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Sample records for severe hidradenitis suppurativa

  1. Cyclosporine treatment of severe Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Anderson, Marianne D; Zauli, Stefania; Bettoli, Vincenzo

    2016-01-01

    Background: Hidradenitis suppurativa (HS) is an overlooked but common disease severely affecting both genders. HS is generally perceived as difficult to treat and although a number of treatments are available, the need for more effective treatment is apparent. Objectives: Cyclosporine A (CsA) has...

  2. Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, Deirdre Nathalie; Emtestam, Lennart; Jemec, Gregor B

    2014-01-01

    Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that typically occurs after puberty. The primary clinical presentation is painful inflamed nodules or boils in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and buttocks/anus) that progr......Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that typically occurs after puberty. The primary clinical presentation is painful inflamed nodules or boils in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and buttocks....../anus) that progress to abscesses, sinus tracts and scarring. Severity is typically described according to three Hurley categories, with most patients having mild or moderate disease. Estimated prevalence is 1-4% worldwide and HS is three times more common in women than men. Patients' disease burden includes intense...

  3. Adalimumab for the treatment of moderate to severe Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Kimball, Alexa B; Kerdel, Francisco; Adams, David

    2012-01-01

    Hidradenitis suppurativa (HS) is a chronic, painful skin disease characterized by abscesses, nodules, and draining fistulas in the axilla and groin of young adults.......Hidradenitis suppurativa (HS) is a chronic, painful skin disease characterized by abscesses, nodules, and draining fistulas in the axilla and groin of young adults....

  4. Psychosocial impact of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Esmann, S.; Jemec, G.B.E.

    2011-01-01

    Hidradenitis suppurativa influences patients' lives in many ways. It is therefore necessary to focus on the effects of the disease on daily life in order better to define patient-related outcomes in hidradenitis suppurativa studies. Interviews were conducted with 12 patients with hidradenitis sup...

  5. Adalimumab for the treatment of moderate to severe hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Kimball, A.B.; Kerdel, F.; Adams, D.

    2012-01-01

    Background: Hidradenitis suppurativa (HS) is a chronic, painful skin disease characterized by abscesses, nodules, and draining fistulas in the axilla and groin of young adults. Objective: To evaluate the efficacy and safety of adalimumab, an anti-tumor necrosis factor-αantibody, in patients......, respectively (EOW vs. placebo difference, 1.8% [CI,- 6.4% to 10.1%]; weekly vs. placebo difference, 3.9% [CI,- 5.2% to 13.0%]). Significantly greater improvements in patient-reported outcomes and pain were seen in the weekly dosing group than in the placebo group. A decrease in response was seen after...... the switch from weekly to EOW dosing in period 2. Limitations: Weeks 16 to 52 of the study were open-label. The study was not powered to assess the risk for known serious adverse effects of adalimumab, such as tuberculosis, other serious infections, and demyelinating disorders. Conclusion: Adalimumab dosed...

  6. Hidradenitis Suppurativa/Acne Inversa

    DEFF Research Database (Denmark)

    Zouboulis, Christos C.; Del Marmol, Véronique; Mrowietz, Ulrich

    2015-01-01

    BACKGROUND: Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating disease, which inflicts a significant burden on patients and is associated with comorbid disorders, such as significantly reduced quality of life, depression, stigmatization, inactivity...

  7. The bacteriology of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Ring, Hans Christian; Riis Mikkelsen, Peter; Miller, Iben Marie

    2015-01-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory disabling skin disease consisting of recurrent nodules, sinuses, fistulas and scarring involving the intertriginous regions. HS is often a therapeutic challenge and most treatments are off-label. A better understanding of aetiology......, supports a microbial role in disease pathogenesis. However, these antibiotics also work as immunomodulators of especially T cells, and the underlying mechanisms may therefore be more complex. We performed a systematic review of previous studies investigating the bacterial flora in hidradenitis suppurativa...

  8. An Update on Hidradenitis Suppurativa (Part I): Epidemiology, Clinical Aspects, and Definition of Disease Severity.

    Science.gov (United States)

    Martorell, A; García-Martínez, F J; Jiménez-Gallo, D; Pascual, J C; Pereyra-Rodriguez, J; Salgado, L; Vilarrasa, E

    2015-11-01

    Hidradenitis suppurativa is a chronic inflammatory disorder that has attracted increasing attention in recent years due to underestimations of prevalence and the considerable impact of the condition on interpersonal relationships, physical appearance, self-esteem, and body image. Although hidradenitis suppurative has a significant psychological impact on patients and can even cause physical limitations when thick scarring results in limb mobility limitation, until very recently little evidence was available relating to its epidemiology, etiology, or pathogenesis. In this review, we highlight the latest advances in our understanding of the epidemiological and clinical aspects of hidradenitis suppurativa. We will also look at the different classification systems for hidradenitis suppurativa and discuss the emergence of skin ultrasound as a promising technique for monitoring the course of this chronic inflammatory disease. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  9. Pain management in patients with hidradenitis suppurativa

    NARCIS (Netherlands)

    Horvath, Barbara; Janse, Ineke C.; Sibbald, Gary R.

    Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory disease. HS patients' quality of life is severely impaired, and this impairment correlates strongly with their pain. Pain in HS can be acute or chronic and has both inflammatory and noninflammatory origins. The purpose

  10. Coagulation Status in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Johansen, Maria Egede; Mogensen, Ulla B

    2015-01-01

    BACKGROUND: Chronic inflammatory diseases other than hidradenitis suppurativa (HS) have been associated with prothrombotic/hypercoagulable status. OBJECTIVE: To investigate a possible association between the chronic inflammatory skin disease HS and prothrombotic/hypercoagulable state. METHODS: We.......3432). CONCLUSION: We did not find an association between HS and prothrombotic/hypercoagulable status. Thus, thrombocytes may not be activated in HS. Furthermore, INR may not be affected in HS, suggesting that intrinsic and vitamin K-dependent coagulation factors appear unaffected....

  11. [Update of hidradenitis suppurativa in Primary Care].

    Science.gov (United States)

    García-Martínez, F J; Pascual, J C; López-Martín, I; Pereyra-Rodríguez, J J; Martorell Calatayud, A; Salgado-Boquete, L; Labandeira-García, J

    Hidradenitis suppurativa is a prevalent disease that is noted for its clinical variability and by its severe impact on quality of life. A meticulous scientific literature review is presented in this article in order to give an update on what is known on this condition. Primary Care physicians obviously play an important role in the early diagnosis and management of hidradenitis suppurativa. This review aims to provide a current and practical overview about this disease in order to optimise the healthcare for these patients by making the best use of available resources. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Recognizing syndromic hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gasparic, J; Theut Riis, P; Jemec, G B

    2017-01-01

    may inform the search for aetiological factors in HS. PubMed, Ovid and Web of Science were systematically searched using '(hidradenitis OR acne invers*) AND (syndrome OR KID OR PASS OR PAPA OR PASH OR SAPHO OR bazex-dupre OR 'dowling degos' OR triad OR tetrad)' and Cochrane Library using 'hidradenitis...... OR acne invers*'. A total of 82 articles were included in the final review. We summarize 134 cases collected from the 82 included articles. The syndromes are discussed, focusing on etiopathogenesis, clinical presentation and treatment. This study is based on case reports; therefore, conclusions may...

  13. Depression in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Onderdijk, A J; van der Zee, H H; Esmann, S

    2013-01-01

    BACKGROUND: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL). It is hypothesized that depression...... not significantly higher in HS patients compared to controls (9% vs. 6%). CONCLUSIONS: HS is a chronic skin disease with major impact on QoL even when compared to other dermatological diseases. MDI scores in HS patients correlate with disease severity. This correlation could indicate that the MDI represents a valid.......6 (P Diseases, 10th edition (ICD-10) criteria were...

  14. Hidradenitis suppurativa: Inside and out

    Directory of Open Access Journals (Sweden)

    Sharmila Patil

    2018-01-01

    Full Text Available Hidradenitis suppurativa is a chronic, disabling, suppurative disease characterized by deep tender subcutaneous nodules; complicated by fibrosis and extensive sinuses affecting primarily the apocrine gland bearing areas. It affects all races in early 20s with greater prevalence seen in women (3 to 5:1. The estimated disease prevalence is 1 - 4 %. The disease is speculated to be caused by follicular structural abnormalities with associated risk factors as smoking, obesity, positive family history and shaving. Certain co-morbidities can also be seen such as inflammatory bowel disease, spondyloarthropathies, epithelial tumors, pyoderma gangrenosum etc. Treatment modalities include counseling of the patient to lose weight if obese, to wear loose clothes, stop smoking and maintain good hygiene. Topical antibiotics, like 1% clindamycin, have shown to give good results along with benzoyl peroxide wash. Orally cocktail of antibiotics can be given, though biologicals remain the best treatment option. Surgical excision can be done in later stages and in recalcitrant cases.

  15. Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP) : a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III

    NARCIS (Netherlands)

    Blok, J. L.; Spoo, J. R.; Leeman, F. W. J.; Jonkman, M. F.; Horvath, B.

    BackgroundSurgery is the only curative treatment for removal of the persistent sinus tracts in the skin that are characteristic of severe hidradenitis suppurativa (HS). Complete resection of the affected tissue by wide excision is currently regarded as the preferred surgical technique in these

  16. HiSCR (Hidradenitis Suppurativa Clinical Response)

    DEFF Research Database (Denmark)

    Kimball, B. A.; Sobell, J. M.; Zouboulis, C C

    2016-01-01

    Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility as an out......Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility...... as an outcome measure. Methods: Patients with baseline total abscess and inflammatory nodule count (AN count) of at least three and draining fistula count of 20 or fewer comprised the post hoc subpopulation analysed. HiSCR (at least a 50% reduction in total AN count, with no increase in abscess count...... week, or placebo (1 : 1 : 1). Results: The subpopulation included 132 (85.7%) patients; 70.5% women and 73.5% white. At week 16, HiSCR was achieved by 54.5% receiving weekly adalimumab, 33.3% every other week, and 25.6% placebo and HS-PGA Response was achieved by 20.5% receiving weekly adalimumab, 6...

  17. Hidradenitis Suppurativa in Children and Adolescents

    DEFF Research Database (Denmark)

    Mikkelsen, Peter Riis; Jemec, Gregor B E

    2014-01-01

    Hidradenitis suppurativa (HS) is a burdensome disease and has the potential to affect the life course of patients. It is a rare disease in children, and the recorded literature is correspondingly scarce. This article reviews the therapeutic options for HS in children and adolescents, and highlights...

  18. Autoinflammatory syndromes associated with hidradenitis suppurativa and/or acne

    DEFF Research Database (Denmark)

    Vinkel, Caroline; Thomsen, Simon F.

    2017-01-01

    Autoinflammatory syndromes associated with hidradenitis suppurativa (HS) and/or acne are rare but potentially debilitating disorders if not diagnosed and treated correctly. They share a common pathogenesis involving a dysregulated innate immune system with abnormal interleukin (IL)-1 signaling...... leading to sterile neutrophilic inflammation. The clinical features are recurrent episodes of fever, painful arthritis, and skin lesions consistent with HS, acne, and pyoderma gangrenosum (PG) accompanied by elevated systemic inflammatory markers in blood. So far, several clinically different syndromes...... have been reported in the literature including pyoderma gangrenosum, acne, and pyogenic arthritis (PAPA), pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH), pyoderma gangrenosum, acne, and spondyloarthritis (PASS), pyoderma gangrenosum, acne, pyogenic arthritis, and hidradenitis...

  19. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser.

    Science.gov (United States)

    Madan, V; Hindle, E; Hussain, W; August, P J

    2008-12-01

    Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition. To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments. HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire. Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement. CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.

  20. Combining Magnetic Resonance Imaging (MRI) and Medical Infrared Thermography (MIT) in the pre- and per-operating management of severe Hidradenitis Suppurativa (HS).

    Science.gov (United States)

    Derruau, Stéphane; Renard, Yohann; Pron, Hervé; Taiar, Redha; Abdi, Ellie; Polidori, Guillaume; Lorimier, Sandrine

    2018-05-12

    Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recurrent skin disease. Surgical excision of wounds appears to be the only curative treatment for the prevention of recurrence of moderate to severe stages. Magnetic resonance imaging (MRI) is a standard reference examination for the detection of HS peri-anal inflammatory fistula. In this case study, the use of real-time medical infrared thermography, in combination with MRI as appropriate imaging, is proposed. The aim is to assist surgeons in the pre- and peri-surgical management of severe perianal hidradenitis suppurativa with the intent to ensure that all diseased lesions were removed during surgery and therefore to limit recurrence. The results show that medical infrared thermography (MIT), coupled with MRI, could be highly effective strategy to address thermally distinguished health tissues and inflammatory sites during excision, as characterised by differential increases in temperature. Medical infrared thermography could be used to check the total excision of inflammatory lesions as a noninvasive method that is not painful, not radiant, and is easily transportable during surgery. Ultimately, this method could be complementary with MRI in providing clinicians with objective data on the status of tissues below the perianal skin surface in the pre- and per-operating management of severe hidradenitis suppurativa. Copyright © 2018 Elsevier B.V. All rights reserved.

  1. Disutility in Patients with Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Riis, Peter Theut; Vinding, Gabrielle Randskov; Ring, Hans Christian

    2016-01-01

    Disutility reflects the disability caused by a disease. The EuroQoL-5D (EQ-5D) questionnaire is a measure of health-related overall utility. The questionnaire has only been applied previously to a small number of patients with hidradenitis. In this study a survey of 421 patients with hidradenitis...... suppurativa was conducted using the EQ-5D questionnaire. Questions regarding pain, maodour and pruritus were included to determine quantitatively whether these factors are associated with low EQ-5D index and visual analogue scale (VAS) scores. The index and VAS scores obtained were compared with reference...

  2. Two phase 3 trials of adalimumab for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Kimball, Alexa Boer; Okun, Martin; Williams, David A

    2016-01-01

    BACKGROUND Hidradenitis suppurativa is a painful, chronic inflammatory skin disease with few options for effective treatment. In a phase 2 trial, adalimumab, an antibody against tumor necrosis factor á, showed efficacy against hidradenitis suppurativa. METHODS PIONEER I and II were similarly desi...

  3. Serum Anticytokine Autoantibody Levels Are Not Increased in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Theut Riis, Peter; Von Stemann, Jakob Hjorth; Kjærsgaard Andersen, Rune

    2017-01-01

    Background: Hidradenitis suppurativa is a skin disease of recurrent episodes of inflammatory nodules, abscesses, and scarring of the intertriginous regions, e.g. the axillae and groin. A dysregulated immune response to one or more unknown antigens in hidradenitis suppurativa has been suggested. O...

  4. The Association between Hidradenitis Suppurativa and Crohn's Disease

    DEFF Research Database (Denmark)

    van der Zee, Hessel H; Horvath, Barbara; Jemec, Gregor B E

    2016-01-01

    Hidradenitis suppurativa is a chronic, autoinflammatory skin disease. Shalom et al. demonstrate in a large cross-sectional study an association between Crohn's disease and hidradenitis suppurativa, but not with ulcerative colitis. This association supports the hypothesis that a similar pathogenic...... mechanism contributes to both diseases, providing new possibilities for functional studies and therapy development....

  5. Therapeutic approach to Crohn disease: possible parallels with hidradenitis suppurativa.

    Science.gov (United States)

    González Lama, Y; Marín-Jiménez, I

    2016-09-01

    The current controversy in the setting of dermatology surrounding the treatment of inflammatory diseases, and specifically hidradenitis suppurativa, bears strong similarities with the debate concerning inflammatory bowel disease (IBD) that took place several years ago. That debate led to new perspectives on this disease and, in particular, its treatment after the development of biological agents. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  6. Improving quality of life in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, D.N.; Esmann, S.; Jemec, G.B.

    2012-01-01

    Hidradenitis suppurativa is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL) and related psychosocial morbidity. Current knowledge...... on improving QoL in patients with hidradenitis suppurativa is therefore reviewed. The literature is limited but indicates that there are two ways of improving patients' QoL: therapy of the somatic disease or psychosocial interventions....

  7. Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients.

    Science.gov (United States)

    Blok, J L; Boersma, M; Terra, J B; Spoo, J R; Leeman, F W J; van den Heuvel, E R; Huizinga, J; Jonkman, M F; Horváth, B

    2015-08-01

    Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia. A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires. A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied). The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery. © 2015 European Academy of Dermatology and Venereology.

  8. Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity

    DEFF Research Database (Denmark)

    Zouboulis, C C; Tzellos, T; Kyrgidis, A

    2017-01-01

    BACKGROUND: A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking. OBJECTIVES: To develop and validate a novel dynamic scoring system to assess the severity of HS. METHODS: A Delphi voting procedure was conducted among the members......, as well as examination for correlation (Spearman's rho) and agreement (Cohen's kappa) with existing scores, were engaged to recognize the variables for a new International HS4 (IHS4) that was established by a second Delphi round. RESULTS: Consensus HS4 was based on number of skin lesions, number of skin....... Three candidate scores were presented to the second Delphi round. The resulting IHS4 score is arrived at by the number of nodules (multiplied by 1) plus the number of abscesses (multiplied by 2) plus the number of draining tunnels (multiplied by 4). A total score of 3 or less signifies mild, 4...

  9. New insights into the diagnosis of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    van der Zee, Hessel H; Jemec, Gregor B E

    2015-01-01

    Current classifications for hidradenitis suppurativa (HS), such as the Hurley staging system, are not very specific. The absence of rigorous classifications is incongruous with the clinical variability of the condition. There is no pathognomonic sign for HS that leads to a diagnosis...... that is unquestionable. Consequently, diagnosis is made largely through clinical presentation of the condition. The use of several validated tools assists in confirming the diagnosis and the severity of the disease. In future investigations, the identification of phenotypes and clinical subtypes--taking into account...

  10. An Atypical Localized Form of Hidradenitis Suppurativa of the Jawline and Neck Mimicking Severe Cystic Acne on Presentation.

    Science.gov (United States)

    Castrillón Velásquez, María Adriana; Kim, Minhee; Tan, Mei-Heng; Tran, Kim; Murrell, Dedee F

    2017-10-01

    Hidradenitis suppurativa (HS) is a chronic and debilitating suppurative disease primarily affecting the axillae, perineum, and inframammary regions, where apocrine sweat glands are present. However, HS can occur in atypical locations. We present an interesting case of a 40-year-old man who developed chronic painful subcutaneous nodules, deep sinus tracts, and abscesses involving the jawline and the anterior aspect of the neck as the only parts of the body affected and who responded satisfactorily to adalimumab and laser hair removal treatment. This case is relevant because it helps clinicians to remember that HS may be isolated to atypical locations, such as the anterior aspect of the neck and chin. It also supports another possible HS pathogenesis which consists of the occlusion of terminal hair follicles rather than being essentially a disorder of the apocrine glands.

  11. Association of Metabolic Syndrome and Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Ellervik, Christina; Vinding, Gabrielle Randskov

    2014-01-01

    ,predominantly female, and more often smokers compared with the non-HS group.EXPOSURE Hidradenitis suppurativa.MAIN OUTCOMES AND MEASURES Metabolic syndrome and its components of diabetes mellitus, hypertension, dyslipidemia, and obesity.RESULTS When compared with the non-HS group, the odds ratios (ORs.......62 (95%CI, 1.73-7.60) and 2.24 (95%CI, 1.78-2.82), respectively, for abdominal obesity. With regard to dyslipidemia, significant results were found for decreased levels of high-density lipoprotein cholesterol, with ORs of 2.97 (95%CI, 1.45-6.08) and 1.94(95%CI, 1.52-2.48) for the hospital HS and general...

  12. Unusual presentation of hidradenitis suppurativa with massive enlargement of penis.

    Science.gov (United States)

    Baughman, Steven M; Cespedes, R Duane

    2004-08-01

    Hidradenitis suppurativa is a chronic, recurrent inflammatory disease affecting the cutaneous apocrine glands and resulting in their obstruction. This enigmatic disease causes recurrent episodes of infection, edema, scarring, and fibrosis of surrounding tissues. We present the case of a 55-year-old man with two decades of inguinal hidradenitis suppurativa that resulted in extensive penile subcutaneous lymphedema and enlargement secondary to scarring and obstructive lymphadenopathy. Reconstructive phalloplasty to restore normal penile function was required. Minimal recurrent induration, normal cutaneous sensation, and normal voiding and erectile function were noted at 3 years of follow-up.

  13. Experience with ustekinumab for the treatment of moderate to severe Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gulliver, W.P.; Baker, K.A.; Jemec, G.B.E.

    2012-01-01

    , however, abrogation of tumour necrosis factor-α (TNF-α) function has proven effective in some patients. Objective To assess the safety and efficacy of the interleukin-12/23 inhibitor, ustekinumab for treatment of HS in three patients with moderate-severe disease. Methods The subjects received 3-45 mg...... subcutaneous injections of ustekinumab at 0, 1 and 4 months. Improvement was assessed by the dermatology life quality index (DLQI), visual analogue scale of pain (VAS) and physician's global assessment (PGA) at each monthly visit. Results Prior to treatment, subjects had moderate-severe HS (Hurley stage II......-III) with a DLQI score between 8 and 12. At 6 months, one patient showed complete disease remission, while a 25-49% improvement was seen in a second patient and no change in a third. A moderate but statistically significant relationship was observed between VAS and DLQI scores (r = 0.75; P

  14. Renal amyloid A amyloidosis as a complication of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Schandorff, Kristine D; Miller, Iben M; Krustrup, Dorrit

    2016-01-01

    Rheumatic disease is the dominant cause of amyloid A (AA) amyloidosis, but other chronic inflammatory diseases may have similar consequences. Hidradenitis suppurativa (HS) is a relatively common, but little known skin disease characterized by chronic inflammation. Here we present a case of chronic...

  15. Hidradenitis suppurativa : From pathogenesis to emerging treatment options

    NARCIS (Netherlands)

    Dickinson-Blok, Janine Louise

    2015-01-01

    Hidradenitis suppurativa (HS) is a chronic skin disease that is characterized by inflammation of the hair follicles. The cause of HS is largely unknown and the disease remains difficult to treat. Mrs. Janine Dickinson-Blok studied the pathogenesis of HS and the efficacy of existing and emerging

  16. Bacterial biofilm in chronic lesions of Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Ring, H C; Bay, L; Nilsson, M

    2017-01-01

    BACKGROUND: Chronic non-healing or recurrent inflammatory lesions, reminiscent of infection but recalcitrant to antibiotic therapy generally characterize biofilm driven-diseases. Chronic lesions of Hidradenitis Suppurativa (HS) exhibit several aspects, which are compatible with well-known biofilm...... infections. OBJECTIVE: To determine and quantify the potential presence of bacterial aggregates in chronic HS lesions. METHODS: In 42 consecutive HS patients suffering from chronic lesions, biopsies were obtained from lesional as well as from perilesional skin. Samples were investigated using Peptide Nucleic...... Acid (PNA) - Fluorescence in situ Hybridization (FISH) in combination with Confocal Laser Scanning Microscopy (CLSM). In addition, corresponding histopathological analysis in hematoxylin and eosin slides were performed. RESULTS: Biofilms were seen in 67% of the samples of chronic lesions and in 75...

  17. Body composition and basal metabolic rate in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, I M; Rytgaard, Helene Charlotte; Mogensen, U B

    2016-01-01

    BACKGROUND: Several studies have suggested an association between Hidradenitis Suppurativa (HS) and obesity. Obesity is often expressed as Body Mass Index (BMI). However, BMI lacks information on body composition. General obesity is a predictor of health status and cardiovascular risk, but body...... composition (e.g. abdominal fat) may be more so. Basal metabolic rate (BMR) is an expression of resting metabolism and may serve as a complementary tool when assessing the possibly underlying metabolism behind a persons' body composition. OBJECTIVE: To investigate the body composition and basal metabolic rate...... in individuals with HS compared with healthy controls. METHODS: We performed a cross-sectional study on both a hospital-based and population-based HS group and compared with controls using Bioelectrical Impedance Analysis to assess body composition. RESULTS: We identified a hospital-based HS group of 32 hospital...

  18. Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III.

    Science.gov (United States)

    Blok, J L; Spoo, J R; Leeman, F W J; Jonkman, M F; Horváth, B

    2015-02-01

    Surgery is the only curative treatment for removal of the persistent sinus tracts in the skin that are characteristic of severe hidradenitis suppurativa (HS). Complete resection of the affected tissue by wide excision is currently regarded as the preferred surgical technique in these cases. However, relatively large amounts of healthy tissue are removed with this method and suitable skin-tissue-saving techniques aiming at creating less-extensive surgical defects are therefore needed in severe HS. We describe a skin-tissue-saving surgical technique for HS Hurley stage II-III disease: the Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP) procedure. In contrast to wide excisions that generally reach into the deep subcutaneous fat, the fat is maximally spared with the STEEP procedure by performing successive tangential excisions of lesional tissue until the epithelialized bottom of the sinus tracts has been reached. From here, secondary intention healing can occur. In addition, fibrotic tissue is completely removed in the same manner as this also serves as a source of recurrence. This tissue-sparing technique results in low recurrence rates, high patient satisfaction with relatively short healing times and favourable cosmetic outcomes without contractures. © 2014 European Academy of Dermatology and Venereology.

  19. Preliminary findings suggest hidradenitis suppurativa may be due to defective follicular support

    DEFF Research Database (Denmark)

    Danby, F W; Jemec, G B E; Marsch, W Ch

    2013-01-01

    BACKGROUND: The initial pathology in hidradenitis suppurativa (HS)/acne inversa takes place in the folliculopilosebaceous unit (FPSU) and its surrounding tissue. The process involves follicular hyperkeratosis, inflammation and perifolliculitis. Identification of the exact origin of inflammation m...

  20. Non-surgical treatments for hidradenitis suppurativa: A systematic review.

    Science.gov (United States)

    Robert, E; Bodin, F; Paul, C; Konstantinou, M-P; Gall, Y; Grolleau, J-L; Laloze, J; Chaput, B

    2017-08-01

    The management of hidradenitis suppurativa is multidisciplinary, involving general measures, medical treatment and surgery. Non-surgical treatments, often first-line procedures, mainly concern forms of low-to-moderate severity or, conversely, very severe forms in non-operable patients or those refusing surgery. While many treatments have been attempted, few randomized controlled trials have been conducted, so the choice of treatments is most often based on the personal experience of the clinicians. The objective of this systematic review is to propose a synthetic analysis of the currently available non-surgical procedures. This systematic review of the literature was conducted in accordance with the PRISMA criteria. We searched for articles in the Medline ® , PubMed Central, Embase and Cochrane databases published between January 2005 and September 2015. Sixty-four articles were included. They generally had a low level of evidence; indeed, the majority of them were retrospective observational studies. They involved biotherapy (44%), dynamic phototherapy (16%), antibiotics (11%), Laser (8%), retinoids (6%) and immunosuppressive therapies, anti-inflammatory drugs, zinc, metformin, gammaglobulins and fumarates. None of the non-surgical treatments can treat all stages of the disease and offer long-term remission. Antibiotics and biotherapy seem to have real effectiveness but their effect remains suspensive and the disease is almost certain to reappear once they are stopped. As regards antibiotics, no association has shown their superiority in a study with a high level of evidence. And while some biotherapies seem quite effective, due to their side effects they should be reserved for moderate-to-severe, resistant or inoperable forms of the disease. Randomized controlled studies are needed before valid conclusions can be drawn. In the resistant or disabling forms, it is consequently advisable to orientate to the greatest possible extent towards radical surgery, which

  1. Hidradenitis Suppurativa and Crohn’s Disease: A Case Series

    LENUS (Irish Health Repository)

    Kirthi, S

    2017-09-01

    Hidradenitis Suppurativa (HS) is characterized by chronic recurrent abscesses, nodules and draining sinus tracts with scar formation. Cutaneous Crohn’s Disease (CD) may also present similarly. We wished to identify and describe an Irish cohort with combined HS and CD, with a view to a better recognition of clinical manifestations and understanding of the pathophysiology underlying these two overlapping conditions. Cases were identified using the HIPE Code at Tallaght Hospital from 1990-2014 and retrospective review was performed. Seven patients with both HS and CD were identified, 5(71%) female. The median age of diagnosis with both conditions was 37 years. In all cases, CD had preceded the diagnosis of HS. All patients smoked. Six had an increased BMI and 43% had additional autoimmune conditions. All patients required treatment with a TNF-alpha inhibitor for HS with 5 of 6 subjects having reduced frequency of flare ups and clinically less active HS on follow up

  2. Hidradenitis suppurativa in a HIV-infected child

    Directory of Open Access Journals (Sweden)

    G Prabhu

    2012-01-01

    Full Text Available Hidradenitis suppurativa (HS, a painful and chronic condition, commonly occurs in women and coincides with post-pubertal increase in sex hormones. A 13-year-old pre-pubertal HIV-infected male child presented to our clinic with a discharging right axillary lymph node swelling. The biopsy of the lesion showed features of HS. The patient was treated with oral antibiotics, oral steroids, and local antibiotic wash. Though the patient responded to this treatment, the clinical response was not adequate and the lesion recurred. Subsequently, the child was started on antiretroviral therapy (zidovudine, lamivudine, and nevirapine. Following these medications, the lesions healed and had not recurred till we last examined the child. Thus, this is a rare presentation of a known condition in an HIV-infected pre-pubertal male child, which did not respond to usual modalities of treatment and had to be treated with antiretroviral therapy.

  3. Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis.

    Science.gov (United States)

    Alharbi, Badr; Shlash, Ahmed; Bedaiwi, Khaled; Hooti, Qais Al; Almohaisen, Abdulrahman; Shlash, Saud; Said, Mohammad

    2015-01-01

    Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS). HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.

  4. Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis

    Directory of Open Access Journals (Sweden)

    Badr Alharbi

    2015-01-01

    Full Text Available Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS. HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.

  5. Increased Suicide Risk in Patients with Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Thorlacius, Linnea; Cohen, Arnon D; Gislason, Gunnar H

    2018-01-01

    Patients with skin disorders are considered at a higher risk of depression and anxiety than the background population. Patients with hidradenitis suppurativa (HS) may be particularly affected. We explored the association between HS and depression, anxiety, and completed suicides in the Danish...... nonsignificant association with depression (odds ratio [95% confidence interval] = 1.13; 0.87-1.47]; P = 0.36 and hospitalization due to depression (1.32 [0.94-1.85]; P = 0.1083). To the best of our knowledge, no previous studies have reported on the increased risk of completed suicide among HS patients...... national registries, expanding to include data on suicidal behavior, using both a cross-sectional and a cohort study design. Both designs included 7,732 patients with HS and a background population of 4,354,137. The cohort study revealed that HS patients had an increased risk of completed suicide after...

  6. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gulliver, Wayne; Zouboulis, Christos C.; Prens, Errol

    2016-01-01

    Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due...

  7. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    NARCIS (Netherlands)

    W.P. Gulliver (Wayne P.); C.C. Zouboulis (Christos C.); E.P. Prens (Errol); G.B.E. Jemec (Gregor); T. Tzellos (Thrasivoulos)

    2016-01-01

    textabstractHidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is

  8. New treatment strategies for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Andersen, R.; Jemec, G. B.E.

    2016-01-01

    and pathogenesis are only partially understood at present. Recent research has, however, identified possible targets for specific intervention using biologicals. In addition, classical clinically driven developments of new treatments continue to evolve, leading to several interesting new therapies for HS patients...... included. A total of 365 papers were identified, 79 of which were retained for analysis following exclusions. The following treatments are discussed in detail: infliximab, adalimumab, ustekinumab, anakinra, alitretinoin, metformin and Vitamin D. HS is a disease with a considerable morbidity and a great...

  9. Review of Current Immunologic Therapies for Hidradenitis Suppurativa

    Directory of Open Access Journals (Sweden)

    Victoria K. Shanmugam

    2017-01-01

    Full Text Available Hidradenitis suppurativa (HS is a chronic, recurrent, inflammatory disease of apocrine gland-bearing skin which affects approximately 1–4% of the population. The disease is more common in women and patients of African American descent and approximately one-third of patients report a family history. Obesity and smoking are known risk factors, but associations with other immune disorders, especially inflammatory bowel disease, are also recognized. The pathogenesis of HS is poorly understood and host innate or adaptive immune response, defective keratinocyte function, and the microbial environment in the hair follicle and apocrine gland have all been postulated to play a role in disease activity. While surgical interventions can be helpful to reduce disease burden, there is a high recurrence rate. Increasingly, data supports targeted immune therapy for HS, and longitudinal studies suggest benefit from these agents, both when used alone and as an adjunct to surgical treatments. The purpose of this review is to outline the current data supporting use of targeted immune therapy in HS management.

  10. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients.

    Science.gov (United States)

    Gener, G; Canoui-Poitrine, F; Revuz, J E; Faye, O; Poli, F; Gabison, G; Pouget, F; Viallette, C; Wolkenstein, P; Bastuji-Garin, S

    2009-01-01

    Antibiotics are frequently used to treat hidradenitis suppurativa (HS); however, few data on their efficacy are available. To evaluate the efficacy of a combination of systemic clindamycin (300 mg twice daily) and rifampicin (600 mg daily) in the treatment of patients with severe HS. Patients (n = 116) who received this combination were studied retrospectively. The main outcome measure was the severity of the disease, assessed by the Sartorius score, before and after 10 weeks of treatment. The Sartorius score dramatically improved at the end of treatment (median = 29, interquartile range = 14.5, vs. median = 14.5, interquartile range = 11; p < 0.001), as did other parameters of severity as well as the quality of life score. Eight patients (6.9%) stopped the treatment because of side effects. The combination of clindamycin and rifampicin is effective in the treatment of severe HS. Copyright 2009 S. Karger AG, Basel.

  11. Prevalence and Risk of Inflammatory Bowel Disease in Patients with Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Jemec, Gregor B.E.; Kimball, Alexa B.

    2017-01-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. In small studies, inflammatory bowel disease has been associated with the increased prevalence of HS, but the data on the concurrence of inflammatory bowel disease in patients with HS are limited. We therefore investigated...

  12. Hidradenitis Suppurativa and electrocardiographic changes - a cross-sectional population study

    DEFF Research Database (Denmark)

    Juhl, C R; Miller, I M; Jemec, G B

    2018-01-01

    BACKGROUND: Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease, recently associated with metabolic syndrome, subclinical atherosclerosis and increased risk of cardiovascular disease. OBJECTIVES: The aim of the study was to investigate the hitherto unknown electrocardiographic c...... resting electrocardiograms. We investigated the difference in means by unpaired t-test or the analysis of variance (ANOVA) test. RESULTS: Heart rate was significantly higher (mean difference: 2.3 bpm [1.2:3.4] p..., there was no significant difference (0.3 bpm [-0.7:1.4] p=0.52). Severe HS was significantly associated with increased heart rate across all models (2.9 bpm [0.7:5.1] p=0.01). Mean QRS-duration was significantly shorter in the mild HS group, but not in the moderate- and severe HS groups CONCLUSION: Mean resting heart rate...

  13. Hidradenitis suppurativa/acne inversa: bilocated epithelial hyperplasia with very different sequelae.

    Science.gov (United States)

    von Laffert, M; Stadie, V; Wohlrab, J; Marsch, W C

    2011-02-01

    Hidradenitis suppurativa/acne inversa is a chronic, inflammatory, scarring disease in the terminal hair follicle and apocrine gland-bearing areas (skin folds). There is considerable histological evidence that perifolliculitis and follicular hyperkeratosis precede the rupture of the follicle. The timing of the epithelial hyperplasia at the infundibula of inflamed terminal follicles has not yet been clarified. To clarify the early histopathological life of lesions ('chronology') in hidradenitis suppurativa/acne inversa, focusing on the terminal follicle structure and its surrounding tissue (hyperkeratosis, hyperplasia of follicular epithelium, perifolliculitis and rupture). In total, 485 operative specimens obtained from 128 patients with diagnosed hidradenitis suppurativa/acne inversa (all surgically treated by wide excision) were examined histologically. Two to five histological preparations (total 485) per operation area (total 196) were prepared by multiple slicing. Hidradenitis suppurativa/acne inversa showed a heterogeneous histological pattern: hyperkeratosis of the terminal follicles (89%), hyperplasia of follicular epithelium (80%), pronounced perifolliculitis (68%) and follicle rupture (24%). Perifolliculitis, follicular hyperkeratosis and hyperplasia occurred prior to the rupture of the follicle. Other histological criteria were: subepidermal cellular inflammatory infiltrate (82%), epidermal psoriasiform hyperplasia (56%), pronounced acute dermal inflammation (28%), pronounced chronic dermal inflammation (49%), and involvement of apocrine glands (52%) and subcutis (31%). Infundibular hyperkeratosis, hyperplasia of the follicular epithelium and perifolliculitis are major histopathological characteristics of hidradenitis suppurativa/acne inversa. These apparently precede rupture of the follicle. In particular, hyperplasia of the follicular epithelium probably marks the beginning of sinus formation, which usually spreads horizontally. Psoriasiform hyperplasia

  14. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity

    DEFF Research Database (Denmark)

    Sartorius, K; Emtestam, L; Jemec, G B E

    2009-01-01

    in HS. OBJECTIVES: To evaluate the modified Hidradenitis Suppurativa Score (HSS) and to study the impact of body mass index (BMI) and smoking habits on disease severity. METHODS: Two hundred and fifty-one consecutive patients with HS referred to a clinic with special interest in the disease were...... included, of whom 115 were scored. Points were given for regions involved, types of lesion (nodules, fistulas), total area involved and whether lesions were separated by normal skin. Background characteristics included BMI and smoking habits. Two hundred and forty-six patients completed the Dermatology...... as smoking habits in patients with HS is presented. The results suggest that the HSS may be a relevant outcome measure in future therapeutic trials in HS....

  15. The follicular skin microbiome in patients with hidradenitis suppurativa and healthy controls

    DEFF Research Database (Denmark)

    Ring, Hans Christian; Thorsen, Jonathan; Saunte, Ditte M.

    2017-01-01

    IMPORTANCE: Although the pathogenesis of hidradenitis suppurativa (HS) remains enigmatic, several factors point to potential involvement of the cutaneous microbiome. Insight into the cutaneous microbiome in HS using next-generation sequencing may provide novel data on the microbiological diversity...... of the skin.  OBJECTIVE: To investigate the follicular skin microbiome in patients with HS and in healthy controls.  DESIGN, SETTING, AND PARTICIPANTS: This case-control study obtained punch biopsy specimens from patients with HS (lesional and nonlesional) and healthy controls between October 1, 2014....... Biopsy specimens from healthy controls were obtained from the axilla only.  MAIN OUTCOMES AND MEASURES: The different microbiomes were investigated using next-generation sequencing targeting 16S and 18S ribosomal RNA.  RESULTS: The skin microbiome was characterized in 30 patients with HS (mean [SD] age...

  16. A 3D ultrasound study of sinus tract formation in hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Wortsman, Ximena; Jemec, Gregor

    2013-01-01

    Imaging of hidradenitis suppurativa allows the study of both the lesion morphology and evolution. Hidradenitis lesions of different stages were studied using 3D ultrasound in a cross sectional pilot study. A total of 25 HS patients (18 female/ 7 male, aged 18-46 year-old) and 10 healthy controls (5...... female/5 male, aged 21-49 year-old) were studied. All patients were referred by dermatologists. All examinations were performed on the right axilla and compared with both controls and the skin outside the lesional areas. 3D ultrasound images demonstrated enlargement of the deepest portion of the hair...

  17. A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Miller, I; Lynggaard, C D; Lophaven, S

    2011-01-01

    BACKGROUND: Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed. OBJECTIVES: To test the efficacy of adalimumab in HS. METHODS: This was a prospective, randomized, double-blinded, placebo-controlled,......BACKGROUND: Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed. OBJECTIVES: To test the efficacy of adalimumab in HS. METHODS: This was a prospective, randomized, double-blinded, placebo......-controlled, two-centre clinical trial conducted in Denmark. Inclusion criteria were age above 18 years and a clinical diagnosis of moderate to severe HS defined as Hurley stage II or III for at least 6 months. The patients were randomized 1:2 (placebo/active). Actively treated patients received adalimumab 80 mg...... subcutaneously (s.c.) at baseline followed by 40 mg s.c. every other week for 12 weeks. Placebo-treated patients received identical-looking injections with no active ingredient. The medicine was dispensed in sequentially numbered computer-randomized containers. Participants, care givers and those assessing...

  18. Surgical approach to extensive hidradenitis suppurativa in the perineal/perianal and gluteal regions.

    Science.gov (United States)

    Balik, Emre; Eren, Tunc; Bulut, Türker; Büyükuncu, Yilmaz; Bugra, Dursun; Yamaner, Sümer

    2009-03-01

    Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes. A retrospective review of the medical records from January 1990 to July 2003 of 15 patients was performed. Fifteen patients underwent treatment for extensive hidradenitis suppurativa in the gluteal, perineal/perianal, and inguinal areas with total surgical excision. All patients were men (100%) and their mean age was 42.5 (range, 23-66) years. The patients underwent a total number of 21 operations. In 11 patients wounds were left open for secondary healing, and the mean time for complete wound healing in this group was 12.2 (range, 9.5-22) weeks. Two patients underwent primary wound closure by the application of rotation flaps, and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the initial operation. In this group, complete wound healing took a total of 8 weeks. Only one diverting colostomy was needed in a patient in the delayed skin-grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision followed by the application of a rotation flap. This patient had had complaints of gluteal discharge for approximately 30 years. The cancer recurred after 6 months in the perianal region and immediate abdominoperineal resection was performed. He died during the second postoperative month due to systemic

  19. Challenging Ulcerative Vulvar Conditions: Hidradenitis Suppurativa, Crohn Disease, and Aphthous Ulcers.

    Science.gov (United States)

    Stewart, Kristen M A

    2017-09-01

    This article discusses the clinical evaluation and approach to patients with 3 complex ulcerative vulvar conditions: hidradenitis suppurativa, metastatic Crohn disease of the vulva, and aphthous ulcers. These conditions are particularly challenging to medical providers because, although each is known to present with nonspecific examination findings that vary in morphology, the predominance of the diagnosis is based on clinical examination and exclusion of a wide variety of other conditions. Care of patients with these conditions is further complicated by the lack of therapeutic data and the significant impact these conditions have on quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Hidradenitis suppurativa gains increasing interest on World Wide Web: a source for patient information?

    Science.gov (United States)

    Hessam, Schapoor; Salem, Johannes; Bechara, Falk G; Haferkamp, Axel; Heidenreich, Axel; Paffenholz, Pia; Sand, Michael; Tsaur, Igor; Borgmann, Hendrik

    2017-07-01

    Gathering health information from Internet websites is increasingly utilized by patients. No data exist about hidradenitis suppurativa (HS)-related online health information. Thus, we aimed to study the quality, popularity, readability, and timeliness of the most frequented websites on HS. Google Trends was used to evaluate the public interest in HS. An Internet search on Google was performed for the terms "hidradenitis suppurativa," "acne inversa," and "Verneuil's disease." Readability scores, HONcode quality certification, Alexa popularity rank, and content were assessed. Google search queries on HS have steadily risen in the last 10 years. The website analysis revealed 39 unique websites, which were difficult to read. Ten websites (26%) had HONcode quality certification, and the median (IQR) Alexa popularity rank was 48871 (2333-361275). Thirteen websites (33%) yielded disease-specific photos with a median rating between "quite useful" and "uncertain." A therapy option with adalimumab was mentioned on 11 websites (28%). In addition to an increasing interest, we found a broad variation in the quality, readability, popularity, and timeliness of content on HS-related websites. Improvement of the quality and readability of HS-related websites is desirable to potentially raise disease awareness and contribute to an earlier presentation of patients suffering with undiagnosed HS. © 2017 The International Society of Dermatology.

  1. Hidradenitis Suppurativa

    Science.gov (United States)

    ... Registration General information Housing & travel Education Exhibit hall Mobile app 2019 Annual Meeting Derm Exam Prep Course ... SkinPAC State societies Scope of practice Truth in advertising NP/PA laws Action center Public and patients ...

  2. Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa.

    Science.gov (United States)

    Kouris, Anargyros; Platsidaki, Eftychia; Christodoulou, Christos; Efstathiou, Vasiliki; Dessinioti, Clio; Tzanetakou, Vasiliki; Korkoliakou, Panagiota; Zisimou, Chrisa; Antoniou, Christina; Kontochristopoulos, George

    2016-01-01

    Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact. To evaluate the quality of life, depression, anxiety, loneliness, and self-esteem in patients with HS. Ninety-four patients with HS were enrolled in the study. The quality of life, depression, anxiety, loneliness, and self-esteem of the patients were assessed using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), the UCLA Loneliness Scale (UCLA-Version 3), and the Rosenberg Self-Esteem Scale (RSES), respectively. The DLQI mean score was 11.43 ± 6.61 in patients with HS. The patients with HS presented statistically significantly higher anxiety (6.41 ± 3.31 vs. 5.00 ± 1.59, p loneliness and social isolation scores (42.86 ± 8.63 vs. 35.57 ± 6.17, p < 0.001) and lower self-esteem scores (18.91 ± 1.79 vs. 19.77 ± 2.53, p = 0.008) than the healthy controls. HS is a distressing, recurrent disease that impairs quality of life. We can suggest services that allow an integrated approach, which includes psychosocial support, offering the patients relief from isolation and an opportunity to share common experiences. © 2017 S. Karger AG, Basel.

  3. Recurrence of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis.

    Science.gov (United States)

    Mehdizadeh, Ali; Hazen, Paul G; Bechara, Falk G; Zwingerman, Nora; Moazenzadeh, Marzyeh; Bashash, Morteza; Sibbald, R Gary; Alavi, Afsaneh

    2015-11-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates. This study provides a comprehensive systematic review of surgical approaches in the management of HS. A systematic literature search and meta-analysis of proportions were performed on the included studies. Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing. There was poor quality evidence and potential improper reporting of the results. This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Anoperineal disease in Hidradenitis suppurativa: MR imaging distinction from perianal Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Monnier, Louise; Amara, Nedjoua; Hoeffel, Christine [Hopital Maison Blanche, Department of Radiology, Reims (France); Dohan, Anthony [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Radiology, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Zagdanski, Anne-Marie [Saint Louis Hospital, Department of Radiology, Paris (France); Drame, Moustapha [Hopital Robert Debre, Department of Statistics, Reims (France); Soyer, Philippe [Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France)

    2017-10-15

    To determine whether Hidradenitis suppurativa (HS)-related anoperineal disease can be distinguished from Crohn's disease (CD) using MRI. Pelvic MRI of 23 HS and 46 CD patients with anoperineal disease between 2007 and 2014 were independently analysed by two radiologists. For diagnosis of HS, sensitivity, specificity and positive likelihood ratios (LRs) of inflammatory features and of their anatomical distribution were calculated and compared to those of CD. In HS, fistulae were less present (P =.033) and less frequently involved the sphincters (P =.001) than in CD. Granulomas were more frequent (P =.0005). For anterior/inguinal and posterior localizations, sensitivity, specificity and LR for diagnosis of HS were 70% (49.1, 84.4), 87% (74.3, 93.9), 5.3 (2.41, 11.79) and 57% (36.8, 74.4), 93% (82.5, 97.8), 8.67 (2.74, 27.41), respectively. Combination of signs including posterior involvement, absence of rectal wall thickening and bilaterality of features yielded specificity of 100% (95% CI: 92.3-100) for HS. Although MRI presentations of anoperineal disease may overlap between CD and HS, specific diagnosis of HS is possible with a combination of three features: absence of features' predominance in perianal area, absence of rectal wall thickening and bilaterality of features. (orig.)

  5. Axillary Reconstruction for Hidradenitis Suppurativa with an Inner-Arm Transposition Flap Creating a Brachioplasty Effect

    Directory of Open Access Journals (Sweden)

    Daniel L. Ching

    2017-05-01

    Full Text Available BackgroundHidradenitis suppurativa (HS is a chronic skin condition that can affect any area with apocrine sweat glands and has the potential to involve multiple sites concurrently. Commonly affected sites include the axilla, groin, perineum and perianal areas. In this study we performed a literature review on the surgical methods for HS and describe an innovative technique for reconstructing axilla HS using an inner-arm transposition flap.MethodsWe reviewed all cases (5 cases from 4 patients of transposition flap reconstruction performed by the senior author at a single London tertiary hospital from 2008–2013. Patient related outcome measures were collected using the Derriford appearance scale (DAS 24 and a study specific questionnaire.ResultsAll patients were satisfied with their final result. One out of five cases had a complication but did not result in flap failure. There is no disease recurrence to date. DAS 24 scores collected demonstrated acceptable postoperative distress that did not deviate far from the norm tables while study specific questionnaire reveal desirable outcomes.ConclusionsWe have managed to achieve our aim through the use of the innovative inner-arm transposition flap. Our study hopes to provide an additional technique for axillary reconstruction. This technique offers the effective concealment of scars with the benefit of tightening of the arm tissue producing ‘brachioplasty like’ effects. All things considered it would be reasonable to conclude the innovative flap technique is a reliable, effective, and simple method that results in multiple benefits.

  6. Reconstruction in extensive axillary Hidradenitis suppurativa with local fasciocutaneous V-Y advancement flaps

    Directory of Open Access Journals (Sweden)

    Sharma Ramesh

    2006-01-01

    Full Text Available We present our experience with the use of local fasciocutaneous V-Y advancement flaps in the reconstruction of 10 axillae in 6 patients for large defects following wide excision of long-standing Hidradenitis suppurativa of the axilla. The defects were closed with local V-Y subcutaneous island flaps. A single flap from the chest wall was sufficient for moderate defects. However, for larger defects, an additional flap was taken from the medial side of the ipsilateral arm. The donor defects could be closed primarily in all the patients. The local areas of the lateral chest wall and the medial side of the arm have a plentiful supply of cutaneous perforators and the flaps can be designed in a V-Y fashion without resorting to preoperative marking of the perforator. The flaps were freed sufficiently to allow adequate movement for closure of the defects. Although no attempt was made to identify the perforators specifically, many perforators were seen entering the flap. Some perforators can be safely divided to increase reach of the flap. All the flaps survived completely. A follow up of 2.5 years is presented.

  7. Development and initial psychometric evaluation of patient-reported outcome questionnaires to evaluate the symptoms and impact of hidradenitis suppurativa.

    Science.gov (United States)

    Kimball, Alexa B; Sundaram, Murali; Banderas, Benjamin; Foley, Catherine; Shields, Alan L

    2018-03-01

    Two patient-reported outcome (PRO) questionnaires, the Hidradenitis Suppurativa Symptom Assessment (HSSA) and Hidradenitis Suppurativa Impact Assessment (HSIA), were developed to measure signs, symptoms and impacts of HS in treatment efficacy studies. In accordance with FDA guidelines and published best practices, four stages of research were conducted to create the questionnaires: concept elicitation, questionnaire construction, content evaluation and psychometric evaluation. Subjects (N = 20) who participated in the concept elicitation stage reported 15 unique HS-related signs and symptoms and 51 impacts. Following this, eight sign and symptom concepts and 21 impacts were selected for construction of the HSSA and HSIA, respectively. During content evaluation, cognitive debriefing interviews with HS subjects (N = 20) confirmed subjects could read, comprehend and meaningfully respond to both questionnaires. Modifications made after this stage of work resulted in a nine-item HSSA and a 17-item HSIA. The HSSA and HSIA were subsequently entered into a US-based observational study (N = 40), and the scores produced by each were found to be reliable, construct valid, and able to distinguish among clinically distinct groups. The HSSA and HSIA are content-valid, HS-specific, PRO questionnaires with demonstrated ability to generate reliable, valid scores when administered to patients with HS in a research setting.

  8. Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis.

