D.A.M., Inc. is accredited by ...

  8. LASIK - Laser Eye Surgery

    Science.gov (United States)

    ... Refractive Surgery Procedures What Is Photorefractive Keratectomy (PRK)? LASIK — Laser Eye Surgery Leer en Español: LASIK—Cirugía ocular con láser ... loss of close-up focusing power. How the LASIK procedure works LASIK is performed while the patient ...

  9. [Gases in vitreoretinal surgery].

    Science.gov (United States)

    Janco, L; Vida, R; Bartos, M; Villémová, K; Izák, M

    2012-02-01

    To evaluate the importance and benefits of using gases in vitreoretinal surgery. The gases represent a wide group of substances used in eye surgery for more than 100 years. The role of intraocular gases in vitreoretinal surgery is irreplaceable. Their use is still considered to be the "gold standard". An important step in eye surgery was the introduction of expanding gases--sulfur hexafluoride and perfluorocarbons into routine clinical practice. The most common indications for the use of intraocular gases are: retinal detachment, idiopathic macular hole, complications of vitreoretinal surgery and others. The introduction of intraocular gases into routine clinical practice, along with other modern surgical techniques resulted in significant improvement of postoperative outcomes in a wide range of eye diseases. Understanding the principles of intraocular gases use brings the benefits to the patient and physician as well. Due to their physical and chemical properties they pose far the best and most appropriate variant of intraocular tamponade. Gases also bring some disadvantages, such as difficulties in detailed fundus examination, visual acuity testing, ultrasonographic examination, difficulties in application of intravitreal drugs or reduced possibility of retina laser treatment. The gases significantly change optical system properties of the eye. The use of gases in vitreoretinal surgery has significantly increased success rate of retinal detachment surgery, complicated posterior segment cases, trauma, surgery of the macula and other diseases.

  10. Robust surgery loading

    NARCIS (Netherlands)

    Hans, Elias W.; Wullink, Gerhard; van Houdenhoven, Mark; Kazemier, Geert

    2008-01-01

    We consider the robust surgery loading problem for a hospital’s operating theatre department, which concerns assigning surgeries and sufficient planned slack to operating room days. The objective is to maximize capacity utilization and minimize the risk of overtime, and thus cancelled patients. This

  11. [Cognitive deterioration after surgery

    DEFF Research Database (Denmark)

    Steinmetz, J.; Rasmussen, L.S.

    2008-01-01

    Delirium and postoperative cognitive dysfunction are important and common complications after surgery. Risk factors are first of all increasing age and type of surgery, whereas the type of anaesthesia does not seem to play an important role. Mortality is higher among patients with cognitive...

  12. Hand Surgery: Anesthesia

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Surgery Anesthesia Email to a friend * required ...

  13. Penile enlargement surgery.

    Science.gov (United States)

    Alter, G J

    1998-06-01

    Aesthetic surgery to improve the appearance of the penis, scrotum, and pubic region has successfully evolved. Penile lengthening is performed by releasing the suspensory ligament of the penis followed by use of penile weights. Girth is increased by wrapping a dermal-fat graft around the penile circumference. The choice of surgery is determined by the patient's anatomy and desires.

  14. Left ventricular mass regression is independent of gradient drop and effective orifice area after aortic valve replacement with a porcine bioprosthesis.

    Science.gov (United States)

    Sádaba, Justo Rafael; Herregods, Marie-Christine; Bogaert, Jan; Harringer, Wolfgang; Gerosa, Gino

    2012-11-01

    The question of whether left ventricular mass (LVM) regression following aortic valve replacement (AVR) is affected by the prosthesis indexed effective orifice area (IEOA) and transprosthetic gradient has not been fully elucidated. Data from a prospective, core-laboratory-reviewed echocardiography and magnetic resonance imaging (MRI) study was used to determine if the degree of LVM regression following AVR with two types of porcine bioprosthesis in patients suffering from predominant aortic valve stenosis (AS) was related to the prosthesis IEOA and transprosthetic gradient. Over a two-year period, 149 patients enrolled at eight centers received either an Epic or an Epic Supra aortic bioprosthesis (St. Jude Medical, MN, USA). Preoperative valve dysfunction was pure AS in 54 patients (36%) and mixed valve disease (primarily stenosis) in 95 patients (64%). LVM was determined preoperatively and at six months postoperatively, using MRI. The prosthesis IEOA and transprosthetic gradient were calculated at six months by means of echocardiography. Data were available for 111 patients at both enrolment and six months postoperatively. The LVM at enrolment and at follow up was 154.96 +/- 42.50 g and 114.83 +/- 29.20 g, respectively (p regression methods, showed LVM regression to be independent of the mean systolic pressure gradient, peak systolic pressure and prosthesis IEOA at six months (p = 0.53, 0.43, and 0.15, respectively). At six months after AVR with a porcine bioprosthesis to treat AS, there was a significant LVM regression that was independent of the prosthesis IEOA and the mean systolic pressure gradient and peak systolic pressure.

  15. How to prevent endophthalmitis in cataract surgeries?

    Directory of Open Access Journals (Sweden)

    Kelkar Aditya

    2008-01-01

    Full Text Available Postoperative endophthalmitis is a very devastating complication and every step should be taken to reduce its occurrence. Unattended air conditioning filter systems are often the culprits and regular maintenance of the filters is of paramount importance. Shedders of pathogenic organisms amongst the theater personnel should be identified by regular screening and should be promptly treated. In addition to the use of Povidone iodine 5% solution in the conjunctival sac few minutes prior to surgery, proper construction of wound, injectable intraocular lenses, use of prophylactic intracameral antibiotics or prophylactic subconjunctival antibiotic injection at the conclusion of cataract surgery, placing a patch after the surgery for at least 4 h and initiating topical antibiotics from the same day of surgery helps to lower the frequency of postoperative endophthalmitis. Intraoperative posterior capsule rupture and anterior vitrectomy are risk factors for acute endophthalmitis, and utmost care to prevent posterior capsular rent should be taken while performing cataract surgery. Also, in case of such complication, these patients should be closely monitored for early signs of endophthalmitis in the postoperative period. In the unfortunate event of endophthalmitis the diagnosis should be prompt and treatment must be initiated as early as possible.

  16. Minimally invasive orthognathic surgery.

    Science.gov (United States)

    Resnick, Cory M; Kaban, Leonard B; Troulis, Maria J

    2009-02-01

    Minimally invasive surgery is defined as the discipline in which operative procedures are performed in novel ways to diminish the sequelae of standard surgical dissections. The goals of minimally invasive surgery are to reduce tissue trauma and to minimize bleeding, edema, and injury, thereby improving the rate and quality of healing. In orthognathic surgery, there are two minimally invasive techniques that can be used separately or in combination: (1) endoscopic exposure and (2) distraction osteogenesis. This article describes the historical developments of the fields of orthognathic surgery and minimally invasive surgery, as well as the integration of the two disciplines. Indications, techniques, and the most current outcome data for specific minimally invasive orthognathic surgical procedures are presented.

  17. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training.

    Science.gov (United States)

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M

    2011-11-01

    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

  18. Quality of Life After Bariatric Surgery.

    Science.gov (United States)

    Mazer, Laura M; Azagury, Dan E; Morton, John M

    2017-06-01

    The purpose of this review is to provide an introduction to quality of life (QOL) outcomes after bariatric surgery and a summary of the current evidence. QOL has been emphasized in bariatric surgery since the NIH Consensus Conference statement in 1991. Initial studies were limited to 1- and 2-year follow-up. More recent findings have expanded the follow-up period up to 12 years, providing a better description of the impact on long-term QOL. Overall, there is little to no consensus regarding the definition of QOL or the ideal survey. Bariatric surgery has the greatest impact on physical QOL, and the impact on mental health remains unclear. There are some specific and less frequently reported threats to quality of life after bariatric surgery that are also discussed. Obesity has a definite impact on quality of life, even without other comorbidities, and surgery for obesity results in significant and lasting improvements in patient-reported quality of life outcomes. This conclusion is limited by a wide variety of survey instruments and absence of consensus on the definition of QOL after bariatric surgery.

  19. Robotic-assisted laparoendoscopic single-site surgery (R-LESS) in urology: an evidence-based analysis.

    Science.gov (United States)

    Barret, E; Sanchez-Salas, R; Ercolani, M; Forgues, A; Rozet, F; Galiano, M; Cathelineau, X

    2011-06-01

    The objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives of robotic laparoendoscopic single-site surgery (R-LESS). A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). All clinical and investigative reports for robotic LESS and NOTES procedures in the urological literature have been considered. A significant number of clinical urological procedures have been successfully completed utilizing R-LESS procedures. The available experience is limited to referral centers, where the case volume is sufficient to help overcome the challenges and learning curve of LESS surgery. The robotic interface remains the best fit for LESS procedures but its mode of use continues to evolve in attempts to improve surgical technique. We stand today at the dawn of R-LESS surgery, but this approach may well become the standard of care in the near future. Further technological development is needed to allow widespread adoption of the technique.

  20. Cleft Lip and Palate Surgery

    Science.gov (United States)

    ... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...

  1. Gamma knife surgery for craniopharyngioma

    International Nuclear Information System (INIS)

    Prasad, D.; Steiner, M.; Steiner, L.

    1995-01-01

    We present our results of Gamma Knife surgery for craniopharyngioma in nine patients. The current status of surgery, radiation therapy, intracavitary instillation of radionuclides and Gamma Knife surgery in the management of craniopharyngiomas is discussed. (author)

  2. Heart failure - surgeries and devices

    Science.gov (United States)

    ... surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure ... problem may cause heart failure or make heart failure worse. Heart valve surgery may be needed to repair or ...

  3. Epiretinal membrane surgery

    DEFF Research Database (Denmark)

    Hamoudi, Hassan; Correll Christensen, Ulrik; La Cour, Morten

    2017-01-01

    Purpose: To assess the impact of combined phacoemulsification-vitrectomy and sequential surgery for idiopathic epiretinal membrane (ERM) on refractive error (RE) and macular morphology. Methods: In this prospective clinical trial, we allocated phakic eyes with ERM to (1) cataract surgery and subs......Purpose: To assess the impact of combined phacoemulsification-vitrectomy and sequential surgery for idiopathic epiretinal membrane (ERM) on refractive error (RE) and macular morphology. Methods: In this prospective clinical trial, we allocated phakic eyes with ERM to (1) cataract surgery...... and achieved spherical equivalent); secondary outcomes were best-corrected visual acuity (BCVA), and incidence of cystoid macular oedema (CME) defined as >10% increment of central subfield macular thickness (CSMT). Results: Sixty-two eyes were enrolled. The mean RE showed a small myopic shift of -0.36D in all...... between the groups. Four cases (17%) in the CAT group had resolved visual complaints and improved BCVA after cataract surgery resulting in no need for PPV within the follow-up period. Conclusion: Surgery for idiopathic ERM in phakic eyes with either phaco-vitrectomy or sequential surgery are equal...