    Science.gov (United States)

    Scheinfeld, Noah

    2013-06-15

    Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest association are obesity, depression, and pain. HS is associated with many diseases including acne conglobata (AC), dissecting cellulitis, pilonidal cysts, and obesity. Pyoderma fistulans sinifica (fox den disease) appears to be the same entity as Hurley Stage 2 of 3 HS. The rate of acne vulgaris in HS patients mirrors unaffected controls. The most common, albeit still uncommon, association is with seronegative, haplotype unlinked arthritis (most importantly B27), in particular spondolyarthritis. Crohn disease and HS occur together at a rate that varies from 0.6% to 38% in retrospective cases series. Ulcerative colitis occurred with HS in 14% of patients in one series. The next most common association is with pyoderma gangrenosum, but this association is likely under-reported. Synovitis-Acne-Pustulosis Hyperostosis-Osteitis (SAPHO) syndrome, which is rare, has more than 10 reports linking it to HS. Nine case reports have linked Dowling-Degos disease (DDD) to HS and two reports related HS to Fox-Fordyce disease (FF), but because both occur in the axilla this might be a mere coincidence. HS is rarely associated with ophthalmic pathology. Specifically, more than 5 reports link it to Keratitis-Ichthyosis-Deafness syndrome (KID); greater than10 cases link it to interstitial keratitis and 2 cases are linked to Behçet's disease. The presence of proteinuria and acute nephritis link HS to the kidney, especially since and reports have documented resolution of HS after renal transplant. Florid steatocystoma multiplex, Sjogren Syndrome, and HS have been linked and their reports likely underestimate their coincidence because all these entities involve occlusion (albeit by different mechanisms). Three reports link HS and amyloid, but both share some common genetic underpinnings and thus the coincidence of these

  9. Recurrence rate and patient satisfaction of CO2 laser evaporation of lesions in patients with hidradenitis suppurativa: a retrospective study.

    Science.gov (United States)

    Mikkelsen, Peter Riis; Dufour, Deirde Nathalie; Zarchi, Kian; Jemec, Gregor B E

    2015-02-01

    Hidradenitis suppurativa (HS) is a debilitating disease and is difficult to treat. Validation of surgical techniques is therefore of great importance in the management of HS. Carbon dioxide (CO2) laser evaporation has been shown effective, but larger-scale studies are scarce. To determine the recurrence rate, time to recurrence, and factors influencing disease recurrence in skin treated with CO2 laser evaporation, and healing by secondary intention; and patients' satisfaction with treatment. Fifty-eight patients treated with CO2 laser evaporation were interviewed regarding recurrence and satisfaction after a mean of 25.7 months. Seventeen of 58 (29%) reported recurrence of HS lesions within the borders of the treated areas after a mean of 12.7 months. Obesity was a risk factor for recurrence with a hazard ratio of 4.53. Fifty-five patients (95%) reported some or great improvement, and 91% would recommend the CO2 laser surgery to other HS patients. This study supports the claim that CO2 laser treatment is an effective modality for recurrent HS lesions in a majority of patients. The authors identified obesity as a risk factor for recurrence. Self-reported satisfaction is high, and only 3 of 58 report no change in the condition. None reported a worsening.

  10. Towards global consensus on core outcomes for hidradenitis suppurativa research: an update from the HISTORIC consensus meetings I and II*

    Science.gov (United States)

    Thorlacius, L.; Garg, A.; Ingram, J.R.; Villumsen, B.; Riis, P. Theut; Gottlieb, A.B.; Merola, J.F.; Dellavalle, R.; Ardon, C.; Baba, R.; Bechara, F.G.; Cohen, A.D.; Daham, N.; Davis, M.; Emtestam, L.; Fernández-Peñas, P.; Filippelli, M.; Gibbons, A.; Grant, T.; Guilbault, S.; Gulliver, S.; Harris, C; Harvent, C.; Houston, K.; Kirby, J.S.; Matusiak, L.; Mehdizadeh, A.; Mojica, T.; Okun, M.; Orgill, D.; Pallack, L.; Parks-Miller, A.; Prens, E.P.; Randell, S.; Rogers, C.; Rosen, C.F.; Choon, S.E.; van der Zee, H.H.; Christensen, R.; Jemec, G.B.E.

    2018-01-01

    Summary Background A core outcomes set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) has no agreed-upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of the literature and a healthcare professional survey, and initial votes had been cast in two e-Delphi surveys. In this manuscript, we describe two in-person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items. Objectives To consider which items from a long list of candidate items to exclude and which to cluster into outcome domains. Methods The study used an international and multistakeholder approach, involving patients, dermatologists, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey. Results Forty-one individuals from 13 countries and four continents participated. Nine items were excluded and there was consensus to propose seven domains: disease course, physical signs, HS-specific quality of life, satisfaction, symptoms, pain and global assessments. Conclusions The HISTORIC consensus meetings I and II will be followed by further e-Delphi rounds to finalize the core domain set, building on the work of the in-person consensus meetings. PMID:29080368

  11. The microRNA effector RNA-induced silencing complex in hidradenitis suppurativa: a significant dysregulation within active inflammatory lesions.

    Science.gov (United States)

    Hessam, S; Sand, M; Skrygan, M; Bechara, Falk G

    2017-09-01

    Recently, we could show that the expression levels of the key regulators of the microRNA (miRNA) maturation and transport were dysregulated in inflamed hidradenitis suppurativa (HS) tissue (Heyam et al. in Wiley Interdiscip Rev RNA 6:271-289, 2015). The RNA-induced silencing complex (RISC) is the central element of the miRNA pathway and regulates miRNA formation and function. We investigated the expression of the RISC components, namely transactivation-responsive RNA-binding protein-1 (TRBP1), TRBP2, protein activator (PACT) of the interferon-induced protein kinase R, Argonaute RISC Catalytic Component-1 (AGO1) and Component-2 (AGO2), metadherin, and staphylococcal nuclease and Tudor domain-containing-1 (SND1) in inflamed HS tissue compared to healthy and psoriatic controls by real-time reverse transcription polymerase chain reaction. Expression levels of all investigated components were significantly lower in lesional HS skin (n = 18) compared to healthy controls (n = 10). TRBP1, PACT, AGO1, AGO2, and SND1 expression levels were significantly down-regulated in lesional HS skin compared to healthy-appearing perilesional skin (n = 7). TRBP2 and SND1 expression levels were significantly lower in healthy-appearing perilesional skin compared to healthy controls. In lesional HS skin, expression levels of PACT, AGO1, and AGO2 were significantly lower compared to psoriatic skin (n = 10). In summary, our data showed that all investigated components of RISC are dysregulated in the skin of HS patients, providing support for the hypothesis that miRNAs may have a pathological role in the inflammatory pathogenesis of HS.

  12. Interleukin-36 in hidradenitis suppurativa: evidence for a distinctive proinflammatory role and a key factor in the development of an inflammatory loop.

    Science.gov (United States)

    Hessam, S; Sand, M; Gambichler, T; Skrygan, M; Rüddel, I; Bechara, F G

    2018-03-01

    Possible regulatory involvement of the interleukin (IL)-36 family in inflammatory diseases has been suggested. To analyse the expression of IL-36α, IL-36β, IL-36γ and the antagonistic cytokines IL-36 receptor agonist (IL-36Ra), IL-37 and IL-38 in the skin of patients with hidradenitis suppurativa (HS). Skin samples from lesional and corresponding perilesional HS skin, and from healthy controls were included in this study and analysed by quantitative real-time reverse-transcriptase polymerase chain reaction (PCR). To evaluate the PCR results of IL-36α, IL-36β and IL-36γ, a subset of skin samples was studied by immunohistochemistry. Expression levels of IL-36α, IL-36β, IL-36γ and IL-36Ra were all significantly higher in lesional HS skin than in healthy controls. IL-37 and IL-38 levels were significantly higher in perilesional HS skin than in healthy controls and were decreased in lesional HS skin. Limitations of the study are its descriptive nature and the small sample size. Our results showed a possible involvement of IL-36 cytokines in the inflammatory network of HS and a dysbalance between the agonistic and antagonistic cytokines in HS skin. © 2017 British Association of Dermatologists.

  13. Topical treatments of skin pain: a general review with a focus on hidradenitis suppurativa with topical agents.

    Science.gov (United States)

    Scheinfeld, Noah

    2014-07-15

    Hidradenitis Supprurativa (HS) is a painful chronic follicular disease. Few papers have addressed pain control for this debilitating condition. Possible topical agents include tricyclic antidepressants, opioids, anticonvulsants, NSAIDs, NMDA receptor antagonists, local anesthetics and other agents. The first line agents for the topical treatment of the cutaneous pain of HS are diclonefac gel 1% and liposomal xylocaine 4% and 5% cream or 5% ointment. The chief advantage of topical xylocaine is that is quick acting i.e. immediate however with a limited duration of effect 1-2 hours. The use of topical ketamine, which blocks n-methyl-D-aspartate receptors in a non-competitive fashion, might be a useful tool for the treatment of HS pain. Topical doxepin, which available in a 5% commercially preparation (Zonalon®) , makes patients drowsy and is not useful for controlling the pain of HS . Doxepin is available in a 3% or 3.3% concentration (which causes less drowsiness) from compounding pharmacies and can be used in compounded analgesic preparations with positive effect. Topical doxepin is preferred over use of topical amitriptyline because topical doxepin is more effective. Nevertheless, topical amitriptyline increase of the tactile and mechanical nociceptive thresholds and can be used for topical pain control in compound mixture of analgesics . Gabapentin and pregablin can also be used compounded with other agents in topical analgesic preparations with positive topical anesthetic effect. Capsaicin is not useful for topical treatment of the pain of HS. Sometimes compounded of anesthetics medications such as ketamine 10%, bupivacaine 1%, diclofenac 3%, doxepin 3% or 3.3%, and gabapentin 6% can extend the duration of effect so that medication only needs to be used 2 or 3 times a day. Still in my experience the easiest to get and most patient requested agent is topical diclonefac 1% gel.

  14. The ABC of Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Lipsker, Dan; Severac, François; Freysz, Marie

    2016-01-01

    of photos, agreement between the experts was poor with a kappa index of only 0.33 (95% CI 0.22-0.46). After extensive discussion of cases with disagreement, the kappa index increased on day 2 to 0.75 (95% CI 0.60-0.87), allowing to conclude on good interobserver agreement on terminology. Furthermore, a few...

  15. Genetics Home Reference: hidradenitis suppurativa

    Science.gov (United States)

    ... Apr;60(4):539-61; quiz 562-3. doi: 10.1016/j.jaad.2008.11.911. Review. ... Acad Dermatol. 2009 Jul;61(1):51-7. doi: 10.1016/j.jaad.2009.02.013. Epub ... Dermatol Clin. 2010 Oct;28(4):779-93. doi: 10.1016/j.det.2010.07.003. Review. ...

  16. Prodromal symptoms in hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Ring, H C; Theut Riis, P; Zarchi, K

    2017-01-01

    %), paraesthesia (63%) and itching (20%). the majority of the patients stated that the prodromes usually occurred > 24 h (45%) or 12-24 h (20%) before the eruption. CONCLUSION: Our data suggest that the majority of patients with HS experience prodromal symptoms, heralding a flare of their HS. The findings may give...

  17. Negative pressure wound therapy, staged excision and definitive closure with split-thickness skin graft for axillary hidradenitis suppurativa: a retrospective study.

    Science.gov (United States)

    Pearce, F B; Richardson, K A

    2017-01-02

    Bilateral axillary hidradenitis is a chronic, suppurative, and scarring disease that is most effectively treated by complete excision of all hair-bearing tissues. We assessed our staged procedure for excision and placement of a split-thickness skin graft for bilateral axillary hidradenitis in terms of costs, outcomes, and timing of excision. An IRB approved retrospective case analysis was performed on patients that underwent bilateral axillary hidradenitis skin excision with eventual placement of split-thickness skin grafting using the current LSUHSC/University Health hidradenitis surgical treatment protocol. Using ICD-9 codes (705.83) and CPT codes (11041, 11042, 11451, 11600, 11601, 11602, 11603, 11604) we reviewed cases performed at our institution from 1 January 2008 to 24 Febuary 2014 and we selected patients based on bilateral axillary involvement (alone) and >1 year history of active disease. Patients were excluded if resection of tissue encompassed regions outside of the immediately adjacent axillary. A total of seven patients matching criteria for bilateral axillary hidradenitis were selected for analysis. Clinical course, cost and surgical techniques were assessed. Of the seven patients, six required admission throughout their treatment due to lack of funding making use of negative pressure wound therapy at home not possible. These patients stayed an average of 10 days with a mean hospital charge of $35,178 and a mean hospital provider charge of $10,019. No recurrence was demonstrated. All patients attained full range of motion, post grafting. No patient required a further operation due to graft failure. Split-thickness skin grafting without use of bilayer dermal regenerative templates yielded definitive results with acceptable cosmesis and functionality, without the added cost of treatments such as a bilayer dermal regenerative template.

  18. Diagnostik og behandling af hidrosadenitis suppurativa

    DEFF Research Database (Denmark)

    Ring, Hans Christian; Saunte, Ditte Marie; Riis, Peter Theut

    2017-01-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels and scarring involving the intertriginous regions. Although patients with HS present a distinct symptomatology with a subsequent impairment of quality of life, an overall diagnostic time...... of seven years has been reported. A better and broader understanding of this disease may potentially reduce the diagnostic delay. This review provides an updated overview of diagnosis, monitoring tools as well as early treatment interventions....

  19. Intralesional triamcinolone for flares of hidradenitis suppurativa (HS)

    DEFF Research Database (Denmark)

    Riis, Peter Theut; Boer, Jurr; Prens, Errol P

    2016-01-01

    (triamcinolone acetonide 10 mg/mL) in the management of acute flares in HS. METHODS: This was a prospective case series evaluating the effect of intralesional corticosteroids for alleviation of acute flares in HS. Physician- and patient-reported outcomes were noted. RESULTS: Significant reductions in physician......-assessed erythema (median score from 2-1, P edema (median score from 2-1, P

  20. Towards global consensus on core outcomes for hidradenitis suppurativa research

    DEFF Research Database (Denmark)

    Thorlacius, L; Garg, A; Ingram, J R

    2018-01-01

    , involving patients, dermatologists, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey. RESULTS: Forty-one individuals from 13 countries and four...

  1. Hidradenitis suppurativa: a disease of the absent sebaceous gland?

    DEFF Research Database (Denmark)

    Kamp, S; Fiehn, A M; Stenderup, K

    2011-01-01

    in paraffin and stained with haematoxylin and eosin prior to volume estimation using the Cavalieri principle. RESULTS: Sebaceous gland tissue could be visualized in only 10 of 15 suitable hair follicle biopsies from patients with HS but was present in all biopsies from healthy controls (P = 0·05) and the mean...

  2. Quality of life considerations and pain management in hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Jemec, Gregor Be

    2017-01-01

    perceived as unclean and stigmatizing by the patients, but also cause pain and scarring making this inflammatory skin disorder unique. It is obvious that the disease has a significant negative impact on the patients' quality of life (QOL). The impact is influenced not only by the pain which is a significant...... independent contributor to the patients' life quality, but by the clinically significant comorbidity associated with HS. In particular, the psychological comorbidities of depression and anxiety both further compound QOL impairment and pain. It is strongly recommended that these factors be taken into account...... when planning a treatment strategy for patients with HS, and that specific steps are taken to manage pain and comorbidities associated with the reduced QOL generally experienced by this group of patients. Basic pain management includes anti-inflammatory treatments as well as local- and central...

  3. Hedgehog pathway does not play a role in hidradenitis suppurativa pathogenesis

    DEFF Research Database (Denmark)

    Mozeika, E.; Jemec, G.B.E.; Nürnberg, B.M.

    2011-01-01

    in normal embryonic skin, hair follicle, sebaceous and sweat gland development. Mutations of hedgehog pathway in adult skin have previously been found in basal cell carcinomas and in alopecia as well as in epidermal cysts and in odontogenic keratocysts. Therefore, we suggested that the hedgehog pathway...

  4. Leukocyte Profile in Peripheral Blood and Neutrophil-Lymphocyte Ratio in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Ring, Hans Christian; Prens, Errol P.

    2016-01-01

    odds of leukocytosis when compared to controls with an odds ratio for the HS-HOSP group of 4.38 (95% CI = 2.18-8.80; p ... profile in hospital-treated HS patients (HS-HOSP), self-reported population-based HS patients (HS-POP) and population controls. Results: Our study comprised 32 individuals in the HS-HOSP group, 430 in the HS-POP group, and 20,780 controls. The median hs-CRP for the HS-HOSP group was 5.1 mg/l (quartile...... range 2.6-8.2), 2.2 mg/l (1.0-4.3) for the HS-POP group and 1.3 mg/l (0.7-2.9) for the controls. An age-sex-adjusted analysis revealed a significantly higher hs-CRP for both HS groups compared to controls (p

  5. Protocol for the development of a core domain set for hidradenitis suppurativa trial outcomes

    DEFF Research Database (Denmark)

    Thorlacius, Linnea; Ingram, John R; Garg, Amit

    2017-01-01

    . A recent systematic review found a total of 30 outcome measure instruments in 12 RCTs. This use of a broad range of outcome measures can increase difficulties in interpretation and comparison of results and may potentially obstruct appropriate evidence synthesis by causing reporting bias. One strategy...... of candidate items will be obtained by combining three data sets: (1) a systematic review of the literature, (2) US and Danish qualitative interview studies involving patients with HS and (3) an online healthcare professional (HCP) item generation survey. To reach consensus on the COS, 4 anonymous online...... Delphi rounds are then planned together with 2 face-to-face consensus meetings (1 in Europe and 1 in the USA) to ensure global representation. ETHICS AND DISSEMINATION: The study will be performed according to the Helsinki declaration. All results from the study, including inconclusive or negative...

  6. Normal Skin Microbiota is Altered in Pre-clinical Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Ring, Hans Christian; Bay, Lene; Kallenbach, Klaus

    2017-01-01

    therefore hypothesized that clinically unaffected HS skin would also have an increased presence of biofilm compared with that of healthy controls. We conducted a case-control study, investigating the morphology of the axillary skin microbiota. Peptide nucleic acid – fluorescence in situ hybridization probes...... were used in combination with confocal laser scanning microscopy. Significant differences were found in both distribution and quantity of the cutaneous microbiota in clinically non-affected axillary skin of patients with HS compared with healthy controls. Surprisingly, we detected fewer bacteria...... and less biofilm in patients with HS. The reduced microbiota in patients with HS may play an important role in the early course of the disease....

  7. Association of Resilience With Depression and Health-Related Quality of Life for Patients With Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Kirby, Joslyn S; Butt, Melissa; Esmann, Solveig

    2017-01-01

    : To investigate the correlation among resilience, depression, and HRQOL for patients with HS. Design, Setting, and Participants: This cross-sectional survey study of 154 patients from 2 referral centers in the United States and in Denmark was conducted from June 1, 2016, to March 31, 2017. Patients were......) the Dermatology Life Quality Index. The main outcome of interest was the HRQOL as measured by the Dermatology Life Quality Index. Results: All 154 patients submitted a completed survey. The mean (SD) age of the participants was 40.93 (13.5) years; most participants were women (130 [84.4%]), and most participants...

  8. Recurrence rate and patient satisfaction of CO2 laser evaporation of lesions in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Mikkelsen, Peter Riis; Dufour, Deirde Nathalie; Zarchi, Kian

    2015-01-01

    : To determine the recurrence rate, time to recurrence, and factors influencing disease recurrence in skin treated with CO2 laser evaporation, and healing by secondary intention; and patients' satisfaction with treatment. METHODS: Fifty-eight patients treated with CO2 laser evaporation were interviewed regarding...... recurrence and satisfaction after a mean of 25.7 months. RESULTS: Seventeen of 58 (29%) reported recurrence of HS lesions within the borders of the treated areas after a mean of 12.7 months. Obesity was a risk factor for recurrence with a hazard ratio of 4.53. Fifty-five patients (95%) reported some or great...... improvement, and 91% would recommend the CO2 laser surgery to other HS patients. CONCLUSION: This study supports the claim that CO2 laser treatment is an effective modality for recurrent HS lesions in a majority of patients. The authors identified obesity as a risk factor for recurrence. Self...

  9. Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH)--a new autoinflammatory syndrome distinct from PAPA syndrome.

    Science.gov (United States)

    Braun-Falco, Markus; Kovnerystyy, Oleksandr; Lohse, Peter; Ruzicka, Thomas

    2012-03-01

    PAPA syndrome is a recently identified hereditary autoinflammatory syndrome clinically characterized by pyogenic arthritis, severe acne, and pyoderma gangrenosum. It is caused by mutations in the PSTPIP1 gene and may be closely linked to the aseptic abscesses syndrome, which has been shown to be associated with CCTG repeat amplification in the promoter region of PSTPIP1. We describe two unrelated patients with a clinical presentation quite similar to, yet distinct from, PAPA syndrome. Both patients had pyoderma gangrenosum and acute or remittent acne conglobata, but, in contrast to PAPA syndrome, lacked any episodes of pyogenic arthritis. Instead, they had suppurative hidradenitis. Mutations in PSTPIP1 exons 1 to 15 were excluded. In the promoter region, an increased repetition of the CCTG microsatellite motif was present on one allele in both patients. Alterations of the most commonly affected exons of the MEFV, NLRP3, and TNFRSF1A genes also were not detectable. One patient was treated with the interleukin (IL)-1 receptor antagonist anakinra and responded well, although without complete remission. This implies that IL-1ß may be of pathogenetic importance. Small number of patients, no gene mutation identified, and unclear efficacy of therapy are limitations. The clinical triad of pyoderma gangrenosum, acne, and suppurative hidradenitis represents a new disease entity within the spectrum of autoinflammatory syndromes, similar to PAPA and aseptic abscesses syndrome. For this disease, we propose the acronym "PASH" syndrome. PASH syndrome may respond to IL-1ß blockade. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  10. Chronic Inflammatory Disease, Lifestyle and Treatment Response

    Science.gov (United States)

    2018-01-25

    Autoimmune Diseases; Inflammatory Bowel Diseases; Crohn Disease (CD); Colitis, Ulcerative (UC); Arthritis, Rheumatoid (RA); Spondylarthropathies; Arthritis, Psoriatic (PsA); Psoriasis; Hidradenitis Suppurativa (HS); Uveitis

  11. Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

    NARCIS (Netherlands)

    Chernyshov, P. V.; Zouboulis, C. C.; Tomas-Aragones, L.; Jemec, G. B.; Manolache, L.; Tzellos, T.; Sampogna, F.; Evers, A. W. M.; Dessinioti, C.; Marron, S. E.; Bettoli, V.; van Cranenburgh, O. D.; Svensson, A.; Liakou, A. I.; Poot, F.; Szepietowski, J. C.; Salek, M. S.; Finlay, A. Y.

    2018-01-01

    Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in

  12. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek

    2017-01-01

    Chronic inflammatory diseases (CIDs), including Crohn’s disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro...

  13. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek

    2017-01-01

    Chronic inflammatory diseases (CIDs), including Crohn's disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro...

  14. The nature and consequence of Karl Marx's skin disease.

    Science.gov (United States)

    Shuster, S

    2008-01-01

    From an analysis of the original correspondence, it has been possible to establish that Karl Marx's incapacitating skin disease was hidradenitis suppurativa, not 'boils' as was universally assumed at the time and since; the psychological effect of this illness on the man and his work appears to have been considerable.

  15. The increasing relevance of biofilms in common dermatological conditions.

    Science.gov (United States)

    Kravvas, G; Veitch, D; Al-Niaimi, F

    2018-03-01

    Biofilms are diverse groups of microorganisms encased in a self-produced matrix that offers protection against unfavorable conditions and antibiotics. We performed a literature search using the MEDLINE electronic database. Only original articles published in English were considered for review. Biofilms have been implicated in the pathogenesis of acne, eczema, hidradenitis suppurativa, onychomycosis, miliaria, and impetigo. Adverse dermal-filler reactions are also linked to biofilms. Strict aseptic technique and prophylactic antibiotics are recommended in order to avoid such complications. Finally, biofilms are implicated in wounds, mainly chronic and diabetic, where they impede healing and cause recurrent infections. Several novel anti-biofilm agents and wound debridement have been shown to be beneficial. Biofilms are a significant cause of disease with wide implications in the field of dermatology. Several novel treatments have been found to be effective against biofilms, depending on the underlying microbes and type of disease.

  16. Unconventional Use of Intense Pulsed Light

    Directory of Open Access Journals (Sweden)

    D. Piccolo

    2014-01-01

    Full Text Available According to the literature, intense pulsed light (IPL represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne, due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases, port-wine stain (PWS (10 cases, disseminated porokeratosis (10 cases, pilonidal cyst (3 cases, seborrheic keratosis (10 cases, hypertrophic scar (5 cases and keloid scar (5 cases, Becker’s nevus (2 cases, hidradenitis suppurativa (2 cases, and sarcoidosis (1 case. Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator’s experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre. Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.

  17. Unconventional use of intense pulsed light.

    Science.gov (United States)

    Piccolo, D; Di Marcantonio, D; Crisman, G; Cannarozzo, G; Sannino, M; Chiricozzi, A; Chimenti, S

    2014-01-01

    According to the literature, intense pulsed light (IPL) represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne), due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases), port-wine stain (PWS) (10 cases), disseminated porokeratosis (10 cases), pilonidal cyst (3 cases), seborrheic keratosis (10 cases), hypertrophic scar (5 cases) and keloid scar (5 cases), Becker's nevus (2 cases), hidradenitis suppurativa (2 cases), and sarcoidosis (1 case). Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator's experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre). Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.

  18. [Cutaneous involvement in chronic inflammatory bowel disease : Crohn's disease and ulcerative colitis].

    Science.gov (United States)

    Richter, L; Rappersberger, K

    2016-12-01

    Over recent decades, both the incidence and prevalence of chronic inflammatory bowel disease have continued to rise in industrialized countries; the disease is frequently associated with extracutaneous involvement and comorbidity. The purpose of this work was to investigate the frequency and specificity of mucocutaneous manifestations in Crohn's disease (CD) and ulcerative colitis (UC). An extensive search in peer-reviewed journals via PubMed was performed; presented is a summary and analysis of various studies and data, including data of patients treated at our department. CD and UC are frequently associated with mucocutaneous symptoms; however, primary/specific disease-associations are exclusively seen in CD patients. These include peri-anal and -stomal fistulas and ulcerations, "metastatic" Crohn's disease as well as oral granulomatous disease. Moreover, in both CD and UC, there occur several other inflammatory skin conditions such as erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa, chronic oral aphthous disease, Sweet syndrome, pyostomatitis vegetans, and bowel-associated dermatosis-arthritis syndrome. Malnutrition syndromes (zinc and vitamin deficiencies) are only rarely observed. On skin and oral/genital mucous membranes various different inflammatory manifestations may be observed during the course of CD or UC. However, most data about a direct pathogenic relationship of the gastrointestinal and dermatologic disorders are quite heterogeneous or even contradictory. Nevertheless, knowledge of these conditions and their possible association with CD and UC could be crucial for early diagnosis and initiation of an appropriate therapy and thus be essential to prevent secondary tissue damage.

  19. Metformin in dermatology: an overview.

    Science.gov (United States)

    Badr, D; Kurban, M; Abbas, O

    2013-11-01

    For several decades, metformin has been used as an oral hypoglycaemic agent, where it is the first line of treatment in overweight and obese type 2 diabetic patients. This is because it decreases the hepatic glucose output and acts as an insulin sensitizer by increasing the glucose utilization by muscles and adipocytes. As a result of the improvement in glycaemic control, serum insulin concentrations decline slightly, thus improving hyperinsulinaemia and its signs. In addition, it has been shown that metformin has platelet anti-aggregating and antioxidant effects. These pharmacological properties have allowed metformin to be effective in non-diabetic situations including cutaneous conditions. This is an evidence-based review on the use of metformin in the treatment of skin disorders such as hirsutism, acne, hidradenitis suppurativa, acanthosis nigricans, psoriasis, skin cancer, among others. In addition, cutaneous side-effects such as leukocytoclastic vasculitis, bullous pemphigoid, psoriasiform drug eruption, lichen planus and acute alopecia have been associated with metformin use and are discussed in the article. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.

  20. Severe Aplastic Anemia (SAA)

    Science.gov (United States)

    ... page Print this page My Cart Severe aplastic anemia (SAA) Severe aplastic anemia (SAA) is a disease ... leukemia (ALL) Other diseases What is severe aplastic anemia (SAA)? SAA is a bone marrow disease. The ...

  1. New Described Dermatological Disorders

    Directory of Open Access Journals (Sweden)

    Müzeyyen Gönül

    2014-01-01

    Full Text Available Many advances in dermatology have been made in recent years. In the present review article, newly described disorders from the last six years are presented in detail. We divided these reports into different sections, including syndromes, autoinflammatory diseases, tumors, and unclassified disease. Syndromes included are “circumferential skin creases Kunze type” and “unusual type of pachyonychia congenita or a new syndrome”; autoinflammatory diseases include “chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE syndrome,” “pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH syndrome,” and “pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH syndrome”; tumors include “acquired reactive digital fibroma,” “onychocytic matricoma and onychocytic carcinoma,” “infundibulocystic nail bed squamous cell carcinoma,” and “acral histiocytic nodules”; unclassified disorders include “saurian papulosis,” “symmetrical acrokeratoderma,” “confetti-like macular atrophy,” and “skin spicules,” “erythema papulosa semicircularis recidivans.”

  2. [Severe rhabdomyolysis secondary to severe hypernatraemic dehydration].

    Science.gov (United States)

    Mastro-Martínez, Ignacio; Montes-Arjona, Ana María; Escudero-Lirio, Margarita; Hernández-García, Bárbara; Fernández-Cantalejo Padial, José

    2015-01-01

    Rhabdomyolysis is a rare paediatric condition. The case is presented of a patient in whom this developed secondary to severe hypernatraemic dehydration following acute diarrhoea. Infant 11 months of age who presented with vomiting, fever, diarrhoea and anuria for 15 hours. Parents reported adequate preparation of artificial formula and oral rehydration solution. He was admitted with malaise, severe dehydration signs and symptoms, cyanosis, and low reactivity. The laboratory tests highlighted severe metabolic acidosis, hypernatraemia and pre-renal kidney failure (Sodium [Na] plasma 181 mEq/L, urine density> 1030). He was managed in Intensive Care Unit with gradual clinical and renal function improvement. On the third day, slight axial hypotonia and elevated cell lysis enzymes (creatine phosphokinase 75,076 IU/L) were observed, interpreted as rhabdomyolysis. He was treated with intravenous rehydration up to 1.5 times the basal requirements, and he showed a good clinical and biochemical response, being discharged 12 days after admission without motor sequelae. Severe hypernatraemia is described as a rare cause of rhabdomyolysis and renal failure. In critically ill patients, it is important to have a high index of suspicion for rhabdomyolysis and performing serial determinations of creatine phosphokinase for early detection and treatment. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Palmer Drought Severity Index

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — PDSI from the Dai dataset. The Palmer Drought Severity Index (PDSI) is devised by Palmer (1965) to represent the severity of dry and wet spells over the U.S. based...

  4. Increased prevalence of metabolic syndrome in patients with acne inversa.

    Directory of Open Access Journals (Sweden)

    Robert Sabat

    Full Text Available BACKGROUND: Acne inversa (AI; also designated as Hidradenitis suppurativa is a common chronic inflammatory skin disease, localized in the axillary, inguinal and perianal skin areas that causes painful, fistulating sinuses with malodorous purulence and scars. Several chronic inflammatory diseases are associated with the metabolic syndrome and its consequences including arteriosclerosis, coronary heart disease, myocardial infraction, and stroke. So far, the association of AI with systemic metabolic alterations is largely unexplored. METHODS AND FINDINGS: A hospital-based case-control study in 80 AI patients and 100 age- and sex-matched control participants was carried out. The prevalence of central obesity (odds ratio 5.88, hypertriglyceridemia (odds ratio 2.24, hypo-HDL-cholesterolemia (odds ratio 4.56, and hyperglycemia (odds ratio 4.09 in AI patients was significantly higher than in controls. Furthermore, the metabolic syndrome, previously defined as the presence of at least three of the five alterations listed above, was more common in those patients compared to controls (40.0% versus 13.0%; odds ratio 4.46, 95% confidence interval 2.02 to 9.96; P<0.001. AI patients with metabolic syndrome also had more pronounced metabolic alterations than controls with metabolic syndrome. Interestingly, there was no correlation between the severity or duration of the disease and the levels of respective parameters or the number of criteria defining the metabolic syndrome. Rather, the metabolic syndrome was observed in a disproportionately high percentage of young AI patients. CONCLUSIONS: This study shows for the first time that AI patients have a high prevalence of the metabolic syndrome and all of its criteria. It further suggests that the inflammation present in AI patients does not have a major impact on the development of metabolic alterations. Instead, evidence is given for a role of metabolic alterations in the development of AI. We recommend

  5. Severe accident phenomena

    International Nuclear Information System (INIS)

    Jokiniemi, J.; Kilpi, K.; Lindholm, I.; Maekynen, J.; Pekkarinen, E.; Sairanen, R.; Silde, A.

    1995-02-01

    Severe accidents are nuclear reactor accidents in which the reactor core is substantially damaged. The report describes severe reactor accident phenomena and their significance for the safety of nuclear power plants. A comprehensive set of phenomena ranging from accident initiation to containment behaviour and containment integrity questions are covered. The report is based on expertise gained in the severe accident assessment projects conducted at the Technical Research Centre of Finland (VTT). (49 refs., 32 figs., 12 tabs.)

  6. De-severing distance

    DEFF Research Database (Denmark)

    Jensen, Hanne Louise; de Neergaard, Maja

    2016-01-01

    De-severing Distance This paper draws on the growing body of mobility literature that shows how mobility can be viewed as meaningful everyday practices (Freudendal –Pedersen 2007, Cresswell 2006) this paper examines how Heidegger’s term de-severing can help us understand the everyday coping with ...

  7. Severe Bleeding: First Aid

    Science.gov (United States)

    ... 12, 2017. Jevon P, et al. Part 5 — First-aid treatment for severe bleeding. Nursing Times. 2008;104:26. Oct. 19, 2017 Original article: http://www.mayoclinic.org/first-aid/first-aid-severe-bleeding/basics/ART-20056661 . Mayo ...

  8. Allergy in severe asthma

    NARCIS (Netherlands)

    Del Giacco, Stefano R.; Bakirtas, A.; Bel, E.; Custovic, A.; Diamant, Z.; Hamelmann, E.; Heffler, E.; Kalayci, O.; Saglani, S.; Sergejeva, S.; Seys, S.; Simpson, A.; Bjermer, Leif

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps

  9. Currency flaw severity. [Banknotes

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, C.; Burnett, M.; Goodman, C.; Sherrod, R.; Schmoyer, R.; Harrison, C.; Uppuluri, R.

    1986-01-01

    A survey of currency flaw severity was carried out using 300 banknotes and 37 judges. Each judge assigned each note to one of five flaw severity categories. These categories correspond to severity grades of 1 to 5 with 1 equivalent to ''always accepted'' and 5 ''never accepted.'' An average flaw severity grade for each note was obtained by taking the mean of the severity grades assigned to that note by the 37 judges. Thus, each note has a single numerical real-number flaw grade between 1 and 5. Mathematical modeling of the currency flaw survey results is continuing with some very promising initial results. Our present model handles common excess ink and missing ink flaw types quite well. We plan to extend the model to ink level, mash, setoff and blanket impression flaw types.

  10. Severe childhood malnutrition

    DEFF Research Database (Denmark)

    Bhutta, Zulfiqar A; Berkley, James A; Bandsma, Robert H J

    2017-01-01

    The main forms of childhood malnutrition occur predominantly in children malnutrition. Here, we use...... the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal...... nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide...

  11. Several complex variables

    International Nuclear Information System (INIS)

    Field, M.J.

    1976-01-01

    Topics discussed include the elementary of holomorphic functions of several complex variables; the Weierstrass preparation theorem; meromorphic functions, holomorphic line bundles and divisors; elliptic operators on compact manifolds; hermitian connections; the Hodge decomposition theorem. ( author)

  12. Severe malaria in Europe

    DEFF Research Database (Denmark)

    Kurth, Florian; Develoux, Michel; Mechain, Matthieu

    2017-01-01

    BACKGROUND: Malaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria. METHODS: The European Network for Tropical Medicine and Travel Health (Trop......Net) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre...... for microscopically confirmed severe Plasmodium falciparum malaria according to the 2006 WHO criteria. RESULTS: From 2006 to 2014 a total of 185 patients with severe malaria treated in 12 European countries were included. Three patients died, resulting in a 28-day survival rate of 98.4%. The majority of infections...

  13. Severe accident management guidelines

    International Nuclear Information System (INIS)

    Uhle, Jennifer

    2014-01-01

    The events at Fukushima Daiichi have highlighted the importance of Severe Accident Management Guidelines (SAMGs). As the world has learned from the catastrophe and countries are considering changes to their nuclear regulatory programs, the content of SAMGs and their regulatory control are being evaluated. This presentation highlights several factors that are being addressed in the United States as rulemaking is underway pertaining to SAMGs. The question of how to be prepared for the unexpected is discussed with specific insights gleaned from Fukushima. (author)

  14. Allergy in severe asthma.

    Science.gov (United States)

    Del Giacco, S R; Bakirtas, A; Bel, E; Custovic, A; Diamant, Z; Hamelmann, E; Heffler, E; Kalayci, Ö; Saglani, S; Sergejeva, S; Seys, S; Simpson, A; Bjermer, L

    2017-02-01

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Severe childhood malnutrition.

    Science.gov (United States)

    Bhutta, Zulfiqar A; Berkley, James A; Bandsma, Robert H J; Kerac, Marko; Trehan, Indi; Briend, André

    2017-09-21

    The main forms of childhood malnutrition occur predominantly in children malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.

  16. Severe accident behavior

    International Nuclear Information System (INIS)

    Denning, R.S.

    1986-01-01

    The purpose of this paper is to provide an overview of severe accident behavior. The term source term is defined and a brief history of the regulatory use of source term is presented. The processes in severe accidents in light water reactors are described with particular emphasis on the relationships between accident thermal-hydraulics and chemistry. Those factors which have the greatest impact on predicted source terms are identified. Design differences between plants that affect source term estimation are also described. The principal unresolved issues are identified that are the focus of ongoing research and debate in the technical community

  17. Severe congenital neutropenia

    DEFF Research Database (Denmark)

    Borregaard, Niels

    2014-01-01

    In this issue of Blood, Tidwell et al1 demonstrate that mutations in the start codon (protein synthesis is initiated at the codon ATG) of neutrophil elastase (ELANE) result in the production of N-terminally truncated elastase, which mislocates to the nucleus and results in severe congenital neutr...... neutropenia (SCN)....

  18. Severe asthma in childhood

    International Nuclear Information System (INIS)

    Ciznar, P.

    2013-01-01

    Patients with severe asthma are clinically, physiologically and biologically a heterogeneous group. About half of children referred for medical examination for severe asthma have true severe, therapy resistant asthma. The rest of referred patients have difficult to treat asthma. Symptoms persist mostly due to drug non-compliance, inappropriate inhalation technique, persistent environmental exposures or co-morbid conditions. Compared with adults have children more frequently atopic form of severe asthma. This is associated with eosinophilia in peripheral blood and sensitization to inhaled allergens. The IgE levels are high. Therapy of co-morbidities and improvement of treatment compliance lead in most cases to full asthma control. Proportion of children will benefit from biologics like anti-IgE monoclonal antibody, administered by subcutaneous injections in 2 to 4 week intervals. By this therapy it is not only possible to suppress symptoms, but also decrease the total steroid dose and the risk of adverse effects associated with its long-term administration. By achieving a full asthma control we lower future risk of exacerbations and probably improve long-term prognosis of disease, frequently persisting for the rest of life. (author)

  19. [Severe depression : psychoanalysis].

    Science.gov (United States)

    Bouvet de la Maisonneuve, O

    2009-12-01

    The indication for psychoanalysis in severe depression is not clear. And yet, demands for this type of intervention are increasing, despite the absence of any form of consensus on the subject. Freud considered depression as a failure of analytical efforts and, based on this observation, revised his theory, in particular to include the notions of narcissism and the death drive. Many analysts have been reluctant to follow his teachings on this last point and provide depressed patients with analytical-type therapies aimed at restoring narcissism. Melanie Klein pushed Freud's ideas about depression even further and brought such therapies back to the heart of analytical practice. Jacques Lacan took the debate to another level by proposing an overhaul of the principles on which analysis has been based. Today, while following certain precautionary rules, true psychoanalyses can be proposed to patients with severe depression, whether of the bipolar, recurring or even neurotic type that can reach this level of severity. Copyright 2009 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  20. Management of severe accidents

    International Nuclear Information System (INIS)

    Jankowski, M.W.

    1987-01-01

    The definition and the multidimensionality aspects of accident management have been reviewed. The suggested elements in the development of a programme for severe accident management have been identified and discussed. The strategies concentrate on the two tiered approaches. Operative management utilizes the plant's equipment and operators capabilities. The recovery managment concevtrates on preserving the containment, or delaying its failure, inhibiting the release, and on strategies once there has been a release. The inspiration for this paper was an excellent overview report on perspectives on managing severe accidents in commercial nuclear power plants and extending plant operating procedures into the severe accident regime; and by the most recent publication of the International Nuclear Safety Advisory Group (INSAG) considering the question of risk reduction and source term reduction through accident prevention, management and mitigation. The latter document concludes that 'active development of accident management measures by plant personnel can lead to very large reductions in source terms and risk', and goes further in considering and formulating the key issue: 'The most fruitful path to follow in reducing risk even further is through the planning of accident management.' (author)

  1. Several real variables

    CERN Document Server

    Kantorovitz, Shmuel

    2016-01-01

    This undergraduate textbook is based on lectures given by the author on the differential and integral calculus of functions of several real variables. The book has a modern approach and includes topics such as: •The p-norms on vector space and their equivalence •The Weierstrass and Stone-Weierstrass approximation theorems •The differential as a linear functional; Jacobians, Hessians, and Taylor's theorem in several variables •The Implicit Function Theorem for a system of equations, proved via Banach’s Fixed Point Theorem •Applications to Ordinary Differential Equations •Line integrals and an introduction to surface integrals This book features numerous examples, detailed proofs, as well as exercises at the end of sections. Many of the exercises have detailed solutions, making the book suitable for self-study. Several Real Variables will be useful for undergraduate students in mathematics who have completed first courses in linear algebra and analysis of one real variable.

  2. Epidemiology of severe trauma.

    Science.gov (United States)

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. Management of severe accidents

    International Nuclear Information System (INIS)

    Jankowski, M.W.

    1988-01-01

    The definition and the multidimensionality aspects of accident management have been reviewed. The suggested elements in the development of a programme for severe accident management have been identified and discussed. The strategies concentrate on the two tiered approaches. Operative management utilizes the plant's equipment and operators capabilities. The recovery management concentrates on preserving the containment, or delaying its failure, inhibiting the release, and on strategies once there has been a release. The inspiration for this paper was an excellent overview report on perspectives on managing severe accidents in commercial nuclear power plants and extending plant operating procedures into the severe accident regime; and by the most recent publication of the International Nuclear Safety Advisory Group (INSAG) considering the question of risk reduction and source term reduction through accident prevention, management and mitigation. The latter document concludes that active development of accident management measures by plant personnel can lead to very large reductions in source terms and risk, and goes further in considering and formulating the key issue: The most fruitful path to follow in reducing risk even further is through the planning of accident management

  4. Severe fuel damage projects

    International Nuclear Information System (INIS)

    Sdouz, G.

    1987-10-01

    After the descriptions of the generation of a Severe Fuel Damage Accident in a LWR the hypothetical course of such an accident is explained. Then the most significant projects are described. At each project the experimental facility, the most important results and the concluding models and codes are discussed. The selection of the projects is concentrated on the German Projekt Nukleare Sicherheit (PNS), tests performed at the Idaho National Engineering Laboratory (INEL) and smaller projects in France and Great Britain. 25 refs., 26 figs. (Author)

  5. One reason, several logics

    Directory of Open Access Journals (Sweden)

    Evandro Agazzi

    2011-06-01

    Full Text Available Humans have used arguments for defending or refuting statements long before the creation of logic as a specialized discipline. This can be interpreted as the fact that an intuitive notion of "logical consequence" or a psychic disposition to articulate reasoning according to this pattern is present in common sense, and logic simply aims at describing and codifying the features of this spontaneous capacity of human reason. It is well known, however, that several arguments easily accepted by common sense are actually "logical fallacies", and this indicates that logic is not just a descriptive, but also a prescriptive or normative enterprise, in which the notion of logical consequence is defined in a precise way and then certain rules are established in order to maintain the discourse in keeping with this notion. Yet in the justification of the correctness and adequacy of these rules commonsense reasoning must necessarily be used, and in such a way its foundational role is recognized. Moreover, it remains also true that several branches and forms of logic have been elaborated precisely in order to reflect the structural features of correct argument used in different fields of human reasoning and yet insufficiently mirrored by the most familiar logical formalisms.

  6. Several crimes solved

    CERN Multimedia

    Relations with the Host States Service

    2007-01-01

    A member of a contractor's personnel suspected of having committed several thefts in and around Building 180 has recently been questioned by the French police. He was immediately tried by the court in Bourg-en-Bresse and sentenced to six months in prison, with a requirement to serve at least three months. His arrest was facilitated, among other things, by a video recording, fast and detailed statements to the CERN Fire Brigade and close collaboration between the members of the personnel concerned, the Reception and Access Control Service and the police. Several laptops and other items of electronic equipment were seized during a search of the culprit's home. A stolen digital camera has yet to be returned to its owner as he has not reported the theft to the CERN Fire Brigade and the police. The person concerned is therefore requested to go to the Gendarmerie in Saint-Genis-Pouilly with the necessary proof of ownership. In addition, the French authorities have informed CERN that the presumed authors of the a...

  7. Severe service sealing solutions

    International Nuclear Information System (INIS)

    Metcalfe, R.; Wensel, R.

    1994-09-01

    Successful sealing usually requires much more than initial leak-tightness. Friction and wear must also be acceptable, requiring a good understanding of tribology at the sealing interface. This paper describes various sealing solutions for severe service conditions. The CAN2A and CAN8 rotary face seals use tungsten carbide against carbon-graphite to achieve low leakage and long lifetime in nuclear main coolant pumps. The smaller CAN6 seal successfully uses tungsten carbide against silicon carbide in reactor water cleanup pump service. Where friction in CANDU fuelling machine rams must be essentially zero, a hydrostatic seal using two silicon carbide faces is the solution. In the NRU reactor moderator pumps, where pressure is much lower, eccentric seals that prevent boiling at the seal faces are giving excellent service. All these rotary face seals rely on supplementary elastomer seals between their parts. An integrated engineering approach to high performance sealing with O-rings is described. This is epitomized in critical Space Shuttle applications, but is increasingly being applied in CANDU plants. It includes gland design, selection and qualification of material, quality assurance, detection of defects and the effects of lubrication, surface finish, squeeze, stretch and volume constraints. In conclusion, for the severe service applications described, customized solutions have more than paid for themselves by higher reliability, lower maintenance requirements and reduced outage time. (author)

  8. Measurement by phase severance

    International Nuclear Information System (INIS)

    Noyes, H.P.

    1987-03-01

    It is claimed that the measurement process is more accurately described by ''quasi-local phase severance'' than by ''wave function collapse''. The approach starts from the observation that the usual route to quantum mechanics starting from the Hamilton-Jacobi equations throws away half the degrees of freedom, namely, the classical initial state parameters. To overcome this difficulty, the full set of Hamilton-Jacobi equations is interpreted as operator equations acting on a state vector. The measurement theory presented is based on the conventional S-matrix boundary condition of N/sub A/ free particles in the distant past and N/sub B/ free particles in the distant future and taking the usual free particle wave functions, multiplied by phase factors

  9. CANDU severe accident analysis

    International Nuclear Information System (INIS)

    Negut, Gheorghe; Catana, Alexandru; Prisecaru, Ilie; Dupleac, Daniel

    2007-01-01

    Romania is a EU member since January first 2007. This country faces now new challenges which imply also the nuclear power reactors now in operation. Romania operates since 1996 a CANDU nuclear power reactor and soon will start up a second unit. In EU PWR reactors are mostly operated, so that the Romania's reactors have to meet EU standards. Safety analysis guidelines require to model severe accidents for reactors of this type. Starting from previous studies a thermal-hydraulic model for a degraded CANDU core was developed. The initiating event is assumed to be a LOCA with simultaneous loss of moderator and coolant and the failure of emergency core cooling system (ECCS). This type of accident is likely to modify the reactor geometry and will lead to a severe accident development. When the coolant temperatures inside a pressure tube reaches 1000 deg. C, a contact between pressure tube and calandria tube occurs and the decay heat is transferred to the moderator. Due to the lack of cooling, the moderator eventually begins to boil and is expelled, through the calandria vessel relief ducts, into the containment. Therefore the calandria tubes (fuel channels) uncover, then disintegrate and fall down to the calandria vessel bottom. All the quantity of calandria moderator is vaporized and expelled, the debris will heat up and eventually boil. The heat accumulated in the molten debris will be transferred through the calandria vessel wall to the shield water tank surrounding the calandria vessel. The thermal hydraulics phenomena described above are modeled, analyzed and compared with the existing data. (authors)

  10. Treatment of severe tinnitus.

    Science.gov (United States)

    Laurikainen, E; Johansson, R; Akaan-Penttilä, E; Haapaniemi, J

    2000-01-01

    In 1995-96 we selected a group of 26 patients who were suffering from severe invalidating idiopathic tinnitus (IT) in order to evaluate the efficacy of rehabilitation and some alternative therapies. All patients were assessed thoroughly by means of audiology and radiology regarding any objective cause for the symptom. In order to help patients control their symptom by increasing knowledge and adding supportive elements, they were given basic education (presentations of the anatomy and physiology of the ear and hearing system, psychological and social aspects of IT, guided and non-guided group discussions, relaxation therapy, physiotherapy, music therapy) for 4 months, comprising one 2-h session bi-weekly. This type of group therapy was found to be extremely helpful, although no objective evaluation revealed effects on IT sensation (VAS) or psychometric measures (SLC-90). In a second limb of the study, the same patients attended a 6-day intensive course in a spa. The purpose was to evaluate the possible usefulness of the widely recommended alternative therapies for IT. All patients had an opportunity to sample the treatments. Six months later only a few had tried any of these treatments, but all reported that the lessons were the most helpful in association with supportive group discussions. The results indicated that none of these therapies can be recommended, based on rational medical practise.

  11. Morbidity of severe obesity.

    Science.gov (United States)

    Kral, J G

    2001-10-01

    Although obesity is an easy diagnosis to make, its etiologies, pathophysiology, and symptomatology are extraordinarily complex. Progress in surgical technique and anesthesiological management has substantially improved the safety of performing operations on the severely obese in the last 20 years. These improvements have occurred more or less empirically, without a full understanding of etiology or pathophysiology, although this has advanced concomitantly with improvements in practice. This review has attempted to provide a framework to facilitate progress in the neglected areas of patient selection and choice of operation, in an effort to improve long-term outcome. Despite the disparate etiologies of obesity and its diverse comorbidities and complications, there are unifying interdependent pathogenetic mechanisms of great relevance to the practice of antiobesity surgery. The rate of eating, whether driven by HPA dysfunction, ambient stress, or related hereditary susceptibility factors including the increased energy demands of an expanded body fat mass, participates in a cycle that results in disordered satiety (see Fig. 3). This leads to substrate overload, causing extensive metabolic abnormalities such as atherogenesis, insulin resistance, thrombogenesis, and carcinogenesis. This interpretation of the pathophysiology of obesity ironically accords with the original meaning of the word obesity: "to overeat." The ultimate solution to the problem of obesity--preventing it--will not be forthcoming until the food industry is forced to lower production and change its marketing strategies, as the liquor and tobacco industries in the United States were compelled to do. This cannot occur until the large and fast-growing populations of industrialized nations become educated in the personal implications of the energy principle. Regardless of whether school curricula are modified to prioritize health education, the larger problems of cultural and economic change remain for

  12. Severity parameters for steam cracking

    NARCIS (Netherlands)

    Golombok, M.; Bijl, J.L.M.; Kornegoor, M.