  4. Craniofacial Surgery Fellowship Websites.

    Science.gov (United States)

    Silvestre, Jason; Agarwal, Divyansh; Taylor, Jesse A

    2016-06-01

    Applicants for craniofacial surgery fellowships utilize Internet-based resources like the San Francisco (SF) Match to manage applications. The purpose of this study was to evaluate the accessibility and content of craniofacial surgery fellowship websites (CSFWs). A list of available craniofacial surgery fellowships was compiled from directories of the American Society of Craniofacial Surgery (ACSFS) and SF Match. Accessibility of CSFWs was assessed via links from these directories and a Google search. Craniofacial surgery fellowship websites were evaluated on education and recruitment content and compared via program characteristics. Twenty-four of the 28 US-based craniofacial surgery fellowship programs had a CSFW (86%). The ACSFS and SF Match databases had limited CSFW accessibility, but a Google search revealed most CSFWs had the top search result (76%). In total, CSFWs provided an average of 39% of education and recruitment variables. While most programs provided fellowship program descriptions (96%), application links (96%), and faculty listings (83%), relatively few provided rotation schedules (13%), fellow selection process information (13%), or interview dates (8%). CSFW content did not vary by program location, faculty size, accreditation status, or institutional affiliations (P > 0.05). Craniofacial surgery fellowships often lack readily accessible websites from national program lists and have limited information for interested applicants. The consistent lack of online information across programs suggests future opportunities exist to improve these educational resources.

  5. Morphometry of the Myopectineal Orifice

    African Journals Online (AJOL)

    Hp 630 Dual Core

    ГЕНЙФСЧРЖ ОО ЙФСЛР КЗФРЛГХ СЕЕЧФ ЦКФСЧЙК Г ЩЗГНРЗХХ ГЦ ЦКЗ ОСЩЗФ ЗЪЦФЗПЛЦЫ СИ ЦКЗ. ГДЖСПЗР ЦКЗ ПЫСТЗЕЦЛРЗГО СФЛИЛЕЗ ...

  6. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. The sixtieth birthday (on December 14, 1996) of C.T.C. Wall, a leading member of the subject''s founding generation, led the editors of this volume to reflect on the extraordinary accomplishments of surgery theory as well as its current enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source surveying surgery theory and its applications. Because no one person could write such a survey, the editors ask

  7. Surveys on surgery theory

    CERN Document Server

    Cappell, Sylvain; Rosenberg, Jonathan

    2014-01-01

    Surgery theory, the basis for the classification theory of manifolds, is now about forty years old. There have been some extraordinary accomplishments in that time, which have led to enormously varied interactions with algebra, analysis, and geometry. Workers in many of these areas have often lamented the lack of a single source that surveys surgery theory and its applications. Indeed, no one person could write such a survey. The sixtieth birthday of C. T. C. Wall, one of the leaders of the founding generation of surgery theory, provided an opportunity to rectify the situation and produce a

  8. A Miniature Robot for Retraction Tasks under Vision Assistance in Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Giuseppe Tortora

    2014-03-01

    Full Text Available Minimally Invasive Surgery (MIS is one of the main aims of modern medicine. It enables surgery to be performed with a lower number and severity of incisions. Medical robots have been developed worldwide to offer a robotic alternative to traditional medical procedures. New approaches aimed at a substantial decrease of visible scars have been explored, such as Natural Orifice Transluminal Endoscopic Surgery (NOTES. Simple surgical tasks such as the retraction of an organ can be a challenge when performed from narrow access ports. For this reason, there is a continuous need to develop new robotic tools for performing dedicated tasks. This article illustrates the design and testing of a new robotic tool for retraction tasks under vision assistance for NOTES. The retraction robots integrate brushless motors to enable additional degrees of freedom to that provided by magnetic anchoring, thus improving the dexterity of the overall platform. The retraction robot can be easily controlled to reach the target organ and apply a retraction force of up to 1.53 N. Additional degrees of freedom can be used for smooth manipulation and grasping of the organ.

  9. Corrective Jaw Surgery

    Medline Plus

    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who ... surgeons surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and ...

  10. COMPUTERS IN SURGERY

    African Journals Online (AJOL)

    BODE

    Key words: Computers, surgery, applications. Introduction ... With improved memory, speed and processing power in an ever more compact ... with picture and voice embedment to wit. With the ... recall the tedium of anatomy, physiology and.

  11. HEAD AND NECK SURGERY

    African Journals Online (AJOL)

    simple and well tolerated, and can be used selectively or as a ... up clinical information was obtained from a review of the patients' .... When a mass is clinically malignant, and facial nerve ... extension of surgery and closer attention to tumour.

  12. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery. It is important to understand that your treatment, which will probably include orthodontics before and after ... to realistically estimate the time required for your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided ...

  13. Aortic valve surgery - open

    Science.gov (United States)

    ... gov/ency/article/007408.htm Aortic valve surgery - open To use the sharing features on this page, ... separates the heart and aorta. The aortic valve opens so blood can flow out. It then closes ...

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who We ... surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and oral ...

  15. Spine surgery - discharge

    Science.gov (United States)

    ... milk). This means you should not lift a laundry basket, grocery bags, or small children. You should ... Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. ...

  16. Pain Medications After Surgery

    Science.gov (United States)

    ... be used for outpatient procedures or more-involved inpatient surgery. For pain relief lasting several hours, an ... surgical care, such as rest, ice packs, rehabilitative exercises and wound care. Ask to have written instructions ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral and maxillofacial surgeons are extensively ...

  18. Scoliosis surgery - child

    Science.gov (United States)

    ... from getting worse. But, when they no longer work, the child's health care provider will recommend surgery. There are several reasons to treat scoliosis: Appearance is a major concern. Scoliosis often causes back pain. If the curve is severe enough, ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics ... several years to complete. Your OMS and orthodontist understand that this is a long-term commitment for ...

  20. Ambulatory paediatric surgery

    African Journals Online (AJOL)

    reminder and instructions 24 - 48 hours before surgery. Effective communication with ... patients, no abnormal postoperative behaviour patterns were recorded by the ... nursing and administration staff - less desirable is a day- stay ward with ...

  1. Aids and Surgery

    African Journals Online (AJOL)

    user

    2004-12-02

    Dec 2, 2004 ... The correlation between HIV infection and surgery began to be highlighted only two ... expect greater clinical exposure to patients with. HIV/AIDS. .... fractures in HIV patient, although too little is known about the relationship ...

  2. HEAD AND NECK SURGERY

    African Journals Online (AJOL)

    +/-symptoms and signs), intravenous calcium gluconate and oral calcium lactate is .... facilitated by surgical stress, Vitamin D deficiency and hungry .... recurrence after thyroid surgery, excluding cancer. Chirurgie. ... Crea C, Alesina P, et al.

  3. Hip fracture surgeries

    Science.gov (United States)

    ... clearly. Sometimes, surgery can make this problem worse. Pressure sores ( pressure ulcers or bed sores) from being in bed or ... the hospital for 3 to 5 days. Full recovery will take from 3 to 4 months to ...

  4. Mitral valve surgery - open

    Science.gov (United States)

    ... Taking warfarin (Coumadin) References Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... A.M. Editorial team. Heart Surgery Read more Heart Valve Diseases Read more Mitral Valve Prolapse Read more A. ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery: Difficulty chewing, or biting food Difficulty swallowing Chronic jaw or jaw joint (TMJ) pain and headache ... Inability to make the lips meet without straining Chronic mouth breathing Sleep apnea (breathing problems when sleeping, ...

  6. Hemorrhoid surgery - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100026.htm Hemorrhoid surgery - series—Normal anatomy To use the sharing ... empties stool from the body through the anus. Hemorrhoids are "cushions" of tissue filled with blood vessels ...

  7. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... We Do Who We Are News Videos Contact Find a Surgeon What We Do Anesthesia Anesthesia Oral ... of sedation and general anesthesia. Click here to find out more. Cleft Lip/Palate and Craniofacial Surgery ...

  8. Laser surgery - skin

    Science.gov (United States)

    ... Bleeding Problem not going away Infection Pain Scarring Skin color changes Some laser surgery is done when you are asleep and ... TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical ... lasers, lights, and tissue interactions. In: Hruza GJ, Avram ...

  9. Aids and Surgery

    African Journals Online (AJOL)

    user

    2004-12-02

    Dec 2, 2004 ... HIV/AIDS patients require surgery sometimes during their illness. The objective of the ... risks to surgical equipes and analysing preventive strategies to HIV ... of Atlanta, and after an assessment of the performance status and ...

  10. Art and Plastic Surgery.

    Science.gov (United States)

    Fernandes, Julio Wilson; Metka, Susanne

    2016-04-01

    The roots of science and art of plastic surgery are very antique. Anatomy, drawing, painting, and sculpting have been very important to the surgery and medicine development over the centuries. Artistic skills besides shape, volume, and lines perception can be a practical aid to the plastic surgeons' daily work. An overview about the interactions between art and plastic surgery is presented, with a few applications to rhinoplasty, cleft lip, and other reconstructive plastic surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  11. Laparoscopic Spine Surgery

    Science.gov (United States)

    ... the frontal approach takes advantage of normal tissue planes and does not require removal of any bone. ... to the “open” procedure may include: Obesity A history of prior abdominal surgery causing dense scar tissue ...

  12. Gastric Bypass Surgery

    Science.gov (United States)

    ... surgery is typically not reversible. It works by decreasing the amount of food you can eat at ... healthy changes in your diet and get regular physical activity and exercise. If you frequently snack on high- ...

  13. Expectations of Sinus Surgery

    Science.gov (United States)

    ... ARS HOME ANATOMY Nasal Anatomy Sinus Anatomy Nasal Physiology Nasal Endoscopy Skull Base Anatomy Virtual Anatomy Disclosure ... reduce the pressure in your nose. Avoid strenuous exercise for the first 2 weeks after surgery. Also ...

  14. Cosmetic surgery: medicolegal considerations

    Directory of Open Access Journals (Sweden)

    Piras Mauro

    2016-01-01

    Full Text Available Cosmetic surgery is one of the two branches of plastic surgery. The characteristic of non-necessity of this surgical speciality implies an increased severity in the evaluation of the risk-benefit balance. Therefore, great care must be taken in providing all the information necessary in order to obtain valid consent to the intervention. We analyzed judgments concerning cosmetic surgery found in national legal databases. A document of National Bioethics Committee (CNB was also analyzed. Conclusion: The receipt of valid, informed consent is of absolute importance not only to legitimise the medical-surgical act, but it also represents the key element in the question concerning the existence of an obligation to achieve certain results/use of certain methods in the cosmetic surgery.

  15. Knee microfracture surgery

    Science.gov (United States)

    Cartilage regeneration - knee ... Three types of anesthesia may be used for knee arthroscopy surgery: Medicine to relax you, and shots of painkillers to numb the knee Spinal (regional) anesthesia General anesthesia (you will be ...

  16. Robotics in Colorectal Surgery

    Science.gov (United States)

    Weaver, Allison; Steele, Scott

    2016-01-01

    Over the past few decades, robotic surgery has developed from a futuristic dream to a real, widely used technology. Today, robotic platforms are used for a range of procedures and have added a new facet to the development and implementation of minimally invasive surgeries. The potential advantages are enormous, but the current progress is impeded by high costs and limited technology. However, recent advances in haptic feedback systems and single-port surgical techniques demonstrate a clear role for robotics and are likely to improve surgical outcomes. Although robotic surgeries have become the gold standard for a number of procedures, the research in colorectal surgery is not definitive and more work needs to be done to prove its safety and efficacy to both surgeons and patients. PMID:27746895

  17. Periscopic Spine Surgery

    National Research Council Canada - National Science Library

    Cleary, Kevin R

    2000-01-01

    .... Key research accomplishments for the first year are: ̂Demonstrated the value of intraoperative CT for visualization and verification of the anatomy in complex spine surgeries in the neurosurgery operating room...