    2001-01-01

    There are several ways to measure severity in steam cracking which are all a function of residence time, temperature, and pressure. Many measures of severity are not practicable for experimental purposes. Our experimental study shows that methane make is the best measure of severity because it is an

  13. Smoking and skin disease

    DEFF Research Database (Denmark)

    Thomsen, S F; Sørensen, L T

    2010-01-01

    Tobacco smoking is a serious and preventable health hazard that can cause or exacerbate a number of diseases and shorten life expectancy, but the role of smoking as an etiologic factor in the development of skin disease is largely unknown. Although epidemiological evidence is sparse, findings...... suggest that tobacco smoking is a contributing factor in systemic lupus erythematosus, psoriasis, palmoplantar pustulosis, cutaneous squamous cell carcinoma, hidradenitis suppurativa, and genital warts. In contrast, smoking may confer some protective effects and mitigate other skin diseases, notably...... pemphigus vulgaris, pyoderma gangrenosum, aphthous ulcers, and Behçet's disease. Various degenerative dermatologic conditions are also impacted by smoking, such as skin wrinkling and dysregulated wound healing, which can result in post-surgical complications and delayed or even arrested healing of chronic...

  14. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek

    2017-01-01

    Chronic inflammatory diseases (CIDs), including Crohn's disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro......-inflammatory molecule tumour necrosis factor-α (TNF) (i.e., TNF inhibitors). Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1) molecular signatures of prognostic value...... to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2) lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including...

  15. Impact of red and processed meat and fibre intake on treatment outcomes among patients with chronic inflammatory diseases

    DEFF Research Database (Denmark)

    Christensen, Robin; Heitmann, Berit L; Andersen, Karina Winther

    2018-01-01

    INTRODUCTION: Chronic inflammatory diseases (CIDs) are frequently treated with biological medications, specifically tumour necrosis factor inhibitors (TNFi)). These medications inhibit the pro-inflammatory molecule TNF alpha, which has been strongly implicated in the aetiology of these diseases. Up...... with inflammatory bowel disease (Crohn's disease and ulcerative colitis), rheumatic disorders (rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis), inflammatory skin diseases (psoriasis, hidradenitis suppurativa) and non-infectious uveitis. At baseline (pretreatment), patient characteristics...... will be assessed using patient-reported outcome measures, clinical assessments of disease activity, quality of life and lifestyle, in addition to registry data on comorbidity and concomitant medication(s). In accordance with current Danish standards, follow-up will be conducted 14-16 weeks after treatment...

  16. Metformin - For the dermatologist

    Science.gov (United States)

    Bubna, Aditya Kumar

    2016-01-01

    Metformin though primarily an antidiabetic drug, has found to play an important role in a number of cutaneous disorders. Because of its role in improving hyperinsulinemia, it has proven beneficial in hormonal acne, hidradenitis suppurativa (HS) and acanthosis nigricans. Its antiandrogenic properties further serve as an add-on to the conventional management of hirsutism associated with polycystic ovarian syndrome. Very recently, systemic usage of metformin for psoriasis and cutaneous malignancies has shown promising results. Interestingly, metformin has also been topically used in hyperpigmentary disorders with pertinent levels of improvement and happens to be the most recent addition to the list of dermatologic indications. Though an oral hypoglycemic agent to begin with, metformin today has proven to be a boon for dermatologists. PMID:26997714

  17. Severe Weather Data Inventory (SWDI)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Severe Weather Data Inventory (SWDI) is an integrated database of severe weather records for the United States. SWDI enables a user to search through a variety...

  18. Severe rosacea: A case report

    Directory of Open Access Journals (Sweden)

    Ebrahim Shirzadeh

    2017-01-01

    Conclusion: Rosacea can be extremely severe and disfiguring, and it can be misdiagnosed as the pathognomonic butterfly rash of LE. Demodex carriage in rosacea is consistent and may play a significant role in the severe forms.

  19. Chronic obstructive pulmonary disease severity is associated with severe pneumonia

    Directory of Open Access Journals (Sweden)

    Jung Seop Eom

    2015-01-01

    Full Text Available CONTEXT: Chronic obstructive pulmonary disease (COPD is a heterogeneous disorder, and various aspects of COPD may be associated with the severity of pneumonia in such patients. AIMS: We examined the risk factors associated with severe pneumonia in a COPD population. MATERIALS AND METHODS: We performed a retrospective observational study using a prospectively collected database of pneumonia patients who were admitted to our hospital through emergency department between 2008 and 2012. Patients with hospital-acquired pneumonia and those with an immunocompromised status were excluded. RESULTS: Of 148 pneumonia patients with COPD for whom chest computed tomography (CT scans were available, 106 (71.6% and 42 (28.4% were classified as non-severe and severe pneumonia, respectively. Multivariate logistic regression analysis revealed that the severity of airflow limitation [odds ratio (OR, 2.751; 95% confidence interval (CI, 1.074-7.050; P = 0.035] and the presence of emphysema on a chest CT scan (OR, 3.366; 95% CI, 1.104-10.265; P = 0.033 were independently associated with severe pneumonia in patients with COPD. CONCLUSIONS: The severity of COPD including the airflow limitation grade and the presence of pulmonary emphysema were independently associated with the development of severe pneumonia.

  20. Current concepts of severe asthma

    Science.gov (United States)

    Raundhal, Mahesh; Oriss, Timothy B.; Ray, Prabir; Wenzel, Sally E.

    2016-01-01

    The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care. Ongoing studies using advanced molecular and immunological tools along with improved clinical classification show that severe asthma does not identify a specific patient phenotype, but rather includes patients with constant medical needs, whose pathobiologic and clinical characteristics vary widely. Accordingly, in recent clinical trials, therapies guided by specific patient characteristics have had better outcomes than previous therapies directed to any subject with a diagnosis of severe asthma. However, there are still significant gaps in our understanding of the full scope of this disease that hinder the development of effective treatments for all severe asthmatics. In this Review, we discuss our current state of knowledge regarding severe asthma, highlighting different molecular and immunological pathways that can be targeted for future therapeutic development. PMID:27367183

  1. Accident management for severe accidents

    International Nuclear Information System (INIS)

    Bari, R.A.; Pratt, W.T.; Lehner, J.; Leonard, M.; Disalvo, R.; Sheron, B.

    1988-01-01

    The management of severe accidents in light water reactors is receiving much attention in several countries. The reduction of risk by measures and/or actions that would affect the behavior of a severe accident is discussed. The research program that is being conducted by the US Nuclear Regulatory Commission focuses on both in-vessel accident management and containment and release accident management. The key issues and approaches taken in this program are summarized. 6 refs

  2. Statistics of severe tornadoes and severe tornado outbreaks

    Directory of Open Access Journals (Sweden)

    B. D. Malamud

    2012-09-01

    Full Text Available The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider severe tornadoes, which we define as L≥10 km, in the continental USA (USA Storm Prediction Center Severe Weather Database. We find that for the period 1982–2011, for individual severe tornadoes (L≥10 km: (i There is a strong linear scaling between the number of severe tornadoes in a year and their total path length in that year. (ii The cumulative frequency path length data suggests that, not taking into account any changing trends over time, we would expect in a given year (on average one severe tornado with a path length L≥115 km and in a decade (on average one severe tornado with a path length L≥215 km. (iii The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20<L<200 km, is well approximated by an inverse power-law relationship with exponent near 3. We then take the total path length of severe tornadoes in a convective day (12:00–12:00 UTC, LD, as a measure of the strength of a 24-h USA tornado outbreak. We find that: (i For 1982–2011, the number of severe tornadoes in a USA convective day outbreak has a strong power-law relationship (exponent 0.80 on the convective day total path length, LD. (ii For 1952–2011, the cumulative frequency path length data for severe tornado outbreaks suggests that we would expect in a given year (on average one daily severe tornado outbreak with total path length LD≥480 km and in a decade (on average one daily severe tornado outbreak with a total path length LD≥1200 km. (iii For 1982–2011, the noncumulative frequency-length statistics of tornado

  3. Severe congenital neutropenia (Kostmann Syndrome)

    African Journals Online (AJOL)

    Severe congenital neutropenia (SCN), Kostmann syndrome is a heterogenous disorder of myelopoiesis characterized by severe chronic ... erogenous hematological disorders, characterized by extremely low circu- lating neutrophils and ..... tic activation of STAT5 and stimulate. G-CSF-induced cell proliferation.26, 27.

  4. Functional Limitations in Severe Haemophilia

    NARCIS (Netherlands)

    Genderen, F.R. van

    2006-01-01

    This thesis aims to describe the Disablement Process (DP) in Dutch adult patients with severe haemophilia, with specific focus on the domain of “Functional Limitations”. Four main questions underlie this thesis: How can Functional Limitations in severe haemophilia be investigated? Can the

  5. Severe anemia in Malawian children

    NARCIS (Netherlands)

    Calis, Job C. J.; Phiri, Kamija S.; Faragher, E. Brian; Brabin, Bernard J.; Bates, Imelda; Cuevas, Luis E.; de Haan, Rob J.; Phiri, Ajib I.; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul J. M.; van Lieshout, Lisette; Beld, Marcel G. H. M.; teo, Yik Y.; Rockett, Kirk A.; Richardson, Anna; Kwiatkowski, Dominic P.; Molyneux, Malcolm E.; Boele van Hensbroek, Michael

    2008-01-01

    Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. Methods We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and

  6. Severe anemia in Malawian children

    NARCIS (Netherlands)

    Calis, Job Cj; Phiri, Kamija S.; Faragher, E. Brian; Brabin, Bernard J.; Bates, Imelda; Cuevas, Luis E.; de Haan, Rob J.; Phiri, Ajib I.; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul Jm; van Lieshout, Lisette; Beld, Marcel Ghm; teo, Yik Y.; Rockett, Kirk A.; Richardson, Anna; Kwiatkowski, Dominic P.; Molyneux, Malcolm E.; van Hensbroek, Michaël Boele

    2016-01-01

    Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool

  7. Severe Anemia in Malawian Children

    NARCIS (Netherlands)

    Calis, J.C.J.; Kamija, S.P.; Faragher, E.B.; Brabin, B.J.; Bates, I.; Cuevas, L.E.; Haan, de R.J.; Phiri, A.I.; Malange, P.; Khoka, M.; Hulshof, P.J.M.; Lieshout, L.; Beld, M.G.H.M.; Teo, Y.Y.; Rockett, K.A.; Richardson, A.; Kwiatkowski, D.P.; Molyneux, M.E.; Hensbroek, van M.B.

    2008-01-01

    Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. Methods We conducted a case¿control study of 381 preschool children with severe anemia (hemoglobin concentration,

  8. Severe accident management guidelines tool

    International Nuclear Information System (INIS)

    Gutierrez Varela, Javier; Tanarro Onrubia, Augustin; Martinez Fanegas, Rafael

    2014-01-01

    Severe Accident is addressed by means of a great number of documents such as guidelines, calculation aids and diagnostic trees. The response methodology often requires the use of several documents at the same time while Technical Support Centre members need to assess the appropriate set of equipment within the adequate mitigation strategies. In order to facilitate the response, TECNATOM has developed SAMG TOOL, initially named GGAS TOOL, which is an easy to use computer program that clearly improves and accelerates the severe accident management. The software is designed with powerful features that allow the users to focus on the decision-making process. Consequently, SAMG TOOL significantly improves the severe accident training, ensuring a better response under a real situation. The software is already installed in several Spanish Nuclear Power Plants and trainees claim that the methodology can be followed easier with it, especially because guidelines, calculation aids, equipment information and strategies availability can be accessed immediately (authors)

  9. Parthenium dermatitis severity score to assess clinical severity of disease

    Directory of Open Access Journals (Sweden)

    Kaushal K Verma

    2017-01-01

    Full Text Available Background: Parthenium dermatitis is the most common type of airborne contact dermatitis in India. It is a chronic disease of a remitting and relapsing course with significant morbidity and distress, but there is no scoring system to assess its severity. Aim: To design a scoring system for the assessment of clinical severity of disease in Parthenium dermatitis and to use this scoring system in various studies to determine its sensitivity, specificity, and reproducibility. Methods and Results: In our first few studies on Parthenium dermatitis, we designed and used a basic clinical severity scoring system based on itching, morphology of the lesions, and areas involved. However, in subsequent studies, we modified it to the present scoring system as Parthenium dermatitis severity score (PDSS. Our studies showed the high sensitivity of PDSS in characterization of the disease severity at the given point of time, as well as to determine the efficacy of a prescribed treatment modality which was reliable and reproducible. Conclusion: Thus, PDSS may be used by clinicians for appropriate scoring of the clinical severity of Parthenium dermatitis and in monitoring the disease response to therapy.

  10. The impact of pediatric skin disease on self-esteem.

    Science.gov (United States)

    Vivar, K L; Kruse, L

    2018-03-01

    Pediatric skin disorders can affect children's self-esteem, relationships with caregivers and peers, and performance in school and activities. This review describes common pediatric congenital and acquired dermatologic disorders and the impact that these disorders can have on children's self-esteem. A review of current, English-language literature was conducted with use of the PubMed database. Search terms included atopic dermatitis, acne, infantile hemangiomas, port wine stains, congenital melanocytic nevi, hidradenitis suppurativa, and self-esteem. During infancy and toddlerhood, skin disorders such as infantile hemangiomas primarily affect the attachment between child and caregiver. School-aged children with port wine stains and atopic dermatitis report increased bullying, teasing, and social isolation. Acne and hidradenitis typically affect older children and teens and these conditions are associated with increased risks of depression and suicidal ideation. Effective management of these conditions has been shown to increase patients' self-esteem. Pediatric dermatologic disorders impact self-esteem throughout childhood. In addition to the surgical and medical management of these disorders, clinicians can also take an active role in the assessment and improvement of the psychosocial impact of these skin disorders.

  11. Severe acute respiratory syndrome (SARS)

    Science.gov (United States)

    SARS; Respiratory failure - SARS ... Complications may include: Respiratory failure Liver failure Heart failure ... 366. McIntosh K, Perlman S. Coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). ...

  12. Severe heparin osteoporosis in pregnancy.

    OpenAIRE

    Griffiths, H. T.; Liu, D. T.

    1984-01-01

    A case of severe osteoporosis following administration of low dose subcutaneous heparin in pregnancy is reported. Possible reasons for the condition are suggested which caution against the indiscriminate use of subcutaneous heparin in pregnancy.

  13. Severe accidents in nuclear reactors

    International Nuclear Information System (INIS)

    Ohai, Dumitru; Dumitrescu, Iulia; Tunaru, Mariana

    2004-01-01

    The likelihood of accidents leading to core meltdown in nuclear reactors is low. The consequences of such an event are but so severe that developing and implementing of adequate measures for preventing or diminishing the consequences of such events are of paramount importance. The analysis of major accidents requires sophisticated computation codes but necessary are also relevant experiments for checking the accuracy of the predictions and capability of these codes. In this paper an overview of the severe accidents worldwide with definitions, computation codes and relating experiments is presented. The experimental research activity of severe accidents was conducted in INR Pitesti since 2003, when the Institute jointed the SARNET Excellence Network. The INR activity within SARNET consists in studying scenarios of severe accidents by means of ASTEC and RELAP/SCDAP codes and conducting bench-scale experiments

  14. Severe ASR damaged concrete bridges

    DEFF Research Database (Denmark)

    Antonio Barbosa, Ricardo; Gustenhoff Hansen, Søren

    2015-01-01

    Technical University of Denmark (DTU) and University of Southern Denmark (SDU) have conducted several full-scale experiments with severe ASR deteriorated bridges. This paper presents few and preliminary results from both the shear tests and the measuring of the material properties. The shear test...... show that the shear capacity is almost unaffected of ASR despite significant reduction in compressive concrete strength. Furthermore, measurements show a significant tensile reinforcement strain developed due to ASR expansion....

  15. Severe forms of food allergy.

    Science.gov (United States)

    Sarinho, Emanuel; Lins, Maria das Graças Moura

    To guide the diagnostic and therapeutic management of severe forms of food allergy. Search in the Medline database using the terms "severe food allergy," "anaphylaxis and food allergy," "generalized urticaria and food allergy," and "food protein-induced enterocolitis syndrome" in the last ten years, searching in the title, abstract, or keyword fields. Food allergy can be serious and life-threatening. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  16. Cernavoda CANDU severe accident evaluation

    International Nuclear Information System (INIS)

    Negut, G.; Marin, A.

    1997-01-01

    The papers present the activities dedicated to Romania Cernavoda Nuclear Power Plant first CANDU Unit severe accident evaluation. This activity is part of more general PSA assessment activities. CANDU specific safety features are calandria moderator and calandria vault water capabilities to remove the residual heat in the case of severe accidents, when the conventional heat sinks are no more available. Severe accidents evaluation, that is a deterministic thermal hydraulic analysis, assesses the accidents progression and gives the milestones when important events take place. This kind of assessment is important to evaluate to recovery time for the reactor operators that can lead to the accident mitigation. The Cernavoda CANDU unit is modeled for the of all heat sinks accident and results compared with the AECL CANDU 600 assessment. (orig.)

  17. Severe anemia in Malawian children.

    Science.gov (United States)

    Calis, Job Cj; Phiri, Kamija S; Faragher, E Brian; Brabin, Bernard J; Bates, Imelda; Cuevas, Luis E; de Haan, Rob J; Phiri, Ajib I; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul Jm; van Lieshout, Lisette; Beld, Marcel Ghm; Teo, Yik Y; Rockett, Kirk A; Richardson, Anna; Kwiatkowski, Dominic P; Molyneux, Malcolm E; van Hensbroek, Michaël Boele

    2016-09-01

    Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool children without severe anemia in urban and rural settings in Malawi. Causal factors previously associated with severe anemia were studied. The data were examined by multivariate analysis and structural equation modeling. Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI], 2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3), hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI, 1.0 to 3.8), the G6PD -202/-376 genetic disorder (adjusted odds ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B 12 deficiency (adjusted odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe anemia. Folate deficiency, sickle cell disease, and laboratory signs of an abnormal inflammatory response were uncommon. Iron deficiency was not prevalent in case patients (adjusted odds ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with bacteremia. Malaria was associated with severe anemia in the urban site (with seasonal transmission) but not in the rural site (where malaria was holoendemic). Seventy-six percent of hookworm infections were found in children under 2 years of age. There are multiple causes of severe anemia in Malawian preschool children, but folate and iron deficiencies are not prominent among them. Even in the presence of malaria parasites, additional or alternative causes of severe anemia should be considered.

  18. The treatment of severe malaria.

    Science.gov (United States)

    Dondorp, Arjen M; Day, Nick P J

    2007-07-01

    In the SEAQUAMAT trial, parenteral artesunate was shown to be associated with a considerably lower mortality than quinine, and is now the recommended treatment for severe malaria in low-transmission areas and in the second and third trimesters of pregnancy. A trial is underway to establish its role in African children. The development of artesunate suppositories may provide the means to treat patients with severe disease in remote rural settings, potentially buying the time needed to reach a health care facility. The increasing availability of basic intensive care facilities in developing countries also has the potential to further reduce mortality.

  19. Surgical Management of Severe Epistaxis.

    Science.gov (United States)

    Lin, Giant; Bleier, Benjamin

    2016-06-01

    Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. Critical maneuvers to improve endoscopic visualization during surgery include head-of-bed elevation, application of topical vasoconstrictors, and local injection of vasonstrictors. Controlled, hypotensive anesthesia may also decrease intraoperative blood loss and improve visualization during surgery. Intractable posterior epistaxis can be controlled with high rates of success with endoscopic sphenopalatine artery ligation. Although less common, intractable anterior epistaxis may be controlled by anterior ethmoid artery ligation once this artery is identified as the primary source. Less common sources of severe epistaxis are also discussed in this article. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Restoration of severely weathered wood

    Science.gov (United States)

    R. Sam. Williams; Mark. Knaebe

    2000-01-01

    Severely weathered window units were used to test various restoration methods and pretreatments. Sanded and unsanded units were pretreated with a consolidant or water repellent preservative, finished with an oil- or latex-based paint system, and exposed outdoors near Madison, WI, for five years. Pretreatments were applied to both window sashes (stiles and rails) and...

  1. Newborn with severe epidermolysis bullosa

    DEFF Research Database (Denmark)

    Boesen, Martin Lehmann; Bygum, Anette; Hertz, Jens Michael

    2016-01-01

    of EB depends on the subtype, and therefore maximum treatment is necessary until the final diagnosis is known. In this case, it took 2 weeks before a final diagnosis was reached. In the meantime, we had several ethical discussions on the treatment level. The most important issues were management of pain...

  2. Severe forms of food allergy

    Directory of Open Access Journals (Sweden)

    Emanuel Sarinho

    2017-11-01

    Conclusion: Severe food allergy may occur in the form of anaphylaxis and food‐protein‐induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.

  3. Containment severe accident thermohydraulic phenomena

    International Nuclear Information System (INIS)

    Frid, W.

    1991-08-01

    This report describes and discusses the containment accident progression and the important severe accident containment thermohydraulic phenomena. The overall objective of the report is to provide a rather detailed presentation of the present status of phenomenological knowledge, including an account of relevant experimental investigations and to discuss, to some extent, the modelling approach used in the MAAP 3.0 computer code. The MAAP code has been used in Sweden as the main tool in the analysis of severe accidents. The dependence of the containment accident progression and containment phenomena on the initial conditions, which in turn are heavily dependent on the in-vessel accident progression and phenomena as well as associated uncertainties, is emphasized. The report is in three parts dealing with: * Swedish reactor containments, the severe accident mitigation programme in Sweden and containment accident progression in Swedish PWRs and BWRs as predicted by the MAAP 3.0 code. * Key non-energetic ex-vessel phenomena (melt fragmentation in water, melt quenching and coolability, core-concrete interaction and high temperature in containment). * Early containment threats due to energetic events (hydrogen combustion, high pressure melt ejection and direct containment heating, and ex-vessel steam explosions). The report concludes that our understanding of the containment severe accident progression and phenomena has improved very significantly over the parts ten years and, thereby, our ability to assess containment threats, to quantify uncertainties, and to interpret the results of experiments and computer code calculations have also increased. (au)

  4. Dyslexia and Severe Reading Disability.

    Science.gov (United States)

    Ngandu, Kathleen M.

    This handbook contains advice for the teacher in diagnosing dyslexia and developing an individualized program for overcoming severe reading problems. Observable characteristics of dyslexia are listed as an aid to the teacher's diagnosis, but it is emphasized that cooperation between the teacher and a reading specialist is of great importance in…

  5. Stuttering Severity and Educational Attainment

    Science.gov (United States)

    O'Brian, Sue; Jones, Mark; Packman, Ann; Menzies, Ross; Onslow, Mark

    2011-01-01

    Purpose: This study investigated the relationship between self-reported stuttering severity ratings and educational attainment. Method: Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering…

  6. Polyradiculopathy secondary to severe hypertriglyceridemia.

    Science.gov (United States)

    Nesbitt, Cassie; Wong, Daniel; Batchelor, Peter

    2015-05-08

    A 74-year-old man presented with a subacute severe thoracic polyradiculopathy affecting the T4-T8 dermatomes bilaterally. Extensive investigation demonstrated markedly raised triglyceride levels of 44 mmol/L (<1.7). The patient's unique presentation is discussed alongside a review of triglyceride-induced neurotoxicity and therapeutic management. 2015 BMJ Publishing Group Ltd.

  7. Bioimpedance in Severely Malnourished Children

    DEFF Research Database (Denmark)

    Girma Nigatu, Tsinuel

    Worldwide severe acute malnutrition (SAM) affects millions of children and considerably contributes to under-five mortality, mainly in low-income settings. Among children with SAM, deaths occur largely in those with oedema and during early phase of treatment often aggravated by infection. Treatment...

  8. Severe combined immune deficiency syndrome

    International Nuclear Information System (INIS)

    Saleem, A.F.; Khawaja, R.D.A.; Shaikh, A.S.; Ali, S.A.; Zaidi, A.K.M.

    2013-01-01

    To determine the clinico-demographic features and laboratory parameters of children with severe combined immunodeficiency (SCID). Study Design: Case series. Place and Duration of Study: Department of Paediatrics and Child Health, the Aga Khan University, Karachi, from July 2006 to July 2011. Methodology: Thirteen infants who were discharged with a diagnosis of SCID were inducted in the study. Their clinicodemographic features and laboratory parameters were determined. Descriptive statistics has been used for computing frequency and percentage. Results: The median age at diagnosis was five months; 5 infants presented within 3 months of life. Three-fourth (77%) were males. Most of the infants were severely malnourished (85%) at the time of presentation. More than two-thirds (69%) were products of consanguineous marriages. All subjects had severe lymphopenia (absolute lymphocyte count (ALC) ranging between 170 – 2280) and low T and B lymphocyte counts. Conclusion: SCID should be considered in infants presenting with severe and recurrent infections. Low ALC (< 2500/mm3), is a reliable diagnostic feature of SCID. These infants should be promptly referred to a facility where stem cell transplant can be done. (author)

  9. Predicting severity of paranoid schizophrenia

    OpenAIRE

    Kolesnichenko Elena Vladimirovna

    2015-01-01

    Clinical symptoms, course and outcomes of paranoid schizophrenia are polymorphic. 206 cases of paranoid schizophrenia were investigated. Clinical predictors were collected from hospital records and interviews. Quantitative assessment of the severity of schizophrenia as special indexes was used. Schizoid, epileptoid, psychasthenic and conformal accentuation of personality in the premorbid, early onset of psychosis, paranoid and hallucinatory-paranoid variants of onset predicted more expressed ...

  10. Severe Malnutrition: A Global Approach.

    Science.gov (United States)

    Pelletier, Jean-Gerard

    1993-01-01

    This report examines the immediate and underlying causes of malnutrition in the developing world. The first section discusses the effects of malnutrition on childhood development and examines the efficacy of nutritional rehabilitation. The second section addresses the medical effects of severe malnutrition, including the onset of ponderostatural…

  11. Severe forms of food allergy

    Directory of Open Access Journals (Sweden)

    Emanuel Sarinho

    Full Text Available Abstract Objectives: To guide the diagnostic and therapeutic management of severe forms of food allergy. Data sources: Search in the Medline database using the terms “severe food allergy,” “anaphylaxis and food allergy,” “generalized urticaria and food allergy,” and “food protein-induced enterocolitis syndrome” in the last ten years, searching in the title, abstract, or keyword fields. Summary of data: Food allergy can be serious and life-threatening. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Conclusion: Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.

  12. Large errors and severe conditions

    CERN Document Server

    Smith, D L; Van Wormer, L A

    2002-01-01

    Physical parameters that can assume real-number values over a continuous range are generally represented by inherently positive random variables. However, if the uncertainties in these parameters are significant (large errors), conventional means of representing and manipulating the associated variables can lead to erroneous results. Instead, all analyses involving them must be conducted in a probabilistic framework. Several issues must be considered: First, non-linear functional relations between primary and derived variables may lead to significant 'error amplification' (severe conditions). Second, the commonly used normal (Gaussian) probability distribution must be replaced by a more appropriate function that avoids the occurrence of negative sampling results. Third, both primary random variables and those derived through well-defined functions must be dealt with entirely in terms of their probability distributions. Parameter 'values' and 'errors' should be interpreted as specific moments of these probabil...

  13. Severe acute malnutrition and infection

    Science.gov (United States)

    Jones, Kelsey D J; Berkley, James A

    2014-01-01

    Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice. PMID:25475887

  14. A CANDU Severe Accident Analysis

    International Nuclear Information System (INIS)

    Negut, Gheorghe; Catana, Alexandru; Prisecaru, Ilie

    2006-01-01

    As interest in severe accident studies has increased in the last years, we have developed a set of simple models to analyze severe accidents for CANDU reactors that should be integrated in the EU codes. The CANDU600 reactor uses natural uranium fuel and heavy water (D2O) as both moderator and coolant, with the moderator and coolant in separate systems. We chose to analyze accident development for a LOCA with simultaneous loss of moderator cooling and the loss of emergency core cooling system (ECCS). This type of accident is likely to modify the reactor geometry and will lead to a severe accident development. When the coolant temperatures inside a pressure tube reaches 10000 deg C, a contact between pressure tube and calandria tube occurs and the residual heat is transferred to the moderator. Due to the lack of cooling, the moderator eventually begins to boil and is expelled, through the calandria vessel relief ducts, into the containment. Therefore the calandria tubes (fuel channels) will be uncovered, then will disintegrate and fall down to the calandria vessel bottom. After all the quantity of moderator is vaporized and expelled, the debris will heat up and eventually boil. The heat accumulated in the molten debris will be transferred through the calandria vessel wall to the shield tank water, which normally surrounds the calandria vessel. The phenomena described above are modelled, analyzed and compared with the existing data. The results are encouraging. (authors)

  15. Gender differences in addiction severity.

    Science.gov (United States)

    Díaz-Mesa, Eva M; García-Portilla, Paz; Fernández-Artamendi, Sergio; Sáiz, Pilar A; Bobes Bascarán, Teresa; Casares, María José; Fonseca, Eduardo; Al-Halabí, Susana; Bobes, Julio

    2016-06-14

    Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.

  16. CANDU safety under severe accidents

    International Nuclear Information System (INIS)

    Snell, V.G.; Howieson, J.Q.; Alikhan, S.; Frescura, G.M.; King, F.; Rogers, J.T.; Tamm, H.

    1996-01-01

    The characteristics of the CANDU reactor relevant to severe accidents are set first by the inherent properties of the design, and second by the Canadian safety/licensing approach. The pressure-tube concept allows the separate, low-pressure, heavy-water moderator to act as a backup heat sink even if there is no water in the fuel channels. Should this also fail, the calandria shell itself can contain the debris, with heat being transferred to the water-filled shield tank around the core. Should the severe core damage sequence progress further, the shield tank and the concrete reactor vault significantly delay the challenge to containment. Furthermore, should core melt lead to containment overpressure, the containment behaviour is such that leaks through the concrete containment wall reduce the possibility of catastrophic structural failure. The Canadian licensing philosophy requires that each accident, together with failure of each safety system in turn, be assessed (and specified dose limits met) as part of the design and licensing basis. In response, designers have provided CANDUs with two independent dedicated shutdown systems, and the likelihood of Anticipated Transients Without Scram is negligible. Probabilistic safety assessment studies have been performed on operating CANDU plants, and on the 4 x 880 MW(e) Darlington station now under construction; furthermore a scoping risk assessment has been done for a CANDU 600 plant. They indicate that the summed severe core damage frequency is of the order of 5 x 10 -6 /year. 95 refs, 3 tabs

  17. CANDU safety under severe accidents

    Energy Technology Data Exchange (ETDEWEB)

    Snell, V G; Howieson, J Q [Atomic Energy of Canada Ltd. (Canada); Alikhan, S [New Brunswick Electric Power Commission (Canada); Frescura, G M; King, F [Ontario Hydro (Canada); Rogers, J T [Carleton Univ., Ottawa, ON (Canada); Tamm, H [Atomic Energy of Canada Ltd. (Canada). Whiteshell Research Lab.

    1996-12-01

    The characteristics of the CANDU reactor relevant to severe accidents are set first by the inherent properties of the design, and second by the Canadian safety/licensing approach. The pressure-tube concept allows the separate, low-pressure, heavy-water moderator to act as a backup heat sink even if there is no water in the fuel channels. Should this also fail, the calandria shell itself can contain the debris, with heat being transferred to the water-filled shield tank around the core. Should the severe core damage sequence progress further, the shield tank and the concrete reactor vault significantly delay the challenge to containment. Furthermore, should core melt lead to containment overpressure, the containment behaviour is such that leaks through the concrete containment wall reduce the possibility of catastrophic structural failure. The Canadian licensing philosophy requires that each accident, together with failure of each safety system in turn, be assessed (and specified dose limits met) as part of the design and licensing basis. In response, designers have provided CANDUs with two independent dedicated shutdown systems, and the likelihood of Anticipated Transients Without Scram is negligible. Probabilistic safety assessment studies have been performed on operating CANDU plants, and on the 4 x 880 MW(e) Darlington station now under construction; furthermore a scoping risk assessment has been done for a CANDU 600 plant. They indicate that the summed severe core damage frequency is of the order of 5 x 10{sup -6}/year. 95 refs, 3 tabs.

  18. Treatment of severe acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Praznik Ivan

    2014-01-01

    Full Text Available Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or other organ systems. The severe form of the disease occurs in 10-20% of cases, and usually requires prolonged hospitalization due to a frequent local and systemic complications. Additionally, considerable mortality despite diagnostic and therapeutic advances, makes this disease a serious health problem nowadays. The aim of this study was to conduct a review of randomized controlled trials to determine differences in the efficiency between standard methods of treatment for severe acute pancreatitis and new treatment ways in terms of decreased mortality. Search of the 'Medline' database of original scientific papers and systematic review articles was made, using a combination of the following keywords: acute pancreatitis, treatment, mortality. In total 914 papers were found, published in the last 13 years; 14 of 64 randomized controlled clinical trials met the selection criteria and were eligible for inclusion. From a total of 16 papers, the conservative treatment was related to 11, which includes some of the new treatment methods, while the effects of new methods of treatment have been the subject of research in the four studies. Combined endoscopic and surgical treatment was applied in only one study. The largest sample of 290 patients was included in the study with platelet activation factor antagonist, while the smallest sample of 22 patients was used in the study that compared total parenteral with enteral nutrition. Continuous regional arterial infusion of protease inhibitors in combination with antibiotics, intravenous supplementation of alanyl-glutamine dipeptide and the early, high-volume continuous veno-venous hemofiltration showed the best results in the treatment of patients with severe acute pancreatitis. Also, the use of low molecular weight heparin and enteral nutrition significantly reduced mortality.

  19. Severe accident source term reassessment

    International Nuclear Information System (INIS)

    Hazzan, M.J.; Gardner, R.; Warman, E.A.; Jacobs, S.B.

    1987-01-01

    This paper summarizes the status of the reassessment of severe reactor accident source terms, which are defined as the quantity, type, and timing of fission product releases from such accidents. Concentration is on the major results and conclusions of analyses with modern methods for both pressurized water reactors (PWRs) and boiling water reactors (BWRs), and the special case of containment bypass. Some distinctions are drawn between analyses for PWRs and BWRs. In general, the more the matter is examined, the consequences, or probability of serious consequences, seem to be less. (author)

  20. Nuclear reactor with several cores

    International Nuclear Information System (INIS)

    Swars, H.

    1977-01-01

    Several sodium-cooled cores in separate vessels with removable closures are placed in a common reactor tank. Each individual vessel is protected against the consequences of an accident in the relevant core. Maintenance devices and inlet and outlet pipes for the coolant are also arranged within the reactor tank. The individual vessels are all enclosed by coolant in a way that in case of emergency cooling or refuelling each core can be continued to be cooled by means of the coolant loops of the other cores. (HP) [de

  1. Severe hyponatremia associated with escitalopram

    Directory of Open Access Journals (Sweden)

    Gautam Rawal

    2017-01-01

    Full Text Available Hyponatremia is a rare but potentially fatal complication of selective serotonin reuptake inhibitor (SSRI therapy with only limited cases of escitalopram as the causative drug. We report the case of a 54-year-old hypertensive female who was admitted to the hospital with seizure episode and subsequently diagnosed to have severe hyponatremia due to SSRI-induced syndrome of inappropriate antidiuretic hormone (SIADH with the cause attributed to the short history of intake of escitalopram for depression. All SSRIs, including escitalopram, can cause SIADH and should be used with caution in the depressive patients with regular monitoring of electrolytes, especially in the elderly.

  2. [Severe candidiasis in heroin addicts].

    Science.gov (United States)

    Badillet, G; Puissant, A; Colliard, H

    1984-01-01

    Seven cases of severe candida infection in heroin addicts are reported. The principal features of this condition which arose in 1980, apparently due to a particular quality of heroin, are described, Candida albicans was the only pathogenic agent isolated from mainly scalp nodular and pustular lesions. These cutaneous lesions were associated in half the cases with ocular lesions, which sometimes had a poor prognosis despite active therapy. Osteo-articular complications were less common. Ketoconazole therapy alone gave good results in this series. The precise reasons for this dissemination of Candida albicans and for these localisations are still not clearly understood.

  3. Towards a Flood Severity Index

    Science.gov (United States)

    Kettner, A.; Chong, A.; Prades, L.; Brakenridge, G. R.; Muir, S.; Amparore, A.; Slayback, D. A.; Poungprom, R.

    2017-12-01

    Flooding is the most common natural hazard worldwide, affecting 21 million people every year. In the immediate moments following a flood event, humanitarian actors like the World Food Program need to make rapid decisions ( 72 hrs) on how to prioritize affected areas impacted by such an event. For other natural disasters like hurricanes/cyclones and earthquakes, there are industry-recognized standards on how the impacted areas are to be classified. Shake maps, quantifying peak ground motion, from for example the US Geological Survey are widely used for assessing earthquakes. Similarly, cyclones are tracked by Joint Typhoon Warning Center (JTWC) and Global Disaster Alert and Coordination System (GDACS) who release storm nodes and tracks (forecasted and actual), with wind buffers and classify the event according to the Saffir-Simpson Hurricane Wind Scale. For floods, the community is usually able to acquire unclassified data of the flood extent as identified from satellite imagery. Most often no water discharge hydrograph is available to classify the event into recurrence intervals simply because there is no gauging station, or the gauging station was unable to record the maximum discharge due to overtopping or flood damage. So, the question remains: How do we methodically turn a flooded area into classified areas of different gradations of impact? Here, we present a first approach towards developing a global applicable flood severity index. The flood severity index is set up such that it considers relatively easily obtainable physical parameters in a short period of time like: flood frequency (relating the current flood to historical events) and magnitude, as well as land cover, slope, and where available pre-event simulated flood depth. The scale includes categories ranging from very minor flooding to catastrophic flooding. We test and evaluate the postulated classification scheme against a set of past flood events. Once a severity category is determined, socio

  4. The severity of an earthquake

    Science.gov (United States)

    ,

    1997-01-01

    The severity of an earthquake can be expressed in terms of both intensity and magnitude. However, the two terms are quite different, and they are often confused. Intensity is based on the observed effects of ground shaking on people, buildings, and natural features. It varies from place to place within the disturbed region depending on the location of the observer with respect to the earthquake epicenter. Magnitude is related to the amount of seismic energy released at the hypocenter of the earthquake. It is based on the amplitude of the earthquake waves recorded on instruments

  5. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    Camassa, N.W.; Boccuzzi, F.; Diettorre, E.; Troilo, A.

    1988-01-01

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  6. CANDU safety under severe accidents

    International Nuclear Information System (INIS)

    Snell, V.G.; Howieson, J.Q.; Frescura, G.M.; King, F.; Rogers, J.T.; Tamm, H.

    1988-01-01

    The characteristics of the CANDU reactor relevant to severe accidents are set first by the inherent properties of the design, and second by the Canadian safety/licensing approach. Probabilistic safety assessment studies have been performed on operating CANDU plants, and on the 4 x 880 MW(e) Darlington station now under construction; furthermore a scoping risk assessment has been done for a CANDU 600 plant. They indicate that the summed severe core damage frequency is of the order of 5 x 10 -6 /year. CANDU nuclear plant designers and owner/operators share information and operational experience nationally and internationally through the CANDU Owners' Group (COG). The research program generally emphasizes the unique aspects of the CANDU concept, such as heat removal through the moderator, but it has also contributed significantly to areas generic to most power reactors such as hydrogen combustion, containment failure modes, fission product chemistry, and high temperature fuel behaviour. Abnormal plant operating procedures are aimed at first using event-specific emergency operating procedures, in cases where the event can be diagnosed. If this is not possible, generic procedures are followed to control Critical Safety Parameters and manage the accident. Similarly, the on-site contingency plans include a generic plan covering overall plant response strategy, and a specific plan covering each category of contingency

  7. [Management of severe alcoholic hepatitis].

    Science.gov (United States)

    Wieser, Verena; Tilg, Herbert

    2014-01-01

    Severe alcoholic hepatitis is still associated with high mortality and presence of liver failure manifested by jaundice, coagulopathy and encephalopathy is a poor prognostic indicator. The management of these patients includes at first hand several supportive measures as treatment of alcohol withdrawal, administration of fluid and vitamins and admission to an intensive care unit in the unstable patient. Glucocorticoids have been since decades the most intensively studied therapy in alcoholic hepatitis and are effective in certain subgroups. Indication for such a therapy is usually defined on a Maddrey Discriminant Function > 32. The Lille score at day 7 is used to decide whether corticosteroid therapy should be stopped or continued for a 1 month course. Nutritional supplementation is also likely to be beneficial. The main progress in better understanding its pathophysiology has come from cytokine studies. Various proinflammatory cytokines such as tumor necrosis factor-alpha (TNFα) or interleukin-1 (IL-1) have been proposed to play a role in this disease. This advancement has recently led to pilot studies investigating anti-TNF drugs such as pentoxifylline, infliximab (anti-TNF antibody) or etanercept in the treatment of this disease. These studies revealed besides for pentoxifylline rather negative results. Despite this fact, targeting of certain cytokines such as IL-1 remains an attractive treatment concept for this devastating disorder in the future.

  8. Mechanical ventilation for severe asthma.

    Science.gov (United States)

    Leatherman, James

    2015-06-01

    Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting.

  9. The management of severe accidents

    International Nuclear Information System (INIS)

    Pelce, J.; Brignon, P.

    1987-01-01

    In considering severe accidents in water power reactors, a major problem that arises is how to manage them in such a way that the situation can be controlled as well as possible, from the aspects both of preventing serious damage to the core of limiting the discharge of radioactivity. A number of countries have announced provisions in the field of accident management, some already set up, others planned, but these mainly apply to preventing damage to the core. Part of this report deals with this aspect, to show that there is a fairly wide consensus on how problems should be approached. Attitudes vary, on the other hand, in the approach to mitigate radioactive release. In fact, few countries have proposed concrete steps to manage severe accidents in the final stages when the core is seriously damaged. Since it is difficult to compare different approaches, only the French approach is described. This description is however very brief, because in the five or six years since it was defined, the approach has been presented many times. The stress is placed more on the comments which this type of approach suggests, to make the subsequent general discussion easier

  10. Common paths to ASD severity and PTSD severity

    DEFF Research Database (Denmark)

    Hansen, Maj; Armour, Cherie; Wittmann, Lutz

    Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests that a c......Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests...... that a common pathway to ASD and PTSD may lie in peritraumatic responses and cognitions. Using structural equation modeling we examined the role of three peritraumatic factors (tonic immobility, panic and dissociation) and three cognitive factors (anxiety sensitivity, negative cognitions about the world......, and negative cognitions about self ) on the development of ASD and PTSD severity in a national study of Danish bank robbery victims (N = 450). Peritraumatic panic, anxiety sensitivity, and negative cognitions about self were found to be significant common risk factors, whereas peritraumatic dissociation...

  11. Convective behaviour in severe accidents

    International Nuclear Information System (INIS)

    Clement, C.F.

    1988-01-01

    The nature and magnitude of the hazard from radioactivity posed by a possible nuclear accident depend strongly on convective behaviour within and immediately adjacent to the plant in question. This behaviour depends upon the nature of the vapour-gas-aerosol mixture concerned, and can show unusual properties such as 'upside-down' convection in which hot mixtures fall and cold mixtures rise. Predictions and criteria as to the types of behaviour which could possibly occur are summarised. Possible applications to present reactors are considered, and ways in which presently expected convection could be drastically modified are described. In some circumstances these could be used to suppress the radioactive source term or to switch its effect between distant dilute contamination and severe local contamination. (author). 8 refs, 2 figs, 2 tabs

  12. Severe accident recriticality analyses (SARA)

    DEFF Research Database (Denmark)

    Frid, W.; Højerup, C.F.; Lindholm, I.

    2001-01-01

    with all three codes. The core initial and boundary conditions prior to recriticality have been studied with the severe accident codes SCDAP/RELAP5, MELCOR and MAAP4. The results of the analyses show that all three codes predict recriticality-both super-prompt power bursts and quasi steady-state power......Recriticality in a BWR during reflooding of an overheated partly degraded core, i.e. with relocated control rods, has been studied for a total loss of electric power accident scenario. In order to assess the impact of recriticality on reactor safety, including accident management strategies......, which results in large energy deposition in the fuel during power burst in some accident scenarios. The highest value, 418 cal g(-1), was obtained with SIMULATE-3K for an Oskarshamn 3 case with reflooding rate of 2000 kg s(-1). In most cases, however, the predicted energy deposition was smaller, below...

  13. Severe accident simulation at Olkiuoto

    Energy Technology Data Exchange (ETDEWEB)

    Tirkkonen, H.; Saarenpaeae, T. [Teollisuuden Voima Oy (TVO), Olkiluoto (Finland); Cliff Po, L.C. [Micro-Simulation Technology, Montville, NJ (United States)

    1995-09-01

    A personal computer-based simulator was developed for the Olkiluoto nuclear plant in Finland for training in severe accident management. The generic software PCTRAN was expanded to model the plant-specific features of the ABB Atom designed BWR including its containment over-pressure protection and filtered vent systems. Scenarios including core heat-up, hydrogen generation, core melt and vessel penetration were developed in this work. Radiation leakage paths and dose rate distribution are presented graphically for operator use in diagnosis and mitigation of accidents. Operating on an graphically for operator use in diagnosis and mitigation of accidents. Operating on an 486 DX2-66, PCTRAN-TVO achieves a speed about 15 times faster than real-time. A convenient and user-friendly graphic interface allows full interactive control. In this paper a review of the component models and verification runs are presented.

  14. Severe Urticaria Following Erythromycin Therapy

    Directory of Open Access Journals (Sweden)

    Anada S. Prasad

    1960-01-01

    Full Text Available Enythromycin is believed to cause no serlous reactions after large doses, nausea, rarely vomiting and occasionally abdominal pain and diarrhea may occur, (Herrell, 1954. According to' Kagan and Faller (1955 no allergic reaction to' erythromycin has been reported. Phlebitis and thrombosis have been observed, (Shoe maker & Yow, 1954. In a report by Solomon and Johnson, (1955 toxic reactions were recorded as being uncommon. In a large series of cases, only one patient had a rash, another had fever possibly due to the drug, nne had nausea and vomiting and 4 had loose bowel movements while under therapy. Among the 122 patients treated with erythromcin, therapy was stopped owing to side effects in only one. My patient had severe urticaria within 24 hours of beginning therapy with erythromycin and a positive skin test was observed. It was believed to be an allergic reaction caused by the drug.

  15. [Tracheobronchoplasty for Severe Diffuse Tracheomalacia].

    Science.gov (United States)

    Hoffmann, H; Gompelmann, D; Heußel, C P; Dienemann, H; Eberhardt, R

    2016-09-01

    Patients with diffuse airway instability due to tracheobronchomalacia or excessive dynamic airway collapse are typically highly symptomatic, with marked dyspnoea, recurrent bronchopulmonary infections and excruciating intractable cough. Silicone stents achieve immediate symptom control, but are - due to the typical complications associated with stent treatment - usually not an option for long-term treatment. The aim of surgical intervention is definitive stabilisation of the trachea and of both main bronchi by posterior splinting of the Paries membranaceus with a polypropylene mesh. This operation is an appropriate treatment option for patients with documented severe tracheobronchomalacia or excessive dynamic airway collapse and is ultimately the only therapy that can achieve permanent symptom control. The success of the operation, however, depends on many factors and requires close interdisciplinary collaboration. Georg Thieme Verlag KG Stuttgart · New York.

  16. Severe rhabdomyolysis after excessive bodybuilding.

    Science.gov (United States)

    Finsterer, J; Zuntner, G; Fuchs, M; Weinberger, A

    2007-12-01

    A 46-year-old male subject performed excessive physical exertion during 4-6 h in a studio for body builders during 5 days. He was not practicing sport prior to this training and denied the use of any aiding substances. Despite muscle aching already after 1 day, he continued the exercises. After the last day, he recognized tiredness and cessation of urine production. Two days after discontinuation of the training, a Herpes simplex infection occurred. Because of acute renal failure, he required hemodialysis. There were absent tendon reflexes and creatine kinase (CK) values up to 208 274 U/L (normal: <170 U/L). After 2 weeks, CK had almost normalized and, after 4 weeks, hemodialysis was discontinued. Excessive muscle training may result in severe, hemodialysis-dependent rhabdomyolysis. Triggering factors may be prior low fitness level, viral infection, or subclinical metabolic myopathy.

  17. Diarrhea in severely burned children.

    Science.gov (United States)

    Thakkar, Kalpesh; Kien, C Lawrence; Rosenblatt, Judah I; Herndon, David N

    2005-01-01

    Diarrhea is a common problem in critically ill patients. Our patients are fed a high-carbohydrate enteral formula. We hypothesized that diarrhea in our patients may be related to the osmotic effects of unabsorbed carbohydrate in the small intestine and colon. We studied 19 patients, 3 months to 17 years, with burns >40% total body surface area. Each subject was studied weekly for up to 4 weeks postburn. Breath H2 concentration was measured. For the 24-hour period before the breath H2 measurement, the enteral carbohydrate intake, stool volume, and total enteral fluid volume were recorded. At each of several weekly intervals for each subject, the times when stool volume and enteral carbohydrate intake were each maximal were noted. Maximal stool volume ranged from 12 to 69 mL/kg/d. At the time point of maximal carbohydrate intake, diarrhea (stool volume >10 mL/kg/d) occurred in 18 of 19 patients, and maximal stool volume occurred in 10 of 19. Breath H2 concentration (ppm/5% CO2; mean +/- SEM) was 5.5 +/- 3.5 at the time of maximal carbohydrate intake, and was 25 +/- 20 at maximal stool volume. There were no correlations among breath H2 concentration, stool volume, enteral fluid intake, and enteral carbohydrate intake. Almost all the subjects had diarrhea over several weeks postburn. The lack of correlation of either carbohydrate intake or breath H2 with stool volume suggests that diarrhea in these patients may be caused by factors other than carbohydrate malabsorption. These data do not support altering nutrition support because of watery diarrhea.

  18. Therapeutic interventions in severe asthma.

    Science.gov (United States)

    Canonica, Giorgio Walter; Senna, Gianenrico; Mitchell, Patrick D; O'Byrne, Paul M; Passalacqua, Giovanni; Varricchi, Gilda

    2016-01-01

    The present paper addresses severe asthma which is limited to 5-10% of the overall population of asthmatics. However, it accounts for 50% or more of socials costs of the disease, as it is responsible for hospitalizations and Emergency Department accesses as well as expensive treatments. The recent identification of different endotypes of asthma, based on the inflammatory pattern, has led to the development of tailored treatments that target different inflammatory mediators. These are major achievements in the perspective of Precision Medicine: a leading approach to the modern treatment strategy. Omalizumab, an anti-IgE antibody, has been the only biologic treatment available on the market for severe asthma during the last decade. It prevents the linkage of the IgE and the receptors, thereby inhibiting mast cell degranulation. In clinical practice omalizumab significantly reduced the asthma exacerbations as well as the concomitant use of oral glucocorticoids. In the "Th2-high asthma" phenotype, the hallmarks are increased levels of eosinophils and other markers (such as periostin). Because anti-IL-5 in this condition plays a crucial role in driving eosinophil inflammation, this cytokine or its receptors on the eosinophil surface has been studied as a potential target for therapy. Two different anti-IL-5 humanized monoclonal antibodies, mepolizumab and reslizumab, have been proven effective in this phenotype of asthma (recently they both came on the market in the United States), as well as an anti-IL-5 receptor alpha (IL5Rα), benralizumab. Other monoclonal antibodies, targeting different cytokines (IL-13, IL-4, IL-17 and TSLP) are still under evaluation, though the preliminary results are encouraging. Finally, AIT, Allergen Immunotherapy, a prototype of Precision Medicine, is considered, also in light of the recent evidences of Sublingual Immunotherapy (SLIT) tablet efficacy and safety in mite allergic asthma patients. Given the high costs of these therapies

  19. Colposacrosuspension for severe genital prolapse.

    Science.gov (United States)

    Cronjé, H S

    2004-04-01

    A descriptive study of 140 patients with severe genital prolapse managed by colposacrosuspension with mesh interposition and a modified Burch colposuspension. A laparotomy was performed with mobilization of the rectum and exploration of the rectovaginal septum. Vaginally, a longitudinal incision was made in the posterior vaginal wall which was completely separated from the rectum. A perineal repair was done, whereafter a strip of Vypro (Johnson & Johnson, Brussels, Belgium) mesh was inserted from the perineum to the sacrum at S1. It was fixated to the perineum and vagina while the rectum was elevated and attached to the mesh. Where a perineal repair was deemed not necessary, the mesh extended from the mid-vagina to the sacrum. A second mesh strip was placed anteriorly of the vagina, covering the upper third of the vagina and extending to the sacrum. After closure of the pelvic peritoneum, covering the mesh, a modified Burch colposuspension was performed. Follow-up was done at 6 weeks, 6 months and yearly thereafter. The median age was 61 years with a median parity of 3. All patients presented with grade 2 (extending to the vaginal introitus) or 3 (outside the vaginal introitus) prolapse. Approximately one-third had urinary incontinence and a similar proportion complained of difficulty in defecation. All the patients underwent colposacrosuspension with the mesh extending to the perineum in 67% of the patients. A Burch colposuspension was performed in 79% of the women. Postoperatively, 97% of the patients were followed for 1-29 months with a median of 8.5 months (mean 10.2 months). Recurrent prolapse, grade 2 or 3, developed in 11 patients (8%) and 17 patients (12%) developed urinary incontinence, needing a transvaginal tape procedure. Removal of the mesh was necessary in one patient (0.7%). Colposacrosuspension for severe genital prolapse delivered satisfactory short-term results. It is, however, a major surgical procedure and elderly or compromised patients may

  20. Severe accident research in France

    International Nuclear Information System (INIS)

    Duco, J.; Reocreux, M.; Tattegrain, A.