  18. Clinical Trials in Surgery

    African Journals Online (AJOL)

    The ANNALS of AFRICAN SURGERY | www.sskenya.org/journal. The ANNALS of ... by two different experiments on small pox by Lady. Mary Wortley Montagu and ... through their 'animal magnetism' were nothing more than an expensive ...

  19. Repetitive endoscopic sinus surgery failure: a role for radical surgery?

    NARCIS (Netherlands)

    Videler, Ward J. M.; Wreesmann, Volkert B.; van der Meulen, Freerk W.; Knegt, Paul P.; Fokkens, Wytske J.

    2006-01-01

    OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the

  20. Indicators for surgery in adhesive bowel obstruction.

    Science.gov (United States)

    Rajanikmanth, P V; Kate, V; Ananthakrishnan, N

    2001-01-01

    There is lack of data on risk factors, which, if present, would indicate the need for surgery in patients with adhesive bowel obstruction. A Cohort of 100 consecutive patients with adhesive obstruction was studied prospectively to compare clinical and investigative parameters between the operative and conservative group. It was found that female gender, previous obstetric or gynaecological procedures, pulse and BP on admission, nature of nasogastric aspirate, single distended loop on abdominal x-ray as also predominant ileal distension were independent factors indicating a high probability of surgical intervention. Patients with 2 or more risk factors had 12 times higher probability of surgery and in those with 3 or more the relative risk was 30 times. Patients with such risk factors should be monitored closely after admission and should be taken for surgery after an initial short trial of conservative measures.

  1. Indexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch.

    Science.gov (United States)

    Chen, Jian; Lin, Yiyun; Kang, Bo; Wang, Zhinong

    2014-02-01

    Prosthesis-patient mismatch (PPM) is defined as a too-small effective orifice area (EOA) of an inserted prosthetic relative to body size, resulting in an abnormally high postoperative gradient. It is unclear, however, whether residual stenosis after aortic valve replacement (AVR) has a negative impact on mid- and long-term survivals. We searched electronic databases, including PubMed, Embase, Medline and the Cochrane controlled trials register, through October 2012, to identify published full-text English studies on the association between PPM and mortality rates. A significant PPM was defined as an indexed EOA (iEOA)<0.85 cm2/m2, and severe PPM as an iEOA<0.65 cm2/m2. Two reviewers independently assessed the studies for inclusion and extracted data. Fourteen observational studies, involving 14 874 patients, met our final inclusion criteria. Meta-analysis demonstrated that PPM significantly increased mid-term (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.19-1.69) and long-term (OR 1.52, 95% CI 1.26-1.84) all-cause mortalities. Subgroup analysis showed that PPM was associated with higher mid- and long-term mortality rates only in younger and predominantly female populations. Risk-adjusted sensitivity analysis showed that severe PPM was associated with reduced survival (adjusted hazard ratio [HR] 1.50, 95% CI 1.24-1.80), whereas moderate PPM was not (adjusted HR 0.96, 95% CI 0.86-1.07). Regardless of severity, however, PPM had a negative effect on survival in patients with impaired ejection fraction (adjusted HR 1.26, 95% CI 1.09-1.47). PPM (iEOA<0.85 cm2/m2) after AVR tended to be associated with increased long-term all-cause mortality in younger patients, females and patients with preoperative left ventricular dysfunction. Severe PPM (iEOA<0.65 cm2/m2) was a significant predictor of reduced long-term survival in all populations undergoing AVR.

  2. Is day surgery safe?

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Engbæk, J; Bartholdy, Jens

    2012-01-01

    Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort.......Day surgery is expanding in several countries, and it is important to collect information about quality. The aim of this study was to assess morbidity and unanticipated hospital visits 0-30 days post-operatively in a large cohort....

  3. Bariatric Surgery for Obesity.

    Science.gov (United States)

    le Roux, Carel W; Heneghan, Helen M

    2018-01-01

    In this review, the authors discuss the indications for and the published outcomes of commonly performed bariatric procedures, including weight loss, perioperative morbidity and mortality, late complications, as well as the impact of bariatric surgery on comorbidities, cardiovascular risk, and mortality. They also briefly discuss the mechanisms by which bariatric/metabolic surgery causes such significant weight loss and health gain. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Robotics in General Surgery

    OpenAIRE

    Wall, James; Chandra, Venita; Krummel, Thomas

    2008-01-01

    In summary, robotics has made a significant contribution to General Surgery in the past 20 years. In its infancy, surgical robotics has seen a shift from early systems that assisted the surgeon to current teleoperator systems that can enhance surgical skills. Telepresence and augmented reality surgery are being realized, while research and development into miniaturization and automation is rapidly moving forward. The future of surgical robotics is bright. Researchers are working to address th...

  5. Metabolic surgery: quo vadis?

    Science.gov (United States)

    Ramos-Leví, Ana M; Rubio Herrera, Miguel A

    2014-01-01

    The impact of bariatric surgery beyond its effect on weight loss has entailed a change in the way of regarding it. The term metabolic surgery has become more popular to designate those interventions that aim at resolving diseases that have been traditionally considered as of exclusive medical management, such as type 2 diabetes mellitus (T2D). Recommendations for metabolic surgery have been largely addressed and discussed in worldwide meetings, but no definitive consensus has been reached yet. Rates of diabetes remission after metabolic surgery have been one of the most debated hot topics, with heterogeneity being a current concern. This review aims to identify and clarify controversies regarding metabolic surgery, by focusing on a critical analysis of T2D remission rates achieved with different bariatric procedures, and using different criteria for its definition. Indications for metabolic surgery for patients with T2D who are not morbidly obese are also discussed. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  6. Innovations in robotic surgery.