    1988-01-01

    French PWR power plant design relies basically on a deterministic approach. Nevertheless, an overall safety objective was issued in 1977 by the safety authority which set an upper probability limit for having unacceptable consequences; this resulted, in particular, in the elaboration of the ''H'' procedures, aimed at reducing significantly the risk of core uncovery subsequent to the loss of redunbant safety-related systems. The U1 symptom-oriented procedure, based on the nuclear steam supply system ''cooling states'', was introduced later, in order to prevent core melting in situations where the operating crew was confused by multiple failures and/or inappropriate previous actions. In the event that a core-melt should occur, the ultimate procedures U2, U4 and U5 - the latter providing a venting of the containment through a filtration system - should enable the radioactive releases to be limited to characteristics compatible with the feasibility of the off-site emergency plans. Such emergency management procedures necessitate a significant study effort in order to be elaborated and qualified; this also presupposes that an adequate level of scientific knowledge has been gained as regards the response of specific components of a PWR under beyond-design conditions. The purpose of severe accident research in France is to attain a level of basic knowledge such that emergency procedures may be conceived and ultimately tested

  1. Pregnancy-associated severe sepsis.

    Science.gov (United States)

    Oud, Lavi

    2016-04-01

    This article examines the contemporary knowledge and uncertainties about the burden of pregnancy-associated severe sepsis (PASS), and its manifestations, management, and outcomes. There are relatively sparse data on PASS, related in part to infrequent reports and varying use of terminology and case definitions. PASS remains rare, although its incidence appears to be rapidly rising in some high-resource countries, affecting especially women with limited resources, minorities, and those with chronic illness. High level of clinician vigilance and rapid initiation of appropriate antimicrobial therapy, coupled with effective systemic support for organ dysfunction and correction of occult and overt hypoperfusion are the keys to limit adverse outcomes. However, timely diagnosis and provision of effective care remain a challenge, with reported prevalent delay in recognition and delivery of time-sensitive care interventions among maternal decedents. The mortality rate of PASS has been rising and its case fatality, although relatively low, has remained unchanged, in contrast to the outcome gains in the general population. The long-term sequelae of PASS remain unknown. The relatively limited contemporary data on PASS suggest a rising public health hazard in the obstetric population in high-resource countries, with ongoing challenges in assuring consistent provision of time-sensitive care.

  2. Severe Anaemia during Late Pregnancy

    Directory of Open Access Journals (Sweden)

    Mahenaz Akhtar

    2012-01-01

    Full Text Available Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10–28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient’s haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

  3. Iodine behaviour in severe accidents

    Energy Technology Data Exchange (ETDEWEB)

    Dutton, L M.C.; Grindon, E; Handy, B J; Sutherland, L [NNC Ltd., Knutsford (United Kingdom); Bruns, W G; Sims, H E [AEA Technology, Harwell (United Kingdom); Dickinson, S [AEA Technology, Winfrith (United Kingdom); Hueber, C; Jacquemain, D [IPSN/CEA, Cadarache, Saint Paul-Lez-Durance (France)

    1996-12-01

    A description is given of analyses which identify which aspects of the modelling and data are most important in evaluating the release of radioactive iodine to the environment following a potential severe accident at a PWR and which identify the major uncertainties which affect that release. Three iodine codes are used namely INSPECT, IODE and IMPAIR, and their predictions are compared with those of the PSA code MAAP. INSPECT is a mechanistic code which models iodine behaviour in the aqueous aerosol, spray water and sump water, and the partitioning of volatile species between the aqueous phases and containment gas space. Organic iodine is not modelled. IODE and IMPAIR are semi-empirical codes which do not model iodine behaviour in the aqueous aerosol, but model organic iodine. The fault sequences addressed are based on analyses for the Sizewell `B` design. Two types of sequence have been analysed.: (a) those in which a major release of fission products from the primary circuit to the containment occur, e.g. a large LOCAS, (b) those where the release by-passes the containment, e.g. a leak into the auxiliary building. In the analysis of the LOCA sequences where the pH of the sump is controlled to be a value of 8 or greater, all three codes predict that the oxidation of iodine to produce gas phase species does not make a significant contribution to the source term due to leakage from the reactor building and that the latter is dominated by iodide in the aerosol. In the case where the pH of the sump is not controlled, it is found that the proportion of gas phase iodine increases significantly, although the cumulative leakage predicted by all three codes is not significantly different from that predicted by MAAP. The radiolytic production of nitric acid could be a major factor in determining the pH, and if the pH were reduced, the codes predict an increase in gas phase iodine species leaked from the containment. (author) 4 figs., 7 tabs., 13 refs.

  4. Severe Accident Recriticality Analyses (SARA)

    Energy Technology Data Exchange (ETDEWEB)

    Frid, W. [Swedish Nuclear Power Inspectorate, Stockholm (Sweden); Hoejerup, F. [Risoe National Lab. (Denmark); Lindholm, I.; Miettinen, J.; Puska, E.K. [VTT Energy, Helsinki (Finland); Nilsson, Lars [Studsvik Eco and Safety AB, Nykoeping (Sweden); Sjoevall, H. [Teoliisuuden Voima Oy (Finland)

    1999-11-01

    Recriticality in a BWR has been studied for a total loss of electric power accident scenario. In a BWR, the B{sub 4}C control rods would melt and relocate from the core before the fuel during core uncovery and heat-up. If electric power returns during this time-window unborated water from ECCS systems will start to reflood the partly control rod free core. Recriticality might take place for which the only mitigating mechanisms are the Doppler effect and void formation. In order to assess the impact of recriticality on reactor safety, including accident management measures, the following issues have been investigated in the SARA project: 1. the energy deposition in the fuel during super-prompt power burst, 2. the quasi steady-state reactor power following the initial power burst and 3. containment response to elevated quasi steady-state reactor power. The approach was to use three computer codes and to further develop and adapt them for the task. The codes were SIMULATE-3K, APROS and RECRIT. Recriticality analyses were carried out for a number of selected reflooding transients for the Oskarshamn 3 plant in Sweden with SIMULATE-3K and for the Olkiluoto 1 plant in Finland with all three codes. The core state initial and boundary conditions prior to recriticality have been studied with the severe accident codes SCDAP/RELAP5, MELCOR and MAAP4. The results of the analyses show that all three codes predict recriticality - both superprompt power bursts and quasi steady-state power generation - for the studied range of parameters, i. e. with core uncovery and heat-up to maximum core temperatures around 1800 K and water flow rates of 45 kg/s to 2000 kg/s injected into the downcomer. Since the recriticality takes place in a small fraction of the core the power densities are high which results in large energy deposition in the fuel during power burst in some accident scenarios. The highest value, 418 cal/g, was obtained with SIMULATE-3K for an Oskarshamn 3 case with reflooding

  5. Severe accident recriticality analyses (SARA)

    Energy Technology Data Exchange (ETDEWEB)

    Frid, W. E-mail: wiktor.frid@ski.se; Hoejerup, F.; Lindholm, I.; Miettinen, J.; Nilsson, L.; Puska, E.K.; Sjoevall, H

    2001-11-01

    Recriticality in a BWR during reflooding of an overheated partly degraded core, i.e. with relocated control rods, has been studied for a total loss of electric power accident scenario. In order to assess the impact of recriticality on reactor safety, including accident management strategies, the following issues have been investigated in the SARA project: (1) the energy deposition in the fuel during super-prompt power burst; (2) the quasi steady-state reactor power following the initial power burst; and (3) containment response to elevated quasi steady-state reactor power. The approach was to use three computer codes and to further develop and adapt them for the task. The codes were SIMULATE-3K, APROS and RECRIT. Recriticality analyses were carried out for a number of selected reflooding transients for the Oskarshamn 3 plant in Sweden with SIMULATE-3K and for the Olkiluoto 1 plant in Finland with all three codes. The core initial and boundary conditions prior to recriticality have been studied with the severe accident codes SCDAP/RELAP5, MELCOR and MAAP4. The results of the analyses show that all three codes predict recriticality--both super-prompt power bursts and quasi steady-state power generation--for the range of parameters studied, i.e. with core uncovering and heat-up to maximum core temperatures of approximately 1800 K, and water flow rates of 45-2000 kg s{sup -1} injected into the downcomer. Since recriticality takes place in a small fraction of the core, the power densities are high, which results in large energy deposition in the fuel during power burst in some accident scenarios. The highest value, 418 cal g{sup -1}, was obtained with SIMULATE-3K for an Oskarshamn 3 case with reflooding rate of 2000 kg s{sup -1}. In most cases, however, the predicted energy deposition was smaller, below the regulatory limits for fuel failure, but close to or above recently observed thresholds for fragmentation and dispersion of high burn-up fuel. The highest calculated

  6. Severe accident recriticality analyses (SARA)

    International Nuclear Information System (INIS)

    Frid, W.; Hoejerup, F.; Lindholm, I.; Miettinen, J.; Nilsson, L.; Puska, E.K.; Sjoevall, H.

    2001-01-01

    Recriticality in a BWR during reflooding of an overheated partly degraded core, i.e. with relocated control rods, has been studied for a total loss of electric power accident scenario. In order to assess the impact of recriticality on reactor safety, including accident management strategies, the following issues have been investigated in the SARA project: (1) the energy deposition in the fuel during super-prompt power burst; (2) the quasi steady-state reactor power following the initial power burst; and (3) containment response to elevated quasi steady-state reactor power. The approach was to use three computer codes and to further develop and adapt them for the task. The codes were SIMULATE-3K, APROS and RECRIT. Recriticality analyses were carried out for a number of selected reflooding transients for the Oskarshamn 3 plant in Sweden with SIMULATE-3K and for the Olkiluoto 1 plant in Finland with all three codes. The core initial and boundary conditions prior to recriticality have been studied with the severe accident codes SCDAP/RELAP5, MELCOR and MAAP4. The results of the analyses show that all three codes predict recriticality--both super-prompt power bursts and quasi steady-state power generation--for the range of parameters studied, i.e. with core uncovering and heat-up to maximum core temperatures of approximately 1800 K, and water flow rates of 45-2000 kg s -1 injected into the downcomer. Since recriticality takes place in a small fraction of the core, the power densities are high, which results in large energy deposition in the fuel during power burst in some accident scenarios. The highest value, 418 cal g -1 , was obtained with SIMULATE-3K for an Oskarshamn 3 case with reflooding rate of 2000 kg s -1 . In most cases, however, the predicted energy deposition was smaller, below the regulatory limits for fuel failure, but close to or above recently observed thresholds for fragmentation and dispersion of high burn-up fuel. The highest calculated quasi steady

  7. Severe Accident Recriticality Analyses (SARA)

    International Nuclear Information System (INIS)

    Frid, W.; Hoejerup, F.; Lindholm, I.; Miettinen, J.; Puska, E.K.; Nilsson, Lars; Sjoevall, H.

    1999-11-01

    Recriticality in a BWR has been studied for a total loss of electric power accident scenario. In a BWR, the B 4 C control rods would melt and relocate from the core before the fuel during core uncovery and heat-up. If electric power returns during this time-window unborated water from ECCS systems will start to reflood the partly control rod free core. Recriticality might take place for which the only mitigating mechanisms are the Doppler effect and void formation. In order to assess the impact of recriticality on reactor safety, including accident management measures, the following issues have been investigated in the SARA project: 1. the energy deposition in the fuel during super-prompt power burst, 2. the quasi steady-state reactor power following the initial power burst and 3. containment response to elevated quasi steady-state reactor power. The approach was to use three computer codes and to further develop and adapt them for the task. The codes were SIMULATE-3K, APROS and RECRIT. Recriticality analyses were carried out for a number of selected reflooding transients for the Oskarshamn 3 plant in Sweden with SIMULATE-3K and for the Olkiluoto 1 plant in Finland with all three codes. The core state initial and boundary conditions prior to recriticality have been studied with the severe accident codes SCDAP/RELAP5, MELCOR and MAAP4. The results of the analyses show that all three codes predict recriticality - both superprompt power bursts and quasi steady-state power generation - for the studied range of parameters, i. e. with core uncovery and heat-up to maximum core temperatures around 1800 K and water flow rates of 45 kg/s to 2000 kg/s injected into the downcomer. Since the recriticality takes place in a small fraction of the core the power densities are high which results in large energy deposition in the fuel during power burst in some accident scenarios. The highest value, 418 cal/g, was obtained with SIMULATE-3K for an Oskarshamn 3 case with reflooding

  8. Genetics Home Reference: severe congenital neutropenia

    Science.gov (United States)

    ... A characteristic of X-linked inheritance is that fathers cannot pass X-linked traits to their sons. ... Genetic Testing Registry: Severe congenital neutropenia 2, autosomal dominant Genetic Testing Registry: Severe congenital neutropenia 3, autosomal ...

  9. Targeted treatment of severe head injury

    African Journals Online (AJOL)

    injury is not a homogeneous concept and is poorly classified for the purposes of treatment.1 The separation of patients into 3 categories of severity (mild, moderate and severe) remains a blunt measure used to guide therapy in individual patients. Patients with severe traumatic brain injury (TBI), i.e. a Glasgow Coma Score ...

  10. Computed tomography in severe protein energy malnutrition.

    OpenAIRE

    Househam, K C; de Villiers, J F

    1987-01-01

    Computed tomography of the brain was performed on eight children aged 1 to 4 years with severe protein energy malnutrition. Clinical features typical of kwashiorkor were present in all the children studied. Severe cerebral atrophy or brain shrinkage according to standard radiological criteria was present in every case. The findings of this study suggest considerable cerebral insult associated with severe protein energy malnutrition.

  11. Asthma Is More Severe in Older Adults

    Science.gov (United States)

    Dweik, Raed A.; Comhair, Suzy A.; Bleecker, Eugene R.; Moore, Wendy C.; Peters, Stephen P.; Busse, William W.; Jarjour, Nizar N.; Calhoun, William J.; Castro, Mario; Chung, K. Fan; Fitzpatrick, Anne; Israel, Elliot; Teague, W. Gerald; Wenzel, Sally E.; Love, Thomas E.; Gaston, Benjamin M.

    2015-01-01

    Background Severe asthma occurs more often in older adult patients. We hypothesized that the greater risk for severe asthma in older individuals is due to aging, and is independent of asthma duration. Methods This is a cross-sectional study of prospectively collected data from adult participants (N=1130; 454 with severe asthma) enrolled from 2002 – 2011 in the Severe Asthma Research Program. Results The association between age and the probability of severe asthma, which was performed by applying a Locally Weighted Scatterplot Smoother, revealed an inflection point at age 45 for risk of severe asthma. The probability of severe asthma increased with each year of life until 45 years and thereafter increased at a much slower rate. Asthma duration also increased the probability of severe asthma but had less effect than aging. After adjustment for most comorbidities of aging and for asthma duration using logistic regression, asthmatics older than 45 maintained the greater probability of severe asthma [OR: 2.73 (95 CI: 1.96; 3.81)]. After 45, the age-related risk of severe asthma continued to increase in men, but not in women. Conclusions Overall, the impact of age and asthma duration on risk for asthma severity in men and women is greatest over times of 18-45 years of age; age has a greater effect than asthma duration on risk of severe asthma. PMID:26200463

  12. Surviving severe traumatic brain injury in Denmark

    DEFF Research Database (Denmark)

    Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter

    2015-01-01

    PURPOSE: To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HS-rehabilitation). PATIENTS AND METHODS: Patients surviving severe TBI were identified from...... severe TBI were admitted to HS-rehabilitation. Female sex, older age, and non-working status pre-injury were independent predictors of no HS-rehabilitation among patients surviving severe TBI. CONCLUSION: The incidence rate of hospitalized patients surviving severe TBI was stable in Denmark...

  13. SEVERITY CLASSIFICATION OF MICROANEURYSMS USING NEURAL NETWORK

    Directory of Open Access Journals (Sweden)

    Shree Divya R

    2014-01-01

    Full Text Available Diabetic Retinopathy is one of the most common causes of blindness that leads to the loss of vision to the human eye. Several methods have been proposed to detect several defects of the human eye like hemorrhages, exudates etc. which are to be considered as the major symptoms. Among them, Microaneurysms should be considered as one of the severe condition for the early blindness. Several techniques have been proposed based on this, but they have certain drawbacks. A new technique called neural network taken for presentation, helps to detect and determine the severity of Microaneurysms which would be able to give a better performance than the existing techniques.

  14. Reporting Severe Hypoglycemia in Type 1 Diabetes

    DEFF Research Database (Denmark)

    Pedersen-Bjergaard, Ulrik; Thorsteinsson, Birger

    2017-01-01

    PURPOSE OF REVIEW: To describe potential factors influencing reporting of severe hypoglycemia in adult patients with type 1 diabetes and to analyze their effect on reported rates of severe hypoglycemia. RECENT FINDINGS: Reported rates of severe hypoglycemia defined as need for third party...... by partners report higher rates of severe hypoglycemia. There is a large variation between studies reporting incidence and prevalence of severe hypoglycemia in patients with type 1 diabetes, mainly explained by definition of severity, methods of reporting, and patient selection. These findings call...... hypoglycemia are 0.02-0.5 events per patient-year and 1-29%, respectively. When subjects with recurrent severe hypoglycemia in the past or suffering from impaired hypoglycemia awareness are excluded from participation in studies, lower rates are reported. Studies applying anonymous reporting or reporting...

  15. State energy severance taxes, 1985-1993

    International Nuclear Information System (INIS)

    1995-09-01

    This report analyzes changes in aggregate and State-level energy severance taxes for 1985 through 1993. Data are presented for crude oil, natural gas, and coal. The report highlights trends in severance tax receipts relative to energy prices and production, using severance tax data published by the Bureau of the Census of the US Department of Commerce and production data published by the Energy Information Administration

  16. Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

    OpenAIRE

    Gupta, Natasha; Ahmed, Seema; Shaffer, Lemuel; Cavens, Paula; Blankstein, Josef

    2014-01-01

    Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term an...

  17. Severe Accident Research Program plan update

    International Nuclear Information System (INIS)

    1992-12-01

    In August 1989, the staff published NUREG-1365, ''Revised Severe Accident Research Program Plan.'' Since 1989, significant progress has been made in severe accident research to warrant an update to NUREG-1365. The staff has prepared this SARP Plan Update to: (1) Identify those issues that have been closed or are near completion, (2) Describe the progress in our understanding of important severe accident phenomena, (3) Define the long-term research that is directed at improving our understanding of severe accident phenomena and developing improved methods for assessing core melt progression, direct containment heating, and fuel-coolant interactions, and (4) Reflect the growing emphasis in two additional areas--advanced light water reactors, and support for the assessment of criteria for containment performance during severe accidents. The report describes recent major accomplishments in understanding the underlying phenomena that can occur during a severe accident. These include Mark I liner failure, severe accident scaling methodology, source term issues, core-concrete interactions, hydrogen transport and combustion, TMI-2 Vessel Investigation Project, and direct containment heating. The report also describes the major planned activities under the SARP over the next several years. These activities will focus on two phenomenological issues (core melt progression, and fuel-coolant interactions and debris coolability) that have significant uncertainties that impact our understanding and ability to predict severe accident phenomena and their effect on containment performance SARP will also focus on severe accident code development, assessment and validation. As the staff completes the research on severe accident issues that relate to current generation reactors, continued research will focus on efforts to independently evaluate the capability of new advanced light water reactor designs to withstand severe accidents

  18. Screening for severe combined immunodeficiency in neonates

    OpenAIRE

    Kelly, Brian T; Tam, Jonathan S; Verbsky, James W; Routes, John M

    2013-01-01

    Brian T Kelly,1 Jonathan S Tam,1 James W Verbsky,1,2 John M Routes1,2 1Department of Pediatrics, 2Department of Microbiology and Molecular Genetics, Medical College of Wisconsin, Milwaukee, WI, USA Abstract: Severe combined immunodeficiency (SCID) is a rare disease that severely affects the cellular and humoral immune systems. Patients with SCID present with recurrent or severe infections and often with chronic diarrhea and failure to thrive. The disease is uniformly fatal, making early diag...

  19. SAMEX: A severe accident management support expert

    International Nuclear Information System (INIS)

    Park, Soo-Yong; Ahn, Kwang-Il

    2010-01-01

    A decision support system for use in a severe accident management following an incident at a nuclear power plant is being developed which is aided by a severe accident risk database module and a severe accident management simulation module. The severe accident management support expert (SAMEX) system can provide the various types of diagnostic and predictive assistance based on the real-time plant specific safety parameters. It consists of four major modules as sub-systems: (a) severe accident risk data base module (SARDB), (b) risk-informed severe accident risk data base management module (RI-SARD), (c) severe accident management simulation module (SAMS), and (d) on-line severe accident management guidance module (on-line SAMG). The modules are integrated into a code package that executes within a WINDOWS XP operating environment, using extensive user friendly graphics control. In Korea, the integrated approach of the decision support system is being carried out under the nuclear R and D program planned by the Korean Ministry of Education, Science and Technology (MEST). An objective of the project is to develop the support system which can show a theoretical possibility. If the system is feasible, the project team will recommend the radiation protection technical support center of a national regulatory body to implement a plant specific system, which is applicable to a real accident, for the purpose of immediate and various diagnosis based on the given plant status information and of prediction of an expected accident progression under a severe accident situation.

  20. Severe accidents: in nuclear power plants

    International Nuclear Information System (INIS)

    1986-01-01

    A ''severe'' nuclear accident refers to a reactor accident that could exceed reactor design specifications to such a degree as to prevent cooling of the reactor's core by normal means. This report summarizes the work of a NEA Senior Group of Experts who have studied the potential response of existing light-water reactors to severe accidents and have found that current designs of reactors are far more capable of coping with severe accidents than design specifications would suggest. The report emphasises the specific knowledge and means that can be used for diagnosing a severe accident and for managing its progression in order to prevent or mitigate its consequences

  1. Association between severity of chronic obstructive pulmonary ...

    African Journals Online (AJOL)

    The statistical analysis was performed by SPSS software and the Kendall's tau-b correlation test. Results: The mean age (±standard deviation) was 64.3 ± 11.3 years. Twelve percent were female and 88 percent were male. The COPD severity, according to the ATS criteria, was mild in 16%, moderate in 48%, severe in 32% ...

  2. Euthanasia of Severely Handicapped Infants: Ethical Issues.

    Science.gov (United States)

    Cohen, Libby

    Ethical decisions are involved in life and death decisions for severely handicapped infants. Although it has become common practice for physicians not to treat severely handicapped infants, the ethical considerations involved in euthanasia are complex. A review of the literature reveals that concerns center around the quality of life of the…

  3. Prevalence of exchange blood transfusion in severe ...

    African Journals Online (AJOL)

    Background: Exchange blood transfusion (EBT) is carried out for the treatment of conditions presenting with severe hyperbilirubinaemia and anaemia, such as ABO incompatibility, sepsis, prematurity and birth trauma among others. While it is fast being abandoned as treatment modality for severe neonatal jaundice in the ...

  4. Personality dimensions and service failure severity

    African Journals Online (AJOL)

    kirstam

    Dr L. Kruger is a senior lecturer in the Department of Marketing Management ... severity rather than possible individual consumer effects on service failure severity. ... When service failures occur, there is an imbalance in the relationship, because ... service recovery strategies may result in a successful recovery experience ( ...

  5. Fire severity classification: Uses and abuses

    Science.gov (United States)

    Theresa B. Jain; Russell T. Graham

    2003-01-01

    Burn severity (also referred to as fire severity) is not a single definition, but rather a concept and its classification is a function of the measured units unique to the system of interest. The systems include: flora and fauna, soil microbiology and hydrologic processes, atmospheric inputs, fire management, and society. Depending on the particular system of interest...

  6. Severe accident training simulator APROS SA

    International Nuclear Information System (INIS)

    Raiko, Eerikki; Salminen, Kai; Lundstroem, Petra; Harti, Mika; Routamo, Tomi

    2003-01-01

    APROS SA is a severe accident training simulator based on the APROS simulation environment. APROS SA has been developed in Fortum Nuclear Services Ltd to serve as a training tool for the personnel of the Loviisa NPP. Training with APROS SA gives the personnel a deeper understanding of the severe accident phenomena and thus it is an important part of the implementation of the severe accident management strategy. APROS SA consists of two parts, a comprehensive Loviisa plant model and an external severe accident model. The external model is an extension to the Loviisa plant model, which allows the simulation to proceed into the severe accident phase. The severe accident model has three submodels: the core melting and relocation model, corium pool model and fission product model. In addition to these, a new thermal-hydraulic solver is introduced to the core region of the Loviisa plant model to replace the more limited APROS thermal-hydraulic solver. The full APROS SA training simulator has a graphical user interface with visualizations of both severe accident management panels at the operator room and the important physical phenomena during the accident. This paper describes the background of the APROS SA training simulator, the severe accident submodels and the graphical user interface. A short description how APROS SA will be used as a training tool at the Loviisa NPP is also given

  7. Severe interpersonal violence against children in sport

    NARCIS (Netherlands)

    Vertommen, Tine; Kampen, Jarl; Schipper-van Veldhoven, Nicolette; Uzieblo, Kasia; Eede, Van Den Filip

    2018-01-01

    In a recent large-scale prevalence study of interpersonal violence (IV) against child athletes in the Netherlands and Belgium we found that 9% of adult respondents who participated in organized sports before the age of 18 had experienced severe psychological violence, 8% severe physical violence,

  8. Severe hypothyroidism masquerading as renal impairment

    DEFF Research Database (Denmark)

    Bistrup, C; Jensen, Dorte Møller; Kvetny, J

    1996-01-01

    A case of severe hypothyroidism in a 51-year old male is presented. The patient was especially complaining of weakness, stiffness and moderate pain in the proximal muscle groups together with rhinorrhea and nasal stenosis. Because of severely elevated S-creatine-kinase combined with reduced...

  9. Nutrition of patients with severe neurologic impairment

    Directory of Open Access Journals (Sweden)

    Orel Anija

    2017-12-01

    Full Text Available Commercial enteral formulas are generally recommended for gastrostomy feeding in patients with severe neurologic impairment. However, pureed food diets are still widely used and even gaining popularity among certain groups. We tried to compare the effectiveness of gastrostomy feeding for treatment of severe malnutrition with either enteral formulas or pureed feeds.

  10. Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Natasha Gupta

    2014-01-01

    Full Text Available Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural effusion, and chronic pericarditis. This patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis.

  11. Air pollution and asthma severity in adults

    Science.gov (United States)

    Rage, Estelle; Siroux, Valérie; Künzli, Nino; Pin, Isabelle; Kauffmann, Francine

    2009-01-01

    Objectives There is evidence that exposure to air pollution affects asthma, but the effect of air pollution on asthma severity has not been addressed. The aim was to assess the relation between asthma severity during the past 12 months and home outdoor concentrations of air pollution. Methods Asthma severity over the last 12 months was assessed in two complementary ways among 328 adult asthmatics from the French Epidemiological study on the Genetics and Environment of Asthma (EGEA) examined between 1991 and 1995. The 4-class severity score integrated clinical events and type of treatment. The 5-level asthma score is based only on the occurrence of symptoms. Nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) concentrations were assigned to each residence using two different methods. The first was based on the closest monitor data from 1991–1995. The second consisted in spatial models that used geostatistical interpolations and then assigned air pollutants to the geo-coded residences (1998). Results Higher asthma severity score was significantly related to the 8-hour average of ozone during April-September (O3-8hr) and the number of days (O3-days) with 8-hour ozone averages above 110 μg.m−3 (for a 36-day increase, equivalent to the inter quartile range, in O3-days, odds ratio (95% confidence interval) 2.22 (1.61–3.07) for one class difference in score). Adjustment for age, sex, smoking habits, occupational exposure, and educational level did not alter results. Asthma severity was unrelated to NO2. Both exposure assessment methods and severity scores resulted in very similar findings. SO2 correlated with severity but reached statistical significance only for the model based assignment of exposure. Conclusions The observed associations between asthma severity and air pollution, in particular O3, support the hypothesis that air pollution at levels far below current standards increases asthma severity. PMID:19017701

  12. Impact of pavement conditions on crash severity.

    Science.gov (United States)

    Li, Yingfeng; Liu, Chunxiao; Ding, Liang

    2013-10-01

    Pavement condition has been known as a key factor related to ride quality, but it is less clear how exactly pavement conditions are related to traffic crashes. The researchers used Geographic Information System (GIS) to link Texas Department of Transportation (TxDOT) Crash Record Information System (CRIS) data and Pavement Management Information System (PMIS) data, which provided an opportunity to examine the impact of pavement conditions on traffic crashes in depth. The study analyzed the correlation between several key pavement condition ratings or scores and crash severity based on a large number of crashes in Texas between 2008 and 2009. The results in general suggested that poor pavement condition scores and ratings were associated with proportionally more severe crashes, but very poor pavement conditions were actually associated with less severe crashes. Very good pavement conditions might induce speeding behaviors and therefore could have caused more severe crashes, especially on non-freeway arterials and during favorable driving conditions. In addition, the results showed that the effects of pavement conditions on crash severity were more evident for passenger vehicles than for commercial vehicles. These results provide insights on how pavement conditions may have contributed to crashes, which may be valuable for safety improvement during pavement design and maintenance. Readers should notice that, although the study found statistically significant effects of pavement variables on crash severity, the effects were rather minor in reality as suggested by frequency analyses. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. [Severe hypertension: definition and patients profiles].

    Science.gov (United States)

    Mourad, Jean-Jacques

    2013-05-01

    Severe arterial hypertension gathers relatively different clinical situations explained by the heterogeneity of the definitions of this clinical setting. From a medical point of view, severe hypertension is a short course situation defined by very high values of blood pressure corresponding to grade 3 hypertension. In France, until 2011, the social security also included in the definition of severe HTA chronic situations characterized by moderate blood pressure values requiring at least triple anthihypertensive therapies associated with a clinical or infraclinical target organ damages. These clinical profiles, much more frequent than grade 3 hypertension, allowed the full reimbursement of care costs for these patients. In France, it is estimated that 10% of hypertensive patients present a severe form with an annual incidence of 50,000 patients. The patients with severe hypertension have an increased cardiovascular morbidity justifying a closer clinical monitoring. From an economic point of view, these severe forms of hypertension have a higher cost of care, explained primarily by a more frequent need of specialized referrals, radiological exams and hospitalizations. This excess cost justified the existence of a full coverage of induced costs by the social security, since the incidence of severe hypertension is more frequent in the low social categories, and in patients with economic fragility.

  14. Hospital Management of Severe Hypertriglyceridemia in Children.

    Science.gov (United States)

    Valaiyapathi, Badhma; Ashraf, Ambika P

    2017-01-01

    Severe Hypertriglyceridemia (HTG), i.e., plasma triglyceride levels exceeding 1000 mg/dL, is one of the established causes of acute pancreatitis and severe abdominal pain. There are no established pediatric guidelines regarding treatment of children and adolescents with severe HTG. To review the pathophysiology and etiology of severe HTG in the pediatric age group, and to discuss management options. Severe HTG is usually due to deficient or absent Lipoprotein Lipase (LPL) activity, which can be due to primary genetic etiology or secondary causes triggering HTG in those with underlying genetic susceptibility. Hospitalization is indicated for patients with severe HTG who are symptomatic with abdominal pain or pancreatitis, in those with uncontrolled diabetes requiring insulin, or, in those with substantial elevations of plasma TG. Fasting followed by fat free diet until plasma TG declines to severe pancreatitis, shock or multi-organ failure. Medications such as fibrates and omega-3 fatty acids are not effective if LPL activity is absent or when plasma TG is >1800 mg/dL. Medications only have an adjunct role in the management. Low fat diet, lifestyle changes, weight loss, control of secondary causes, and patient education form the mainstay of management once the patient is discharged. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  15. Monitoring severe accidents using AI techniques

    International Nuclear Information System (INIS)

    No, Young Gyu; Ahn, Kwang Il; Kim, Ju Hyun; Na, Man Gyun; Lim, Dong Hyuk

    2012-01-01

    After the Fukushima nuclear accident in 2011, there has been increasing concern regarding severe accidents in nuclear facilities. Severe accident scenarios are difficult for operators to monitor and identify. Therefore, accurate prediction of a severe accident is important in order to manage it appropriately in the unfavorable conditions. In this study, artificial intelligence (AI) techniques, such as support vector classification (SVC), probabilistic neural network (PNN), group method of data handling (GMDH), and fuzzy neural network (FNN), were used to monitor the major transient scenarios of a severe accident caused by three different initiating events, the hot-leg loss of coolant accident (LOCA), the cold-leg LOCA, and the steam generator tube rupture in pressurized water reactors (PWRs). The SVC and PNN models were used for the event classification. The GMDH and FNN models were employed to accurately predict the important timing representing severe accident scenarios. In addition, in order to verify the proposed algorithm, data from a number of numerical simulations were required in order to train the AI techniques due to the shortage of real LOCA data. The data was acquired by performing simulations using the MAAP4 code. The prediction accuracy of the three types of initiating events was sufficiently high to predict severe accident scenarios. Therefore, the AI techniques can be applied successfully in the identification and monitoring of severe accident scenarios in real PWRs.

  16. Monitoring severe accidents using AI techniques

    Energy Technology Data Exchange (ETDEWEB)

    No, Young Gyu; Ahn, Kwang Il [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, Ju Hyun; Na, Man Gyun [Dept. of Nuclear Engineering, Chosun University, Gwangju (Korea, Republic of); Lim, Dong Hyuk [Korea Institute of Nuclear Nonproliferation and Control, Daejon (Korea, Republic of)

    2012-05-15

    After the Fukushima nuclear accident in 2011, there has been increasing concern regarding severe accidents in nuclear facilities. Severe accident scenarios are difficult for operators to monitor and identify. Therefore, accurate prediction of a severe accident is important in order to manage it appropriately in the unfavorable conditions. In this study, artificial intelligence (AI) techniques, such as support vector classification (SVC), probabilistic neural network (PNN), group method of data handling (GMDH), and fuzzy neural network (FNN), were used to monitor the major transient scenarios of a severe accident caused by three different initiating events, the hot-leg loss of coolant accident (LOCA), the cold-leg LOCA, and the steam generator tube rupture in pressurized water reactors (PWRs). The SVC and PNN models were used for the event classification. The GMDH and FNN models were employed to accurately predict the important timing representing severe accident scenarios. In addition, in order to verify the proposed algorithm, data from a number of numerical simulations were required in order to train the AI techniques due to the shortage of real LOCA data. The data was acquired by performing simulations using the MAAP4 code. The prediction accuracy of the three types of initiating events was sufficiently high to predict severe accident scenarios. Therefore, the AI techniques can be applied successfully in the identification and monitoring of severe accident scenarios in real PWRs.

  17. Monitoring Severe Accidents Using AI Techniques

    International Nuclear Information System (INIS)

    No, Young Gyu; Kim, Ju Hyun; Na, Man Gyun; Ahn, Kwang Il

    2011-01-01

    It is very difficult for nuclear power plant operators to monitor and identify the major severe accident scenarios following an initiating event by staring at temporal trends of important parameters. The objective of this study is to develop and verify the monitoring for severe accidents using artificial intelligence (AI) techniques such as support vector classification (SVC), probabilistic neural network (PNN), group method of data handling (GMDH) and fuzzy neural network (FNN). The SVC and PNN are used for event classification among the severe accidents. Also, GMDH and FNN are used to monitor for severe accidents. The inputs to AI techniques are initial time-integrated values obtained by integrating measurement signals during a short time interval after reactor scram. In this study, 3 types of initiating events such as the hot-leg LOCA, the cold-leg LOCA and SGTR are considered and it is verified how well the proposed scenario identification algorithm using the GMDH and FNN models identifies the timings when the reactor core will be uncovered, when CET will exceed 1200 .deg. F and when the reactor vessel will fail. In cases that an initiating event develops into a severe accident, the proposed algorithm showed accurate classification of initiating events. Also, it well predicted timings for important occurrences during severe accident progression scenarios, which is very helpful for operators to perform severe accident management

  18. NPP Krsko Severe Accident Management Guidelines Implementation

    International Nuclear Information System (INIS)

    Basic, I.; Krajnc, B.; Bilic-Zabric, T.; Spiler, J.

    2002-01-01

    Severe Accident Management is a framework to identify and implement the Emergency Response Capabilities that can be used to prevent or mitigate severe accidents and their consequences. The USA NRC has indicated that the development of a licensee plant specific accident management program will be required in order to close out the severe accident regulatory issue (Ref. SECY-88-147). Generic Letter 88-20 ties the Accident management Program to IPE for each plant. The SECY-89-012 defines those actions taken during the course of an accident by the plant operating and technical staff to: 1) prevent core damage, 2) terminate the progress of core damage if it begins and retain the core within the reactor vessel, 3) maintain containment integrity as long as possible, and 4) minimize offsite releases. The subject of this paper is to document the severe accident management activities, which resulted in a plant specific Severe Accident Management Guidelines implementation. They have been developed based on the Krsko IPE (Individual Plant Examination) insights, Generic WOG SAMGs (Westinghouse Owners Group Severe Accident Management Guidances) and plant specific documents developed within this effort. Among the required plant specific actions the following are the most important ones: Identification and documentation of those Krsko plant specific severe accident management features (which also resulted from the IPE investigations). The development of the Krsko plant specific background documents (Severe Accident Plant Specific Strategies and SAMG Setpoint Calculation). Also, paper discusses effort done in the areas of NPP Krsko SAMG review (internal and external ), validation on Krsko Full Scope Simulator (Severe Accident sequences are simulated by MAAP4 in real time) and world 1st IAEA Review of Accident Management Programmes (RAMP). (author)

  19. The American 'severe fuel damage program'

    International Nuclear Information System (INIS)

    Sdouz, G.

    1982-03-01

    The TMI-2 accident has initiated a new phase of safety research. It is necessary to consider severe accidents with degraded or molten core. For NRC there was a need for an improved understanding of this reactor behaviour and the 'Severe Fuel Dage Program' was initiated. Planned are in-pile experiments in PBF, NRU and ESSOR and in addition separate effects tests and results from TMI-2. The analytical component of the program is the development of different versions of the code SCDAP for the detailed analysis during severe accident transients. (Author) [de

  20. Function theory of several complex variables

    CERN Document Server

    Krantz, Steven G

    2001-01-01

    The theory of several complex variables can be studied from several different perspectives. In this book, Steven Krantz approaches the subject from the point of view of a classical analyst, emphasizing its function-theoretic aspects. He has taken particular care to write the book with the student in mind, with uniformly extensive and helpful explanations, numerous examples, and plentiful exercises of varying difficulty. In the spirit of a student-oriented text, Krantz begins with an introduction to the subject, including an insightful comparison of analysis of several complex variables with th

  1. Invariant resolutions for several Fueter operators

    Science.gov (United States)

    Colombo, Fabrizio; Souček, Vladimir; Struppa, Daniele C.

    2006-07-01

    A proper generalization of complex function theory to higher dimension is Clifford analysis and an analogue of holomorphic functions of several complex variables were recently described as the space of solutions of several Dirac equations. The four-dimensional case has special features and is closely connected to functions of quaternionic variables. In this paper we present an approach to the Dolbeault sequence for several quaternionic variables based on symmetries and representation theory. In particular we prove that the resolution of the Cauchy-Fueter system obtained algebraically, via Gröbner bases techniques, is equivalent to the one obtained by R.J. Baston (J. Geom. Phys. 1992).

  2. Severe falciparum malaria: A case report

    Science.gov (United States)

    Arcelia, F.; Asymida, F.; Lubis, N. F. M.; Pasaribu, A. P.

    2018-03-01

    Plasmodium parasites caused Malaria. Indonesia is one of the countries in Southeast Asia that endemic to malaria. The burden of malaria is more in the eastern part of Indonesia than the Western part as well as the endemicity. Some cases of malaria will develop to severe form. Usually, the manifestation of children and adult are different. We reported a severe case of malaria in a 14-year-old boy who develops several manifestations such as anemia, hypoglycemia, sepsis and black water fever. We successfully treated the patient with Artesunate intravenous and continued with Dihydroartemisinin-piperaquine.

  3. Severe acute respiratory syndrome: lessons and uncertainties.

    NARCIS (Netherlands)

    Kullberg, B.J.; Voss, A.

    2003-01-01

    The outbreak of severe acute respiratory syndrome (SARS) has produced scientific and epidemiological discoveries with unprecedented speed, and this information has been spread instantaneously to the global health community through the internet. Within a few weeks, the coronavirus associated with

  4. Lightning and severe thunderstorms in event management.

    Science.gov (United States)

    Walsh, Katie M

    2012-01-01

    There are a few national position stands/guidelines that address environmental conditions in athletics, yet they do not govern all outdoor sports. Extreme heat and cold, lightning, and severe wind can all be fatal, yet the majority of outdoor sports have no published guidelines addressing these conditions in relation to activity. Available research on extreme heat and cold conditions in athletics provides prevention strategies, to include acclimatization. Lightning and severe wind are two environmental conditions to which humans cannot accommodate, and they both can be deadly. There are strong positions on extreme heat/cold and lightning safety in athletics, but none affiliated with severe winds. Medical personnel involved in planning large outdoor sporting events must know of the presence of nationally published weather-related documents and apply them to their event. In addition, research needs to be expanded in the realm of establishing guidelines for safety to participants and spectators in severe wind conditions.

  5. Plasmapheresis in the management of severe hypertriglyceridemia.

    Science.gov (United States)

    Seda, Gilbert; Meyer, Jill M; Amundson, Dennis E; Daheshia, Massoud

    2013-08-01

    Plasmapheresis can benefit a variety of critically ill patients. A woman with diabetic ketoacidosis and severe hypertriglyceridemia was treated with plasmapheresis when conventional treatments did not markedly reduce her triglyceridemia. The patient was admitted to a medical intensive care unit because of diabetic ketoacidosis with severe lipemia. The lipemia-associated interference in laboratory studies made treatment of electrolyte abnormalities extremely difficult. The hypertriglyceridemia was initially treated with insulin, antilipidemic medications, and heparin, but the levels of triglycerides remained elevated, delaying results of needed laboratory studies for hours. After plasmapheresis, the serum level of triglycerides decreased by 77% in less than 24 hours. Severe lipemia interferes with photometric laboratory studies, yielding an underestimation of serum levels of electrolytes. Plasmapheresis is safe, rapid, and effective for emergent management of severe hypertriglyceridemia in critically ill patients. The impact of the procedure on critical care nursing is growing as nurses become involved in the treatment and follow-up care of patients who have plasmapheresis.

  6. Severe accidents in Nuclear Power Plants

    International Nuclear Information System (INIS)

    Valle Cepero, R.; Castillo Alvarez, J.; Ramon Fuente, J.

    1996-01-01

    For the assessment of the safety of nuclear power plants it is of great importance the analyses of severe accidents since they allow to estimate the possible failure models of the containment, and also permit knowing the magnitude and composition of the radioactive material that would be released to the environment in case of an accident upon population and the environment. This paper presents in general terms the basic principles for conducting the analysis of severe accidents, the fundamental sources in the generation of radionuclides and aerosols, the transportation and deposition processes, and also makes reference to de main codes used in the modulation of severe accidents. The final part of the paper contents information on how severe accidents are dialed with the regulatory point view in different countries

  7. Postpartum Depression After Mild and Severe Preeclampsia

    NARCIS (Netherlands)

    Hoedjes, Meeke; Berks, Durk; Vogel, Ineke; Franx, Arie; Bangma, Meike; Darlington, Anne-Sophie E.; Visser, Willy; Duvekot, Johannes J.; Habbema, J. Dik F.; Steegers, Eric A. P.; Raat, Hein

    2011-01-01

    Objective: To describe the prevalence of postpartum depressive symptoms after preeclampsia, to assess the extent to which the prevalence of postpartum depressive symptoms differs after mild and severe preeclampsia, and to investigate which factors contribute to such differences. Methods: Women

  8. Learning about Severe Combined Immunodeficiency (SCID)

    Science.gov (United States)

    ... immunodeficiency From The Journal of Allergy and Clinical Immunology Learning About Severe Combined Immunodeficiency (SCID) What is ... immunodeficiency From The Journal of Allergy and Clinical Immunology Get Email Updates Privacy Copyright Contact Accessibility Plug- ...

  9. Correlates of Illness Severity in Infectious Mononucleosis

    Directory of Open Access Journals (Sweden)

    John Odame

    2014-01-01

    Full Text Available INTRODUCTION: Understanding the spectrum and frequencies of Epstein-Barr virus (EBV complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV-related illnesses.

  10. Selected Geomagnetic Measurements From Several Satellites

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — More than 17 million selected magnetic observations from several orbiting low-altitude satellites are contained in this digital collection. Except for MAGSAT, all...

  11. Chemical phenomena under severe accident conditions

    International Nuclear Information System (INIS)

    Powers, D.A.

    1988-01-01

    A severe nuclear reactor accident is expected to involve a vast number of chemical processes. The chemical processes of major safety significance begin with the production of hydrogen during steam oxidation of fuel cladding. Physico-chemical changes in the fuel and the vaporization of radionuclides during reactor accidents have captured much of the attention of the safety community in recent years. Protracted chemical interactions of core debris with structural concrete mark the conclusion of dynamic events in a severe accident. An overview of the current understanding of chemical processes in severe reactor accident is provided in this paper. It is shown that most of this understanding has come from application of findings from other fields though a few areas have in the past been subject to in-depth study of a fundamental nature. Challenges in the study of severe accident chemistry are delineated

  12. Optimal severance payment: theory and practice

    Czech Academy of Sciences Publication Activity Database

    Jeong, Byeongju

    -, č. 255 (2005), s. 1-22 ISSN 1211-3298 Institutional research plan: CEZ:AV0Z70850503 Keywords : severance payment * optimal separation Subject RIV: AH - Economics http://www.cerge-ei.cz/pdf/wp/Wp255.pdf

  13. Bariatric surgery for severely obese adolescents.

    Science.gov (United States)

    Fitzgerald, Dominic A; Baur, Louise

    2014-09-01

    Severe obesity is increasing in adolescents and is associated with cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnoea, polycystic ovarian syndrome and a range of musculoskeletal problems. Premature death is the inevitable outcome of persistent severe obesity in adolescents. In adults with severe obesity, medical and lifestyle interventions have been shown to be expensive and less effective in terms of weight loss than has bariatric surgery. The single completed randomised controlled trial in adolescents shows the same outcome. This is supported by meta analyses of bariatric surgery in adolescent subjects. A more aggressive approach to severe obesity, utilising bariatric surgery in selected cases, within the context of a multi-disciplinary team, is required. Copyright © 2014. Published by Elsevier Ltd.

  14. Co-morbidities in severe asthma

    DEFF Research Database (Denmark)

    Porsbjerg, Celeste; Menzies-Gow, Andrew

    2017-01-01

    Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma...... to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical...... impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD...

  15. Thromboelastography in patients with severe sepsis

    DEFF Research Database (Denmark)

    Haase, Nicolai; Ostrowski, Sisse Rye; Wetterslev, Jørn

    2015-01-01

    PURPOSE: To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis. METHODS: Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156......) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox...... bleeding [HR 2.43 (1.16-5.07)] and possibly explained the excess bleeding with HES in the 6S trial. CONCLUSIONS: In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding....

  16. Deterministic analyses of severe accident issues

    International Nuclear Information System (INIS)

    Dua, S.S.; Moody, F.J.; Muralidharan, R.; Claassen, L.B.

    2004-01-01

    Severe accidents in light water reactors involve complex physical phenomena. In the past there has been a heavy reliance on simple assumptions regarding physical phenomena alongside of probability methods to evaluate risks associated with severe accidents. Recently GE has developed realistic methodologies that permit deterministic evaluations of severe accident progression and of some of the associated phenomena in the case of Boiling Water Reactors (BWRs). These deterministic analyses indicate that with appropriate system modifications, and operator actions, core damage can be prevented in most cases. Furthermore, in cases where core-melt is postulated, containment failure can either be prevented or significantly delayed to allow sufficient time for recovery actions to mitigate severe accidents

  17. Recurrent severe vomiting due to hyperthyroidism

    OpenAIRE

    Chen, Li-ying; Zhou, Bo; Chen, Zhou-wen; Fang, Li-zheng

    2010-01-01

    Thyrotoxicosis may present in many ways; severe vomiting as a prominent symptom of thyrotoxicosis is uncommon. In this paper, we report a 24-year-old Chinese male with hyperthyroidism who presented with recurrent severe vomiting. The patient had had intermittent vomiting for seven years and had lost approximately 15 kg of weight. Gastroscopic examinations revealed chronic gastritis and one occasion peptic ulcer. He was treated with antacid and proton pump inhibitors, but his symptoms had no r...

  18. Pulse Clarithromycin Therapy In Severe ACNE Vulgaris

    Directory of Open Access Journals (Sweden)

    Rathi Sanjay K

    2002-01-01

    Full Text Available Three patients with severe acne vulgaris, not responding with long courses of doxycycline, minocycline and erythromycin were given oral clarithromycin in pulsed regimen. The patients were given 7 days course of clarithromycin 250mg twice daily, which was repeated after a gap of 10 days. Such 3 courses were given. The lesions responded significantly. No significant side effect was noted. Pulse clarithromycin therapy seems to be a good alternative and effective tool in the management of severe acne vulgaris.

  19. Seckel syndrome with severe sinus bradycardia.

    Science.gov (United States)

    Ramasamy, Chandramohan; Satheesh, Santhosh; Selvaraj, Raja

    2015-03-01

    Seckel syndrome is an uncommon form of microcephalic dwarfism. The authors report a young boy with Seckel syndrome who presented with severe sinus bradycardia with symptoms of syncope and presyncope. Implantation of a permanent pacemaker was necessary in view of the severe symptoms. Although uncommon, cardiac abnormalities have been rarely reported in Seckel syndrome. This is the one of the few reports of rhythm abnormalities in this condition.

  20. Severe Neurotoxicity Following Ingestion of Tetraethyl Lead

    OpenAIRE

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

    2010-01-01

    Organic lead compounds are potent neurotoxins which can result in death even from small exposures. Traditionally, these compounds are found in fuel stabilizers, anti-knock agents, and leaded gasoline. Cases of acute organic lead intoxication have not been reported for several decades. We report a case of a 13-year-old Iraqi male who unintentionally ingested a fuel stabilizer containing 80–90% tetraethyl lead, managed at our combat support hospital. The patient developed severe neurologic symp...

  1. National practices in relation to severe accidents

    International Nuclear Information System (INIS)

    Soda, Kunihisa

    1989-01-01

    After the accidents at Three Mile Island and Chernobyl, many studies have been carried out on severe accidents by various organizations including IAEA and OECD/CSNI. In the present article, measures taken in different countries against severe accidents are outlined based on the results of these studies. In Sweden, policies for the management of a severe accident and reduction in the release of radioactive materials were established based on reports issued by the Atomic Energy Committee, which was set up after the Three Mile Island accident. The current policies require that filter vents be provided where necessary. France, following Sweden, adopted the use of filter vents. Operation procedures to be followed in the event of a severe accident have been established in the nation. The measures against severe accidents adopted in West Germany mainly focus on the weakening of the effects of accidents, and are not covered by the design standards. The use of filter vents are also required in Finland and Switzerland. In the U.S., a program for individual plant examination will be implemented over the three-year period beginning in 1989. Studies on measures against severe accidents seem to be performed also in the Soviet Union. (N.K.)

  2. Jose Cabrera NPP severe accident management activities

    International Nuclear Information System (INIS)

    Blanco, J.; Almeida, P.; Saiz, J.; Sastre, J.L.; Delgado, R.

    1998-01-01

    To prepare a common acting plan with respect to Severe Accident Management, in 1994 was founded the severe accident management ''ad-hoc'' working group from the Spanish Westinghouse PWR Nuclear Power Plant Owners Group. In this group actively collaborated the Jose Cabrera NPP Training Centre and the Department of Nuclear Engineering of UNION FENOSA. From this moment, Jose Cabrera NPP began the planning of its specific Severe Accident Management Program, which main point are Severe Accident Management Guidelines (SAMG). To elaborate this guidelines, the Spanish translation of Westinghouse Owners Group (WOG) Severe Accident Management Guidelines were considered the reference documents. The implementation of this Guidelines to Jose Cabrera NPP started on January 1997. Once the specific guidelines have been implemented to the plant, training activities for the personnel involved in severe accident issues will be developed. To prepare the training exercises MAAP4 code will be used, and with this intention, a specific Jose Cabrera NPP MAAP-GRAAPH screen has been developed. Furthermore, a wide selection of MAAP input files for the simulation of different scenarios and accidental events is available. (Author)

  3. Model for predicting the injury severity score.

    Science.gov (United States)

    Hagiwara, Shuichi; Oshima, Kiyohiro; Murata, Masato; Kaneko, Minoru; Aoki, Makoto; Kanbe, Masahiko; Nakamura, Takuro; Ohyama, Yoshio; Tamura, Jun'ichi

    2015-07-01

    To determine the formula that predicts the injury severity score from parameters that are obtained in the emergency department at arrival. We reviewed the medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The injury severity score, age, mean blood pressure, heart rate, Glasgow coma scale, hemoglobin, hematocrit, red blood cell count, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, and fibrin degradation products, were examined in those patients on arrival. To determine the formula that predicts the injury severity score, multiple linear regression analysis was carried out. The injury severity score was set as the dependent variable, and the other parameters were set as candidate objective variables. IBM spss Statistics 20 was used for the statistical analysis. Statistical significance was set at P  Watson ratio was 2.200. A formula for predicting the injury severity score in trauma patients was developed with ordinary parameters such as fibrin degradation products and mean blood pressure. This formula is useful because we can predict the injury severity score easily in the emergency department.

  4. Application Study of Fire Severity Classification

    International Nuclear Information System (INIS)

    Kim, In Hwan; Kim, Hyeong Taek; Jee, Moon Hak; Kim, Yun Jung

    2013-01-01

    This paper introduces the Fire Incidents Severity Classification Method for Korean NPPs that may be derived directly from the data fields and feasibility study for domestic uses. FEDB was characterized in more detail and assessed based on the significance of fire incidents in the updated database and five fire severity categories were defined. The logical approach to determine the fire severity starts from the most severe characteristics, namely challenging fires, and continues to define the less challenging and undetermined categories in progress. If the FEDB is utilized for Korean NPPs, the ways of Fire Severity Classification suggested in 2.4 above can be utilized for the quantitative fire risk analysis in future. The Fire Events Database (FEDB) is the primary source of fire data which are used for fire frequency in Fire PSA (Probabilistic Safety Assessment). The purpose of its development is to calculate the quantitative fire frequency at the comprehensive and consolidated source derived from the fire incident information available for Nuclear Power Plants (NPPs). Recently, the Fire Events Database (FEDB) was updated by Electric Power Research Institute (EPRI) and Nuclear Regulatory Commission (NRC) in U. S. The FEDB is intended to update the fire event history up to 2009. A significant enhancement to it is the reorganization and refinement of the database structure and data fields. It has been expanded and improved data fields, coding consistency, incident detail, data review fields, and reference data source traceability. It has been designed to better support several Fire PRA uses as well

  5. Use of biologics in severe food allergies.

    Science.gov (United States)

    Fiocchi, Alessandro; Pecora, Valentina; Valluzzi, Rocco L; Fierro, Vincenzo; Mennini, Maurizio

    2017-06-01

    Severe cases of food allergy account for the majority of the burden in terms of risks, quality of life, and resource expenditure. The traditional approach to these forms has been strict avoidance. More recently, Oral ImmunoTherapy (OIT) has gained a role in their management. However, in severe food allergies OIT is often infeasible. Case reports, observational, and prospective studies have recently proposed different approaches to severe food allergy. The majority of them include the use of biologics. Omalizumab has been the most studied drug for severe food allergies, and its role as adjuvant treatment to OIT is well established. Interest has been raised on other biologics, as dupilumab, reslizumab, and mepolizumab. Toll-like receptor agonists, and gene therapy using adeno-associated virus coding for Omalizumab are promising alternatives. The recent studies are deeply influencing the clinical practice. We review the modifications of the clinical approach to severe food allergies so far available. We indicate the possible evolutions of treatment with biologics in severe food allergies.

  6. Conclusions on severe accident research priorities

    International Nuclear Information System (INIS)

    Klein-Heßling, W.; Sonnenkalb, M.; Jacquemain, D.; Clément, B.; Raimond, E.; Dimmelmeier, H.; Azarian, G.; Ducros, G.; Journeau, C.; Herranz Puebla, L.E.; Schumm, A.; Miassoedov, A.; Kljenak, I.; Pascal, G.; Bechta, S.; Güntay, S.; Koch, M.K.; Ivanov, I.; Auvinen, A.; Lindholm, I.

    2014-01-01

    Highlights: • Estimation of research priorities related to severe accident phenomena. • Consideration of new topics, partly linked to the severe accidents at Fukushima. • Consideration of results of recent projects, e.g. SARNET, ASAMPSA2, OECD projects. - Abstract: The objectives of the SARNET network of excellence are to define and work on common research programs in the field of severe accidents in Gen. II–III nuclear power plants and to further develop common tools and methodologies for safety assessment in this area. In order to ensure that the research conducted on severe accidents is efficient and well-focused, it is necessary to periodically evaluate and rank the priorities of research. This was done at the end of 2008 by the Severe Accident Research Priority (SARP) group at the end of the SARNET project of the 6th Framework Programme of European Commission (FP6). This group has updated this work in the FP7 SARNET2 project by accounting for the recent experimental results, the remaining safety issues as e.g. highlighted by Level 2 PSA national studies and the results of the recent ASAMPSA2 FP7 project. These evaluation activities were conducted in close relation with the work performed under the auspices of international organizations like OECD or IAEA. The Fukushima-Daiichi severe accidents, which occurred while SARNET2 was running, had some effects on the prioritization and definition of new research topics. Although significant progress has been gained and simulation models (e.g. the ASTEC integral code, jointly developed by IRSN and GRS) were improved, leading to an increased confidence in the predictive capabilities for assessing the success potential of countermeasures and/or mitigation measures, most of the selected research topics in 2008 are still of high priority. But the Fukushima-Daiichi accidents underlined that research efforts had to focus still more to improve severe accident management efficiency

  7. Correlates of illness severity in infectious mononucleosis

    Science.gov (United States)

    Odame, John; Robinson, Joan; Khodai-Booran, Nasser; Yeung, Simon; Mazzulli, Tony; Stephens, Derek; Allen, Upton D

    2014-01-01

    INTRODUCTION: Understanding the spectrum and frequencies of Epstein-Barr virus (EBV) complications and markers of illness severity in immunocompetent patients with primary EBV infection will inform management of patients with EBV-related illnesses. OBJECTIVES: To determine the clinical and laboratory correlates of illness severity among infants, children and youth with infectious mononucleosis (IM). METHODS: Study subjects with confirmed IM were prospectively enrolled. Illness severity was assessed at baseline and at six weeks using a scoring tool. Peripheral blood viral loads served as a measure of viral burden. RESULTS: Among 32 children and young adults with IM, the median age was 16 years (range two to 24 years). The predominant clinical findings were lymphadenopathy (23 of 32 [72%]), pharyngitis (16 of 32 [50%]), fever (nine of 32 [28%]) and splenomegaly (six of 32 [19%]). With respect to symptoms or signs that persisted to at least six weeks after illness onset, the predominant complaint was lymphadenopathy in 35% of subjects available for reassessment. Deranged liver function tests were present at presentation in up to 44% of subjects. Patients with the highest viral loads at presentation had significantly higher illness severity scores associated with fatigue (P=0.02). Other than the scores associated with fatigue, viral load values were not significantly correlated with the illness severity scores at baseline and at six weeks. CONCLUSION: In IM, viral loads are not necessarily correlated with illness severity, with the exception of fatigue. EBV-related hepatitis is common in IM, confirming the status of this virus as a relatively common cause of transient hepatitis in children and youth. This entity is not necessarily a marker of disease severity. PMID:25371691

  8. Severe accident testing of electrical penetration assemblies

    International Nuclear Information System (INIS)

    Clauss, D.B.

    1989-11-01

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

  9. Cost per severe accident as an index for severe accident consequence assessment and its applications

    International Nuclear Information System (INIS)

    Silva, Kampanart; Ishiwatari, Yuki; Takahara, Shogo

    2014-01-01

    The Fukushima Accident emphasizes the need to integrate the assessments of health effects, economic impacts, social impacts and environmental impacts, in order to perform a comprehensive consequence assessment of severe accidents in nuclear power plants. “Cost per severe accident” is introduced as an index for that purpose. The calculation methodology, including the consequence analysis using level 3 probabilistic risk assessment code OSCAAR and the calculation method of the cost per severe accident, is proposed. This methodology was applied to a virtual 1,100 MWe boiling water reactor. The breakdown of the cost per severe accident was provided. The radiation effect cost, the relocation cost and the decontamination cost were the three largest components. Sensitivity analyses were carried out, and parameters sensitive to cost per severe accident were specified. The cost per severe accident was compared with the amount of source terms, to demonstrate the performance of the cost per severe accident as an index to evaluate severe accident consequences. The ways to use the cost per severe accident for optimization of radiation protection countermeasures and for estimation of the effects of accident management strategies are discussed as its applications. - Highlights: • Cost per severe accident is used for severe accident consequence assessment. • Assessments of health, economic, social and environmental impacts are included. • Radiation effect, relocation and decontamination costs are important cost components. • Cost per severe accident can be used to optimize radiation protection measures. • Effects of accident management can be estimated using the cost per severe accident

  10. Severe accident management. Optimized guidelines and strategies

    International Nuclear Information System (INIS)

    Braun, Matthias; Löffler, Micha; Plank, Hermann; Asse, Dietmar; Dimmelmeier, Harald

    2014-01-01

    The highest priority for mitigating the consequences of a severe accident with core melt lies in securing containment integrity, as this represents the last barrier against fission product release to the environment. Containment integrity is endangered by several physical phenomena, especially highly transient phenomena following high-pressure reactor pressure vessel failure (like direct containment heating or steam explosions which can lead to early containment failure), hydrogen combustion, quasi-static over-pressure, temperature failure of penetrations, and basemat penetration by core melt. Each of these challenges can be counteracted by dedicated severe accident mitigation hardware, like dedicated primary circuit depressurization valves, hydrogen recombiners or igniters, filtered containment venting, containment cooling systems, and core melt stabilization systems (if available). However, besides their main safety function these systems often have also secondary effects that need to be considered. Filtered containment venting causes (though limited) fission product release into the environment, primary circuit depressurization leads to loss of coolant, and an ex-vessel core melt stabilization system as well as hydrogen igniters can generate high pressure and temperature loads on the containment. To ensure that during a severe accident any available systems are used to their full beneficial extent while minimizing their potential negative impact, AREVA has implemented a severe accident management for German nuclear power plants. This concept makes use of extensive numerical simulations of the entire plant, quantifying the impact of system activations (operational systems, safety systems, as well as dedicated severe accident systems) on the accident progression for various scenarios. Based on the knowledge gained, a handbook has been developed, allowing the plant operators to understand the current state of the plant (supported by computational aids), to predict

  11. Predictors of Severity in Pediatric Scrub Typhus.

    Science.gov (United States)

    Narayanasamy, Dinesh Kumar; Arun Babu, Thirunavukkarasu; Vijayadevagaran, Vijayasankar; Kittu, Devi; Ananthakrishnan, Shanthi

    2018-01-24

    To identify the factors that can predict the severity of scrub typhus in children. This prospective study was conducted at a tertiary care teaching hospital between November 2014 to October 2016. All children scrub typhus were included in the study. These children were followed during the hospital course and their laboratory results, response to treatment and complications were documented. Cases of 'severe scrub typhus' were identified based on criteria from published adult and pediatric studies. Out of 930 children with fever for more than 7d, IgM ELISA for scrub typhus was positive in 230 children. Ninety one (40.6%) cases fulfilled the criteria of 'severe scrub typhus' in children. Out of 45 factors, 27 potential factors were studied. The multivariate analysis identified 5 factors, breathlessness (OR: 6.85, 95%CI: 2.69 to 9.87), altered sensorium (OR: 11.48, 95% CI 3.43 to 10.19), leucocytosis (OR: 3.38, 95% CI 1.12 to 10.16), hypoalbuminemia (OR: 10.78, 95% CI 2.66 to 48.76), and hyponatremia (OR: 10.08, 95% CI 2.11 to 23.42) to be significantly associated with the 'severe scrub typhus' cases. Breathlessness, altered sensorium, leucocytosis, hypoalbuminemia, and hyponatremia predict severity in childhood scrub typhus. Presence of these factors should alert the treating physician regarding the need for intensive monitoring, treatment or referral.

  12. Severe accident issue resolution -- definition and perspective

    International Nuclear Information System (INIS)

    Harper, F.T.

    1995-01-01

    The purpose of this discussion is to introduce the session on the Progress on the Resolution of Severe Accident Issues. There has been much work in the area of resolution of severe accident issues over the past few years. This work has been focused on those issues most important to risk as assessed by comprehensive studies such as NUREG-1150. In particular, issues associated with early containment failure have been analyzed. These efforts to resolve issues have been hampered by the fact that open-quotes issue resolutionclose quotes has not always been well defined. The term open-quotes issue resolutionclose quotes conjures tip different images for the regulator, the accident analyst, the physicist, and the probabalist. In fact it is common to have as many different images of issue resolution as there are people in the room. This issue is complicated by the fact that the uncertainty in severe accident issues is enormous. (When convolved, the quantitative uncertainty in an integrated analysis due to severe accident issues can span several orders of magnitude.) In this summary, hierarchy is presented in an attempt to add some perspective to the resolution of issues in the face of large uncertainties. Recommendations are also made for analysts communicating in the area of issue resolution

  13. Severe hypertriglyceridemia-related acute pancreatitis.

    Science.gov (United States)

    Stefanutti, Claudia; Labbadia, Giancarlo; Morozzi, Claudia

    2013-04-01

    Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. In some cases, inborn errors of metabolism such as lipoprotein lipase deficiency, apoprotein C-II deficiency, and familial hypertriglyceridemia have been reported as causes of severe hypertriglyceridemia. More often, severe hypertriglyceridemia describes various clinical conditions characterized by high plasma levels of triglycerides (>1000 mg/dL), chylomicron remnants, or intermediate density lipoprotein like particles, and/or chylomicrons. International guidelines on the management of acute pancreatitis are currently available. Standard therapeutic measures are based on the use of lipid-lowering agents (fenofibrate, gemfibrozil, niacin, Ω-3 fatty acids), low molecular weight heparin, and insulin in diabetic patients. However, when standard medical therapies have failed, non-pharmacological approaches based upon the removal of triglycerides with therapeutic plasma exchange can also provide benefit to patients with severe hypertriglyceridemia and acute pancreatitis. Plasma exchange could be very helpful in reducing triglycerides levels during the acute phase of hyperlipidemic pancreatitis, and in the prevention of recurrence. The current evidence on management of acute pancreatitis and severe hypertriglyceridemia, focusing on symptoms, treatment and potential complications is reviewed herein. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  14. Use of simulators in severe accident management

    International Nuclear Information System (INIS)

    Evans, R.C.

    1994-01-01

    The U.S. nuclear utility industry is moving in a deliberate fashion through a coordinated industry severe accident working group to study and augment, where appropriate, the existing utility organizational and emergency planning structure to address accident and severe accident management. Full-scope simulators are used extensively to train licensed operators for their initial license examinations and continually thereafter in licensed operator requalification training and yearly examinations. The goal of the training (both initial and requalification) is to ensure that operators possess adequate knowledge, skills and abilities to prevent an event from progressing to core damage. The use of full-scope simulators in severe accident management training is in large part viewed by the industry as being premature. The working group study has not progressed to the point where the decision to employ full-scope simulators can be logically considered. It is not however premature to consider part-task or work station simulators as invaluable research tools to support the industry's study. These simulators could be employed, subject to limitations in the current state of knowledge regarding severe accident progression and phenomenological responses, in the validation and verification (V and V) of severe accident models or codes as they are developed. The U.S. nuclear utility industry has made substantial strides in the past 12 years in the accident prevention, mitigation and management arena. These strides are a product of the industry's preference for a logical and systematic approach to change. (orig.)

  15. Anaesthetic management of patients with severe sepsis.

    Science.gov (United States)

    Eissa, D; Carton, E G; Buggy, D J

    2010-12-01

    Severe sepsis, a syndrome characterized by systemic inflammation and acute organ dysfunction in response to infection, is a major healthcare problem affecting all age groups throughout the world. Anaesthetists play a central role in the multidisciplinary management of patients with severe sepsis from their initial deterioration at ward level, transfer to the diagnostic imaging suite, and intraoperative management for emergency surgery. The timely administration of appropriate i.v. antimicrobial therapy is a crucial step in the care of patients with severe sepsis who may require surgery to control the source of sepsis. Preoperative resuscitation, aimed at optimizing major organ perfusion, is based on judicious use of fluids, vasopressors, and inotropes. Intraoperative anaesthesia management requires careful induction and maintenance of anaesthesia, optimizing intravascular volume status, avoidance of lung injury during mechanical ventilation, and ongoing monitoring of arterial blood gases, lactate concentration, haematological and renal indices, and electrolyte levels. Postoperative care overlaps with ongoing management of the severe sepsis syndrome patient in the intensive care unit. These patients are by definition, high risk, already requiring multiple supports, and require experienced and skilful decision-making to optimize their chances of a favourable outcome. Similar to acute myocardial infarction, stroke, or acute trauma, the initial hours (golden hours) of clinical management of severe sepsis represent an important opportunity to reduce morbidity and mortality. Rapid clinical assessment, resuscitation and surgical management by a focused multidisciplinary team, and early effective antimicrobial therapy are the key components to improved patient outcome.

  16. Coolability of severely degraded CANDU cores

    International Nuclear Information System (INIS)

    Meneley, D.A.; Blahnik, C.; Rogers, J.T.; Snell, V.G.; Mijhawan, S.

    1995-07-01

    Analytical and experimental studies have shown that the separately cooled moderator in a CANDU reactor provides an effective heat sink in the event of a loss-of-coolant accident (LOCA) accompanied by total failure of the emergency core cooling system (ECCS). The moderator heat sink prevents fuel melting and maintains the integrity of the fuel channels, therefore terminating this severe accident short of severe core damage. Nevertheless, there is a probability, however low, that the moderator heat sink could fail in such an accident. The pioneering work of Rogers (1984) for such a severe accident using simplified models showed that the fuel channels would fail and a bed of dry, solid debris would be formed at the bottom of the calandria which would heat up and eventually melt. However, the molten pool of core material would be retained in the calandria vessel, cooled by the independently cooled shield-tank water, and would eventually re solidify. Thus, the calandria vessel would act inherently as a core-catcher as long as the shield tank integrity is maintained. The present paper reviews subsequent work on the damage to a CANDU core under severe accident conditions and describes an empirically based mechanistic model of this process. It is shown that, for such severe accident sequences in a CANDU reactor, the end state following core disassembly consists of a porous bed of dry solid, coarse debris, irrespective of the initiating event and the core disassembly process. (author). 48 refs., 3 tabs., 18 figs

  17. Coolability of severely degraded CANDU cores. Revised

    International Nuclear Information System (INIS)

    Meneley, D.A.; Blahnik, C.; Rogers, J.T.; Snell, V.G.; Nijhawan, S.

    1996-01-01

    Analytical and experimental studies have shown that the separately cooled moderator in a CANDU reactor provides an effective heat sink in the event of a loss-of-coolant accident (LOCA) accompanied by total failure of the emergency core cooling system (ECCS). The moderator heat sink prevents fuel melting and maintains the integrity of the fuel channels, therefore terminating this severe accident short of severe core damage. Nevertheless, there is a probability, however low, that the moderator heat sink could fail in such an accident. The pioneering work of Rogers (1984) for such a severe accident using simplified models showed that the fuel channels would fail and a bed of dry, solid debris would be formed at the bottom of the calandria which would heat up and eventually melt. However, the molten pool of core material would be retained in the calandria vessel, cooled by the independently cooled shield-tank water, and would eventually resolidify. Thus, the calandria vessel would act inherently as a 'core-catcher' as long as the shield tank integrity is maintained. The present paper reviews subsequent work on the damage to a CANDU core under severe accident conditions and describes an empirically based mechanistic model of this process. It is shown that, for such severe accident sequences in a CANDU reactor, the end state following core disassembly consists of a porous bed of dry solid, coarse debris, irrespective of the initiating event and the core disassembly process. (author)

  18. Interaction of radionuclides in severe accident conditions

    International Nuclear Information System (INIS)

    Nagrale, Dhanesh B.; Bera, Subrata; Deo, Anuj Kumar; Paul, U.K.; Prasad, M.; Gaikwad, A.J.

    2015-01-01

    Nuclear power plants are designed with inherent engineering safety systems and associated operational procedures that provide an in-depth defence against accidents. Radionuclides such as Iodine, Cesium, Tellurium, Barium, Strontium, Rubidium, Molybdenum and many others may get released during a severe accident. Among these, Iodine, one of the fission products, behaviour is significant for the analysis of severe accident consequences because iodine is a chemically more active to the potential components released to the environment. During severe accident, Iodine is released and transported in aqueous, organic and inorganic forms. Iodine release from fuel, iodine transport in primary coolant system, containment, and reaction with control rods are some of the important phases in a severe accident scenario. The behaviour of iodine is governed by aerosol physics, depletion mechanisms gravitational settling, diffusiophoresis and thermophoresis. The presence of gaseous organic compounds and oxidizing compounds on iodine, reactions of aerosol iodine with boron and formation of cesium iodide which results in more volatile iodine release in containment play significant roles. Water radiolysis products due to presence of dissolved impurities, chloride ions, organic impurities should be considered while calculating iodine release. Containment filtered venting system (CFVS) consists of venturi scrubber and a scrubber tank which is dosed with NaOH and NaS_2O_3 in water where iodine will react with the chemicals and convert into NaI and Na_2SO_4. This paper elaborates the issues with respect to interaction of radionuclides and its consideration in modeling of severe accident. (author)

  19. Kiss-induced severe anaphylactic reactions

    Directory of Open Access Journals (Sweden)

    Atanasković-Marković Marina

    2010-01-01

    Full Text Available Introduction. Ingestion is the principal route for food allergens to trigger allergic reaction in atopic persons. However, in some highly sensitive patients severe symptoms may develop upon skin contact and by inhalation. The clinical spectrum ranges from mild facial urticaria and angioedema to life-threatening anaphylactic reactions. Outline of Cases. We describe cases of severe anaphylactic reactions by skin contact, induced by kissing in five children with prior history of severe anaphylaxis caused by food ingestion. These cases were found to have the medical history of IgE mediated food allergy, a very high total and specific serum IgE level and very strong family history of allergy. Conclusion. The presence of tiny particles of food on the kisser's lips was sufficient to trigger an anaphylactic reaction in sensitized children with prior history of severe allergic reaction caused by ingestion of food. Allergic reaction provoked with food allergens by skin contact can be a risk factor for generalized reactions. Therefore, extreme care has to be taken in avoiding kissing allergic children after eating foods to which they are highly allergic. Considering that kissing can be a cause of severe danger for the food allergic patient, such persons should inform their partners about the risk factor for causing their food hypersensitivity.

  20. United States position on severe accidents

    International Nuclear Information System (INIS)

    Ross, D.F.

    1988-01-01

    The United States policy on severe accidents was published in 1985 for both new plant applications and for existing plants. Implementation of this policy is in progress. This policy, aided by a related safety goal policy and by analysis capabilities emerging from improved understanding of accident phenomenology, is viewed as a logical development from the pioneering work in the WASH-1400 Reactor Safety Study published by the United States Nuclear Regulatory Commission (NRC) in 1975. This work provided an estimate of the probability and consequences of severe accidents which, prior to that time, had been mostly evaluated by somewhat arbitrary assumptions dating back 30 years. The early history of severe accident evaluation is briefly summarized for the period 1957-1979. Then, the galvanizing action of Three Mile Island Unit 2 (TMI-2) on severe accident analysis, experimentation and regulation is reviewed. Expressions of US policy in the form of rulemaking, severe accident policy, safety research, safety goal policy and court decisions (on adequacy of safety) are discussed. Finally, the NRC policy as of March 1988 is stated, along with a prospective look at the next few years. (author). 19 refs

  1. Uncertainties and severe-accident management

    International Nuclear Information System (INIS)

    Kastenberg, W.E.

    1991-01-01

    Severe-accident management can be defined as the use of existing and or alternative resources, systems, and actions to prevent or mitigate a core-melt accident. Together with risk management (e.g., changes in plant operation and/or addition of equipment) and emergency planning (off-site actions), accident management provides an extension of the defense-indepth safety philosophy for severe accidents. A significant number of probabilistic safety assessments have been completed, which yield the principal plant vulnerabilities, and can be categorized as (a) dominant sequences with respect to core-melt frequency, (b) dominant sequences with respect to various risk measures, (c) dominant threats that challenge safety functions, and (d) dominant threats with respect to failure of safety systems. Severe-accident management strategies can be generically classified as (a) use of alternative resources, (b) use of alternative equipment, and (c) use of alternative actions. For each sequence/threat and each combination of strategy, there may be several options available to the operator. Each strategy/option involves phenomenological and operational considerations regarding uncertainty. These include (a) uncertainty in key phenomena, (b) uncertainty in operator behavior, (c) uncertainty in system availability and behavior, and (d) uncertainty in information availability (i.e., instrumentation). This paper focuses on phenomenological uncertainties associated with severe-accident management strategies

  2. The development of severe accident analysis technology

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Heuy Dong; Cho, Sung Won; Kim, Sang Baek; Park, Jong Hwa; Lee, Kyu Jung; Park, Lae Joon; Hu, Hoh; Hong, Sung Wan [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    1993-07-01

    The objective of the development of severe accident analysis technology is to understand the severe accident phenomena such as core melt progression and to provide a reliable analytical tool to assess severe accidents in a nuclear power plant. Furthermore, establishment of the accident management strategies for the prevention/mitigation of severe accidents is also the purpose of this research. The study may be categorized into three areas. For the first area, two specific issues were reviewed to identify the further research direction, that is the natural circulation in the reactor coolant system and the fuel-coolant interaction as an in-vessel and an ex-vessel phenomenological study. For the second area, the MELCOR and the CONTAIN codes have been upgraded, and a validation calculation of the MELCOR has been performed for the PHEBUS-B9+ experiment. Finally, the experimental program has been established for the in-vessel and the ex-vessel severe accident phenomena with the in-pile test loop in KMRR and the integral containment test facilities, respectively. (Author).

  3. Occurrence and severity of agitated behavior after severe traumatic brain injury

    DEFF Research Database (Denmark)

    Moth Wolffbrandt, Mia; Poulsen, Ingrid; Engberg, Aase W

    2013-01-01

    To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS).......To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS)....

  4. NPP Krsko Severe Accident Management Guidelines Upgrade

    International Nuclear Information System (INIS)

    Mihalina, Mario; Spalj, Srdjan; Glaser, Bruno; Jalovec, Robi; Jankovic, Gordan

    2014-01-01

    Nuclear Power Plant Krsko (NEK) has decided to take steps for upgrade of safety measures to prevent severe accidents, and to improve the means to successfully mitigate their consequences. The content of the program for the NEK Safety Upgrade is consistent with the nuclear industry response to Fukushima accident, which revealed many new insights into severe accidents. Therefore, new strategies and usage of new systems and components should be integrated into current NEK Severe Accident Management Guidelines (SAMG's). SAMG's are developed to arrest the progression of a core damage accident and to limit the extent of resulting releases of fission products. NEK new SAMG's revision major changes are made due to: replacement of Electrical Recombiners by Passive Autocatalytic Recombiners (PARs) and the installation of Passive Containment Filtered Vent System (PCFV); to handle a fuel damage situation in Spent Fuel Pool (SFP) and to assess risk of core damage situation during shutdown operation. (authors)

  5. SEVERE ACCIDENT MANAGEMENT STATUS AT Loviisa

    International Nuclear Information System (INIS)

    Kymalainen, O.; Tuomisto, H.

    1997-01-01

    Some of the specific design features of IVO's Loviisa Plant, most notably the ice-condenser containment, strongly affect the plant response in a hypothetical core melt accident. They have together with the relatively stringent Finnish regulatory requirements forced IVO to develop a tailor made severe accident management strategy for Loviisa. The low design pressure of the ice-condenser containment complicates the design of the hydrogen management system. On the other hand, the ice-condensers and the water available from them are facilitating factors regarding in-vessel retention of corium by external cooling of reactor pressure vessel. This paper summarizes the Finnish severe accident requirements, IVO's approach to severe accidents, and its application to the Loviisa Plant

  6. Staphylococcus aureus and hand eczema severity

    DEFF Research Database (Denmark)

    Haslund, P; Bangsgaard, N; Jarløv, J O

    2009-01-01

    BACKGROUND: The role of bacterial infections in hand eczema (HE) remains to be assessed. OBJECTIVES: To determine the prevalence of Staphylococcus aureus in patients with HE compared with controls, and to relate presence of S. aureus, subtypes and toxin production to severity of HE. METHODS......: Bacterial swabs were taken at three different visits from the hand and nose in 50 patients with HE and 50 controls. Staphylococcus aureus was subtyped by spa typing and assigned to clonal complexes (CCs), and isolates were tested for exotoxin-producing S. aureus strains. The Hand Eczema Severity Index...... and in the nose in all cases, and between visits in 90% of cases. Ten different CC types were identified, no association with severity was found, and toxin-producing strains were not found more frequently in patients with HE than in controls. CONCLUSIONS: Staphylococcus aureus was present on hands in almost half...

  7. Harmonic and complex analysis in several variables

    CERN Document Server

    Krantz, Steven G

    2017-01-01

    Authored by a ranking authority in harmonic analysis of several complex variables, this book embodies a state-of-the-art entrée at the intersection of two important fields of research: complex analysis and harmonic analysis. Written with the graduate student in mind, it is assumed that the reader has familiarity with the basics of complex analysis of one and several complex variables as well as with real and functional analysis. The monograph is largely self-contained and develops the harmonic analysis of several complex variables from the first principles. The text includes copious examples, explanations, an exhaustive bibliography for further reading, and figures that illustrate the geometric nature of the subject. Each chapter ends with an exercise set. Additionally, each chapter begins with a prologue, introducing the reader to the subject matter that follows; capsules presented in each section give perspective and a spirited launch to the segment; preludes help put ideas into context. Mathematicians and...

  8. Current management of severe dengue infection.

    Science.gov (United States)

    Lee, Tau Hong; Lee, Linda Kay; Lye, David Chien; Leo, Yee Sin

    2017-01-01

    Traditionally a disease mainly affecting the pediatric population, dengue burden has increased significantly in recent decades and adults with severe disease may become more common. There is currently no effective anti-viral agent available for the treatment of dengue and supportive care is the mainstay of management. Areas covered: We present a review of current literature on dengue severity classification systems and the management of severe dengue in adults. In particular, emphasis was placed on organ impairment in dengue and management of elderly individuals with multiple medical problems. Expert commentary: There is an urgent need to search for an effective anti-viral agent to treat infected individuals. The commercial availability of a dengue vaccine in older children has provided optimism in reducing the disease burden but long term efficacy and safety are unknown. The results from phase III trials of two new candidate vaccines are eagerly awaited.

  9. A review of severe accident assessment

    International Nuclear Information System (INIS)

    Kawashima, Kei

    2000-01-01

    One of the most difficult problems on evaluation of external costs on nuclear power generation is value on a severe accident risk. Once forming a severe accident, its effect is very important and extends to a wide range, to give a lot of damages. It is a main area of study on externality of energy to compare various risks by means of price conversion at unit kWh. Here was outlined on research examples on main severe accident risks before then. A common fact on estimation cost such research examples is to limit it to direct cost (mainly to health damage) at accident phenomenon. As an actual problem, it is very difficult to substantially quantify such parameters because of basically belonging to social psychology. It is due to no finding out decisive evaluation method on this problem to be adopted conventional EED (Expert Expected Damages) approach in the ExternE Phase III, either. (G.K.)

  10. Hepatitis E-induced severe myositis.

    Science.gov (United States)

    Mengel, Annerose M; Stenzel, Werner; Meisel, Andreas; Büning, Carsten

    2016-02-01

    Hepatitis E virus (HEV) is endemic in Asian and African countries but is rarely reported in Western countries. Although there are some prominent neurological manifestations, HEV is rarely recognized by neurologists. This is a case report of myositis induced by HEV. We report the life-threatening case of a 57-year-old man with flaccid tetraparesis due to myositis, acute hepatitis, and renal failure caused by HEV infection. Muscle biopsy revealed scattered myofiber necrosis with a diffuse, mild lymphomonocytic infiltrate in the endomysium and perimysium. Because the patient suffered from an acute HEV infection with a rapidly progressive course of severe myopathy, we started ribavirin treatment. He recovered partially within 3 weeks and recovered fully within 6 months. This case highlights a neurological manifestation of endemic HEV infection with severe myositis in a patient with alcoholic chronic liver disease. Ribavirin treatment is effective in severe HEV infection and may also lead to rapid neurological recovery. © 2015 Wiley Periodicals, Inc.

  11. Severe accident mitigation through containment design

    International Nuclear Information System (INIS)

    Bergeron, K.D.

    1990-01-01

    Recent US Department of Energy plans to construct a Heavy Water Reactor for the production of defense nuclear materials have created a unique opportunity to explore ways to mitigate severe accident concerns in the design stage. Drawing on an extensive background in USNRC-sponsored severe accident work, Sandia National Laboratories has been exploring a number of Heavy Water New Production Reactor (HW-NPR) containment design strategies that might mitigate the consequences of a core-melt accident without greatly impacting construction cost or reactor operations. Severe accident specialists have undertaken these assessments with the intent of providing the plant designers with some of the phenomenological advantages and disadvantages of various mitigation strategies. This paper will highlight some of the more interesting concepts and summarize the results obtained. 9 refs., 2 tabs

  12. Severe accident mitigation through containment design

    International Nuclear Information System (INIS)

    Bergeron, K.D.

    1990-01-01

    Recent U.S. Department of Energy plans to construct a Heavy Water Reactor for the production of defense nuclear materials have created a unique opportunity to explore ways to mitigate severe accident concerns in the design stage. Drawing on an extensive background in US-NRC-sponsored severe accident work, Sandia National Laboratories has been exploring a number of Heavy Water New Production Reactor (HW-NPR) containment design strategies that might mitigate the consequences of a core-melt accident without greatly impacting construction cost or reactor operations. Severe accident specialists have undertaken these assessments with the intent of providing the plant designers with some of the phenomenological advantages and disadvantages of various mitigation strategies. This paper will highlight some of the more interesting concepts and summarize the results obtained. (author). 9 refs., 2 tabs

  13. MRI manifestations of severe SSPE in infants

    International Nuclear Information System (INIS)

    Liu Hui; Xiao Enhua; Tan Lihua; Wu Xiaochuan; Fan Songqing

    2006-01-01

    Objective: To improve the understanding of MRI findings in severe SSPE. Methods: The MRI features in 2 cases of severe SSPE confirmed by pathology were reported, and related literature was reviewed. Results: In one case, various degrees of asymmetrical cerebral swelling were seen in bilateral gray matter and white matter under the cortex, and without clear dividing line between gray and white matter, especially in temporal lobe. Abnormal signals were revealed on T 1 and T 2 WI. In another case, lesions in the brain stem, temporal lobe, globus pallidus, putamen, thalamus, and radiate coronet showed hypointense signal on T 1 WI and hyperintense signal on T 2 WI with cerebral swelling, and no obviouse cerebral atrophy was found. The local abnormal lesions had occupying effects and enhancement in both cases. Conclusion: Lasting of various degrees of cerebral swelling may be the characteristic sign on MRI in severe SSPE, differing from cerebral atrophy that might be seen in common SSPE. (authors)

  14. Bone scanning in severe external otitis

    International Nuclear Information System (INIS)

    Levin, W.J.; Shary, J.H. III; Nichols, L.T.; Lucente, F.E.

    1986-01-01

    Technetium99 Methylene Diphosphate bone scanning has been considered an early valuable tool to diagnose necrotizing progressive malignant external otitis. However, to our knowledge, no formal studies have actually compared bone scans of otherwise young, healthy patients with severe external otitis to scans of patients with clinical presentation of malignant external otitis. Twelve patients with only severe external otitis were studied with Technetium99 Diphosphate and were compared to known cases of malignant otitis. All scans were evaluated by two neuroradiologists with no prior knowledge of the clinical status of the patients. Nine of the 12 patients had positive bone scans with many scans resembling those reported with malignant external otitis. Interestingly, there was no consistent correlation between the severity of clinical presentation and the amount of Technetium uptake. These findings suggest that a positive bone scan alone should not be interpreted as indicative of malignant external otitis

  15. Eating disorder severity and functional impairment

    DEFF Research Database (Denmark)

    Davidsen, Annika Helgadóttir; Hoyt, William T.; Poulsen, Stig Bernt

    2017-01-01

    Purpose: The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship. Methods: The study included 159 patients...... was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically. Results: Duration of illness significantly moderated the relationship between eating disorder severity and functional...... impairment; the relationship was strongest for patients with a shorter duration of illness. Psychological distress partly mediated the relationship between eating disorder severity and functional impairment. Duration of illness significantly moderated the relationship between psychological distress...

  16. Management of severe hypertension in the newborn.

    Science.gov (United States)

    Dionne, Janis M; Flynn, Joseph T

    2017-12-01

    Blood pressure is considered a vital sign, as values too low or too high can be related with serious morbidity and mortality. In neonates, normal blood pressure values undergo rapid changes, especially in premature infants, making the recognition of abnormal blood pressures more challenging. Severe hypertension can occur in neonates and infants and is a medical emergency, often manifesting with congestive heart failure or other life-threatening complications. The cause or risk factors for the hypertension can usually be identified and may guide management. Most classes of antihypertensive medications have been used in the neonatal population. For severe hypertension, intravenous short-acting medications are preferred for a controlled reduction of blood pressure. In this article, we focus on identification, aetiology and management of severe hypertension in the newborn. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. [Severe vaginal discharge following rectal surgery].

    Science.gov (United States)

    Burg, L C; Bremers, A J A; Heesakkers, J P F A; Kluivers, K B

    2018-01-01

    Almost 50% of women who have had rectal surgery subsequently develop vaginal discharge. Due to the recurrent and unexpected nature of this heavy discharge, they often experience it as very distressing. Many of these women undergo extensive diagnostic tests that are mainly focused on identifying fistula formation. If no fistula is found, in most cases no other cause for severe vaginal discharge can be demonstrated. In our practice, we saw three patients (49-, 54- and 74-years-old, respectively) with similar severe vaginal discharge after rectal surgery and in whom no explanation for the vaginal discharge could be found. For this reason we conducted a literature search into this condition. Anatomical changes appear to be responsible for heavy vaginal discharge following rectal surgery. Changes in pelvic floor muscles and compression of the distal part of the vagina may lead to pooling of fluid in the proximal part of the vagina, resulting in severe discharge. Symptomatic treatment may reduce the symptoms.

  18. Severe accident testing of a personnel airlock

    International Nuclear Information System (INIS)

    Clauss, D.B.; Parks, M.B.; Julien, J.T.; Peters, S.W.

    1988-01-01

    Sandia National Laboratories (Sandia) is investigating the leakage potential of mechanical penetrations as part of a research program on containment integrity under severe accident loads for the U.S. Nuclear Regulatory Commission (NRC). Barnes et al. (1984) and Shackelford et al. (1985) identified leakage from personnel airlocks as an important failure mode of containments subject to severe accident loads. However, these studies were based on relatively simple analysis methods. The complex structural interaction between the door, gasket, and bulkhead in personnel airlocks makes analytical evaluation of leakage difficult. In order to provide data to validate methods for evaluating the leakage potential, a full-size personnel airlock was subject to simulated severe accident loads consisting of pressure and temperature up to 300 psig and 800 degrees F. The test was conducted at Chicago Bridge and Iron under contract to Sandia. The authors provide a detailed report on the test program

  19. Severe chronic allergic (and related) diseases

    DEFF Research Database (Denmark)

    Bousquet, J; Anto, J M; Demoly, P

    2012-01-01

    -up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic...... and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness...... and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies....

  20. A discussion on disease severity index values: using the disease severity index for null hypothesis testing

    Science.gov (United States)

    A disease severity index (DSI) is a single number for summarizing a large amount of information on disease severity. It has been used to indicate the performance of a cultivar in regard to disease resistance at a particular location, to relate disease severity to yield loss, to determine the effecti...

  1. Managing problematic severe asthma: beyond the guidelines.

    Science.gov (United States)

    Pike, Katharine C; Levy, Mark L; Moreiras, John; Fleming, Louise

    2018-04-01

    This review discusses issues related to managing problematic severe asthma in children and young people. A small minority of children have genuinely severe asthma symptoms which are difficult to control. Children with genuinely severe asthma need investigations and treatments beyond those described within conventional guidelines. However, the majority of children with poor symptom control despite high-intensity treatment achieve improvement in their asthma control once attention has been paid to the basics of asthma management. Basic asthma management requires optimisation of inhaler technique and treatment adherence, avoidance of environmental triggers and self-management education. It is also important that clinicians recognise risk factors that predispose patients to asthma exacerbations and potentially life-threatening attacks. These correctable issues need to be tackled in partnership with children and young people and their families. This requires a coordinated approach between professionals across healthcare settings. Establishing appropriate infrastructure for coordinated asthma care benefits not only those with problematic severe asthma, but also the wider asthma population as similar correctable issues exist for children with asthma of all severities. Investigation and management of genuine severe asthma requires specialist multidisciplinary expertise and a systematic approach to characterising patients' asthma phenotypes and delivering individualised care. While inhaled corticosteroids continue to play a leading role in asthma therapy, new treatments on the horizon might further support phenotype-specific therapy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Severe hypoglycaemia associated with ingesting counterfeit medication.

    Science.gov (United States)

    Chaubey, Santosh K; Sangla, Kunwarjit S; Suthaharan, Emershia N; Tan, Yong M

    2010-06-21

    Cross-border importation of traditional and prescription medications is common, and many of these drugs are not approved by the Australian Therapeutic Goods Administration. Furthermore, counterfeit versions of prescription medications are also available (eg, weight-loss medications, anabolic steroids, and medications to enhance sexual performance). We describe a 54-year-old man with the first Australian case of severe hypoglycaemia induced by imported, laboratory-confirmed counterfeit Cialis. This serves to remind medical practitioners that counterfeit medication may be the cause of severe hypoglycaemia (or other unexplained illness).

  3. Concrete under severe conditions. Environment and loading

    International Nuclear Information System (INIS)

    2007-01-01

    The objective of the CONSEC Conferences is to focus on concrete infrastructures, either subjected to severe environment or severe loading, or any combination of severe conditions. Experience from the performance of existing concrete structures, and especially under severe environmental conditions, severe accidental loading or extended lifespan, has demonstrated the need for better integration of structural and durability design, new design concepts including reliability-based durability design, performance-based material requirements, structural robustness, and an improved basis for documentation of obtained construction quality and durability properties during concrete construction. An improved basis for operation and preventive maintenance of concrete structures including repairs and retrofitting is also very important. Premature corrosion of reinforcing steel, inadequate structural design for seismic or blast loading, are examples of reduced service life of concrete structures that not only represent technical and economical problems, but also a huge waste of natural resources and hence also, an environmental and ecological problem. Experience of structures effectively submitted to severe conditions represents a unique benchmark for quantifying the actual safety and durability margin of concrete structures. In fact for several reasons, most concrete design codes, job specifications and other requirements for concrete structures have frequently shown to yield insufficient and unsatisfactory results and ability to solve the above problems, as well as issues raised by specific very long-term or very severe requirements for nuclear and industrial waste management, or civil works of strategic relevance. Recently available high to ultra-high performance concrete may find rational and valuable application in such cases. It is very important, therefore, to bring people with different professional backgrounds together to exchange experience and develop multi

  4. Lectures on counterexamples in several complex variables

    CERN Document Server

    Fornæss, John Erik

    2007-01-01

    Counterexamples are remarkably effective for understanding the meaning, and the limitations, of mathematical results. Fornæss and Stensønes look at some of the major ideas of several complex variables by considering counterexamples to what might seem like reasonable variations or generalizations. The first part of the book reviews some of the basics of the theory, in a self-contained introduction to several complex variables. The counterexamples cover a variety of important topics: the Levi problem, plurisubharmonic functions, Monge-Ampère equations, CR geometry, function theory, and the \\bar\\

  5. Analytic functions of several complex variables

    CERN Document Server

    Gunning, Robert C

    2009-01-01

    The theory of analytic functions of several complex variables enjoyed a period of remarkable development in the middle part of the twentieth century. After initial successes by Poincaré and others in the late 19th and early 20th centuries, the theory encountered obstacles that prevented it from growing quickly into an analogue of the theory for functions of one complex variable. Beginning in the 1930s, initially through the work of Oka, then H. Cartan, and continuing with the work of Grauert, Remmert, and others, new tools were introduced into the theory of several complex variables that resol

  6. Estuary wader capacity following severe weather mortality

    International Nuclear Information System (INIS)

    Clark, J.A.; Baillie, S.R.; Clark, N.A.; Langston, R.H.W.

    1993-01-01

    The building of a tidal power barrage across an estuary may lead to substantial changes in its ecology. Many of Britain's estuaries hold internationally important numbers of waders. Careful consideration, therefore, needs to be given to the likely effects of tidal power barrages on wader populations. The opportunity for increased understanding of the mechanisms which govern wader populations was provided by a period of severe winter weather in 1991, which resulted in a substantial mortality of waders in eastern England. Such conditions are known to be stressful to birds and the study objectives were to investigate both the effects of and recovery from severe weather. (author)

  7. Acute severe asthma presenting in late pregnancy.

    Science.gov (United States)

    Holland, S M; Thomson, K D

    2006-01-01

    Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.

  8. Neuropsychiatric aspects of severe brain injuries

    Directory of Open Access Journals (Sweden)

    O. S. Zaitsev

    2012-01-01

    Full Text Available The state-of-the-art of Russian neuropsychiatry and priority developments in different psychopathological syndromes in severe brain injuries are assessed. Many cognitive and emotional impairments are explained in terms of the idea on the organization of psychic activity over time. It is emphasized that to achieve the premorbid levels of an interhemispheric interaction and functional asymmetry of the cerebral hemispheres affords psychic activity recovery. The experience in investigating, classifying, and treating various mental disorders occurring after severe brain injuries is generalized. The basic principles of psychopharmacotherapy and rehabilitation of victims are stated.

  9. Cylindrical pressure vessel constructed of several layers

    International Nuclear Information System (INIS)

    Yamauchi, Takeshi.

    1976-01-01

    For a cylindrical pressure vessel constructed of several layers whose jacket has at least one circumferential weld joining the individual layers, it is proposed to provide this at least at the first bending line turning point (counting from the weld between the jacket and vessel floor), which the sinusoidally shaped jacket has. The section of the jacket extending in between should be made as a full wall section. The proposal is based on calculations of the bending stiffness of cylindrical jackets, which could not yet be confirmed for jackets having several layers. (UWI) [de

  10. Heat transfer phenomena revelant to severe accidents

    International Nuclear Information System (INIS)

    Dallman, R.J.; Duffey, R.B.

    1990-01-01

    A number of aspects of severe accidents have been reviewed, particularly in relation to the heat transfer characteristics and the important phenomena. It is shown that natural circulation, forced convection, and entrainment phenomena are important for both the reactor system and ex-vessel events. It is also shown that the phenomena related to two component enhanced heat transfer is important in the pool of molten core debris, in relation to the potential for attack of the liner structure and the concrete. These mechanisms are discussed within the general context of severe accident progression

  11. Heat transfer phenomena relevant to severe accidents

    International Nuclear Information System (INIS)

    Dallman, R.J.; Duffey, R.B.

    1990-01-01

    A number of aspects of severe accidents have been reviewed, particularly in relation to the heat transfer characteristics and the important phenomena. It is shown that natural circulation, forced convection, and entrainment phenomena are important for both the reactor system and ex-vessel events. It is also shown that the phenomena related to two component enhanced heat transfer is important in the pool of molten core debris, in relation to the potential for attack of the liner structure and the concrete. These mechanisms are discussed within the general context of severe accident progression. 26 refs

  12. Therapy of moderate and severe psoriasis

    Directory of Open Access Journals (Sweden)

    Werfel, Thomas

    2006-04-01

    Full Text Available Objective and methods: This health technology assessment (HTA report synthesises systematically randomized controlled studies (RCT on the therapy of moderate and severe psoriasis vulgaris which were published between 1999 and 2004; it includes some important clinical studies which have been published after 2004 and thus updates the English HTA report by Griffiths et al. [1]. The major objective is the evaluation of the medical effectiveness of different therapeutical approaches and the cost effectiveness with relevance for Germany. Results: The major conclusions from the results of medical RCT on moderate and severe psoriasis vulgaris are: Oral fumarates are effective in the treatment of moderate to severe psoriasis vulgaris. However, fumarates quiet frequently cause moderate side effects. Cyclosporine and methotrexate are both effective in the treatment of severe psoriasis vulgaris. Both substances have a different spectrum of side effects which may limit the individual applicability. Acetritin is only moderately effective in the treatment of severe psoriasis of the plaque type. Calcipotriol or UV-radiation used at the same time can increase the clinical effectiveness of acetritin. Systemic PUVA, balneo-PUVA and UVB therapy are all effective for the treatment of severe psoriasis. The combination of UV therapy with vitamin D3 analogues or with topical steroids is more effective than the treatment with UV radiation alone. Saltwater baths increase the effectiveness of UVB therapy. No RCT on the therapeutical effects of topical tar or of dithranol in combination with UV therapy have been published so far. A continuous therapy with PUVA should not be applied due to its proven photocarcinogenicity. Three substances from the group of biologicals (Efalizumab, Etanercept, and Infliximab are now available in Europe and a further substance (Alefacept is available in the USA for the treatment of moderate to severe psoriasis. All biologicals have been

  13. Dronabinol in severe, enduring anorexia nervosa

    DEFF Research Database (Denmark)

    Andries, Alin; Frystyk, Jan; Flyvbjerg, Allan

    2014-01-01

    The evidence for pharmacological treatment of severe, longstanding anorexia nervosa (AN) is sparse and the few controlled pharmacologic studies have focused on a narrow range of drugs. The aim of the present study was to investigate the effects of treatment with a synthetic cannabinoid agonist...