    Science.gov (United States)

    Gettman, Matthew; Rivera, Marcelino

    2016-05-01

    Developments in robotic surgery have continued to advance care throughout the field of urology. The purpose of this review is to evaluate innovations in robotic surgery over the past 18 months. The release of the da Vinci Xi system heralded an improvement on the Si system with improved docking, the ability to further manipulate robotic arms without clashing, and an autofocus universal endoscope. Robotic simulation continues to evolve with improvements in simulation training design to include augmented reality in robotic surgical education. Robotic-assisted laparoendoscopic single-site surgery continues to evolve with improvements on technique that allow for tackling previously complex pathologic surgical anatomy including urologic oncology and reconstruction. Last, innovations of new surgical platforms with robotic systems to improve surgeon ergonomics and efficiency in ureteral and renal surgery are being applied in the clinical setting. Urologic surgery continues to be at the forefront of the revolution of robotic surgery with advancements in not only existing technology but also creation of entirely novel surgical systems.

  7. Ostomy Surgery of the Bowel

    Science.gov (United States)

    ... Digestive System & How it Works Zollinger-Ellison Syndrome Ostomy Surgery of the Bowel What is ostomy surgery of the bowel? Ostomy surgery of the ... of the body. Why does a person need ostomy surgery of the bowel? A person may need ...

  8. Salvage surgery for local failure of oral squamous cell carcinoma

    International Nuclear Information System (INIS)

    Omura, Ken; Harada, Hiroyuki; Shimamoto, Hiroaki

    2003-01-01

    Local failure rates following treatment for squamous cell carcinoma of the oral cavity have been reported to be in the range of 25%-48%. This study investigated the pattern of failure for squamous cell carcinoma (SCC) of the oral cavity and evaluated salvage surgery for local recurrent disease. The tumor files of 549 patients undergoing treatment for SCC of the oral cavity between 1980 and 2000 at Chiba Cancer Center Hospital were reviewed. Of 549 patients, 289 were initially treated with radiation therapy for their primary tumor, and 260 with surgery, either with or without radiation therapy. One hundred and sixty-one patients developed failures, yielding a failure rate of 29.3%. The site of recurrent tumor was local in 72 (13.1%) patients, regional in 89 (16.2%) patients, and distant in 5 (0.9%) patients. Local failure developed in 49 (17.0%) patients with radiation therapy and in 23 (8.8%) patients with surgery. Out of these 72 patients with local failure, 41 (56.9%) patients had salvage surgery for their disease. Twenty-five (73.5%) of the 34 patients initially treated with radiation therapy were salvaged with surgery, and 4 (57.1%) of the 7 patients initially treated with surgery were cured with further surgery. For the treatment of patients with local failure, the disease should be diagnosed more carefully than untreated disease. The disease that has recurred after radiation therapy may be more likely to be salvaged by surgery, however, the disease that has developed after surgery may have a limited indication for re-surgery. (author)

  9. Esophageal hiatus surgery: video laparoscopic approach

    International Nuclear Information System (INIS)

    Rodriguez, G.; Fernandez, G.; Gatti, A.; Balboa, O.

    2003-01-01

    Since the early nineties,surgery of esophageal hiatus(treatment of disease due to gastroesophageal reflux,gastric denervation surgery in treatment of duodenal chronic ulcer)through video laparoscopic approach,has gained broad dissemination and acceptance at world level.This phenomenon is explained by the excellent exposure and visualization of an anatomic region which is deeply situated in the upper hemi abdomen, added to the advantages of an approach which, while minimally invasive, attains short and medium term results comparable to those of conventional surgery.The describes the initial experience of the authors with this type of surgery as well as a review of literature, with special emphasis on the surgical technique employed.Case material covers 23 patient: fourteen had Nissen Rossetti fun duplication, 4 suffered from miotomies associated with fun duplications of varying type and 5 were gastric denervation surgeries by reason of duodenal ulcer.There were 2 conversions, both due to esophageal perforation.There were no major postoperative complications and mortality was nil. while functional results were highly satisfactory.The authors therefore conclude that since results which they obtained were coincidental with those of international bibliography, work along these lines should continue

  10. Reengineering a cardiovascular surgery service.

    Science.gov (United States)

    Tunick, P A; Etkin, S; Horrocks, A; Jeglinski, G; Kelly, J; Sutton, P

    1997-04-01

    Reengineering, involving the radical redesign of business processes, has been used successfully in a variety of health care settings. In 1994 New York University (NYU) Medical Center (MC) launched its first reengineering team, whose purpose was to redesign the entire process of caring for patients-from referral to discharge-on the cardiovascular (CV) surgery service. REENIGINEERING TEAM: The multidisciplinary CV Surgery Reengineering Team was charged with two goals: improving customer (patient, family, and referring physician) satisfaction and improving profitability. The methodology to be used was based on a reengineering philosophy-discarding basic assumptions and designing the patient care process from the ground up. THE TRANSFER-IN INITIATIVE: A survey of NYU cardiologists, distributed in April 1994, suggested that the organization was considered a difficult place to transfer patients. The team's recommendations led to a new, streamlined transfer-in policy. The average waiting time from when a referring physician requested a patient transfer and the time when an NYUMC physician accepted the transfer decreased from an average of 9 hours under the old system to immediate acceptance. Three customer satisfaction task forces implemented multiple programs to make the service more user friendly. In addition, referrals increased and length of stay decreased, without an adverse impact on the mortality rate. For the first time at NYUMC, a multidisciplinary team was given the mandate to achieve major changes in an entire patient care process. Similar projects are now underway.