  14. Needs of people with severe mental illness

    NARCIS (Netherlands)

    Wiersma, D

    2006-01-01

    Objective: This study reviews conceptual and methodological issues of needs for care among people with severe mental illness (SMI) and presents data on their prevalence, correlates and consequences for mental health care. Method: Focus is on the definition of the concept of need as what people can

  15. PPO.02 Severe maternal morbidity in Ireland

    NARCIS (Netherlands)

    Manning, E.; Lutomski, J.E.; O'Connor, L.; Corcoran, P.; Greene, R.

    2014-01-01

    OBJECTIVE: To assess the incidence of severe maternal morbidity (SMM) and examine associated factors in Ireland. METHODS: In 2011, 67,806 maternities were reported from 19 maternity units, representing 93% of maternities in Ireland. SMM was classified as the presence of one or more of 15 categories

  16. Several applications of Cartwright-Field's inequality

    OpenAIRE

    Minculete, Nicuşor; Furuichi, Shigeru

    2011-01-01

    In this paper we present several applications of Cartwright-Field's inequality. Among these we found Young's inequality, Bernoulli's inequality, the inequality between the weighted power means, H\\"{o}lder's inequality and Cauchy's inequality. We give also two applications related to arithmetic functions and to operator inequalities.

  17. Convex trace functions of several variables

    DEFF Research Database (Denmark)

    Hansen, Frank

    2002-01-01

    We prove that the function (x1,...,xk)¿Tr(f(x1,...,xk)), defined on k-tuples of symmetric matrices of order (n1,...,nk) in the domain of f, is convex for any convex function f of k variables. The matrix f(x1,...,xk) is defined by the functional calculus for functions of several variables, and it ...

  18. Severe sepsis and septic shock [author's reply

    NARCIS (Netherlands)

    Angus, Derek C.; van der Poll, Tom

    2013-01-01

    To the Editor: We would like to address two potentially confusing issues concerning venous oxygen saturation (Svo(2)) as presented in Table 1 of the review by Angus and van der Poll (Aug. 29 issue).(1) First, Table 1 suggests that Svo(2) is raised in sepsis, severe sepsis, and septic shock.

  19. Severe Hailstorm in Nepal: A case study

    Science.gov (United States)

    Aryal, D.

    2017-12-01

    During the pre-monsoon months (March-May) in Nepal, severe thunder and hailstorms cause significant property and agricultural damage in addition to loss of life from lightening. Forecasting thunderstorm severity remains a challenge even in wealthy, developed countries that have modern meteorological data gathering infrastructure, such as Doppler Radar. This study attempts to isolate the specific and unique characteristics of a hailstorm that not only might explain its severity, but also suggest forecasting techniquees for future forecasting in Nepal. The primary data sources for this investigation included Infrared Satellite images, which illustrated the sequences of convective activity, and original archived ESRL India and China upper air data, which was used for synoptic and mesoscale analyses. On May 3, 2001 between the hours of 1100pm and midnight, a severe thunderstorm accompanied by hail stones estimated at 1kg, devastated the village of Thori (Southern border to India). 800 thatched houses were destroyed, over 500 farm animals were killed and more than 200 hectares of crops lost. Many inhabitants were injured, but luckily only one death. Thori hailstorm had its origins in a topographically induced lee-side convergence area in the deserts of Pakistan on May 2, 2001, from where it propagated eastwards into India and evolved into an eastward travelling Mesoscale Convective System reaching Thori near midnight on May 3. Atmospheric instability over the Gangetic Plains, fuelled by a very active surface heat low, cold temperatures and dynamic lifting mechanisms aloft, created a synoptic and mesoscale environment capable of generating a dangerous thunderstorm.

  20. Underestimation of Severity of Previous Whiplash Injuries

    Science.gov (United States)

    Naqui, SZH; Lovell, SJ; Lovell, ME

    2008-01-01

    INTRODUCTION We noted a report that more significant symptoms may be expressed after second whiplash injuries by a suggested cumulative effect, including degeneration. We wondered if patients were underestimating the severity of their earlier injury. PATIENTS AND METHODS We studied recent medicolegal reports, to assess subjects with a second whiplash injury. They had been asked whether their earlier injury was worse, the same or lesser in severity. RESULTS From the study cohort, 101 patients (87%) felt that they had fully recovered from their first injury and 15 (13%) had not. Seventy-six subjects considered their first injury of lesser severity, 24 worse and 16 the same. Of the 24 that felt the violence of their first accident was worse, only 8 had worse symptoms, and 16 felt their symptoms were mainly the same or less than their symptoms from their second injury. Statistical analysis of the data revealed that the proportion of those claiming a difference who said the previous injury was lesser was 76% (95% CI 66–84%). The observed proportion with a lesser injury was considerably higher than the 50% anticipated. CONCLUSIONS We feel that subjects may underestimate the severity of an earlier injury and associated symptoms. Reasons for this may include secondary gain rather than any proposed cumulative effect. PMID:18201501

  1. Severe Accident Test Station Activity Report

    Energy Technology Data Exchange (ETDEWEB)

    Pint, Bruce A [ORNL; Terrani, Kurt A [ORNL

    2015-06-01

    Enhancing safety margins in light water reactor (LWR) severe accidents is currently the focus of a number of international R&D programs. The current UO2/Zr-based alloy fuel system is particularly susceptible since the Zr-based cladding experiences rapid oxidation kinetics in steam at elevated temperatures. Therefore, alternative cladding materials that offer slower oxidation kinetics and a smaller enthalpy of oxidation can significantly reduce the rate of heat and hydrogen generation in the core during a coolant-limited severe accident. In the U.S. program, the high temperature steam oxidation performance of accident tolerant fuel (ATF) cladding solutions has been evaluated in the Severe Accident Test Station (SATS) at Oak Ridge National Laboratory (ORNL) since 2012. This report summarizes the capabilities of the SATS and provides an overview of the oxidation kinetics of several candidate cladding materials. A suggested baseline for evaluating ATF candidates is a two order of magnitude reduction in the steam oxidation resistance above 1000ºC compared to Zr-based alloys. The ATF candidates are categorized based on the protective external oxide or scale that forms during exposure to steam at high temperature: chromia, alumina, and silica. Comparisons are made to literature and SATS data for Zr-based alloys and other less-protective materials.

  2. Bilateral microperc in a severe kyphoscoliosis

    OpenAIRE

    Dağgülli, Mansur; Penbegül, Necmettin; Dede, Onur; Utanğaç, Mehmet Mazhar

    2016-01-01

    Percutaneous nephrolithotomy is the standard modality for large renal calculi in normal and abnormal renal anatomic situations. This case report describes a 57-year-old male patient who presented with bilateral kidney stones and severe kyphoscoliosis. He had successfully been treated with a bilateral microperc technique.

  3. CT findings in severe thoracic sarcoidosis

    International Nuclear Information System (INIS)

    Hennebicque, Anne-Sophie; Brillet, Pierre-Yves; Moulahi, Hassen; Brauner, Michel W.; Nunes, Hilario; Valeyre, Dominique

    2005-01-01

    Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions. (orig.)

  4. Establishing the severity of personality disorder.

    Science.gov (United States)

    Tyrer, P; Johnson, T

    1996-12-01

    The authors developed a simplified method of rating the severity of personality disorder. The new rating method is based on four levels of severity: no personality disorder, personality difficulty, simple personality disorder, and diffuse personality disorder. The new method was applied to different diagnostic systems and was then compared with an old rating system based on six severity levels. Data were derived from a longitudinal study in which 163 patients with anxiety and depressive disorders had initial assessments of personality status and were followed up over 2 years. Ratings of psychiatric symptoms were made by using the Comprehensive Psychopathological Rating Scale over this period. The results were analyzed with special attention to linear and quadratic trends. The new system was clinically useful in separating patients' initial assessments and outcomes. Patients with no personality disorder had the lowest initial symptom scores and the best outcomes, and those with diffuse personality disorder had the highest initial levels of symptoms and improved least over the 2 years. When the patients were separated by the old classification system, 72% of the variation between groups was accounted for by linear and quadratic trends; the comparable percentage was 97% when the patients were categorized by the new system. The new system of rating severity of personality disturbance is an improvement on existing methods and allows ratings to be made easily from DSM-IV and ICD-10.

  5. Neurosurgery for management of severe head injury

    International Nuclear Information System (INIS)

    Seitz, K.; Richter, H.P.

    1998-01-01

    Neurosurgery as a treatment of severe head injuries is not restricted to invasive surgery but also includes peri-operative intensive care medicine. Thanks to the technological progress and advanced diagnostic tools, especially drug treatments and their efficiency as well as risks can be far better monitored and analysed today. (orig./CB) [de

  6. [Severe, subacute axonal polyneuropathy due to hypophosphatemia].

    NARCIS (Netherlands)

    Eijk, J.J.J. van; Abdo, W.F.; Deurwaarder, E. den; Zwarts, M.J.; Warrenburg, B.P.C. van de

    2010-01-01

    A 46-year-old man receiving tube feeding because of anorexia and weight loss developed progressive neurological symptoms initially resembling Guillain-Barre syndrome. Eventually axonal neuropathy due to severe hypophosphatemia was diagnosed. Hypophosphatemia can be caused by the so-called refeeding

  7. Development of a severity score for CRPS

    NARCIS (Netherlands)

    Harden, R.N.; Bruehl, S.; Perez, R.S.G.M.; Birklein, F.; Marinus, J.; Maihofner, C.; Lubenow, T.; Buvanendran, A.; Mackey, S.; Graciosa, J.; Mogilevski, M.; Ramsden, C.; Schlereth, T.; Chont, M.; Vatine, J.J.

    2010-01-01

    The clinical diagnosis of Complex Regional Pain Syndrome (CRPS) is a dichotomous (yes/no) categorization necessary for clinical decision-making. However, such dichotomous diagnostic categories do not convey an individual's subtle and temporal gradations in severity of the condition, and have poor

  8. Development of a severity score for CRPS.

    Science.gov (United States)

    Harden, R Norman; Bruehl, Stephen; Perez, Roberto S G M; Birklein, Frank; Marinus, Johan; Maihofner, Christian; Lubenow, Timothy; Buvanendran, Asokumar; Mackey, Sean; Graciosa, Joseph; Mogilevski, Mila; Ramsden, Christopher; Schlereth, Tanja; Chont, Melissa; Vatine, Jean-Jacques

    2010-12-01

    The clinical diagnosis of Complex Regional Pain Syndrome (CRPS) is a dichotomous (yes/no) categorization necessary for clinical decision-making. However, such dichotomous diagnostic categories do not convey an individual's subtle and temporal gradations in severity of the condition, and have poor statistical power when used as an outcome measure in research. This study evaluated the validity and potential utility of a continuous type score to index severity of CRPS. Psychometric and medical evaluations were conducted in 114 CRPS patients and 41 non-CRPS neuropathic pain patients. Based on the presence/absence of 17 clinically-assessed signs and symptoms of CRPS, an overall CRPS Severity Score (CSS) was derived. The CSS discriminated well between CRPS and non-CRPS patients (pCRPS diagnoses using both IASP diagnostic criteria (Eta=0.69) and proposed revised criteria (Eta=0.77-0.88). Higher CSS was associated with significantly higher clinical pain intensity, distress, and functional impairments, as well as greater bilateral temperature asymmetry and thermal perception abnormalities (p'sCRPS, and support its validity as an index of CRPS severity. Its utility as an outcome measure in research studies is also suggested, with potential statistical advantages over dichotomous diagnostic criteria. Copyright © 2010. Published by Elsevier B.V.

  9. Hand eczema severity and quality of life

    DEFF Research Database (Denmark)

    Agner, Tove; Andersen, Klaus E; Brandao, Francisco M

    2008-01-01

    Background and Objectives: Hand eczema is a chronic disease with negative impact on quality of life (QoL). In this study, QoL in hand eczema patients is assessed and related to age, sex, severity, and diagnostic subgroups. Methods: A total of 416 patients with hand eczema from 10 European patch...

  10. Caffeinated drinks, alcohol consumption and hangover severity

    NARCIS (Netherlands)

    Penning, R.; de Haan, L.; Verster, J.C.

    2011-01-01

    This study examined the relationship between consumption of caffeinated beverages and alcohol, and effects on next day hangover severity. In 2010, a survey funded by Utrecht University was conducted among N=549 Dutch students. Beverages consumed on their latest drinking session that produced a

  11. Scapular fracture: lower severity and mortality

    Directory of Open Access Journals (Sweden)

    Javad Salimi

    Full Text Available CONTEXT AND OBJECTIVE: The presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. The aim was to study injury patterns and their overall outcomes in patients with scapula fractures. DESIGN AND SETTING: Cross-sectional study of trauma patients treated at six general hospitals in Tehran. METHODS: One-year trauma records were obtained from six general hospitals Among these, forty-one had sustained a scapular fracture and were included in this study. RESULTS: Scapular fracture occurred predominantly among 20 to 50-year-old patients (78%. Road traffic accidents (RTAs were the main cause of injury (73.2%; 30/41. Pedestrians accounted for 46.7% (14/30 of the injuries due to RTAs. Falls were the next most common cause, accounting for seven cases (17.1%. Body fractures were the most common type of scapular fractures (80%. Eighteen patients (43.9% had isolated scapular fractures. Limb fracture was the most common associated injury, detected in 18 cases (43.9%. Three patients (7.3% had severe injuries (injury severity score, ISS > 16 which resulted in one death (2.4%. The majority of the patients were treated conservatively (87.8%. CONCLUSIONS: Patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. However, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.

  12. Relationship between cataract severity and socioeconomic status.

    Science.gov (United States)

    Wesolosky, Jason D; Rudnisky, Christopher J

    2013-12-01

    To determine the relationship between cataract severity and socioeconomic status (SES). Retrospective, observational case series. A total of 1350 eyes underwent phacoemulsification cataract extraction by a single surgeon using an Alcon Infiniti system. Cataract severity was measured using phaco time in seconds. SES was measured using area-level aggregate census data: median income, education, proportion of common-law couples, and employment rate. Preoperative best corrected visual acuity was obtained and converted to logarithm of the minimum angle of resolution values. For patients undergoing bilateral surgery, the generalized estimating equation was used to account for the correlation between eyes. Univariate analyses were performed using simple regression, and multivariate analyses were performed to account for variables with significant relationships (p < 0.05) on univariate testing. Sensitivity analyses were performed to assess the effect of including patient age in the controlled analyses. Multivariate analyses demonstrated that cataracts were more severe when the median income was lower (p = 0.001) and the proportion of common-law couples living in a patient's community (p = 0.012) and the unemployment rate (p = 0.002) were higher. These associations persisted even when controlling for patient age. Patients of lower SES have more severe cataracts. Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  13. Severe aortic stenosis: diagnosis, treatment and prognosis

    NARCIS (Netherlands)

    M.W.A. van Geldorp (Martijn)

    2013-01-01

    textabstractDegenerative aortic stenosis is the most common valvular heart disease in developed countries. The prevalence of severe aortic stenosis increases with age from 1% in people below 65 years of age to nearly 6% in people over the age of 85. Since the population life expectancy continues to

  14. Severe aortic valve stenosis and nosebleed

    NARCIS (Netherlands)

    Schoedel, Johannes; Obergfell, Achim; Maass, Alexander H.; Schodel, Johannes

    2007-01-01

    Aortic valve stenosis is known to be associated with loss of high molecular von Willebrand multimers. This can lead to gastrointestinal bleeding in patients with gastrointestinal angiodysplasia, the Heyde syndrome. Here we present a case of anaemia and severe epistaxis associated with acquired von

  15. Several unusual cases of child abuse.

    Science.gov (United States)

    Palmer, H; Weston, J T

    1976-10-01

    All childhood deaths which occurred in New Mexico during 1974 and 1975 were reviewed. Nine fatal instances of abuse were identified representing the entire spectrum of physical abuse: neglect, abuse in a single episode of injury, repetitive abuse, or sexual abuse. Several cases are summarized. These are unusual either in the distribution of pathologic findings or in the problems encountered in court presentation.

  16. Golimumab for moderate to severe ulcerative colitis

    NARCIS (Netherlands)

    Strik, Anne S.; Berends, Sophie E.; Mathôt, Ron A.; D'Haens, Geert R.; Löwenberg, Mark

    2017-01-01

    Golimumab (GLM) is a subcutaneously administered human anti-tumor necrosis factor (TNF) agent that has been approved by the regulatory authorities for the treatment of moderate to severe ulcerative colitis (UC) in 2013. Areas covered: Maintained clinical remission rates up to 50% have been shown in

  17. Managing the Student with Severe Food Allergies

    Science.gov (United States)

    Robinson, Joanne M.; Ficca, Michelle

    2012-01-01

    School nurses play a key role in managing students with food allergies. It is becoming more common to encounter students with severe allergies to multiple foods, putting them at risk for anaphylaxis. It is essential that the school nurse have a clear understanding of food allergies and how to effectively manage students in the school setting.…

  18. Determinants of severe periodontal disease among diabetes ...

    African Journals Online (AJOL)

    Aim: To determine the prevalence and factors associated with severe periodontal disease among diabetic patients. Design: Cross sectional study. Study subjects and methods: Diabetes mellitus patients visiting their regularly scheduled medical review at NCH Diabetic clinic participated in the study. Data collection was ...

  19. Urine ethanol concentration and alcohol hangover severity

    NARCIS (Netherlands)

    Brookhuis, Karel; Van De Loo, Aurora; Mackus, M.; Verster, Joris

    Background The aim of this study was to examine the relationship between urine ethanol concentration and alcohol hangover severity. Methods N = 36 healthy social drinkers participated in a naturalistic study, comprising a hangover day and a control day. N = 18 of them have regular hangovers (the

  20. Clinical severity and prognosis of hand eczema

    DEFF Research Database (Denmark)

    Hald, M; Agner, T; Blands, J

    2009-01-01

    ) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased...

  1. Imaging in severe acute respiratory syndrome (SARS)

    International Nuclear Information System (INIS)

    Antonio, G.E.; Wong, K.T.; Chu, W.C.W.; Hui, D.S.C.; Cheng, F.W.T.; Yuen, E.H.Y.; Chung, S.S.C.; Fok, T.F.; Sung, J.J.Y.; Ahuja, A.T.

    2003-01-01

    Severe acute respiratory syndrome (SARS) is a highly infectious disease caused by a novel coronavirus, and has become pandemic within a short period of time. Imaging plays an important role in the diagnosis, management and follow-up of patients with SARS. The current status of imaging in SARS is presented in this review

  2. GERD: Can Certain Medications Increase Severity?

    Science.gov (United States)

    ... increase severity? I've heard that some medications can aggravate the symptoms of GERD. Can you tell me more? Answers from Michael F. Picco, M.D. Certain medications and dietary supplements can irritate the lining of your esophagus, causing heartburn ...

  3. Computer Needs of Severely Mentally Retarded Persons.

    Science.gov (United States)

    Flanagan, Kelly

    1982-01-01

    The article reviews technology applicable for use by severely mentally retarded learners. Descriptions are given of assistive devices (including communication aids), controls and interfaces (such as single switch access to standard software), and software (including games to teach cause and effect and simple matching and counting). (CL)

  4. Protein metabolism in severe childhood malnutrition

    Science.gov (United States)

    The major clinical syndromes of severe childhood malnutrition (SCM) are marasmus (non-oedematous SCM), kwashiorkor and marasmic-kwashiorkor (oedematous SCM). Whereas treatment of marasmus is straightforward and the associated mortality is low, kwashiorkor and marasmic-kwashiorkor are difficult to tr...

  5. Severe traumatic brain injury managed with decompressive ...

    African Journals Online (AJOL)

    2012-05-29

    May 29, 2012 ... Patients with severe taumatic brain injury may develop intractable raised ICP resulting in high mortality ... Glasgow coma score was 8/15 (E1V3M4) and he had left ... An emergency right fronto-temporo-parietal decompressive.

  6. Severe Hyperacusis, Photophobia, and Skin Hypersensitivity

    Directory of Open Access Journals (Sweden)

    Alessandra Barbara Fioretti

    2016-01-01

    Full Text Available We report a case of a patient with severe hyperacusis, photophobia, and skin hypersensitivity. The patient was initially treated with sound therapy and medical therapy for 4 months and successfully with a selective serotonin reuptake inhibitor (SSRI and cognitive behavioral therapy which improved her mood and the tolerance for sounds and light.

  7. Psychosocial factors predicting severity of depression among ...

    African Journals Online (AJOL)

    Background and Objectives: Depression as major psychological sequelea of the HIV/AIDS infection has continued to attract investigation. With few studies in Nigeria, it is unclear whether levels of perceived stigma, sexual risk behaviors, and anticipated discrimination are differentially associated with severity of depression.

  8. Several versions of forward gas ionization calorimeter

    International Nuclear Information System (INIS)

    Babintsev, V.V.; Kholodenko, A.G.; Rodnov, Yu.V.

    1994-01-01

    The properties of several versions of a gas ionization calorimeter are analyzed by means of the simulation with the GEANT code. The jet energy and coordinate resolutions are evaluated. Some versions of the forward calorimeter meet the ATLAS requirements. 13 refs., 15 figs., 7 tabs

  9. Serum bicarbonate and dehydration severity in gastroenteritis

    OpenAIRE

    Narchi, H.

    1998-01-01

    The concentration of bicarbonate was measured in serum samples from 106 children with gastroenteritis and dehydration. A concentration less than 22 mmol/l was more common in children with severe dehydration, but the magnitude of bicarbonate reduction was not significantly different with increasing degrees of dehydration. Doctors should not rely on the serum bicarbonate concentration when assessing fluid deficit.



  10. Intracranial Monitoring after Severe Traumatic Brain Injury

    OpenAIRE

    Donnelly, Joseph

    2018-01-01

    Intracranial monitoring after severe traumatic brain injury offers the possibility for early detection and amelioration of physiological insults. In this thesis, I explore cerebral insults due raised intracranial pressure, decreased cerebral perfusion pressure and impaired cerebral pressure reactivity after traumatic brain injury. In chapter 2, the importance of intracranial pressure, cerebral perfusion pressure and pressure reactivity in regulating the cerebral circulation is elucidated ...

  11. Problems in severe bilateral urinary tract anomalies

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens

    1989-01-01

    function. There were two deaths. Five children have severe and two a moderate reduction of renal function; twenty good renal function. There were ten nephrectomies and four heminephrectomies. Seven patients had a temporary and eight a permanent urinary diversion. However, four of the latter were later...

  12. Speech Intelligibility in Severe Adductor Spasmodic Dysphonia

    Science.gov (United States)

    Bender, Brenda K.; Cannito, Michael P.; Murry, Thomas; Woodson, Gayle E.

    2004-01-01

    This study compared speech intelligibility in nondisabled speakers and speakers with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (Botox) injection. Standard speech samples were obtained from 10 speakers diagnosed with severe ADSD prior to and 1 month following Botox injection, as well as from 10 age- and gender-matched…

  13. PPIB mutations cause severe osteogenesis imperfecta

    NARCIS (Netherlands)

    van Dijk, Fleur S.; Nesbitt, Isabel M.; Zwikstra, Eline H.; Nikkels, Peter G. J.; Piersma, Sander R.; Fratantoni, Silvina A.; Jimenez, Connie R.; Huizer, Margriet; Morsman, Alice C.; Cobben, Jan M.; van Roij, Mirjam H. H.; Elting, Mariet W.; Verbeke, Jonathan I. M. L.; Wijnaendts, Liliane C. D.; Shaw, Nick J.; Högler, Wolfgang; McKeown, Carole; Sistermans, Erik A.; Dalton, Ann; Meijers-Heijboer, Hanne; Pals, Gerard

    2009-01-01

    Deficiency of cartilage-associated protein (CRTAP) or prolyl 3-hydroxylase 1(P3H1) has been reported in autosomal-recessive lethal or severe osteogenesis imperfecta (OI). CRTAP, P3H1, and cyclophilin B (CyPB) form an intracellular collagen-modifying complex that 3-hydroxylates proline at position

  14. Leisure Education Programs for the Severely Disabled.

    Science.gov (United States)

    Schleien, Stuart J.; And Others

    1985-01-01

    The importance of leisure education for severely disabled students is emphasized as a means of enabling them to purposefully use leisure time and to expand social and motor skills that facilitate independent daily living. Sample activities for inclusion in physical education programs are included. (DG)

  15. Exceptionally elevated triglyceride in severe lipemia retinalis

    Directory of Open Access Journals (Sweden)

    Yin HY

    2016-10-01

    Full Text Available Han Y Yin,1–3 Roberto Warman,2,4 Edward H Suh,2 Anny MS Cheng2,3 1Wayne State University, School of Medicine, Detroit, MI, 2Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, 3Ocular Surface Center, Miami, 4Division of Pediatric Ophthalmology, Nicklaus Children’s Hospital, Miami, FL, USA Purpose: To report a case of successful treatment for severe lipemia retinalis with extreme severe hypertriglyceridemia (sHTG.Design: Observational case report.Observations: A 6-week-old infant with severe lipemia retinalis manifested diffuse creamy retinal vessels complicated with vulvar xanthomas. Extreme sHTG with 185-folds of the normal level was reported. Chromosome microarray and lipid gene sequencing confirmed a homozygous lipoprotein lipase gene coding mutation.Results: Under strict adherence to a high medium-chain triglycerides formula and discontinuation of breast milk, the lipemia retinalis and vulval lesions resolved along with a stable plasma lipid level throughout the follow-up period of 6 months.Conclusion: Strict adherence to a low-fat diet without breast milk appears to be effective in treating infants with severe lipemia retinalis associated with exceptionally high triglycerides. Keywords: hypertriglyceride, infant, lipemia retinalis, lipoprotein lipase gene

  16. Application of FFTBM to severe accidents

    International Nuclear Information System (INIS)

    Prosek, A.; Leskovar, M.

    2005-01-01

    In Europe an initiative for the reduction of uncertainties in severe accident safety issues was initiated. Generally, the error made in predicting plant behaviour is called uncertainty, while the discrepancies between measured and calculated trends related to experimental facilities are called the accuracy of the prediction. The purpose of the work is to assess the accuracy of the calculations of the severe accident International Standard Problem ISP-46 (Phebus FPT1), performed with two versions of MELCOR 1.8.5 for validation purposes. For the quantitative assessment of calculations the improved fast Fourier transform based method (FFTBM) was used with the capability to calculate time dependent code accuracy. In addition, a new measure for the indication of the time shift between the experimental and the calculated signal was proposed. The quantitative results obtained with FFTBM confirm the qualitative conclusions made during the Jozef Stefan Institute participation in ISP-46. In general good agreement of thermal-hydraulic variables and satisfactory agreement of total releases for most radionuclide classes was obtained. The quantitative FFTBM results showed that for the Phebus FPT1 severe accident experiment the accuracy of thermal-hydraulic variables calculated with the MELCOR severe accident code is close to the accuracy of thermal-hydraulic variables for design basis accident experiments calculated with best-estimate system codes. (author)

  17. COPD exacerbations by disease severity in England

    Directory of Open Access Journals (Sweden)

    Merinopoulou E

    2016-04-01

    Full Text Available Evie Merinopoulou,1 Mireia Raluy-Callado,1 Sreeram Ramagopalan,1 Sharon MacLachlan,1 Javaria Mona Khalid2 1Real-World Evidence, Evidera, 2Takeda Development Centre Europe Ltd, London, UK Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD are associated with accelerated disease progression and are important drivers of health care resource utilization. The study aimed to quantify the rates of COPD exacerbations in England and assess health care resource utilization by severity categories according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2013.Methods: Data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics were used to identify patients with a COPD diagnosis aged ≥40 years. Those with complete spirometric, modified Medical Research Council Dyspnea Scale information, and exacerbation history 12 months prior to January 1, 2011 (index date were classified into GOLD severity groups. Study outcomes over follow-up (up to December 31, 2013 were exacerbation rates and resource utilization (general practitioner visits, hospital admissions.Results: From the 44,201 patients in the study cohort, 83.5% were classified into severity levels GOLD A: 33.8%, GOLD B: 21.0%, GOLD C: 18.1%, and GOLD D: 27.0%. Mean age at diagnosis was 66 years and 52.0% were male. Annual exacerbation rates per person-year increased with severity, from 0.83 (95% confidence interval [CI]: 0.81–0.85 for GOLD A to 2.51 (95% CI: 2.47–2.55 for GOLD D. General practitioner visit rates per person-year also increased with severity, from 4.82 (95% CI: 4.74–4.93 for GOLD A to 7.44 (95% CI: 7.31–7.61 for GOLD D. COPD-related hospitalization rates per person-year increased from less symptoms (GOLD A: 0.28, GOLD C: 0.39 to more symptoms (GOLD B: 0.52, GOLD D: 0.84.Conclusion: Patients in the most severe category (GOLD D experienced nearly three times the number of exacerbations and COPD

  18. Designing a Pediatric Severe Sepsis Screening Tool

    Directory of Open Access Journals (Sweden)

    Robert eSepanski

    2014-06-01

    Full Text Available We sought to create a screening tool with improved predictive value for pediatric severe sepsis and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric Emergency Department (ED. Gold standard severe sepsis cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over two months. The tool’s identification of severe sepsis was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool’s predictive value based on receiver operating curve (ROC characteristics. Age-specific normal and abnormal values for heart rate (HR and respiratory rate (RR were empirically derived from 143,603 children seen in a second pediatric ED over three years. Univariate analyses were performed for each measure in the tool to assess its association with severe sepsis and to characterize it as an early or late indicator of severe sepsis. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool’s positive predictive value was 48.7%, a significant, nearly three-fold improvement over the original ICCPS tool. False positive Systemic Inflammatory Response Syndrome (SIRS identifications were nearly six-fold lower.

  19. Severe Weather Environments in Atmospheric Reanalyses

    Science.gov (United States)

    King, A. T.; Kennedy, A. D.

    2017-12-01

    Atmospheric reanalyses combine historical observation data using a fixed assimilation scheme to achieve a dynamically coherent representation of the atmosphere. How well these reanalyses represent severe weather environments via proxies is poorly defined. To quantify the performance of reanalyses, a database of proximity soundings near severe storms from the Rapid Update Cycle 2 (RUC-2) model will be compared to a suite of reanalyses including: North American Reanalysis (NARR), European Interim Reanalysis (ERA-Interim), 2nd Modern-Era Retrospective Reanalysis for Research and Applications (MERRA-2), Japanese 55-year Reanalysis (JRA-55), 20th Century Reanalysis (20CR), and Climate Forecast System Reanalysis (CFSR). A variety of severe weather parameters will be calculated from these soundings including: convective available potential energy (CAPE), storm relative helicity (SRH), supercell composite parameter (SCP), and significant tornado parameter (STP). These soundings will be generated using the SHARPpy python module, which is an open source tool used to calculate severe weather parameters. Preliminary results indicate that the NARR and JRA55 are significantly more skilled at producing accurate severe weather environments than the other reanalyses. The primary difference between these two reanalyses and the remaining reanalyses is a significant negative bias for thermodynamic parameters. To facilitate climatological studies, the scope of work will be expanded to compute these parameters for the entire domain and duration of select renalyses. Preliminary results from this effort will be presented and compared to observations at select locations. This dataset will be made pubically available to the larger scientific community, and details of this product will be provided.

  20. Core loss during a severe accident (COLOSS)

    International Nuclear Information System (INIS)

    Adroguer, B.; Bertrand, F.; Chatelard, P.; Cocuaud, N.; Van Dorsselaere, J.P.; Bellenfant, L.; Knocke, D.; Bottomley, D.; Vrtilkova, V.; Belovsky, L.; Mueller, K.; Hering, W.; Homann, C.; Krauss, W.; Miassoedov, A.; Schanz, G.; Steinbrueck, M.; Stuckert, J.; Hozer, Z.; Bandini, G.; Birchley, J.; Berlepsch, T. von; Kleinhietpass, I.; Buck, M.; Benitez, J.A.F.; Virtanen, E.; Marguet, S.; Azarian, G.; Caillaux, A.; Plank, H.; Boldyrev, A.; Veshchunov, M.; Kobzar, V.; Zvonarev, Y.; Goryachev, A.

    2005-01-01

    The COLOSS project was a 3-year shared-cost action, which started in February 2000. The work-programme performed by 19 partners was shaped around complementary activities aimed at improving severe accident codes. Unresolved risk-relevant issues regarding H 2 production, melt generation and the source term were studied through a large number of experiments such as (a) dissolution of fresh and high burn-up UO 2 and MOX by molten Zircaloy (b) simultaneous dissolution of UO 2 and ZrO 2 (c) oxidation of U-O-Zr mixtures (d) degradation-oxidation of B 4 C control rods. Corresponding models were developed and implemented in severe accident computer codes. Upgraded codes were then used to apply results in plant calculations and evaluate their consequences on key severe accident sequences in different plants involving B 4 C control rods and in the TMI-2 accident. Significant results have been produced from separate-effects, semi-global and large-scale tests on COLOSS topics enabling the development and validation of models and the improvement of some severe accident codes. Breakthroughs were achieved on some issues for which more data are needed for consolidation of the modelling in particular on burn-up effects on UO 2 and MOX dissolution and oxidation of U-O-Zr and B 4 C-metal mixtures. There was experimental evidence that the oxidation of these mixtures can contribute significantly to the large H 2 production observed during the reflooding of degraded cores under severe accident conditions. The plant calculation activity enabled (a) the assessment of codes to calculate core degradation with the identification of main uncertainties and needs for short-term developments and (b) the identification of safety implications of new results. Main results and recommendations for future R and D activities are summarized in this paper

  1. Metabolic profile of clinically severe obese patients.

    Science.gov (United States)

    Faria, Silvia Leite; Faria, Orlando Pereira; Menezes, Caroline Soares; de Gouvêa, Heloisa Rodrigues; de Almeida Cardeal, Mariane

    2012-08-01

    Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition. We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables. Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC. The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

  2. Social networking for adolescents with severe haemophilia.

    Science.gov (United States)

    Khair, K; Holland, M; Carrington, S

    2012-05-01

    Access to modern treatments allows adolescents with haemophilia to manage their haemophilia at home, with improved treatment outcomes and quality of life, but has reduced peer support and the potential for experiential learning from older peers. Social networking, aided by modern communication technologies, may offer health benefits through peer support. We sought to assess whether or not disease-specific social networking could benefit adolescents with severe haemophilia. A total of 150 adolescents (aged 10-18) with severe haemophilia A or B from 11 UK treatment centres or those who had attended focus groups to explore the potential for a social network designed specifically for their use were surveyed. Teenage boys with severe haemophilia in the UK who responded to an online and paper questionnaire (n = 47; 31% response rate) rarely knew of or socialized with others with haemophilia outside their families. Two-thirds of respondents said they would like to meet others. For 70% of boys, parents were the major source of information about haemophilia, yet more than half said they often had trouble finding answers to their questions. These boys frequently used online social networks to chat with friends. Adolescents with severe haemophilia frequently have limited contact with others and many wish to have greater contact. They may benefit from peer support and experiential learning gained through online social networking. The SixVibe restricted access social network is to be launched in 2011. It includes features designed to promote and facilitate the development of peer-to peer disease management skills for adolescents with severe haemophilia. © 2011 Blackwell Publishing Ltd.

  3. Recurrent severe vomiting due to hyperthyroidism

    Science.gov (United States)

    Chen, Li-ying; Zhou, Bo; Chen, Zhou-wen; Fang, Li-zheng

    2010-01-01

    Thyrotoxicosis may present in many ways; severe vomiting as a prominent symptom of thyrotoxicosis is uncommon. In this paper, we report a 24-year-old Chinese male with hyperthyroidism who presented with recurrent severe vomiting. The patient had had intermittent vomiting for seven years and had lost approximately 15 kg of weight. Gastroscopic examinations revealed chronic gastritis and one occasion peptic ulcer. He was treated with antacid and proton pump inhibitors, but his symptoms had no relief. His presenting symptoms suggested hyperthyroidism and were confirmed by laboratory data. After a month of propylthiouracil therapy, his symptoms were relieved. It should be noted that hyperthyroidism patients can have unexplained vomiting, and that hyperthyroidism may coexist with peptic ulcer in rare cases. Awareness of such atypical presentations of hyperthyroidism may help to make a correct diagnosis. PMID:20205308

  4. Severe bradycardia and prolonged hypotension in ciguatera.

    Science.gov (United States)

    Chan, Thomas Yan Keung

    2013-06-01

    Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed.

  5. Relatives of patients with severe brain injury

    DEFF Research Database (Denmark)

    Norup, Anne; Petersen, Janne; Lykke Mortensen, Erik

    2015-01-01

    PRIMARY OBJECTIVE: To investigate trajectories and predictors of trajectories of anxiety and depression in relatives of patients with a severe brain injury during the first year after injury. RESEARCH DESIGN: A prospective longitudinal study with four repeated measurements. SUBJECTS: Ninety...... relatives of patients with severe brain injury. METHODS: The relatives were assessed on the anxiety and depression scales from the Symptom Checklist-90-Revised and latent variable growth curve models were used to model the trajectories. The effects of patient's age, patient's Glasgow Coma Score, level...... should focus not only on specific deficits in the patient, but also on how the emotional state and well-being of the relatives evolve, while trying to adjust and cope with a new life-situation....

  6. Estrogen-associated severe hypertriglyceridemia with pancreatitis.

    Science.gov (United States)

    Aljenedil, Sumayah; Hegele, Robert A; Genest, Jacques; Awan, Zuhier

    Estrogen, whether therapeutic or physiologic, can cause hypertriglyceridemia. Hypertriglyceridemia-induced pancreatitis is a rare complication. We report 2 women who developed estrogen-associated severe hypertriglyceridemia with pancreatitis. The first patient developed pancreatitis secondary to hypertriglyceridemia associated with in vitro fertilization cycles. Marked reduction in her triglyceride was achieved with dietary restrictions and fibrate. The second patient developed pancreatitis secondary to hypertriglyceridemia during her pregnancies. She was noncompliant with the treatment; therefore, her triglyceride remained high after delivery. In both patients, no hypertriglyceridemia-associated genes mutations were identified, although the second patient had strong polygenic susceptibility to hypertriglyceridemia. Estrogen-induced severe hypertriglyceridemia with pancreatitis can be a life-threatening condition. Screening in high-risk patients is crucial to prevent subsequent complications. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  7. Severe hypertriglyceridemia presenting as eruptive xanthomatosis

    Directory of Open Access Journals (Sweden)

    Sameera S Vangara

    2018-01-01

    Full Text Available Eruptive xanthomatosis is described as the sudden eruption of erythematous yellow papules in the presence of hypertriglyceridemia, often associated with serum triglyceride levels above 2000 mg/dl. Severe hypertriglyceridemia can be caused by primary genetic mutations, secondary chronic diseases, or a combination of both. Uncontrolled diabetes mellitus is a known risk factor. It is imperative for physicians to be aware of eruptive xanthomatosis as a warning sign for severe hypertriglyceridemia due to the underlying risk for the potentially fatal complication of acute pancreatitis. Herein, we discuss a case of a 52-year-old man with uncontrolled diabetes mellitus who presented with eruptive xanthomata and a triglyceride level of 7157 mg/dl, the highest recorded value in the absence of acute pancreatitis, with a remarkable response to drug therapy. A review of the literature is included to discuss the clinical relevance and appropriate treatment of this disease entity.

  8. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  9. Vaporization of structural materials in severe accidents

    International Nuclear Information System (INIS)

    Lorenz, R.A.

    1982-01-01

    Vaporized structural materials form the bulk of aerosol particles that can transport fission products in severe LWR accidents. As part of the Severe Accident Sequence Analysis (SASA) program at Oak Ridge National Laboratory, a model has been developed based on a mass transport coefficient to describe the transport of materials from the surface of a molten pool. In many accident scenarios, the coefficient can be calculated from existing correlations for mass transfer by natural convection. Data from SASCHA fuel melting tests (Karlsruhe, Germany) show that the partial pressures of many of the melt components (Fe, Cr, Co, Mn, Sn) required for the model can be calculated from the vapor pressures of the pure species and Raoult's law. These calculations indicate much lower aerosol concentrations than reported in previous studies

  10. Severe human Babesia divergens infection in Norway

    Directory of Open Access Journals (Sweden)

    K. Mørch

    2015-04-01

    Full Text Available Human babesiosis is a rare but potentially life-threatening parasitic disease transmitted by ixodid ticks, and has not previously been reported in Norway. We report a case of severe babesiosis that occurred in Norway in 2007. The patient had previously undergone a splenectomy. He was frequently exposed to tick bites in an area endemic for bovine babesiosis in the west of Norway. The patient presented with severe haemolysis and multiorgan failure. Giemsa-stained blood smears revealed 30% parasitaemia with Babesia spp. He was treated with quinine in combination with clindamycin, apheresis, and supportive treatment with ventilatory support and haemofiltration, and made a complete recovery. This is the first case reported in Norway; however Babesia divergens seroprevalence in cattle in Norway is high, as is the risk of Ixodes ricinus tick bite in the general population. Babesiosis should be considered in the differential diagnosis of unexplained febrile haemolytic disease.

  11. Can Severe Kyphoscoliosis Lead to Aorta Rupture?

    Science.gov (United States)

    Kotopoulos, Constantinos; Karakasi, Maria Valeria; Kapetanakis, Stylianos; Pavlidis, Pavlos

    2016-09-01

    Neurofibromatosis type 1 is a polysystemic disease presenting with a multifaceted clinical picture. Clinical manifestations may present in the skin, as well as in the skeletal and cardiovascular system. The present study aims to describe and examine the case of a 46-year-old woman, who suffered from neurofibromatosis type 1 and died abruptly in the emergency room. The forensic examination attributed her death to traumatic rupture of the thoracic aorta resulting from an acute angulation that her vertebral column formed in the thoracic region (severe kyphosis). Outspread cutaneous neurofibromas, severe scoliosis, and osteoporosis (brittle bones) were observed during the autopsy. No atherosclerotic lesions were detected in the aortic lumen. To the authors' knowledge, no similar case has been reported throughout relevant literature.

  12. Severe periodontitis and higher cirrhosis mortality

    DEFF Research Database (Denmark)

    Ladegaard Grønkjær, Lea; Holmstrup, Palle; Schou, Søren

    2018-01-01

    Background Periodontitis and edentulism are prevalent in patients with cirrhosis, but their clinical significance is largely unknown. Objective The objective of this article is to determine the association of severe periodontitis and edentulism with mortality in patients with cirrhosis. Methods...... A total of 184 cirrhosis patients underwent an oral examination. All-cause and cirrhosis-related mortality was recorded. The associations of periodontitis and edentulism with mortality were explored by Kaplan–Meier survival plots and Cox proportional hazards regression adjusted for age, gender, cirrhosis...... etiology, Child–Pugh score, Model for End-Stage Liver Disease score, smoker status, present alcohol use, comorbidity, and nutritional risk score. Results The total follow-up time was 74,197 days (203.14 years). At entry, 44% of the patients had severe periodontitis and 18% were edentulous. Forty...

  13. Four billion people facing severe water scarcity.

    Science.gov (United States)

    Mekonnen, Mesfin M; Hoekstra, Arjen Y

    2016-02-01

    Freshwater scarcity is increasingly perceived as a global systemic risk. Previous global water scarcity assessments, measuring water scarcity annually, have underestimated experienced water scarcity by failing to capture the seasonal fluctuations in water consumption and availability. We assess blue water scarcity globally at a high spatial resolution on a monthly basis. We find that two-thirds of the global population (4.0 billion people) live under conditions of severe water scarcity at least 1 month of the year. Nearly half of those people live in India and China. Half a billion people in the world face severe water scarcity all year round. Putting caps to water consumption by river basin, increasing water-use efficiencies, and better sharing of the limited freshwater resources will be key in reducing the threat posed by water scarcity on biodiversity and human welfare.

  14. Stimulus induced bursts in severe postanoxic encephalopathy.

    Science.gov (United States)

    Tjepkema-Cloostermans, Marleen C; Wijers, Elisabeth T; van Putten, Michel J A M

    2016-11-01

    To report on a distinct effect of auditory and sensory stimuli on the EEG in comatose patients with severe postanoxic encephalopathy. In two comatose patients admitted to the Intensive Care Unit (ICU) with severe postanoxic encephalopathy and burst-suppression EEG, we studied the effect of external stimuli (sound and touch) on the occurrence of bursts. In patient A bursts could be induced by either auditory or sensory stimuli. In patient B bursts could only be induced by touching different facial regions (forehead, nose and chin). When stimuli were presented with relatively long intervals, bursts persistently followed the stimuli, while stimuli with short intervals (encephalopathy can be induced by external stimuli, resulting in stimulus-dependent burst-suppression. Stimulus induced bursts should not be interpreted as prognostic favourable EEG reactivity. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  15. Severe brachial plexus injuries in rugby.

    Science.gov (United States)

    Altaf, F; Mannan, K; Bharania, P; Sewell, M D; Di Mascio, L; Sinisi, M

    2012-03-01

    We describe the mechanisms, pattern of injuries, management and outcomes of severe injuries to the brachial plexus sustained during the play of rugby. Thirteen cases of severe injury to the brachial plexus caused by tackles in rugby had detailed clinical assessment, and operative exploration of the brachial plexus. Seventeen spinal nerves were avulsed, two were ruptured and there were traction lesions in continuity of 24 spinal nerves. The pattern of nerve lesion was related to the posture of the neck and the forequarter at the moment of impact. Early repair by nerve transfer enabled some functional recovery, and decompression of lesions in continuity was followed by recovery of nerve function and relief of pain. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Global Strain in Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K

    2012-01-01

    Score, history with ischemic heart disease and ejection fraction. CONCLUSIONS: -In patients with symptomatic severe aortic stenosis undergoing AVR reduced GLS provides important prognostic information beyond standard risk factors. Clinical Trial Registration-URL: http://www.clinicaltrial.gov. Unique identifier......BACKGROUND: -Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement (AVR) is unknown. METHODS AND RESULTS: -A total of 125 patients with severe...... and mortality. In a stepwise cox model with forward selection GLS was the sole independent predictor HR=1.13 (95% confidence interval 1.02-1.25), p=0.04. Comparing the overall log likelihood χ(2) of the predictive power of the multivariable model containing GLS was statistically superior to models based on Euro...

  17. Korean Conference on Several Complex Variables

    CERN Document Server

    Byun, Jisoo; Gaussier, Hervé; Hirachi, Kengo; Kim, Kang-Tae; Shcherbina, Nikolay

    2015-01-01

    This volume includes 28 chapters by authors who are leading researchers of the world describing many of the up-to-date aspects in the field of several complex variables (SCV). These contributions are based upon their presentations at the 10th Korean Conference on Several Complex Variables (KSCV10), held as a satellite conference to the International Congress of Mathematicians (ICM) 2014 in Seoul, Korea. SCV has been the term for multidimensional complex analysis, one of the central research areas in mathematics. Studies over time have revealed a variety of rich, intriguing, new knowledge in complex analysis and geometry of analytic spaces and holomorphic functions which were "hidden" in the case of complex dimension one. These new theories have significant intersections with algebraic geometry, differential geometry, partial differential equations, dynamics, functional analysis and operator theory, and sheaves and cohomology, as well as the traditional analysis of holomorphic functions in all dimensions. This...

  18. Severe fuel-damage scoping test performance

    International Nuclear Information System (INIS)

    Gruen, G.E.; Buescher, B.J.

    1983-01-01

    As a result of the Three Mile Island Unit-2 (TMI-2) accident, the Nuclear Regulatory Commission has initiated a severe fuel damage test program to evaluate fuel rod and core response during severe accidents similar to TMI-2. The first test of Phase I of this series has been successfully completed in the Power Burst Facility at the Idaho National Engineering Laboratory. Following the first test, calculations were performed using the TRAC-BD1 computer code with actual experimental boundary conditions. This paper discusses the test conduct and performance and presents the calculated and measured test bundle results. The test resulted in a slow heatup to 2000 K over about 4 h, with an accelerated reaction of the zirconium cladding at temperatures above 1600 K in the lower part or the bundle and 2000 K in the upper portion of the bundle

  19. Aetiology and treatment of severe postpartum haemorrhage

    DEFF Research Database (Denmark)

    Edwards, Hellen

    2017-01-01

    This thesis is comprised of three studies focusing on severe postpartum haemorrhage (PPH). PPH is a major cause of maternal morbidity and mortality worldwide. Risk factors include retained placenta, prolonged duration of the third stage of labour, previous caesarean section, and operative vaginal...... delivery. Occurrence and development of PPH are, however, unpredictable and can sometimes give rise to massive haemorrhage or even hysterectomy and maternal death. Severe haemorrhage can lead to coagulopathy causing further haemorrhage and requiring substitution with blood transfusions. The aim...... had a cardiac arrest, and a total of 128 women (52%) required a hysterectomy. Hysterectomy was associated with increased blood loss, increased number of blood transfusions, a higher fresh frozen plasma to red blood cell ratio (p=0.010), and an increased number of red blood cells before first platelet...

  20. Eosinophilic ascites due to severe eosinophilic ileitis

    Directory of Open Access Journals (Sweden)

    Setia Namrata

    2010-01-01

    Full Text Available Background: There is a broad etiology for effusion eosinophilia that includes allergic, reactive, infectious, immune, neoplastic, and idiopathic causes. We report and describe the cytomorphologic findings of a rare case of eosinophilic ascites due to severe eosinophilic ileitis. Case Presentation: A 17-year-old male manifested acutely with eosinophilic ascites due to severe biopsy-proven subserosal eosinophilic ileitis. Isolated peritoneal fluid submitted for cytologic evaluation revealed that 65% eosinophils were present in a bloody background. The patient responded to corticosteroids, with complete resolution of his ascites. Conclusion: Eosinophilic gastroenteritis with subserosal involvement should be added to the list of causes for eosinophils in peritoneal fluid. The finding of eosinophilic ascites, with appropriate clinical and laboratory findings, may warrant the need to perform laparoscopic intestinal biopsies to confirm the diagnosis.

  1. Eosinophilic ascites due to severe eosinophilic ileitis.

    Science.gov (United States)

    Setia, Namrata; Ghobrial, Peter; Liron, Pantanowitz

    2010-09-17

    There is a broad etiology for effusion eosinophilia that includes allergic, reactive, infectious, immune, neoplastic, and idiopathic causes. We report and describe the cytomorphologic findings of a rare case of eosinophilic ascites due to severe eosinophilic ileitis. A 17-year-old male manifested acutely with eosinophilic ascites due to severe biopsy-proven subserosal eosinophilic ileitis. Isolated peritoneal fluid submitted for cytologic evaluation revealed that 65% eosinophils were present in a bloody background. The patient responded to corticosteroids, with complete resolution of his ascites. Eosinophilic gastroenteritis with subserosal involvement should be added to the list of causes for eosinophils in peritoneal fluid. The finding of eosinophilic ascites, with appropriate clinical and laboratory findings, may warrant the need to perform laparoscopic intestinal biopsies to confirm the diagnosis.

  2. Heart failure due to severe myocardial calcification

    International Nuclear Information System (INIS)

    Takahashi, Shouichi; Maida, Kiyoshi; Yokoyama, Hitoshi; Tanaka, Shigeo

    1993-01-01

    A 28-year-old female who had had irradiation on the chest wall at the age of 5 as a remedy for keloid granulation after burn, recently developed congestive heart failure. Severe tricuspid regurgitation was demonstrated by echocardiography with a certain calcification in the cardiac shadow on chest radiogram. Calcified right ventricle and ventricular septum were noticed operatively, which disturbed ventricular motion and also caused tricuspid valve deformity. These calcified myocardium apparently corresponded with the irradiation field. After tricuspid valve replacement, she regained physical activity satisfactorily without congestive heart failure. Because she had no other known causes of cardiac calcification such as hypercalcemia, myocarditis, myocardial infarction or renal diseases, irradiation on the chest wall could be responsible for the severe myocardial calcification. (author)

  3. Severe human Babesia divergens infection in Norway.

    Science.gov (United States)

    Mørch, K; Holmaas, G; Frolander, P S; Kristoffersen, E K

    2015-04-01

    Human babesiosis is a rare but potentially life-threatening parasitic disease transmitted by ixodid ticks, and has not previously been reported in Norway. We report a case of severe babesiosis that occurred in Norway in 2007. The patient had previously undergone a splenectomy. He was frequently exposed to tick bites in an area endemic for bovine babesiosis in the west of Norway. The patient presented with severe haemolysis and multiorgan failure. Giemsa-stained blood smears revealed 30% parasitaemia with Babesia spp. He was treated with quinine in combination with clindamycin, apheresis, and supportive treatment with ventilatory support and haemofiltration, and made a complete recovery. This is the first case reported in Norway; however Babesia divergens seroprevalence in cattle in Norway is high, as is the risk of Ixodes ricinus tick bite in the general population. Babesiosis should be considered in the differential diagnosis of unexplained febrile haemolytic disease. Copyright © 2015. Published by Elsevier Ltd.

  4. Severe Heterotopic Ossification following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Alexander L. Dodds

    2014-01-01

    Full Text Available Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement.

  5. Several Items Comparisons of Intercultural Food Communication

    Institute of Scientific and Technical Information of China (English)

    刘智慧

    2011-01-01

    Introduction This paper is included seven parts,food culture introduction,forms and manners of western food,forms and manners of Chinese food,three main kinds of difference of foods,mergence,taboo and conclusion.I will divide it into several parts to analyze them.I adopt ~me examples and history stories.As all of my expressions,I hope you can enjoy my paper and have a good stomach.

  6. Prevention and mitigation of severe accidents

    International Nuclear Information System (INIS)

    Weisshaeupl, H.

    1996-01-01

    For the European Pressurized water Reactor (EPR), jointly developed by French and German industry, great emphasis is laid to gain further improvement in prevention of severe accidents based on the accumulative experience and proven technology of the French and German PWR reactors. In this evolutionary development, a balanced and comprehensive approach in respect to implement new passive features has been chosen. Improvements in each step of the defense in depth concept lead to a further decrease in the probability of occurrence of a severe accident with partial or even gross melting of the core. The different phenomenons that occur during such an hypothetical accident must be taken into account during the conception of specific measurements necessary to mitigate accident consequences. To cope with the consequences of a severe accident with core melt down means to deal with different phenomena which may threaten the integrity of the containment or may lead to an enhanced fission product release into the environment: high pressure reactor pressure vessel failure; energetic molten fuel coolant interaction; direct containment heating, molten core concrete interaction; hydrogen combustion; long term pressure and temperature increase in the containment. The EPR approach follows the recommendations from the DFD (Deutsch-Franzosischer Direktionsausschuss), jointly prepared by the French and German safety authorities. The EPR concept consist to prevent or eliminate as far as possible scenarios which are connected with high loads (high pressure failure of the reactor pressure vessel, or global hydrogen detonation etc..) by dedicated design provisions, and to deal with the consequences of severe accident scenarios which are not ruled out by specific safety measures. The measures comprise: the primary system depressurization; the control of hydrogen; the stabilisation and cooling of the melted core; the containment heat removal. They are completed by specific characteristics

  7. Severe accident management. Prevention and Mitigation

    International Nuclear Information System (INIS)

    1992-01-01

    Effective planning for the management of severe accidents at nuclear power plants can produce both a reduction in the frequency of such accidents as well as the ability to mitigate their consequences if and when they should occur. This report provides an overview of accident management activities in OECD countries. It also presents the conclusions of a group of international experts regarding the development of accident management methods, the integration of accident management planning into reactor operations, and the benefits of accident management

  8. Severe hepatic dysfunction after sevoflurane exposure

    International Nuclear Information System (INIS)

    Alotaibi, Wadha M.

    2008-01-01

    Sevoflurane is thought to have a potential for hepatotoxicity. A few cases of hepatotoxicity have been reported since it was introduced in 1999 into clinical practice in Japan. The underlying pathophysiology of hepatotoxicity is non-specific. We report a case of severe hepatic dysfunction after uneventful sevoflurane anesthesia in a child with posterior fossa resection of medulloblastoma. The case of sevoflurane being incriminated is unclear due to various confounding factors that is worthy of discussion. (author)

  9. Overview of severe accident research at JAERI

    International Nuclear Information System (INIS)

    Sugimoto, Jun

    1999-01-01

    Severe accident research at JAERI aims at the confirmation of the safety margin, the quantification of the associated risk, and the evaluation of the effectiveness of the accident management measures of the nuclear power reactors, in accordance with the government five-year nuclear safety research program. JAERI has been conducting a wide range of severe accident research activities both in experiment and analysis, such as melt coolant interactions, fission product behaviors in coolant system, containment integrity and assessment of accident management measures. Molten core/coolant interaction and in-vessel molten coolability have been investigated in ALPHA Program. MUSE experiments in ALPHA Program has been conducted for the precise energy measurement due to steam explosion in melt jet and stratified geometries. In VEGA Program, which aims at FP release from irradiated fuels at high temperature and high pressure under various atmospheric conditions, the facility construction is almost completed. In WIND Program the revaporization of aerosols due to decay heating and also the integrity of the piping from this heat source are being investigated. Code development activities are in progress for an integrated source term analysis with THALES, fission product behaviors with ART, steam explosion with JASMINE, and in-vessel debris behaviors with CAMP. The experimental analyses and reactor application have made progress by participating international standard problem and code comparison exercises, along with the use of introduced codes, such as SCDAP/RELAP5 and MELCOR. The outcome of the severe accident research will be utilized for the evaluation of more reliable severe accident scenarios, detailed implementation of the accident management measures, and also for the future reactor development, basically through the sophisticated use of verified analytical tools. (author)

  10. Severe febrile systemic reaction to pneumococcal vaccine.

    Science.gov (United States)

    Hasan, Syed; Yousef, Mahmoud; Shridharani, Sachin

    2005-02-01

    Polyvalent pneumococcal polysaccharide vaccine (Pneumovax, PPV) has been shown to substantially reduce the risk of Streptococcus pneumoniae infections in susceptible individuals. Side effects, such as mild local erythema, induration, pain and fever, have been reported with various frequencies. Rarely, systemic symptoms, including high fever, headache, nausea and photophobia, have been reported in the literature. This case report describes a 38-year-old male who developed severe and prolonged local and systemic symptoms necessitating hospitalization following a dose of pneumovax.

  11. Severe accidents and ESFR design issues

    International Nuclear Information System (INIS)

    Rineiski, A.

    2013-01-01

    Current SFR studies in Germany: ⇒ In support of European SFR studies, mainly on safety and safety-related (design optimization) issues; ⇒ ADS and SFR as main options for spent fuel management in studies on the possibility of P&T; ⇒ ESFR-type designs studied recently; ⇒ ASTRID-type designs to be studied in the future; ⇒ Particular area: modeling of severe accidents with SAS4A/SAS-SFR and SIMMER codes

  12. Bazex Syndrome with Hypoalbuminemia and Severe Ascites

    OpenAIRE

    Matsui, Hidetoshi; Iwae, Shigemichi; Hirayama, Yuji; Yonezawa, Koichiro; Shigeji, Jun

    2016-01-01

    Bazex syndrome is a rare paraneoplastic dermatosis. The underlying malignancy frequently is squamous cell carcinoma of the upper aerodigestive tract or cervical lymph nodes from an unknown primary site. We report a 63-year-old man with squamous cell carcinoma of cervical lymph nodes from an unknown primary site. He developed a mass on the right side of his neck, cutaneous lesions diagnosed as Bazex syndrome, hypoalbuminemia, and severe ascites. Right neck dissection was performed. After neck ...

  13. Ochronosis: a case of severe ochronotic arthropathy

    Directory of Open Access Journals (Sweden)

    Berat Meryem Alkan

    2011-10-01

    Full Text Available Ochronosis involves primarily the large cartilaginous joint surfaces, ribs, intervertebral discs, ear cartilage etc. We report on a 52-year-old woman with typical alkaptonuric ochronosis with dark urine, blue-black pigmentation of the auriculae and hands, spondylarthropathy and severe hip and shoulder joints involvement. The differential diagnosis of this rare condition is discussed with a review of the literature.

  14. Persistent severe polyuria after renal transplant

    OpenAIRE

    Wong, Timothy; Laing, Chris; Ekong, Rosemary; Povey, Sue; Unwin, Robert J.

    2015-01-01

    Polydipsia and polyuria are common symptoms in patients with diabetes insipidus (DI), which can be due to inadequate vasopressin production (cranial DI) or vasopressin insensitivity (nephrogenic DI). Clinical diagnosis of the subtypes of DI can be tricky. We present a 44-year-old man with a strong family history of DI who had been diagnosed with autosomal dominant nephrogenic DI from infancy. At the age of 40, he had progressed to end-stage renal failure. When he experienced unresolving sever...

  15. Validation of dengue infection severity score

    Directory of Open Access Journals (Sweden)

    Pongpan S

    2014-03-01

    Full Text Available Surangrat Pongpan,1,2 Jayanton Patumanond,3 Apichart Wisitwong,4 Chamaiporn Tawichasri,5 Sirianong Namwongprom1,6 1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Occupational Medicine, Phrae Hospital, Phrae, Thailand; 3Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, Thailand; 4Department of Social Medicine, Sawanpracharak Hospital, Nakorn Sawan, Thailand; 5Clinical Epidemiology Society at Chiang Mai, Chiang Mai, Thailand; 6Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: To validate a simple scoring system to classify dengue viral infection severity to patients in different settings. Methods: The developed scoring system derived from 777 patients from three tertiary-care hospitals was applied to 400 patients in the validation data obtained from another three tertiary-care hospitals. Percentage of correct classification, underestimation, and overestimation was compared. The score discriminative performance in the two datasets was compared by analysis of areas under the receiver operating characteristic curves. Results: Patients in the validation data were different from those in the development data in some aspects. In the validation data, classifying patients into three severity levels (dengue fever, dengue hemorrhagic fever, and dengue shock syndrome yielded 50.8% correct prediction (versus 60.7% in the development data, with clinically acceptable underestimation (18.6% versus 25.7% and overestimation (30.8% versus 13.5%. Despite the difference in predictive performances between the validation and the development data, the overall prediction of the scoring system is considered high. Conclusion: The developed severity score may be applied to classify patients with dengue viral infection into three severity levels with clinically acceptable under- or overestimation. Its impact when used in routine

  16. Multiple sclerosis with predominant, severe cognitive impairment

    Science.gov (United States)

    Staff, Nathan P.; Lucchinetti, Claudia F.; Keegan, B. Mark

    2009-01-01

    Objective To describe the characteristics of multiple sclerosis (MS) presenting with severe cognitive impairment as its primary disabling manifestation. Design Retrospective case series. Setting Tertiary referral center. Patients Patients were identified through the Mayo Clinic data retrieval system (1996–2008) with definite MS (McDonald criteria) and severe cognitive impairment as their primary neurological symptom without accompanying significant MS-related impairment or alternative diagnosis for cognitive dysfunction. Twenty-three patients meeting inclusion criteria were compared regarding demographics, clinical course and radiological features. Main Outcome Measures Demographic, clinical, and radiological characteristics of the disease. Results Twelve patients were men. The median age of the first clinical symptom suggestive of CNS demyelination was 33 years, and severe MS-related cognitive impairment developed at a median of 39 years. Cognitive impairment could be dichotomized as subacute fulminant (n=9) or chronic progressive (n=14) in presentation, which corresponded to subsequent relapsing or progressive MS courses. Study patients commonly exhibited psychiatric (65%), mild cerebellar (57%) and cortical symptoms and signs (e.g. seizure, aphasia, apraxia) (39%). Fourteen of 21 (67%), where documented, smoked cigarettes. Brain MRI demonstrated diffuse cerebral atrophy in 16 and gadolinium enhancing lesions in 11. Asymptomatic spinal cord MRI lesions were present in 12 of 16 patients (75%). Immunomodulatory therapies were generally ineffective in improving these patients. Conclusions We describe patients with MS whose clinical phenotype is characterized by severe cognitive dysfunction and prominent cortical and psychiatric signs presenting as a subacute fulminant or chronic progressive clinical course. Cigarette smokers may be over represented in this phenotype. PMID:19752304

  17. An Unexpected Cause of Severe Hypokalemia

    Directory of Open Access Journals (Sweden)

    Fernando Caravaca-Fontan

    2015-01-01

    Full Text Available We describe an unusual case of severe hypokalemia with electrocardiographic changes, due to licorice consumption, in a 15-year-old female student with no previous medical history. Prompt replacement of potassium and cessation of licorice ingestion resulted in a favourable outcome. We also discuss the pathophysiology and diagnosis, emphasizing the importance of a detailed anamnesis to rule out an often forgotten cause of hypokalemia as the licorice poisoning.

  18. On operator diagnosis aid in severe earthquakes

    International Nuclear Information System (INIS)

    Lee, S.H.; Okrent, D.

    1988-01-01

    During a severe earthquake, any component, system, or structure may fail; the plant may be driven into a very complex situation in which instrumentaion and control systems may also fail and provide operators with unreliable information about the processing parameters crucial to plant safety. What can operators do when faced with such complexity. Even though the likelihood of such a severe earthquake may be very low, its consequence may be more serious if mitigative measures are not thought out and implemented in advance. The objectives of the present study is related to the measures to protect the plant from severe damage due to large earthquakes, namely, the improvement of operator capability to respond to seismic damage through the use of Emergency Procedure Guidelines (EPGs). The fact that the symptoms presented to operators may be unreliable in severe earthquakes endangers the validity of actions in EPGs. It is the purpose of this study to design a tool through which study may be done so that the weakness of EPGs may be identified in advance then, if possible, according to the practice results some learning may be obtained so that EPGs may be improved to accomodate the complexity to a maximum. In other words, the present study intends to provide a tool which may simulate available signals, including false ones, such that EPGs may be examined and operator actions may be studied. It is hoped to develop some knowledge needed to complement the currently available knowledge. The final product of this study shall be a program which may provide users the rationale on how it reachs conclusions such that users may improve their knowledge, as well as a program whose knowledge may be updated via user interfacing

  19. Several complex variables and Banach algebras

    International Nuclear Information System (INIS)

    Allan, G.R.

    1976-01-01

    This paper aims to present certain applications of the theory of holomorphic functions of several complex variables to the study of commutative Banach algebras. The material falls into the following sections: (A) Introcution to Banach algebras (this will not presuppose any knowledge of the subject); (B) Groups of differential forms (mainly concerned with setting up a useful language); (C) Polynomially convex domains. (D) Holomorphic functional calculus for Banach algebras; (E) Some applications of the functional calculus. (author)

  20. Severe refractory hypertension during shoulder arthroscopy

    Directory of Open Access Journals (Sweden)

    R O Abrons

    2016-01-01

    Full Text Available The use of epinephrine-containing saline irrigating solutions during arthroscopic shoulder surgery gained popularity after it was reported that the addition of epinephrine reduced bleeding and improved visualization without adverse cardiovascular effects. We share a case of a patient undergoing shoulder arthroscopy who received a standard intra-articular infusion of epinephrine-containing normal saline (1 mcg/mL and experienced severe hemodynamic consequences.

  1. Emotional intelligence, trauma severity, and emotional expression.

    Science.gov (United States)

    Kao, Min C; Chen, Yung Y

    2016-07-01

    This study investigated Emotional Intelligence (EI) as a moderator for the association between emotional expression and adaptive trauma processing, as measured by depressive symptoms. Using Pennebaker's written emotional expression paradigm, 105 participants were assigned to either a conventional trauma-writing or religious trauma-writing condition. Depressive symptoms were assessed at baseline and again at one-month post writing. No significant association between EI and religiousness was found at baseline. Results indicated a three-way interaction among EI, trauma severity, and writing condition on depressive symptoms at follow-up. For the religious trauma-writing condition only, there was a significant difference between high- versus low-EI participants who experienced more severe trauma in depressive symptoms at follow-up, such that low-EI participants registered less depressive symptoms than high-EI participants; while there was no significant difference between low versus high EI for participants with less severe trauma. These findings encourage further investigation of the conditions under which religion may be a beneficial factor in trauma adaptation.

  2. Comparison of several potential myocardial imaging agents

    International Nuclear Information System (INIS)

    Watson, E.E.; Stabin, M.G.; Goodman, M.M.; Knapp, F.F. Jr.; Srivastava, P.C.

    1985-01-01

    Although myocardial imaging is currently dominated by Tl-201, several alternative agents with improved physiologic or radionuclidic properties have been proposed. Based on human and animal studies in the literature, the metabolism of several of these compounds was studied for the purpose of generating radiation dose estimates. Dose estimates are listed for several I-123 labeled free fatty acids, an I-123 labeled phosphonium compound, Rb-82, Cu-64, F-18 FDG (all compounds which are taken up by the normal myocardium), and for Tc-99m pyrophosphate (PYP) (which localizes in myocardial infarcts). Dose estimates could not be generated for C-11 palmitate, but this compound was included in a comparison of myocardial retention times. For the I-123 labeled compounds, I-124 was included as a contaminant in generating the dose estimates. Radiation doses were lowest for Rb-82 (gonads 0.3 to 0.5 μGy/MBq, heart wall 15 μGy/MBq). Doses for the I-123 labeled fatty acids were similar to one another, with IPPA being the lowest (gonads 20 μGy/MBq, heart wall 15 μGy/MBq). Doses for Tc-99m PYP were also low (gonads 4 to 7 μGy/MBq, heart wall 4 μGy/MBq, skeleton 15 μGy/MBq). The desirability of these compounds is discussed briefly, considering half life, imaging mode and energy, and dosimetry, including a comparison of the effective whole body dose equivalents. 34 refs., 11 tabs

  3. Hierarchical feature selection for erythema severity estimation

    Science.gov (United States)

    Wang, Li; Shi, Chenbo; Shu, Chang

    2014-10-01

    At present PASI system of scoring is used for evaluating erythema severity, which can help doctors to diagnose psoriasis [1-3]. The system relies on the subjective judge of doctors, where the accuracy and stability cannot be guaranteed [4]. This paper proposes a stable and precise algorithm for erythema severity estimation. Our contributions are twofold. On one hand, in order to extract the multi-scale redness of erythema, we design the hierarchical feature. Different from traditional methods, we not only utilize the color statistical features, but also divide the detect window into small window and extract hierarchical features. Further, a feature re-ranking step is introduced, which can guarantee that extracted features are irrelevant to each other. On the other hand, an adaptive boosting classifier is applied for further feature selection. During the step of training, the classifier will seek out the most valuable feature for evaluating erythema severity, due to its strong learning ability. Experimental results demonstrate the high precision and robustness of our algorithm. The accuracy is 80.1% on the dataset which comprise 116 patients' images with various kinds of erythema. Now our system has been applied for erythema medical efficacy evaluation in Union Hosp, China.

  4. Asymptomatic myotonia congenita unmasked by severe hypothyroidism.

    Science.gov (United States)

    Passeri, Elena; Sansone, Valeria A; Verdelli, Chiara; Mendola, Marco; Corbetta, Sabrina

    2014-04-01

    Myotonia congenita is an inherited muscle disorder sustained by mutations in the skeletal muscle chloride channel gene CLCN1. Symptoms vary from mild to severe and generalized myotonia and worsen with cold, stressful events and hormonal fluctuations. Here we report the case of a young woman who sought medical attention because of subacute onset of diffuse and severe limb myotonia. CLCN1 gene sequencing showed a heterozygous transversion (T550M), two polymorphisms and one silent mutation. Thyroid function screening revealed severe hypothyroidism. She was placed on l-thyroxine replacement therapy which dramatically improved myotonia. We conclude that hypothyroidism unmasked a genetically determined, clinically asymptomatic chloride channelopathy. Diagnostic work-up in patients with clinically isolated myotonia should not be limited to genetic screening of non-dystrophic or dystrophic myotonias. Considering the high prevalence of hypothyroidism in females, systematic thyroid function screening by looking for additional hypothyroid symptoms and serum TSH levels measurement is mandatory in these patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Severe neurological complication following adjustable gastric banding.

    Science.gov (United States)

    Martines, G; Musa, N; Aquilino, F; Capuano, P

    2018-01-01

    In the last years with the increase of bariatric surgery, first of all as a result of new indications, a rise in the incidence of nutrient-related complications has been observed. Currently little is known about the impact of post-bariatric malnutrition and neurological complications. Wernicke's encephalopathy is a severe neurological syndrome which occurs as a result of thiamine deficiency. Wernicke-Korsakoff syndrome must be considered a serious neurological complication of bariatric surgery with significant morbidity and mortality, with rapidly progressing neurological symptoms, and must be treated immediately. We report the case of a 35 years-old male patient, affected by morbid obesity, anxious-depressive syndrome and alcohol use disorder, who after adjustable gastric banding implanted in another hospital developed a severe malnutrition and neurological syndrome. The patient showed poor adherence to the follow-up and to the dietary indications and after all, we needed to place a PEG for enteral nutrition in order to resolve the malnutrition condition and the neurological syndrome. Our experience emphasizes that preoperative selection and assessment of a patient's nutritional status according to guidelines, is required to identify potential problems, and that bariatric surgeons or physicians caring for patient who have undergone bariatric surgery should be familiar with the constellation of nutritional and neurological disorder that may occur after surgery. We want to remark the importance of preoperative selection of the patients, the follow-up and the cooperation between patient and physician in order to obtain the best result and avoid severe complications.

  6. [Eating habits of patients with severe obesity].

    Science.gov (United States)

    Reséndiz Barragán, Aída Monserrat; Hernández Altamirano, Sheila Viridiana; Sierra Murguía, Mariana Alejandra; Torres Tamayo, Margarita

    2014-11-30

    Severe obesity is a health problem that has medical, emotional and economic consequences. The etiology of severe obesity is multifactorial; however, it is known that the eating habits represent a major factor in the development of this disease. This study aimed to identify eating patterns and specific habits that need to be changed to achieve weight loss. An observational, descriptive, retrospective and cross-sectional study with 250 candidates for bariatric surgery, 79.2% women and 20.8% men aged 37.7 ± 10.2 years and 44.3 ± 7.7 kg/m2 BMI patients was performed. It was found that "drinking water", "eat faster than most people", "leave the plate empty", "have long fasts", "sweet cravings", and "drinking soda" were the most common habits in patients with severe obesity. The existence of significant differences between the habits of men and women and between BMI strata or groups are also discussed. "Snacking" and "eat until you feel uncomfortable" were significantly different between men and women and "eat by yourself because you feel ashamed of eating with others" was significant between BMI strata. It was concluded that it is important that the treatment of these patients includes assessment techniques and behavior modification aimed at these habits. It is recommended to include in future studies patients with normal weight and overweight as well as the use of instruments with adequate psychometric properties. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  7. PEG-asparaginase induced severe hypertriglyceridemia.

    Science.gov (United States)

    Galindo, Rodolfo J; Yoon, Justin; Devoe, Craig; Myers, Alyson K

    2016-04-01

    Asparaginase (ASP) is an effective chemotherapy agent extensively used in children with acute lymphocytic leukemia (ALL). There has been a recent interest in using ASP in adults with ALL, particularly the less toxic pegylated (PEG) formulation. Hypertriglyceridemia (HTG) is a rare complication of PEG-ASP therapy. We report two cases of obese patients who developed severe HTG after receiving PEG for ALL. Both patients were incidentally found to have severe HTG (TG of 4,330 and 4,420 mg/dL). In both patients, there was no personal or family history of dyslipidemia or hypothyroidism. There was no evidence of pancreatitis or skin manifestations of HTG. Both patients were treated with PEG cessation, low-fat diet and pharmacotherapy. Both patients were re-challenged with PEG, with subsequent increase in TG but no associated complications. TG returned to baseline after discontinuing PEG and while on therapy for HTG. A literature review of PEG-induced HTG in adults demonstrated similar results: asymptomatic presentation despite very severe HTG. HTG is a rare but clinically important adverse effect of PEG. Underlying obesity and/or diabetes may represent risk factors. Clinicians should monitor TG levels during PEG therapy to avoid TG-induced pancreatitis.

  8. [Severe hypertriglyceridemia : Diagnostics and new treatment principles].

    Science.gov (United States)

    Kassner, U; Dippel, M; Steinhagen-Thiessen, E

    2017-08-01

    Severe hypertriglyceridemia is defined at a plasma triglyceride (TG) concentration of >885 mg/dl and may result - in particular when clinical symptoms appear before the age of 40 - from "large variant" mutations in genes which influence the function of the lipoprotein lipase (LPL). For diagnosis, secondary factors have to be excluded and treated before further genetic tests are considered. Typical symptoms in almost all patients are recurrent, sometimes severe abdominal pain attacks, which can result in acute pancreatitis, the most important, sometimes life-threatening complication. To minimize the risk of severe pancreatitis, the aim is to maintain the plasma TG concentration hypertriglyceridemia have an increased cardiovascular risk. To lower this is the primary treatment goal here. Treatment mainly consists of a life-long, strict fat- and carbohydrate-restricted diet and the abstention from alcohol. Omega‑3-Fatty acids and fibrates can be used to lower plasma TG levels. Recently, new gene therapy approaches for LPL-deficient patients have become available in Germany.

  9. Self-esteem in severely burned adults.

    Science.gov (United States)

    Imran Haider Zaidi, Syed Muhammad; Yaqoob, Nazia; Noreen, Sidra

    2017-12-01

    A cross-sectional study was conducted to investigate the level of and gender difference in self-esteem among adult victims of severe burn injuries. Severely burned adults aged 20 to 40 years participated in this investigation from March 2015 to April 2016 in five hospitals of Faisalabad and Lahore. Purposive sampling technique was used and a self-esteem scale was used to assess different dimensions of self-esteem. Out of 40 patients, there were 25 men (62.5%) and 15 women (37.5%) with mean age of 28.28±4.60 years (range: 20-40 years). A significant positive relationship between subscales of self-esteem scale were found: self-acceptance and self-competence r=0.55, pself-acceptance and academic self-competence r=0.47, pself-acceptance and social and physical acceptance r=0.57, pself-competence and academic self-competence r=0.48, pself-competence and social and physical acceptance r=0.50, pself-competence and social and physical acceptance r=0.45, pself-competence among severely burned men and women (t=2.18; pself-competency component of self-esteem among women victims.

  10. CANDU severe accident management guidance update

    International Nuclear Information System (INIS)

    Jones, L.; Popov, N.; Gilbert, L.; Weed, J.

    2014-01-01

    The CANDU Owners Group (COG) developed a set of generic and initial station-specific Severe Accident Management Guidance (SAMG) documents to mitigate the consequences to the public in the event of a severe accident. The generic portion of the COG SAMG was completed in 2006; the overall project including the station-specific phase was completed in April 2007. Over the years, the CANDU industry and utilities have continuously increased the knowledge base for SAMG and have incorporated various engineered features based on the knowledge obtained. As a result of the event that occurred at the Fukushima Daiiachi nuclear power plant (NPP) in Japan, the Canadian Nuclear Safety Commission (CNSC) established the CNSC Fukushima Task Force. The results of the task force were documented in INFO-0828, CNSC Staff Action Plan on the CNSC Fukushima Task Force Recommendations. Among the recommendation documented in INFO-828 were Fukushima Action Items (FAIs) directed towards the CANDU utilities in Canada; a portion of which are related to SAMG documentation updates and directed at enhancing SAM response. A COG joint project was established to support the closure of the CNSC FAIs and to revise the current CANDU documentation accordingly. This paper provides a high level summary of the COG project scope and results. It also demonstrates that the CANDU SAMG programs in Canada provide robust protection and mitigation of severe accidents. (author)

  11. CANDU severe accident management guidance update

    Energy Technology Data Exchange (ETDEWEB)

    Jones, L., E-mail: lisa.m.jones@opg.com [Ontario Power Generation, Pickering, ON (Canada); Popov, N., E-mail: nik.popov@rogers.com [Candu Owners Group, Toronto, ON (Canada); Gilbert, L., E-mail: lovell.gilbert@brucepower.com [Bruce Power, Tiverton, ON (Canada); Weed, J., E-mail: jeff.weed@candu.gov [Candu Owners Group, Toronto, ON (Canada)

    2014-07-01

    The CANDU Owners Group (COG) developed a set of generic and initial station-specific Severe Accident Management Guidance (SAMG) documents to mitigate the consequences to the public in the event of a severe accident. The generic portion of the COG SAMG was completed in 2006; the overall project including the station-specific phase was completed in April 2007. Over the years, the CANDU industry and utilities have continuously increased the knowledge base for SAMG and have incorporated various engineered features based on the knowledge obtained. As a result of the event that occurred at the Fukushima Daiiachi nuclear power plant (NPP) in Japan, the Canadian Nuclear Safety Commission (CNSC) established the CNSC Fukushima Task Force. The results of the task force were documented in INFO-0828, CNSC Staff Action Plan on the CNSC Fukushima Task Force Recommendations. Among the recommendation documented in INFO-828 were Fukushima Action Items (FAIs) directed towards the CANDU utilities in Canada; a portion of which are related to SAMG documentation updates and directed at enhancing SAM response. A COG joint project was established to support the closure of the CNSC FAIs and to revise the current CANDU documentation accordingly. This paper provides a high level summary of the COG project scope and results. It also demonstrates that the CANDU SAMG programs in Canada provide robust protection and mitigation of severe accidents. (author)

  12. Thermal hydraulics of CANDU severe accident analysis

    International Nuclear Information System (INIS)

    Negut, Gheorghe; Catana, Alexandru; Prisecaru, Ilie; Dupleac, Daniel

    2007-01-01

    As interest in severe accident studies has increased in the last years, we have developed a set of simple models to analyze severe accidents in CANDU reactors that should be integrated in the EU codes. The CANDU600 reactor uses natural uranium fuel and heavy water (D 2 O) as both moderator and coolant, with the moderator and coolant in separate systems. We chose to analyze accident development for a LOCA with simultaneous loss of moderator cooling and the loss of emergency core cooling system (ECCS). This type of accident is likely to modify the reactor geometry and will lead to a severe accident development. When the coolant temperatures inside a pressure tube reaches 1000 deg. C, a contact between pressure tube and calandria tube occurs and the residual heat is transferred to the moderator. Due to the lack of cooling, the moderator eventually begins to boil and is expelled, through the calandria vessel relief ducts, into the containment. Therefore the calandria tubes (fuel channels) will be uncovered, then will disintegrate and fall down to the calandria vessel bottom. After all the quantity of moderator is vaporized and expelled, the debris will heat up and eventually boil. The heat accumulated in the molten debris will be transferred through the calandria vessel wall to the shield tank water, which normally surrounds the calandria vessel. The phenomena described above are modelled, analyzed and compared with the available data. The results are encouraging. (authors)

  13. [The Nutrition Care of Severe Burn Patients].

    Science.gov (United States)

    Hsieh, Yu-Hsiu

    2016-02-01

    In addition to recent advances in burn patient care techniques such as maintaining warm circumambient temperature, the early excision of wounds, and the use of closed dressing, providing nutrition support through early feeding has proven instrumental in greatly increasing the survival rate of burn patients. Severe burns complicated by many factors initiate tremendous physiological stress that leads to postburn hypermetabolism that includes enhanced tissue catabolism, the loss of muscle mass, and decreases in the body's reservoirs of protein and energy. These problems have become the focus of burn therapy. Treating severe burns aims not only to enhance survival rates but also to restore normal bodily functions as completely as possible. Recent research evaluating the application of anabolic agents and immune-enhance formula for severe burns therapy has generated significant controversy. Inadequate caloric intake is one of the main differences among the related studies, with the effect of many special nutrients such as bran acid amides not taken into consideration. Therefore, considering the sufficiency of caloric and protein intake is critical in assessing effectiveness. Only after patients receive adequate calories and protein may the effect of special nutrients such as glutamine and supplements be evaluated effectively.

  14. Development of Severe Accident Containment Analysis Package

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang-Hwan; Kim, Dong-Min; Seo, Jea-Uk; Lee, Dea-Young; Park, Soon-Ho; Lee, Jae-Gwon; Lee, Jin-Yong; Lee, Byung-Chul [FNC Technology Co., Yongin (Korea, Republic of)

    2016-10-15

    In safety viewpoint, the pressure and temperature of the containment is the important parameters, of course, the local hydrogen concentration is also the parameter of the major concern because of its flammability and the risk of the detonation. In addition, there are possibilities of occurrence of other relevant phenomena following the reactor core melting such as DCH(direct containment heating) due to HPME(high pressure melt ejection), steam explosion due to fuel-coolant interaction in the reactor cavity and molten core concrete interaction at the late stage. It is important to predict the containment responses during a severe accident by a reasonable accuracy for establishing of effective mitigation strategies and preparation of the safety features required. In this paper, the overview of the SACAP development status is presented. SACAP is developed so as to be able to analyze, so called, Ex-Vessel severe accident phenomena including thermal-hydraulics, combustible gas burn, direct containment heating, steam explosion and molten core-concrete interaction. At the parallel time, SACAP and In-Vessel analysis module named CSPACE are processed for integration through MPI communication coupling. Development of the integrated severe accident analysis code system will be completed in following one year to make the code revision zero to be released.

  15. ANS severe accident program overview & planning document

    Energy Technology Data Exchange (ETDEWEB)

    Taleyarkhan, R.P.

    1995-09-01

    The Advanced Neutron Source (ANS) severe accident document was developed to provide a concise and coherent mechanism for presenting the ANS SAP goals, a strategy satisfying these goals, a succinct summary of the work done to date, and what needs to be done in the future to ensure timely licensability. Guidance was received from various bodies [viz., panel members of the ANS severe accident workshop and safety review committee, Department of Energy (DOE) orders, Nuclear Regulatory Commission (NRC) requirements for ALWRs and advanced reactors, ACRS comments, world-wide trends] were utilized to set up the ANS-relevant SAS goals and strategy. An in-containment worker protection goal was also set up to account for the routine experimenters and other workers within containment. The strategy for achieving the goals is centered upon closing the severe accident issues that have the potential for becoming certification issues when assessed against realistic bounding events. Realistic bounding events are defined as events with an occurrency frequency greater than 10{sup {minus}6}/y. Currently, based upon the level-1 probabilistic risk assessment studies, the realistic bounding events for application for issue closure are flow blockage of fuel element coolant channels, and rapid depressurization-related accidents.

  16. An analysis of severe air transport accidents

    International Nuclear Information System (INIS)

    McClure, J.D.; Luna, R.E.

    1989-01-01

    The objective of this paper is to analyze the severity of aircraft accidents that may involve the air transport of radioactive materials (RAM). One of the basic aims of this paper is to provide a numerical description of the severity of aircraft transport accidents so that the accident severity can be compared with the accident performance standards that are specified in IAEA Safety Series 6, the international packaging standards for the safe movement of RAM. The existing packaging regulations in most countries embrace the packaging standards developed by the IAEA. Historically, the packaging standards for Type B packages have been independent of the transport mode. That is, if the shipment occurs in a certified packaging, then the shipment can take place by any transport mode. In 1975, a legislative action occurred in the US Congress which led to the development of a package designed specifically for the air transport of plutonium. Changes were subsequently made to the US packaging regulations in 10CFR71 to incorporate the plutonium air transport performance standards. These standards were used to certify the air transport package for plutonium which is commonly referred to as PAT-1 (US NRC). The PAT-1 was certified by the US Nuclear Regulatory Commission in September 1978

  17. Nuclear power plant Severe Accident Research Plan

    International Nuclear Information System (INIS)

    Larkins, J.T.; Cunningham, M.A.

    1983-01-01

    The Severe Accident Research Plan (SARP) will provide technical information necessary to support regulatory decisions in the severe accident area for existing or planned nuclear power plants, and covers research for the time period of January 1982 through January 1986. SARP will develop generic bases to determine how safe the plants are and where and how their level of safety ought to be improved. The analysis to address these issues will be performed using improved probabilistic risk assessment methodology, as benchmarked to more exact data and analysis. There are thirteen program elements in the plan and the work is phased in two parts, with the first phase being completed in early 1984, at which time an assessment will be made whether or not any major changes will be recommended to the Commission for operating plants to handle severe accidents. Additionally at this time, all of the thirteen program elements in Chapter 5 will be reviewed and assessed in terms of how much additional work is necessary and where major impacts in probabilistic risk assessment might be achieved. Confirmatory research will be carried out in phase II to provide additional assurance on the appropriateness of phase I decisions. Most of this work will be concluded by early 1986

  18. Sputum Neutrophilia in Severe Persistent Asthmatics

    International Nuclear Information System (INIS)

    Naseem, A.; Zaidi, S. B. H.; Liaqat, J.; Iftikhar, R.

    2014-01-01

    Objective: To determine the frequency of sputum neutrophilia in patients with severe persistent bronchial asthma. Study Design: A cross-sectional study. Place and Duration of Study: Department of Medicine, Military Hospital, Rawalpindi, from November 2009 to November 2010. Methodology: Cases of severe persistent bronchial asthma, aged between 12 and 40 years, were included. Sputum samples were collected by induction with hypertonic saline (4.5%). All samples were centrifuged and differential neutrophil count was calculated. Data was analyzed using SPSS 11. Results: Out of 195 patients, there were 129 (66.2%) males and 66 (33.8%) females. The mean age was 27.01 A +- 6.92 years. Mean sputum neutrophilic count was 126.47 A +- 16.52 x 106/ml and the mean neutrophilic percentage was 63.187 A +- 8.3363. Sputum neutrophilia was present in 84 patients (43.1%), out of whom, 56 were males and 28 females. In patients with sputum neutrophilia, mean neutrophilic count was 142.40 A +- 8.49 x 106/ml and the mean neutrophilic percentage was 71.2024 A +- 4.2441%. Conclusion: Sputum neutrophilia is a frequent finding in cases with severe persistent bronchial asthma. Presence of sputum neutrophilia in such cases can lessen the inappropriate use of corticosteroids with their associated long-term side effects. (author)

  19. Method of assessing severe accident management strategies

    International Nuclear Information System (INIS)

    Kastenberg, W.E.; Apostolakis, G.; Dhir, V.K.; Okrent, D.; Jae, M.; Lim, H.; Milici, T.; Park, H.; Swider, J.; Xing, L.; Yu, D.

    1991-01-01

    Accident management can be defined as the innovative use of existing and or alternative resources, systems, and actions to prevent or mitigate a severe accident. A significant number of probabilistic safety assessments (PSAs) have been completed that yield the principal plant vulnerabilities. These vulnerabilities can be categorized as (1) dominant sequences with respect to core-melt frequency. (2) dominant sequences with respect to various risk measures. (3) dominant threats that challenge safety functions. (4) dominant threats with respect to failure of safety systems. For each sequence/threat and each combination of strategy, there may be several options available to the operator. Each strategy/option involves phenomenological and operational considerations regarding uncertainty. These considerations include uncertainties in key phenomena, operator behavior, system availability and behavior, and available information. This paper presents a methodology for assessing severe accident management strategies given the key uncertainties delineated at two workshops held at the University of California, Los Angeles. Based on decision trees and influence diagrams, the methodology is currently being applied to two case studies: cavity flooding in a pressurized water reactor (PWR) to prevent vessel penetration or failure, and drywell flooding in a boiling water reactor to prevent vessel and/or containment failure

  20. Assessment of problematic severe asthma in children

    DEFF Research Database (Denmark)

    Carlsen, K. C. L.; Hedlin, G.; Bush, A.

    2011-01-01

    Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessm......Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi......-disciplinary assessment is performed to identify issues that may need attention, including comorbidities. Thirdly, the pattern of inflammation is assessed, and finally steroid responsiveness is documented. Based upon these four steps an optimal individualised treatment plan is developed. In this article the many gaps...... in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made. The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small...

  1. Regulation Plans on Severe Accidents developed by KINS Severe Accident Regulation Preparation TFT

    International Nuclear Information System (INIS)

    Kim, Kyun Tae; Chung, Ku Young; Na, Han Bee

    2016-01-01

    Some nuclear power plants in Fukushima Daiichi site had lost their emergency reactor cooling function for long-time so the fuels inside the reactors were molten, and the integrity of containment was damaged. Therefore, large amount of radioactive material was released to environment. Because the social and economic effects of severe accidents are enormous, Korean Government already issued 'Severe Accident Policy' in 2001 which requires nuclear power plant operators to set up 'Quantitative Safety Goal', to do 'Probabilistic Safety Analysis', to install 'Severe Accident Countermeasures' and to make 'Severe Accident Management Plan'. After the Fukushima disaster, a Special Safety Inspection was performed for all operating nuclear power plants of Korea. The inspection team from industry, academia, and research institutes assessed Korean NPPs capabilities to cope with or respond to severe accidents and emergency situation caused by natural disasters such as a large earthquake or tsunami. As a result of the special inspection, about 50 action items were identified to increase the capability to cope with natural disaster and severe accidents. Nuclear Safety Act has been amended to require NPP operators to submit Accident Management Plant as part of operating license application. The KINS Severe Accident Regulation Preparation TFT had first investigated oversea severe accident regulation trend before and after the Fukushima accident. Then, the TFT has developed regulation draft for severe accidents such as Severe accident Management Plans, the required design features for new NPPs to prevent severe accident against multiple failures and beyond-design external events, countermeasures to mitigate severe accident and to keep the integrity of containment, and assessment methodology on safety assessment plan and probabilistic safety assessment

  2. Severe Hemifacial Spasm is a Predictor of Severe Indentation and Facial Palsy after Microdecompression Surgery.

    Science.gov (United States)

    Na, Boo Suk; Cho, Jin Whan; Park, Kwan; Kwon, Soonwook; Kim, Ye Sel; Kim, Ji Sun; Youn, Jinyoung

    2018-04-27

    Hemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD). We enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups. The severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD. Spasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD. Copyright © 2018 Korean Neurological Association.

  3. Regulation Plans on Severe Accidents developed by KINS Severe Accident Regulation Preparation TFT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyun Tae; Chung, Ku Young; Na, Han Bee [KINS, Daejeon (Korea, Republic of)

    2016-05-15

    Some nuclear power plants in Fukushima Daiichi site had lost their emergency reactor cooling function for long-time so the fuels inside the reactors were molten, and the integrity of containment was damaged. Therefore, large amount of radioactive material was released to environment. Because the social and economic effects of severe accidents are enormous, Korean Government already issued 'Severe Accident Policy' in 2001 which requires nuclear power plant operators to set up 'Quantitative Safety Goal', to do 'Probabilistic Safety Analysis', to install 'Severe Accident Countermeasures' and to make 'Severe Accident Management Plan'. After the Fukushima disaster, a Special Safety Inspection was performed for all operating nuclear power plants of Korea. The inspection team from industry, academia, and research institutes assessed Korean NPPs capabilities to cope with or respond to severe accidents and emergency situation caused by natural disasters such as a large earthquake or tsunami. As a result of the special inspection, about 50 action items were identified to increase the capability to cope with natural disaster and severe accidents. Nuclear Safety Act has been amended to require NPP operators to submit Accident Management Plant as part of operating license application. The KINS Severe Accident Regulation Preparation TFT had first investigated oversea severe accident regulation trend before and after the Fukushima accident. Then, the TFT has developed regulation draft for severe accidents such as Severe accident Management Plans, the required design features for new NPPs to prevent severe accident against multiple failures and beyond-design external events, countermeasures to mitigate severe accident and to keep the integrity of containment, and assessment methodology on safety assessment plan and probabilistic safety assessment.

  4. Predicting severe injury using vehicle telemetry data.

    Science.gov (United States)

    Ayoung-Chee, Patricia; Mack, Christopher D; Kaufman, Robert; Bulger, Eileen

    2013-01-01

    In 2010, the National Highway Traffic Safety Administration standardized collision data collected by event data recorders, which may help determine appropriate emergency medical service (EMS) response. Previous models (e.g., General Motors ) predict severe injury (Injury Severity Score [ISS] > 15) using occupant demographics and collision data. Occupant information is not automatically available, and 12% of calls from advanced automatic collision notification providers are unanswered. To better inform EMS triage, our goal was to create a predictive model only using vehicle collision data. Using the National Automotive Sampling System Crashworthiness Data System data set, we included front-seat occupants in late-model vehicles (2000 and later) in nonrollover and rollover crashes in years 2000 to 2010. Telematic (change in velocity, direction of force, seat belt use, vehicle type and curb weight, as well as multiple impact) and nontelematic variables (maximum intrusion, narrow impact, and passenger ejection) were included. Missing data were multiply imputed. The University of Washington model was tested to predict severe injury before application of guidelines (Step 0) and for occupants who did not meet Steps 1 and 2 criteria (Step 3) of the Centers for Disease Control and Prevention Field Triage Guidelines. A probability threshold of 20% was chosen in accordance with Centers for Disease Control and Prevention recommendations. There were 28,633 crashes, involving 33,956 vehicles and 52,033 occupants, of whom 9.9% had severe injury. At Step 0, the University of Washington model sensitivity was 40.0% and positive predictive value (PPV) was 20.7%. At Step 3, the sensitivity was 32.3 % and PPV was 10.1%. Model analysis excluding nontelematic variables decreased sensitivity and PPV. The sensitivity of the re-created General Motors model was 38.5% at Step 0 and 28.1% at Step 3. We designed a model using only vehicle collision data that was predictive of severe injury at

  5. Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti

    Full Text Available In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children.In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50 with those without severe sepsis (controls = 354. Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline.The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001. In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons.We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.

  6. Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma

    NARCIS (Netherlands)

    Verkleij, Marieke; van de Griendt, Erik-Jonas; Colland, Vivian; van Loey, Nancy; Beelen, Anita; Geenen, Rinie

    2015-01-01

    Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 +/- A 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups

  7. Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma

    NARCIS (Netherlands)

    Verkleij, Marieke; van de Griendt, E-J.; Colland, V.; Van Loey, N.E.E.; Beelen, A.; Geenen, R.

    2015-01-01

    Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in

  8. Kyphoplasty for severe osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Bao Zhaohua; Wang Genlin; Yang Huilin; Meng Bin; Chen Kangwu; Jiang Weimin

    2010-01-01

    Objective: To evaluate the clininal efficacy of kyphoplasty for severe osteoporotic vertebral compression fractures. Methods: Forty-five patients with severe osteoporotic compressive fractures were treated by kyphoplasty from Jan 2005 to Jan 2009. The compressive rate of the fractured vertebral bodies was more than 75%. According to the morphology of the vertebral compression fracture bodies the unilateral or bilateral balloon kyphoplasty were selected. The anterior vertebral height was measured on a standing lateral radiograph at pre-operative, post-operative (one day after operation) and final follow-up time. A visual analog scale(VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain status and functional activity. Results: The mean follow-up was for 21.7 months (in range from 18 to 48 months). The anterior vertebral body height of fracture vertebra was restored from preoperative (18.7 ± 3.1)% to postoperative (51.4 ± 2.3)%, the follow-up period (50.2 ± 2.7)%. There was a significant improvement between preoperative and postoperative values (P 0.05). The VAS was 8.1 ± 1.4 at preoperative, 2.6 ± 0.9 at postoperative, 2.1 ± 0.5 at final follow-up time; and the ODI was preoperative 91.1 ± 2.3, postoperative 30.7 ± 7.1, follow-up period 26.1 ± 5.1. There was statistically significant improvement in the VAS and ODI in the post-operative assessment compared with the pre-operative assessment (P 0.05). Asymptomatic cement leakage occurred in three cases. New vertebral fracture occurred in one case. Conclusion: The study suggests that balloon kyphoplasty is a safe and effective procedure in the treatment of severe osteoporotic vertebral compression fractures. (authors)

  9. ACR-1000 design provisions for severe accidents

    International Nuclear Information System (INIS)

    Popov, N.K.; Santamaura, P.; Shapiro, H.; Snell, V.G.

    2006-01-01

    Atomic Energy of Canada Limited (AECL) developed the Advanced CANDU Reactor-700 (ACR-700) as an evolutionary advancement of the current CANDU 6 reactor. As a further advancement of the ACR design, AECL is currently developing the ACR-1000 for the Canadian and international market. The ACR-1000 is aimed at producing electrical power for a capital cost and a unit-energy cost significantly less than that of the current generation of operating nuclear plants, while achieving enhanced safety features, shorter construction schedule, high plant capacity factor, improved operations and maintenance, and increased operating life. The reference ACR-1000 plant design is based on an integrated two-unit plant, using enriched fuel and light-water coolant, with each unit having a nominal gross output of about 1200 MWe. The ACR-1000 design meets Canadian regulatory requirements and follows established international practice with respect to severe accident prevention and mitigation. This paper presents the ACR-1000 features that are designed to mitigate limited core damage and severe core damage states, including core retention within vessel, core damage termination, and containment integrity maintenance. While maintaining existing structures of CANDU reactors that provide inherent prevention and retention of core debris, the ACR-1000 design includes additional features for prevention and mitigation of severe accidents. Core retention within vessel in CANDU-type reactors includes both retention within fuel channels, and retention within the calandria vessel. The ACR-1000 calandria vessel design permits for passive rejection of decay heat from the moderator to the shield water. Also, the calandria vessel is designed for debris retention by minimizing penetrations at the bottom periphery and by accommodating thermal and weight loads of the core debris. The ACR-1000 containment is required to withstand external events such as earthquakes, tornados, floods and aircraft crashes

  10. Pazopanib-Induced Severe Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Kazumichi Kawakubo

    2015-08-01

    Full Text Available Pazopanib is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptors, platelet-derived growth factor receptors, and c-Kit approved for the treatment of renal cell carcinoma and soft tissue sarcoma. Nonselective kinase inhibitors, such as sunitinib and sorafenib, are known to be associated with acute pancreatitis. There are few case reports of severe acute pancreatitis induced by pazopanib treatment. We present a case of severe acute pancreatitis caused by pazopanib treatment for cutaneous angiosarcoma. The patient was an 82-year-old female diagnosed with cutaneous angiosarcoma. She had been refractory to docetaxel treatment and began pazopanib therapy. Three months after pazopanib treatment, CT imaging of the abdomen showed the swelling of the pancreas and surrounding soft tissue inflammation without abdominal pain. After she continued pazopanib treatment for 2 months, she presented with nausea and appetite loss. Abdominal CT showed the worsening of the surrounding soft tissue inflammation of the pancreas. Serum amylase and lipase levels were 296 and 177 IU/l, respectively. She was diagnosed with acute pancreatitis induced by pazopanib treatment and was managed conservatively with discontinuation of pazopanib, but the symptoms did not improve. Subsequently, an abdominal CT scan demonstrated the appearance of a pancreatic pseudocyst. She underwent endoscopic ultrasound-guided pseudocyst drainage using a flared-end fully covered self-expandable metallic stent. Then, the symptoms resolved without recurrence. Due to the remarkable progress of molecular targeted therapy, the oncologist should know that acute pancreatitis was recognized as a potential adverse event of pazopanib treatment and could proceed to severe acute pancreatitis.

  11. Severe hypertriglyceridemia. Clinical characteristics and therapeutic management.

    Science.gov (United States)

    Masson, Walter; Rossi, Emiliano; Siniawski, Daniel; Damonte, Juan; Halsband, Ana; Barolo, Ramiro; Scaramal, Miguel

    2018-05-19

    The therapeutic management of severe hypertriglyceridaemia represents a clinical challenge. The objectives of this study were 1) to identify the clinical characteristics of patients with severe hypertriglyceridaemia, and 2) to analyse the treatment established by the physicians in each case. A cross-sectional study was carried out using the computerised medical records of all patients>18 years of age with a blood triglyceride level≥1,000mg/dL between 1 January 2011 and 31 December 2016. Clinical and laboratory variables were collected. The behaviour of the physicians in the 6 months after the lipid finding was analysed. A total of 420 patients were included (mean age 49.1±11.4 years, males 78.8%). The median of triglycerides was 1,329mg/dL (interquartile range 1,174-1,658). No secondary causes were found in 34.1% of the patients. The most frequent secondary causes were obesity (38.6%) and diabetes (28.1%). Physical activity was recommended and a nutritionist was referred to in 49.1% and 44.2% of the patients, respectively. Secondary causes were identified and attempts were made to correct them in 40.7% of cases. The most indicated pharmacological treatments were fenofibrate 200mg/day (26.5%) and gemfibrozil 900mg/day (19.3%). Few patients received the indication of omega 3 fatty acids or niacin. This study showed, for the first time in our country, the characteristics of a population with severe hypertriglyceridaemia. The therapeutic measures instituted by the physicians were insufficient. Knowing the characteristics in this particular clinical scenario could improve the current approach of these patients. Copyright © 2018 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Severe sepsis secondary to emphysematous cystitis

    Directory of Open Access Journals (Sweden)

    M.M. Gargouri

    2015-03-01

    Full Text Available Emphysematous cystitis (EC is a rare, rapidly progressive infection characterized by gas formation within the bladder wall. Gas production is mainly due to fermentation of glucose or albumin by the pathogenic organisms. We present the case of a patient with EC who presented with severe sepsis of unknown origin. He was also found to have two vesical calculi and a horseshoe kidney. EC was diagnosed on ultrasonography which showed circumferential, acoustic shadowing around the bladder wall. Computed tomography (CT confirmed the diagnosis. Rapid healing could be achieved with appropriate antibiotics and bladder drainage. Endoscopic disintegration of the stones was performed three weeks later, and follow-up was uneventful.