  11. In Silico Investigation of a Surgical Interface for Remote Control of Modular Miniature Robots in Minimally Invasive Surgery

    Directory of Open Access Journals (Sweden)

    Apollon Zygomalas

    2014-01-01

    Full Text Available Aim. Modular mini-robots can be used in novel minimally invasive surgery techniques like natural orifice transluminal endoscopic surgery (NOTES and laparoendoscopic single site (LESS surgery. The control of these miniature assistants is complicated. The aim of this study is the in silico investigation of a remote controlling interface for modular miniature robots which can be used in minimally invasive surgery. Methods. The conceptual controlling system was developed, programmed, and simulated using professional robotics simulation software. Three different modes of control were programmed. The remote controlling surgical interface was virtually designed as a high scale representation of the respective modular mini-robot, therefore a modular controlling system itself. Results. With the proposed modular controlling system the user could easily identify the conformation of the modular mini-robot and adequately modify it as needed. The arrangement of each module was always known. The in silico investigation gave useful information regarding the controlling mode, the adequate speed of rearrangements, and the number of modules needed for efficient working tasks. Conclusions. The proposed conceptual model may promote the research and development of more sophisticated modular controlling systems. Modular surgical interfaces may improve the handling and the dexterity of modular miniature robots during minimally invasive procedures.

  12. Initiation devices, initiation systems including initiation devices and related methods

    Energy Technology Data Exchange (ETDEWEB)

    Daniels, Michael A.; Condit, Reston A.; Rasmussen, Nikki; Wallace, Ronald S.

    2018-04-10

    Initiation devices may include at least one substrate, an initiation element positioned on a first side of the at least one substrate, and a spark gap electrically coupled to the initiation element and positioned on a second side of the at least one substrate. Initiation devices may include a plurality of substrates where at least one substrate of the plurality of substrates is electrically connected to at least one adjacent substrate of the plurality of substrates with at least one via extending through the at least one substrate. Initiation systems may include such initiation devices. Methods of igniting energetic materials include passing a current through a spark gap formed on at least one substrate of the initiation device, passing the current through at least one via formed through the at least one substrate, and passing the current through an explosive bridge wire of the initiation device.

  13. The influence of initial temperature on flame acceleration and deflagration-to-detonation transition

    International Nuclear Information System (INIS)

    Ciccarelli, G.; Boccio, J.L.; Ginsberg, T.

    1996-01-01

    The influence of initial mixture temperature on deflagration-to-detonation transition (DDT) has been investigated experimentally. The experiments were carried out in a 27-cm-inner diameter, 21.3-meter-long heated detonation tube, which was equipped with periodic orifice plates to promote flame acceleration. Hydrogen-air-steam mixtures were tested at a range of temperatures up to 650K and at an initial pressure of 0.1 MPa. In most cases, the limiting hydrogen mole fraction which resulted in transition to detonation corresponded to the mixture whose detonation cell size, λ, was approximately equal to the inner diameter of the orifice plate, d (e.g., d/λ∼1). The only exception was in dry hydrogen-air mixtures at 650K where the DDT limit was observed to be 11 percent hydrogen, corresponding to a value of d/λ equal to 5.5. For a 10.5 percent hydrogen mixture at 650K, the flame accelerated to a maximum velocity of about 120 m/s and then decelerated to below 2 m/s. This observation indicates that the d/λ = 1 DDT limit criterion provides a necessary condition but not a sufficient one for the onset of DDT in obstacle-laden ducts. In this particular case, the mixture initial condition (i.e., temperature) resulted in the inability of the mixture to sustain flame acceleration to the point where DDT could occur. It was also observed that the distance required for the flame to accelerate to the onset of detonation was a function of both the hydrogen mole fraction and the mixture initial temperature. For example, decreasing the hydrogen mole fraction or increasing the initial mixture temperature resulted in longer transition distances

  14. Pediatric endocrine surgery development

    Directory of Open Access Journals (Sweden)

    Ivan I. Dedov

    2017-12-01

    Full Text Available Department of pediatric surgery at the Endocrinology Research Centre has been around for nearly two years. During operation, surgical treatment has received more than 500 patients with various endocrine disorders. The article discusses modern diagnostic approaches and surgical options for diseases included in the new direction of pediatric surgery – endocrine surgery in children. There are discussions about options for radical treatment of Graves disease in children, positive and negative aspects of surgical and radioactive iodine treatment. Is own stats of postoperative hyperparathyroidism. Is proposed to optimize the algorithm of actions in identifying thyroid nodules in children. In primary hyperparathyroidism, the emphasis is on the complexity of the postoperative management of patients related to the feature of children’s age in determining the severity of the reactions on the water-electrolyte disorders. Separately reviewed the literature of the adrenal glands diseases in children, demonstrating their own clinical cases which required surgical intervention. The authors describe the possibilities of modern neurosurgical equipment in the Endocrinology Research Centre in operations on the pituitary gland in children. Patients of different age groups performed transnasal transsphenoidal removal of tumors of the chiasm-sellar region using endoscopic assistance. The article also cited research data of pancreas diseases and their surgical treatment. Much attention is paid to the gender section of endocrine surgery in children. Discusses the tactics in disorders of sex development, gonadal tumors in children, diseases of the breast. In conclusion outlines the prospects for the development of endocrine surgery in children.

  15. Innovations in Bariatric Surgery.

    Science.gov (United States)

    Zhu, Catherine; Pryor, Aurora D

    2015-11-01

    Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

  16. Surgery for trigger finger.

    Science.gov (United States)

    Fiorini, Haroldo Junior; Tamaoki, Marcel Jun; Lenza, Mário; Gomes Dos Santos, Joao Baptista; Faloppa, Flávio; Belloti, Joao Carlos

    2018-02-20

    Trigger finger is a common clinical disorder, characterised by pain and catching as the patient flexes and extends digits because of disproportion between the diameter of flexor tendons and the A1 pulley. The treatment approach may include non-surgical or surgical treatments. Currently there is no consensus about the best surgical treatment approach (open, percutaneous or endoscopic approaches). To evaluate the effectiveness and safety of different methods of surgical treatment for trigger finger (open, percutaneous or endoscopic approaches) in adults at any stage of the disease. We searched CENTRAL, MEDLINE, Embase and LILACS up to August 2017. We included randomised or quasi-randomised controlled trials that assessed adults with trigger finger and compared any type of surgical treatment with each other or with any other non-surgical intervention. The major outcomes were the resolution of trigger finger, pain, hand function, participant-reported treatment success or satisfaction, recurrence of triggering, adverse events and neurovascular injury. Two review authors independently selected the trial reports, extracted the data and assessed the risk of bias. Measures of treatment effect for dichotomous outcomes calculated risk ratios (RRs), and mean differences (MDs) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs). When possible, the data were pooled into meta-analysis using the random-effects model. GRADE was used to assess the quality of evidence for each outcome. Fourteen trials were included, totalling 1260 participants, with 1361 trigger fingers. The age of participants included in the studies ranged from 16 to 88 years; and the majority of participants were women (approximately 70%). The average duration of symptoms ranged from three to 15 months, and the follow-up after the procedure ranged from eight weeks to 23 months.The studies reported nine types of comparisons: open surgery versus steroid injections (two

  17. SURGERY AND CARDIOVASCULAR SURGERY JOURNALS ANALYSIS.

    Science.gov (United States)

    Schanaider, Alberto

    2015-01-01

    To analyze critically the effectiveness and value of bibliometric indicators in journals of Surgery or Cardiovacular Surgery in the context of the postgraduate programs of CAPES Medicine III. A sampling with 16 academic programs and one professional master of Medicine III, encompassing the General and Digestive System Surgery, Cardiovascular Surgery and Multidisciplinary courses with such contents, was evaluated. Thomson Reuters/ISI (JCR), Elsevier/Scopus (SJR), and also Scielo databases were used. Only in seven programs, the teachers had an average of Qualis A1 articles greater than the others strata. Eleven journals in the surgical area are in stratum A1 (5%) and it reaches 25% in Cardiovascular Surgery. Among the six journals with the largest number of publications Qualis A1 in area Medicine III, five are from non-specific areas. The Acta Cirúrgica Brasileira represented 58% of the publications in the stratum A2. There are some obstacles in the Qualis classification with little uniformity among the Medicine areas I, II and III. A permanent committee should be set to update the Qualis, composed by the three medical areas. It should be considered using other index databases and the unification of the Qualis criteria for journals in medicine. Rating criteria of multi and transdisciplinary journals need to be reviewed. It is essential an institutional financial support for national journals chosen by peers aiming to provide a full computerization process and a professional reviewer of the English language, in order to increase the impact factor. Analisar criticamente a eficácia e valor de indicadores bibliométricos dos periódicos da Cirurgia e Cirurgia Cardiovascular no contexto dos Programas de Pós-Graduação da área Medicina III da CAPES. Foi avaliada uma amostragem com 16 programas acadêmicos e um mestrado profissional da área de Medicina III, compreendendo a Cirurgia Geral e do Aparelho Digestivo, a Cirurgia Cardiovascular e Cursos Multidisciplinares

  18. Viscoless microincision cataract surgery

    Directory of Open Access Journals (Sweden)

    Guy Sallet

    2008-06-01

    Full Text Available Guy SalletDepartment of Opthamology, Aalsters Stedelijk Ziekenhuis, BelgiumAbstract: A cataract surgery technique is described in which incisions, continuous circular capsulorhexis and hydrodissection are made without the use of any viscoelastics. Two small incisions are created through which the different parts of the procedure can take place, maintaining a stable anterior chamber under continuous irrigation. Subsequent bimanual phacoemulsification can be done through these microincisions. At the end of the procedure, an intraocular lens can be inserted through the self-sealing incision under continuous irrigation. 50 consecutive cataract patients were operated on without the use of viscoelastics and then compared with a group of 50 patients who had been helped with viscoelastics. No difference in outcome, endothelial cell count or pachymetry was noted between the two groups. No intraoperative complication was encountered. Viscoless cataract surgery was a safe procedure with potential advantages.Keywords: ophthalmic visco-surgical device, viscoless cataract surgery, microincision

  19. Single port laparoscopic surgery

    DEFF Research Database (Denmark)

    Springborg, Henrik; Istre, Olav

    2012-01-01

    LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique, however, its large-scale adoption awaits results of prospective randomized controlled studies confirming...... potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark, in which 40 patients have been treated for benign gynecologic conditions....... Although the operations described are the first of their kind reported in Denmark, favorable operating times and very low complication rates are seen. It is the authors' opinion that in addition to being feasible for hysterectomy, single port laparoscopy may become the preferred method for many simple...

  20. Robotic aortic surgery.

    Science.gov (United States)

    Duran, Cassidy; Kashef, Elika; El-Sayed, Hosam F; Bismuth, Jean

    2011-01-01

    Surgical robotics was first utilized to facilitate neurosurgical biopsies in 1985, and it has since found application in orthopedics, urology, gynecology, and cardiothoracic, general, and vascular surgery. Surgical assistance systems provide intelligent, versatile tools that augment the physician's ability to treat patients by eliminating hand tremor and enabling dexterous operation inside the patient's body. Surgical robotics systems have enabled surgeons to treat otherwise untreatable conditions while also reducing morbidity and error rates, shortening operative times, reducing radiation exposure, and improving overall workflow. These capabilities have begun to be realized in two important realms of aortic vascular surgery, namely, flexible robotics for exclusion of complex aortic aneurysms using branched endografts, and robot-assisted laparoscopic aortic surgery for occlusive and aneurysmal disease.