  13. Assessment of outcome after severe brain damage.

    Science.gov (United States)

    Jennett, B; Bond, M

    1975-03-01

    Persisting disability after brain damage usually comprises both mental and physical handicap. The mental component is often the more important in contributing to overall social disability. Lack of an objective scale leads to vague and over-optimistic estimates of outcome, which obscure the ultimate results of early management. A five-point scale is described--death, persistent vegetative state, severe disability, moderate disability, and good recovery. Duration as well as intensity of disability should be included in an index of ill-health; this applies particularly after head injury, because many disabled survivors are young.

  14. Occupational Radiation Protection in Severe Accident Management

    International Nuclear Information System (INIS)

    2015-01-01

    As an early response to the Fukushima Daiichi NPP accident, the Information System on Occupational Exposure (ISOE) Bureau decided to focus on the following issues as an initial response of the joint program after having direct communications with the Japanese official participants in April 2011: - Management of high radiation area worker doses: It has been decided to make available the experience and information from the Chernobyl accident in terms of how emergency worker / responder doses were legally and practically managed, - Personal protective equipment for highly-contaminated areas: It was agreed to collect information about the types of personnel protective equipment and other equipment (e.g. air bottles, respirators, air-hoods or plastic suits, etc.), as well as high-radiation area worker dosimetry use (e.g. type, number and placement of dosimetry) for different types of emergency and high-radiation work situations. Detailed information was collected on dose criteria which are used for emergency workers /responders and their basis, dose management criteria for high dose/dose rate areas, protective equipment which is recommended for emergency workers / responders, recommended individual monitoring procedures, and any special requirement for assessment from the ISOE participating nuclear utilities and regulatory authorities and made available for Japanese utilities. With this positive response of the ISOE official participants and interest in the situation in Fukushima, the Expert Group on Occupational Radiation Protection in Severe Accident Management (EG-SAM) was established by the ISOE Management Board in May 2011. The overall objective of the EG-SAM is to contribute to occupational exposure management (providing a view on management of high radiation area worker doses) within the Fukushima plant boundary with the ISOE participants and to develop a state-of-the-art ISOE report on best radiation protection management practices for proper radiation

  15. Hurricane Isabel gives accelerators a severe test

    International Nuclear Information System (INIS)

    Swapan Chattopadhyay

    2004-01-01

    Hurricane Isabel was at category five--the most violent on the Saffir-Simpson scale of hurricane strength--when it began threatening the central Atlantic seaboard of the US. Over the course of several days, precautions against the extreme weather conditions were taken across the Jefferson Lab site in south-east Virginia. On 18 September 2003, when Isabel struck North Carolina's Outer Banks and moved northward, directly across the region around the laboratory, the storm was still quite destructive, albeit considerably reduced in strength. The flood surge and trees felled by wind substantially damaged or even devastated buildings and homes, including many belonging to Jefferson Lab staff members. For the laboratory itself, Isabel delivered an unplanned and severe challenge in another form: a power outage that lasted nearly three-and-a-half days, and which severely tested the robustness of Jefferson Lab's two superconducting machines, the Continuous Electron Beam Accelerator Facility (CEBAF) and the superconducting radiofrequency ''driver'' accelerator of the laboratory's free-electron laser. Robustness matters greatly for science at a time when microwave superconducting linear accelerators (linacs) are not only being considered, but in some cases already being built for projects such as neutron sources, rare-isotope accelerators, innovative light sources and TeV-scale electron-positron linear colliders. Hurricane Isabel interrupted a several-week-long maintenance shutdown of CEBAF, which serves nuclear and particle physics and represents the world's pioneering large-scale implementation of superconducting radiofrequency (SRF) technology. The racetrack-shaped machine is actually a pair of 500-600 MeV SRF linacs interconnected by recirculation arc beamlines. CEBAF delivers simultaneous beams at up to 6 GeV to three experimental halls. An imminent upgrade will double the energy to 12 GeV and add an extra hall for ''quark confinement'' studies. On a smaller scale

  16. Severe excessive daytime sleepiness induced by hydroxyurea.

    Science.gov (United States)

    Revol, Bruno; Joyeux-Faure, Marie; Albahary, Marie-Victoire; Gressin, Remy; Mallaret, Michel; Pepin, Jean-Louis; Launois, Sandrine H

    2017-06-01

    Excessive daytime sleepiness (EDS) has been reported with many drugs, either as an extension of a hypnotic effect (e.g. central nervous system depressants) or as an idiosyncratic response of the patient. Here, we report unexpected and severe subjective and objective EDS induced by hydroxyurea therapy, with a favorable outcome after withdrawal. Clinical history, sleep log, polysomnography, and multiple sleep latency tests confirming the absence of other EDS causes are presented. © 2016 Société Française de Pharmacologie et de Thérapeutique.

  17. Adsorption isotherms of pear at several temperatures

    OpenAIRE

    Mitrevski Vangelče; Lutovska Monika; Mijakovski Vladimir; Pavkov Ivan S.; Babić Mirko M.; Radojčin Milivoje T.

    2015-01-01

    The moisture adsorption isotherms of pear were determined at 15ºC, 30ºC and 45ºC using the standard static gravimetric method over a range of water activity from 0.112 to 0.920. The experimental data were fitted with isotherm equations recommended in ASAE Standard D245.5. In order to find which equation gives the best results, large number of numerical experiments were performed. After that, several statistical criteria proposed in scientific literature for...

  18. Correction of severe postburn claw hand.

    Science.gov (United States)

    Davami, Babak; Pourkhameneh, Golnar

    2011-12-01

    Burn scar contractures are perhaps the most frequent and most frustrating sequelae of thermal injuries to the hand. Unfortunately, stiffness occurs in the burned hand quickly. A week of neglect in the burned hand can lead to digital malpositioning and distortion that may be difficult to correct. The dorsal contracture is the most common of all the complications of the burned hand. It is the result of damage to the thin dorsal skin and scant subcutaneous tissue, which offers little protection to the deeper structures. Consequently, these injuries are deep resulting in a spectrum of deformities that has remained the bane of reconstructive surgery. Flap coverage will be required in the event of exposure of joints and tendons with absent paratenons. Multiple different flap types are available to treat complex severe postburn hand contractures. In our center, which is the largest regional burn center in northwest Iran, we have considerable experience in the treatment of thermal hand injuries. Between 2005 and 2010, we treated 53 consecutive patients with 65 severe postburn hand deformities. There were 35 men and 18 women with a mean age of 35±3 years. Flame injury was the inciting traumatic event in each patient. The severity of original injury and inadequate early treatment resulted in all of the fingers developing a severe extension contracture with scarred and adherent extensor tendons and subluxed metacarpophalangeal joints. In 36 cases, the injury was in the patients' dominant hand. We first incised the dorsal aspect of the contracted hands where there was maximum tension, then tenolysed the extensor tendons and released the volar capsules, collateral ligaments, and volar plate in all cases. In 30 cases, we also tenolysed the flexor tendons. We reduced the subluxed metacarpophalangeal joints and fixed them with Kirschner wires in 70 to 90 degrees flexion. Then, we planned and performed axial groin flaps to reconstruct the defects in all of them. In all of these

  19. Nuclear power plant with several reactors

    Energy Technology Data Exchange (ETDEWEB)

    Grishanin, E I; Ilyunin, V G; Kuznetsov, I A; Murogov, V M; Shmelev, A N

    1972-05-10

    A design of a nuclear power plant suggested involves several reactors consequently transmitting heat to a gaseous coolant in the joint thermodynamical circuit. In order to increase the power and the rate of fuel reproduction the low temperature section of the thermodynamical circuit involves a fast nuclear reactor, whereas a thermal nuclear reactor is employed in the high temperature section of the circuit for intermediate heating and for over-heating of the working body. Between the fast nuclear and the thermal nuclear reactors there is a turbine providing for the necessary ratio between pressures in the reactors. Each reactor may employ its own coolant.

  20. Severe iron intoxication treated with exchange transfusion

    DEFF Research Database (Denmark)

    Carlsson, M; Cortes, D; Jepsen, S

    2009-01-01

    An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 µg....../dl (244 µmol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 µg/dl (24 µmol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate....

  1. Severe iron intoxication treated with exchange transfusion

    DEFF Research Database (Denmark)

    Carlsson, Marcella; Cortes, Dina; Jepsen, Søren

    2008-01-01

    An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 mi...... microg/dl (244 micromol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 microg/dl (24 micromol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate....

  2. Containment severe accident management - selected strategies

    International Nuclear Information System (INIS)

    Duco, J.; Royen, J.; Rohde, J.; Frid, W.; De Boeck, B.

    1994-01-01

    The OECD Nuclear Energy Agency (NEA) organized in June 1994, in collaboration with the Swedish Nuclear Power Inspectorate (SKI), a Specialist Meeting on Selected Containment Severe Accident Management Strategies, to discuss their feasibility, effectiveness, benefits and drawbacks, and long-term impact. The meeting focused on water reactors, mainly on existing systems. The technical content covered topics such as general aspects of accident management strategies in OECD Member countries, hydrogen management techniques and other containment accident management strategies, surveillance and protection of the containment function. The main conclusions of the meeting are summarized in the paper. (author)

  3. Severe Hypoglycemia Accompanied with Thyroid Crisis

    Directory of Open Access Journals (Sweden)

    Yuki Nakatani

    2012-01-01

    Full Text Available We report a 32-year-old Japanese women with severe hypoglycemia accompanied with thyroid crisis. She complained of dyspnea, general fatigue, and leg edema. She was diagnosed with hyperthyroidism with congestive heart failure and liver dysfunction. Soon after admission, sudden cardiopulmonary arrest occurred. She was then transferred to the intensive care unit. Her serum glucose level was 7 mg/dl. Intravenous glucose, hydrocortisone, diuretics, and continuous hemodiafiltration (CHDF saved her. We considered that hypoglycemia occurred due to heart failure and liver dysfunction due to thyroid crisis.

  4. Chemical considerations in severe accident analysis

    International Nuclear Information System (INIS)

    Malinauskas, A.P.; Kress, T.S.

    1988-01-01

    The Reactor Safety Study presented the first systematic attempt to include fission product physicochemical effects in the determination of expected consequences of hypothetical nuclear reactor power plant accidents. At the time, however, the data base was sparse, and the treatment of fission product behavior was not entirely consistent or accurate. Considerable research has since been performed to identify and understand chemical phenomena that can occur in the course of a nuclear reactor accident, and how these phenomena affect fission product behavior. In this report, the current status of our understanding of the chemistry of fission products in severe core damage accidents is summarized and contrasted with that of the Reactor Safety Study

  5. SEVERE IMMUNE HEMOLYTIC ANEMIA AFTER LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    A. I. Sushkov

    2013-01-01

    Full Text Available Clinical case of successful treatment of severe immune hemolytic anemia after liver transplantation is represen- ted in this article. The cause of complication was so-called passenger lymphocyte syndrome (a type of graft- versus-host disease. Two plasmapheresis sessions and Ig (0.5 g/kg in combination with increased maintenance immunosuppression with a short course of oral methylprednisolone in a total dose of 150 mg during 12 days were effective. The patient was discharged from hospital 34 days after transplantation in a satisfactory condition with a stable hemoglobin level. 

  6. Intrathoracic lipoblastoma presenting with severe respiratory distress

    OpenAIRE

    Joseph Motshedi Sekgololo; Risenga Frank Chauke; Peter Shere Ramoroko; Khondker Mofazzal Hossain

    2017-01-01

    Lipoblastoma is a rare benign tumour which originates from an adipose tissue. In this study we report the case of a three year old boy who presented with a large intrathoracic tumour occupying the whole of the left hemithorax. He presented in severe respiratory distress. A chest X-ray showed total opacity of the left hemithorax, and CT-scan showed a low attenuation mass inkeeping with fat in the left hemithorax. A complete resection of a tumour was undertaken, with histopathology report confi...

  7. Several rotor noise sources and treatments

    Energy Technology Data Exchange (ETDEWEB)

    Tangler, J. [National Renewable Energy Laboratory, Golden, CO (United States)

    1997-12-31

    Noise has been a design consideration in the development of advanced blades and turbines at the National Renewable Energy Laboratory. During atmospheric testing associated with these efforts various types of aeroacoustic noise have been encountered. This presentation discusses several of these noise sources and treatments used to mitigate or eliminate the noise. Tonal noise resulting from tip-vortex/trailing-edge interaction and laminar separation bubbles was found to be easily eliminated. Impulsive noise resulting from blade/vortex interaction for rotors that furl and that due to tower shadow can be mitigated by various means. (au)

  8. Artemisinin derivatives for treating severe malaria.

    Science.gov (United States)

    McIntosh, H M; Olliaro, P

    2000-01-01

    Artemisinin derivatives may have advantages over quinoline drugs for treating severe malaria since they are fast acting and effective against quinine resistant malaria parasites. The objective of this review was to assess the effects of artemisinin drugs for severe and complicated falciparum malaria in adults and children. We searched the Cochrane Infectious Diseases Group trials register, Cochrane Controlled Trials Register, Medline, Embase, Science Citation Index, Lilacs, African Index Medicus, conference abstracts and reference lists of articles. We contacted organisations, researchers in the field and drug companies. Randomised and pseudo-randomised trials comparing artemisinin drugs (rectal, intramuscular or intravenous) with standard treatment, or comparisons between artemisinin derivatives in adults or children with severe or complicated falciparum malaria. Eligibility, trial quality assessment and data extraction were done independently by two reviewers. Study authors were contacted for additional information. Twenty three trials are included, allocation concealment was adequate in nine. Sixteen trials compared artemisinin drugs with quinine in 2653 patients. Artemisinin drugs were associated with better survival (mortality odds ratio 0.61, 95% confidence interval 0.46 to 0.82, random effects model). In trials where concealment of allocation was adequate (2261 patients), this was barely statistically significant (odds ratio 0.72, 95% CI 0.54 to 0.96, random effects model). In 1939 patients with cerebral malaria, mortality was also lower with artemisinin drugs overall (odds ratio 0.63, 95% CI 0.44 to 0.88, random effects model). The difference was not significant however when only trials reporting adequate concealment of allocation were analysed (odds ratio 0.78, 95% CI 0.55 to 1.10, random effects model) based on 1607 patients. No difference in neurological sequelae was shown. Compared with quinine, artemisinin drugs showed faster parasite clearance from

  9. Severe calcinosis cutis in an infant

    International Nuclear Information System (INIS)

    Puvabanditsin, Surasak; Patel, Jigneshkumar B.; Garrow, Eugene; Titapiwatanakun, Ruetima; Getachew, Rahel

    2005-01-01

    We report on an infant with severe asphyxia and persistent pulmonary hypertension as a newborn. The baby received prolonged intravenous calcium gluconate therapy for hypocalcemia. At 5 weeks of age, multiple firm, indurated areas (armor-like lesions) were palpable in the subcutaneous tissues of the trunk, arms, legs, and face, particularly in skin folds. Roentgenographic study showed generalized soft-tissue calcifications throughout the body, extremities, and face. Calcinosis cutis occurs through a variety of pathogenetic mechanisms. Case reports on calcinosis cutis in infants are uncommon, and the calcifications are mostly localized. In our patient, they are generalized. (orig.)

  10. Incidence of diseases primarily affecting the skin by age group: population-based epidemiologic study in Olmsted County, Minnesota, and comparison with age-specific incidence rates worldwide.

    Science.gov (United States)

    Wessman, Laurel L; Andersen, Louise K; Davis, Mark D P

    2018-01-29

    Understanding the effects of age on the epidemiology of diseases primarily affecting the skin is important to the practice of dermatology, both for proper allocation of resources and for optimal patient-centered care. To fully appreciate the effect that age may have on the population-based calculations of incidence of diseases primarily affecting the skin in Olmsted County, Minnesota, and worldwide, we performed a review of all relevant Rochester Epidemiology Project-published data and compared them to similar reports in the worldwide English literature. Using the Rochester Epidemiology Project, population-based epidemiologic studies have been performed to estimate the incidence of specific skin diseases over the past 50 years. In older persons (>65 years), nonmelanoma skin cancer, lentigo maligna, herpes zoster, delusional infestation, venous stasis syndrome, venous ulcer, and burning mouth syndrome were more commonly diagnosed. In those younger than 65 years, atypical nevi, psoriatic arthritis, pityriasis rosea, herpes progenitalis, genital warts, alopecia areata, hidradenitis suppurativa, infantile hemangioma, Behçet's disease, and sarcoidosis (isolated cutaneous, with sarcoidosis-specific cutaneous lesions and with erythema nodosum) had a higher incidence. Many of the incidence rates by age group of diseases primarily affecting the skin derived from the Rochester Epidemiology Project were similar to those reported elsewhere. © 2018 The International Society of Dermatology.

  11. Beyond Psoriasis: Novel Uses for Biologic Response Modifiers in Pediatric Dermatology.

    Science.gov (United States)

    Bellodi-Schmidt, Fernanda; Shah, Kara N

    2016-01-01

    Dermatologists have witnessed the increasing availability of novel biologic response modifiers for the treatment of inflammatory and autoimmune diseases in recent years. The most common dermatologic indication for the use of biologic response modifiers in adults is psoriasis, but the U.S. Food and Drug Administration has not approved any of these agents for use in any dermatologic disease in children with the exception of omalizumab, and as such, use in this population is considered off-label. In this review, we focus on the use of these agents in children to treat inflammatory skin diseases other than psoriasis, including atopic dermatitis, hidradenitis suppurativa, pemphigus vulgaris, bullous pemphigoid, and toxic epidermal necrolysis, with an emphasis on the use of etanercept, infliximab, rituximab, omalizumab, and ustekinumab. By highlighting novel uses of these agents, particularly for the treatment of dermatologic conditions for which optimal therapies are yet to be established, we hope to raise awareness of the potential use of this class of medications to treat inflammatory skin diseases in children. © 2015 Wiley Periodicals, Inc.

  12. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases: A Danish Multidisciplinary Collaboration on Prognostic Factors and Personalised Medicine

    Directory of Open Access Journals (Sweden)

    Vibeke Andersen

    2017-05-01

    Full Text Available Chronic inflammatory diseases (CIDs, including Crohn’s disease and ulcerative colitis (inflammatory bowel diseases, IBD, rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro-inflammatory molecule tumour necrosis factor-α (TNF (i.e., TNF inhibitors. Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1 molecular signatures of prognostic value to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2 lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including lifestyle and treatment response and biological specimens (blood, faeces, urine, and, in IBD patients, intestinal biopsies are sampled prior to and while on TNF inhibitor therapy. Both hypothesis-driven and data-driven analyses will be performed according to pre-specified protocols including pathway analyses resulting from candidate gene expression analyses and global approaches (e.g., metabolomics, metagenomics, proteomics. The final purpose is to improve the lives of patients suffering from CIDs, by providing tools facilitating treatment selection and dietary recommendations likely to improve the clinical outcome.

  13. The diverse application of laser hair removal therapy: a tertiary laser unit's experience with less common indications and a literature overview.

    Science.gov (United States)

    Koch, D; Pratsou, P; Szczecinska, W; Lanigan, S; Abdullah, A

    2015-01-01

    We describe the diversity of indications for laser hair removal (LHR) therapy and compare our experience with the literature. Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed retrospectively. Thirty-one treated patients with the following indications were identified: hair-bearing skin grafts/flaps, intra-oral hair-bearing flap, Becker's naevus, localised nevoid hypertrichosis, peristomal hair-bearing skin, scrotal skin prior to vaginoplasty in male-to-female (MTF) gender reassignment, pilonidal sinus disease (PSD), pseudofolliculitis barbae (PFB) and hidradenitis suppurativa (HS). Seven patients with the following indications have been reported before: intra-oral hair-bearing graft, naevoid hypertrichosis and peristomal hair-bearing skin. A clinical review of the evidence available for each indication is provided. Our experience and that in the published literature suggest that LHR is a safe, well-tolerated and effective treatment modality for the indications we report, leading to significant symptom and functional improvement with high patient satisfaction. LHR appears effective in the treatment of chronic inflammatory conditions such as PSD, PFB and HS, particularly at an early disease stage. We aim to increase awareness of the diversity of laser hair removal indications and add evidence to the medical literature of the wide range of indications for this useful treatment modality.

  14. Gastric antral vascular ectasia causing severe anemia.

    Science.gov (United States)

    Toyota, M; Hinoda, Y; Nakagawa, N; Arimura, Y; Tokuchi, S; Takaoka, A; Kitagawa, S; Usuki, T; Yabana, T; Yachi, A; Imai, K

    1996-10-01

    Gastric antral vascular ectasia (GAVE) that caused continuous gastrointestinal bleeding is reported in a 76-year-old woman who had been treated with repeated blood transfusions because of severe anemia. Endoscopic examination was performed and diffuse speckled telangiectasia of the entire antrum was observed. Laboratory data showed SGOT > SGPT, decreased chE level and the increased levels of serum gastrin and ICG at 15 min. Anti-HCV antibody was positive. Image examination revealed splenomegaly. There was no family history of telangiectasia, and no telangiectasia was found in other organs. The diagnosis was established as GAVE with liver cirrhosis. Surgical resection of the distal stomach resulted in termination of the bleeding, and the cirrhotic changes of the surface of the liver were revealed at that time, providing further evidence of liver cirrhosis. Although the pathogenesis of GAVE is unknown, liver cirrhosis and hypergastrinemia are thought to be associated with the condition. Importantly, this condition is a cause of severe gastrointestinal bleeding in elderly patients.

  15. Control room habitability during severe accidents

    International Nuclear Information System (INIS)

    Siu, R.P.

    1989-01-01

    The requirements for protection of control room personnel against radiation hazards are specified in 10CFR50, Appendix A, GDC 19. The conventional approach involves a mechanistic evaluation of the radiation doses to control room personnel during design-basis accidents. In this study, an assessment of control room habitability during severe accidents is conducted. The potential levels of radiation hazards to control room personnel are evaluated in terms of both magnitude and probability of occurrence. The expected values for the probabilities of exceeding GDC-19 limits and the cumulative probability distributions of control room doses are determined. In this study, a pressurized water reactor with a large dry containment has been selected for analysis. The types of control rooms evaluated in this study include designs with: (a) filtered local intakes only, (b) filtered recirculation only, (c) filtered local intakes and recirculation, and (d) filtered dual remote intakes and recirculation. From the observations, it is concluded that, except for control room D, all other control room designs may require improvements in order to provide adequate radiation protection during severe accidents, particularly in terms of reducing whole-body gamma doses and skin doses. Potential design improvements include reduction of intake flows for concepts relying on pressurization, reduction in overall leakages, and control room pressurization through the use of bottled air supply

  16. Students’ conceptions analysis on several electricity concepts

    Science.gov (United States)

    Saputro, D. E.; Sarwanto, S.; Sukarmin, S.; Ratnasari, D.

    2018-05-01

    This research is aimed to analyse students’ conceptions on several electricity concept. This is a descriptive research with the subjects of new students of Sebelas Maret University. The numbers of the subject were 279 students that consisted of several departments such as science education, physics education, chemistry education, biology education and mathematics education in the academic year of 2017/2018. The instrument used in this research was the multiple-choice test with arguments. Based on the result of the research and analysis, it can be concluded that most of the students still find misconceptions and do not understand electricity concept on sub-topics such as electric current characteristic in the series and parallel arrangement, the value of capacitor capacitance, the influence of the capacitor charge and discharge towards the loads, and the amount of capacitor series arrangement. For the future research, it is suggested to improve students’ conceptual understanding with appropriate learning method and assessment instrument because electricity is one of physics material that closely related with students’ daily life.

  17. Management of severe constipation in children.

    Science.gov (United States)

    Noviello, C; Romano, M; Zangari, A; Papparella, A; Martino, A; Cobellis, G

    2013-04-01

    Constipation is a common pediatric problem. Sometimes the hospitalization is necessary and in these patients the organic cause should be verified. The authors report their experience in the management of children with severe constipation. Anorectal manometry (ARM) was performed after a careful examination of perineum and bowel disimpaction. Once organic cause had be excluded, the patient got medical therapy. If recto-anal inhibitory reflex (RAIR) was absent, not collaborative patient or medical treatment failed, the child underwent contrast enema (CE) and rectal suction biopsies (RSB). Local anesthetics were used for anal fissures or internal anal sphincter (IAS) hypertonia. Anal malformations and Hirschsprung's disease (HD) were surgically treated. Posterior sagittal anorectoplasty was performed for anal malformations. In 5 years 98 children (63 males) were observed (mean age 6 years). 5 children were premature for gestational age, 4 presented failure to thrive, 5 anal malformations and 45 anal fissures. ARM was performed in 87 children and 74 of them showed normal RAIR. Hypertonia of the IAS was recorded in 38 patients. RAIR was absent/unclear in 13 patients. Follow-up revealed 6 patients (negative to ARM) with poor results without oral laxative. CE was performed in 19 children (2 positive cases) and RBS in 25 patients (2 cases of HD). Children with severe constipation must be carefully observed and studied because of not negligible incidence of organic cause. The first step in the management of these patients is the evacuation of the fecaloma.

  18. Early nutritional support in severe traumatic patients.

    Science.gov (United States)

    Chuntrasakul, C; Siltharm, S; Chinswangwatanakul, V; Pongprasobchai, T; Chockvivatanavanit, S; Bunnak, A

    1996-01-01

    Multiple trauma is associated with altered metabolism, wasting of the lean body mass and compromised wound healing. Nutritional support is one way to improve the condition of these critically ill patients. We performed a prospective randomized study on the effect of early nutritional support in severely injured patients admitted to the Division of Traumatic Surgery, Siriraj Hospital between June 1992 and January 1994. Thirty-eight severe traumatic patients with ISS between 20-40 were randomly divided into control and study group. The 17 patients in the control group were treated in the conventional method with administration of hypo caloric intravenous regimen and supplement with oral diet as soon as the bowel function was returned. The 21 patients of the study group were fed either by enteral or parenteral feeding or both with an appropriate caloric and protein requirement as soon as hemodynamic status was stabilized. We found the study group had a lower mortality rate, a lower complication rate, a shorter period of ICU stay, and an earlier weaning from the ventilator than the control group. The study group also lost less weight than the control group. Nitrogen balance in the study group was significantly lower than the control group.

  19. Severe rectal complications after prostate brachytherapy

    International Nuclear Information System (INIS)

    Wallner, Kent; Sutlief, Stephen; Bergsagel, Carl; Merrick, Gregory S.

    2015-01-01

    Purpose: Some investigators have reported severe rectal complications after brachytherapy. Due to the low number of such events, their relationship to dosimetric parameters has not been well characterized. Methods and materials: A total of 3126 patients were treated with low dose rate brachytherapy from 1998 through 2010. 2464 had implant alone, and 313 had implant preceded by 44–46 Gy supplemental external beam radiation (EBRT). Post-implant dosimetry was based on a CT scan obtained on the day of implant, generally within 30 min of the procedure. Every patient’s record was reviewed for occurrence of rectal complications. Results: Eight of 2464 patients (0.32%) treated with brachytherapy alone developed a radiation-related rectal fistula. Average prostatic and rectal dose parameters were moderately higher for fistula patients than for patients without a severe rectal complication. For instance, the average R100 was 1.2 ± 0.75 cc for fistula patients, versus 0.37 ± 0.88 cc for non-fistula patients. However, the fistula patients’ values were well within the range of values for patients without a rectal complication. Four patients had some attempt at repair or reconstruction, but long-term functional outcomes were not favorable. Conclusions: Rectal fistulas are a very uncommon potential complication of prostate brachytherapy, which can occur even in the setting of acceptable day 0 rectal doses. Their occurrence is not easily explained by standard dosimetric or clinical factors

  20. Preventing drug resistance in severe influenza

    Science.gov (United States)

    Dobrovolny, Hana; Deecke, Lucas

    2015-03-01

    Severe, long-lasting influenza infections are often caused by new strains of influenza. The long duration of these infections leads to an increased opportunity for the emergence of drug resistant mutants. This is particularly problematic for new strains of influenza since there is often no vaccine, so drug treatment is the first line of defense. One strategy for trying to minimize drug resistance is to apply periodic treatment. During treatment the wild-type virus decreases, but resistant virus might increase; when there is no treatment, wild-type virus will hopefully out-compete the resistant virus, driving down the number of resistant virus. We combine a mathematical model of severe influenza with a model of drug resistance to study emergence of drug resistance during a long-lasting infection. We apply periodic treatment with two types of antivirals: neuraminidase inhibitors, which block release of virions; and adamantanes, which block replication of virions. We compare the efficacy of the two drugs in reducing emergence of drug resistant mutants and examine the effect of treatment frequency on the emergence of drug resistant mutants.

  1. Postmortem CT of severe head injuries

    International Nuclear Information System (INIS)

    Tamura, Masaru; Tsukahara, Yoshio; Nagaseki, Yoshishige; Horikoshi, Satoru; Yodonawa, Masahiko

    1983-01-01

    CT findings of fatal head injuries were analysed for the cause of death. Postmortem CT examinations were undertaken on 14 cases who died before reaching the hospital or shortly after arrival at the hospital (immediate death group). CT were also examined in non-operative 20 cases who were comatose and who died within 24 hours after severe head injuries (early death group). In the immediate death group, the following findings were demonstrated: a huge amount of free intracranial and intraventricular air in 8 cases; traumatic basal subarachnoid hemorrhage in 3 cases; a mixture of pneumocephalus and subarachnoid hemorrhage in 2 cases, and intracranial hematoma in 1 case. In the early death group: a mixture of pneumocephalus and subarachnoid hemorrhage in 2 cases; traumatic subarachnoid hemorrhage in 5 cases; intracranial hematoma in 11 cases, and brain contusion in 2 cases. The huge amount of intracranial free air due to the severe fracture of the skull base will make the CNS collapse immediately. Basal subarachnoid hemorrhage with signs of brain-stem injuries may result in instantaneous death. Acute subdural hematoma with contusion and edema in elderly patients was the most frequent cause of death in the early death group. (author)

  2. Partial differential equations in several complex variables

    CERN Document Server

    Chen, So-Chin

    2001-01-01

    This book is intended both as an introductory text and as a reference book for those interested in studying several complex variables in the context of partial differential equations. In the last few decades, significant progress has been made in the fields of Cauchy-Riemann and tangential Cauchy-Riemann operators. This book gives an up-to-date account of the theories for these equations and their applications. The background material in several complex variables is developed in the first three chapters, leading to the Levi problem. The next three chapters are devoted to the solvability and regularity of the Cauchy-Riemann equations using Hilbert space techniques. The authors provide a systematic study of the Cauchy-Riemann equations and the \\bar\\partial-Neumann problem, including L^2 existence theorems on pseudoconvex domains, \\frac 12-subelliptic estimates for the \\bar\\partial-Neumann problems on strongly pseudoconvex domains, global regularity of \\bar\\partial on more general pseudoconvex domains, boundary ...

  3. [Insomnia. A severe health care problem].

    Science.gov (United States)

    Sánchez-Cárdenas, Ana Gabriela; Navarro-Gerrard, Christian; Nellen-Hummel, Haiko; Halabe-Cherem, José

    2016-01-01

    The magnitude which sleep has on personal well-being is similar to the effects of diet and exercise. Sleep deprivation has severe negative effects on an individual's overall health, and this is usually overseen. From 30 to 40 % of the population has presented insomnia at a certain moment of life and from 9 to 15 % have evolved into a chronic and severe insomnia. Recent investigations have related sleep deprivation with obesity, metabolic disorders, heart disease, mental health problems and dementia. Recently, more investigations have focused on the multiple alterations suffered by the immune system in cases of sleep deprivation. In order to make an opportune diagnosis of insomnia, it is vital to obtain a detailed history of the patients' sleep habits. In the physical exam one must search for signs and symptoms which might suggest an organic cause that generates the patient's insomnia. One of the pillars in treatment of these patients consists in acquiring an adequate sleep hygiene based on the optimization of the environment and the behavior that are associated with sleep.

  4. Safety of repair for severe duodenal injuries.

    Science.gov (United States)

    Velmahos, George C; Constantinou, Constantinos; Kasotakis, George

    2008-01-01

    There is ongoing debate about the management of severe duodenal injuries (SDIs), and earlier studies have recommended pyloric exclusion. The objective of this study was to compare primary repair with pyloric exclusion to examine if primary repair can be safely used in SDIs. The medical records of 193 consecutive patients who were admitted between August 1992 and January 2004 with duodenal injuries were reviewed. After excluding early deaths (n = 50), low-grade duodenal injuries (n = 81), and pancreatoduodenectomies for catastrophic trauma (n = 12), a total of 50 patients with SDIs (grade III, IV, or V) were analyzed. Primary repair (PR--simple duodenorrhaphy or resection and primary anastomosis) was performed in 34 (68%) and pyloric exclusion (PE) in 16 (32%). Characteristics and outcomes of these two groups were compared. PE and PR patients were similar for age, injury severity score, abdominal abbreviated injury score, physiologic status on admission, time to operation, and most abdominal organs injured. PE patients had more pancreatic injuries (63% vs. 24%, p duodenum (79% vs. 42%, p = 0.02), and a nonsignificant trend toward more grade IV and V injuries (37% vs. 18%, p = 0.11). There was no difference in morbidity (including complications specific to the duodenal repair), mortality, and intensive care unit and hospital length of stay between the two groups. Pyloric exclusion is not necessary for all patients with SDIs, as previously suggested. Selected SDI patients can be safely managed by simple primary repair.

  5. Several accidents about ERHRS of CEFR

    International Nuclear Information System (INIS)

    Zhang, D.

    2000-01-01

    An analysis of about several unusual accidents about Emergency Residual Heat Removal System (ERHRS) of China Experiment Fast Reactor (CEFR) is presented. CEFR is a pool-type sodium-cooled fast reactor. The ERHRS of this reactor is designed in passive principle, which enhances the interior reliability of CEFR. It consists of two sets of independent channels. Each channel is comprised of decay heat exchanger (DHX), intermediate circuit, sodium-air heat exchanger (AHX) and related auxiliary system. Both DHX are located in the hot pool of the main vessel directly, which is used to cool the hot sodium. The whole set of ERHRS is completely passive except the ventilation valves of AHX. But, as a very important set of engineered safety features which is the final way to remove the heat from the reactor core, it is necessary to pay attention to all of the possibilities that may reduce this ability. Several accidents are analyzed including when the ventilation valves couldn't be opened, when only one set of ERHRS could work and so on. The calculation results show that the ERHRS can keep the reactor in a safety status. Even though it is, experiments are still necessary in the view of engineering. (author)

  6. Severe neurotoxicity following ingestion of tetraethyl lead.

    Science.gov (United States)

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

    2010-03-01

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

  7. The Airway Microbiome in Severe Asthma: Associations with Disease Features and Severity

    Science.gov (United States)

    Huang, Yvonne J.; Nariya, Snehal; Harris, Jeffrey M.; Lynch, Susan V.; Choy, David F.; Arron, Joseph R.; Boushey, Homer

    2015-01-01

    Background Asthma is heterogeneous, and airway dysbiosis is associated with clinical features in mild-moderate asthma. Whether similar relationships exist among patients with severe asthma is unknown. Objective To evaluate relationships between the bronchial microbiome and features of severe asthma. Methods Bronchial brushings from 40 participants in the BOBCAT study (Bronchoscopic Exploratory Research Study of Biomarkers in Corticosteroid-refractory Asthma) were evaluated using 16S rRNA-based methods. Relationships to clinical and inflammatory features were analyzed among microbiome-profiled subjects. Secondarily, bacterial compositional profiles were compared between severe asthmatics, and previously studied healthy controls (n=7), and mild-moderate asthma subjects (n=41). Results In severe asthma, bronchial bacterial composition was associated with several disease-related features, including body-mass index (BMI; Bray-Curtis distance PERMANOVA, p < 0.05), changes in Asthma Control Questionnaire (ACQ) scores (p < 0.01), sputum total leukocytes (p = 0.06) and bronchial biopsy eosinophils (per mm2; p = 0.07). Bacterial communities associated with worsening ACQ and sputum total leukocytes (predominantly Proteobacteria) differed markedly from those associated with BMI (Bacteroidetes/Firmicutes). In contrast, improving/stable ACQ and bronchial epithelial gene expression of FKBP5, an indicator of steroid responsiveness, correlated with Actinobacteria. Mostly negative correlations were observed between biopsy eosinophils and Proteobacteria. No taxa were associated with a T-helper type 2-related epithelial gene expression signature, but expression of Th17-related genes was associated with Proteobacteria. Severe asthma subjects, compared to healthy controls or mild-moderate asthmatics, were significantly enriched in Actinobacteria, although the largest differences observed involved a Klebsiella genus member (7.8 fold-increase in severe asthma, padj < 0.001) Conclusions

  8. Severe fire weather and intensive forest management increase fire severity in a multi-ownership landscape.

    Science.gov (United States)

    Zald, Harold S J; Dunn, Christopher J

    2018-04-26

    Many studies have examined how fuels, topography, climate, and fire weather influence fire severity. Less is known about how different forest management practices influence fire severity in multi-owner landscapes, despite costly and controversial suppression of wildfires that do not acknowledge ownership boundaries. In 2013, the Douglas Complex burned over 19,000 ha of Oregon & California Railroad (O&C) lands in Southwestern Oregon, USA. O&C lands are composed of a checkerboard of private industrial and federal forestland (Bureau of Land Management, BLM) with contrasting management objectives, providing a unique experimental landscape to understand how different management practices influence wildfire severity. Leveraging Landsat based estimates of fire severity (Relative differenced Normalized Burn Ratio, RdNBR) and geospatial data on fire progression, weather, topography, pre-fire forest conditions, and land ownership, we asked (1) what is the relative importance of different variables driving fire severity, and (2) is intensive plantation forestry associated with higher fire severity? Using Random Forest ensemble machine learning, we found daily fire weather was the most important predictor of fire severity, followed by stand age and ownership, followed by topographic features. Estimates of pre-fire forest biomass were not an important predictor of fire severity. Adjusting for all other predictor variables in a general least squares model incorporating spatial autocorrelation, mean predicted RdNBR was higher on private industrial forests (RdNBR 521.85 ± 18.67 [mean ± SE]) vs. BLM forests (398.87 ± 18.23) with a much greater proportion of older forests. Our findings suggest intensive plantation forestry characterized by young forests and spatially homogenized fuels, rather than pre-fire biomass, were significant drivers of wildfire severity. This has implications for perceptions of wildfire risk, shared fire management responsibilities, and developing

  9. Severe European winters in a secular perspective

    Science.gov (United States)

    Hoy, Andreas; Hänsel, Stephanie

    2017-04-01

    Temperature conditions during the winter time are substantially shaped by a strong year-to-year variability. European winters since the late 1980s - compared to previous decades and centuries - were mainly characterised by a high temperature level, including recent record-warm winters. Yet, comparably cold winters and severe cold spells still occur nowadays, like recently observed from 2009 to 2013 and in early 2017. Central England experienced its second coldest December since start of observations more than 350 years ago in 2010, and some of the lowest temperatures ever measured in northern Europe (below -50 °C in Lapland) were recorded in January 1999. Analysing thermal characteristics and spatial distribution of severe (historical) winters - using early instrumental data - helps expanding and consolidating our knowledge of past weather extremes. This contribution presents efforts towards this direction. We focus on a) compiling and assessing a very long-term instrumental, spatially widespread and well-distributed, high-quality meteorological data set to b) investigate very cold winter temperatures in Europe from early measurements until today. In a first step, we analyse the longest available time series of monthly temperature averages within Europe. Our dataset extends from the Nordic countries up to the Mediterranean and from the British Isles up to Russia. We utilise as much as possible homogenised times series in order to ensure reliable results. Homogenised data derive from the NORDHOM (Scandinavia) and HISTALP (greater alpine region) datasets or were obtained from national weather services and universities. Other (not specifically homogenised) data were derived from the ECA&D dataset or national institutions. The employed time series often start already during the 18th century, with Paris & Central England being the longest datasets (from 1659). In a second step, daily temperature averages are involved. Only some of those series are homogenised, but

  10. Management of Severe Pancreatic Fistula After Pancreatoduodenectomy.

    Science.gov (United States)

    Smits, F Jasmijn; van Santvoort, Hjalmar C; Besselink, Marc G; Batenburg, Marilot C T; Slooff, Robbert A E; Boerma, Djamila; Busch, Olivier R; Coene, Peter P L O; van Dam, Ronald M; van Dijk, David P J; van Eijck, Casper H J; Festen, Sebastiaan; van der Harst, Erwin; de Hingh, Ignace H J T; de Jong, Koert P; Tol, Johanna A M G; Borel Rinkes, Inne H M; Molenaar, I Quintus

    2017-06-01

    Postoperative pancreatic fistula is a potentially life-threatening complication after pancreatoduodenectomy. Evidence for best management is lacking. To evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as primary treatment for pancreatic fistula after pancreatoduodenectomy. A multicenter, retrospective, propensity-matched cohort study was conducted in 9 centers of the Dutch Pancreatic Cancer Group from January 1, 2005, to September 30, 2013. From a cohort of 2196 consecutive patients who underwent pancreatoduodenectomy, 309 patients with severe pancreatic fistula were included. Propensity score matching (based on sex, age, comorbidity, disease severity, and previous reinterventions) was used to minimize selection bias. Data analysis was performed from January to July 2016. First intervention for pancreatic fistula: catheter drainage or relaparotomy. Primary end point was in-hospital mortality; secondary end points included new-onset organ failure. Of the 309 patients included in the analysis, 209 (67.6%) were men, and mean (SD) age was 64.6 (10.1) years. Overall in-hospital mortality was 17.8% (55 patients): 227 patients (73.5%) underwent primary catheter drainage and 82 patients (26.5%) underwent primary relaparotomy. Primary catheter drainage was successful (ie, survival without relaparotomy) in 175 patients (77.1%). With propensity score matching, 64 patients undergoing primary relaparotomy were matched to 64 patients undergoing primary catheter drainage. Mortality was lower after catheter drainage (14.1% vs 35.9%; P = .007; risk ratio, 0.39; 95% CI, 0.20-0.76). The rate of new-onset single-organ failure (4.7% vs 20.3%; P = .007; risk ratio, 0.15; 95% CI, 0.03-0.60) and new-onset multiple-organ failure (15.6% vs 39.1%; P = .008; risk ratio, 0.40; 95% CI, 0.20-0.77) were also lower after primary catheter drainage. In this propensity-matched cohort, catheter drainage as first intervention for severe

  11. ACR-1000: Enhanced response to severe accidents

    International Nuclear Information System (INIS)

    Popov, N.K.; Santamaura, P.; Shapiro, H.; Snell, V.G.

    2006-01-01

    Full text: Atomic Energy of Canada Limited (AECL) developed the Advanced CANDU Reactor-TM700 (ACR-700TM) as an evolutionary advancement of the current CANDU 6R reactor. As further advancement of the ACR design, AECL is currently developing the ACR-1000TM for the Canadian and international market. The ACR-1000 is aimed at producing electrical power for a capital cost and a unit-energy cost significantly less than that of the current generation of operating nuclear plants, while achieving shorter construction schedule, high plant capacity factor, improved operations and maintenance, increased operating life. and enhanced safety features. The reference ACR-1000 plant design is based on an integrated two-unit plant, using enriched fuel and light-water coolant, with each unit having a nominal gross output of about 1200 MWe. This paper presents the ACR-1000 features that are designed to mitigate limited core damage and severe core damage states, including core retention within vessel, core damage termination, and containment integrity maintenance. Core retention within vessel in CANDU-type reactors includes both retention within fuel channels, and retention within the calandria vessel. The moderator heavy water in the ACR-1000 calandria vessel, as in any other CANDU-type reactor, provides ample heat removal capacity in severe accidents. The ACR-1000 calandria vessel design permits for passive rejection of decay heat from the moderator to the shield water. Also, the calandria vessel will be designed for debris retention. Core damage termination is achieved by flooding of the core components with water and keeping them flooded thereafter. Successful termination can be achieved in the fuel channels, calandria vessel or calandria vault by water supply by the Long Term Cooling (LTC) pumps and by gravity feed from the Reserve Water System. The ACR-1000 containment is required to withstand external events such as earthquakes, tornados, floods and aircraft crashes. Containment

  12. SARNET: Severe accident research network of excellence

    International Nuclear Information System (INIS)

    Albiol, T.; Van Dorsselaere, J. P.; Chaumont, B.; Haste, T.; Journeau, Ch.; Meyer, L.; Sehgal, Bal Raj; Schwinges, Bernd; Beraha, D.; Annunziato, A.; Zeyen, R.

    2010-01-01

    Fifty-one organisations network in SARNET (Severe Accident Research Network of Excellence) their research capacities in order to resolve the most important pending issues for enhancing, with regard to Severe Accidents (SA), the safety of existing and future Nuclear Power Plants (NPPs). This project. co-funded by the European Commission (EC) under the 6. Framework Programme, has been defined in order to optimise the use of the available means and to constitute sustainable research groups in the European Union. SARNET tackles the fragmentation that may exist between the different national R and D programmes, in defining common research programmes and developing common computer tools and methodologies for safety assessment. SARNET comprises most of the organisations involved in SA research in Europe, plus Canada. To reach these objectives, all the organisations networked in SARNET contributed to a joint Programme of Activities, which consisted of: Implementation of an advanced communication tool for accessing all project information, fostering exchange of information, and managing documents; Harmonization and re-orientation of the research programmes, and definition of new ones; Analysis of the experimental results provided by research programmes in order to elaborate a common understanding of relevant phenomena; Development of the ASTEC code (integral computer code used to predict the NPP behaviour during a postulated SA), which capitalizes in terms of physical models the knowledge produced within SARNET; Development of Scientific Databases in which all the results of research programmes are stored in a common format (DATANET); Development of a common methodology for Probabilistic Safety Assessment of NPPs; Development of short courses and writing a textbook on Severe Accidents for students and researchers; Promotion of personnel mobility amongst various European organisations. This paper presents the major achievements after four and a half years of operation of the

  13. Dual unitarization scheme with several trajectories

    International Nuclear Information System (INIS)

    Chaichiam, M.; Hayashi, M.

    1977-12-01

    Consequences of bootstrap with several input Regge trajectories are investigated. We find that in a formal treatment of bootstrap the consistency requires the intercept of output Pomeron pole in the one-dimensional case to be larger than one: αsub(B)(0) > 1, a situation reminiscent of the one in the Reggeon field theory. Symmetry breakings of the Pomeron couplings are derived. These couplings coincide with those of the f-dominated Pomeron model of Carlitz-Green-Zee in the approximation, when in the unitarity loops only highest Regge trajectories are included. The case when all possible trajectories are exchanged is also discussed. Predictions of dual unitary model for the slopes of differential cross section for diffractive scattering are made which differ from the ones of the CGZ model. Comparison with the experimentally available data is done. (author)

  14. [Severe infective endocarditis through the history].

    Science.gov (United States)

    Rouzé, S; Leguerrier, A; Verhoye, J P; Flécher, E

    2017-02-01

    The history of infective endocarditis (IE) is a good example of medical progress. Initially incurable, endocarditis, when diagnosed, was synonym of death. After significant diagnostic progress, thanks to Osler's contribution especially, the first surgeries and antibacterial drugs obtained very few successful cures. We had to wait until Flamming's discovery to observe frequent cures thanks to antibiotics. Surgery manages to push possibilities of cure a bit further. However, paravalvular extensions, described since the first surgical case of IE, was a real technical matter. Thus, the second half of 20th century was devoted to overcoming this surgical challenge. In this historical review, we describe the story of severe IE, especially with paravalvular involvement, by highlighting major progress - clinical and surgical, that allows its current management. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Fission product behaviour in severe accidents

    International Nuclear Information System (INIS)

    Jokiniemi, J.; Auvinen, A.; Maekynen, J.; Valmari, T.

    1998-01-01

    The understanding of fission product (FP) behaviour in severe accidents is important for source term assessment and accident mitigation measures. For example in accident management the operator needs to know the effect of different actions on the behaviour and release of fission products. At VTT fission product behaviour have been studied in different national and international projects. In this presentation the results of projects in EU funded 4th framework programme Nuclear Fission Safety 1994-1998 are reported. The projects are: fission product vapour/aerosol chemistry in the primary circuit (FI4SCT960020), aerosol physics in containment (FI4SCT950016), revaporisation of test samples from Phebus fission products (FI4SCT960019) and assessment of models for fission product revaporisation (FI4SCT960044). Also results from the national project 'aerosol experiments in the Victoria facility' funded by IVO PE and VTT Energy are reported

  16. Correction of a severe Class III malocclusion.

    Science.gov (United States)

    Arslan, Seher Gündüz; Kama, Jalan Devecioglu; Baran, Sedat

    2004-08-01

    The success of early orthopedic treatment in patients with Class III anomalies depends on facial skeletal development and type of treatment. This case report describes the treatment of a 12.6-year-old girl who had a severe Class III malocclusion with a 6-mm anterior crossbite, a deep overbite, a narrow maxilla, and unerupted maxillary canines. The treatment plan included rapid palatal expansion to expand the maxilla, reverse headgear to correct the maxillary retrognathia, a removable anterior inclined bite plane to correct the anterior crossbite and the deep overbite, and fixed edgewise appliances to align the teeth. One canine was brought into alignment, but the other was placed in occlusion in its transposed position. Ideal overjet and overbite relationships were established, and the final esthetic result was pleasing.

  17. Antiinflammatory Effect of Several Umbelliferae Species

    Directory of Open Access Journals (Sweden)

    SUWIJIYO PRAMONO

    2005-03-01

    Full Text Available A screening for antiinflammatory effects was performed on several Indonesian Umbelliferae plants based on the contents of saponins and flavonoids. They were compared with Bupleurum falcatum L. as an introduced antiinflammatory plant. Roots and grains of each plant were collected, dried, and extracted with ethanol. The ethanolic extracts were then analyzed for their saponin and flavonoid contents by gravimetric and UV-vis spectrophotometric method. Antiinflammatory activity test was conducted on carragenin induced rat paw oedema. The results showed that the highest contents of saponin and flavonoid were found in the grains of Apium graveolens L. and showed antiinflammatory effect that was equivalent to that of the root of B. falcatum.

  18. [Severe mental disorders: cure? What an idea!

    Science.gov (United States)

    Vignat, Jean-Pierre

    The evolution of mental disorders, notably the most severe forms such as schizophrenia, is a constant concern in terms of the necessary assessment of treatments and their efficiency, and to the human and economic cost of the 'chronicity' of the disorders. Many patients experience a positive evolution, evaluated in terms of subjective quality of life. However, the concept of recovery does not seem appropriate. The field of representations which the patient and the caregiver form with regard to the disease and its curability is an important element. The co-construction of the patient's future, in an approach centred on the patient, on their freedom and their autonomy, opens up the way towards recovery. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. RECENT ADVANCES IN BIOMARKERS IN SEVERE BURNS.

    Science.gov (United States)

    Ruiz-Castilla, Mireia; Roca, Oriol; Masclans, Joan R; Barret, Joan P

    2016-02-01

    The pathophysiology of burn injuries is tremendously complex. A thorough understanding is essential for correct treatment of the burned area and also to limit the appearance of organ dysfunction, which, in fact, is a key determinant of morbidity and mortality. In this context, research into biomarkers may play a major role. Biomarkers have traditionally been considered an important area of medical research: the measurement of certain biomarkers has led to a better understanding of pathophysiology, while others have been used either to assess the effectiveness of specific treatments or for prognostic purposes. Research into biomarkers may help to improve the prognosis of patients with severe burn injury. The aim of the present clinical review is to discuss new evidence of the value of biomarkers in this setting.

  20. [Severe parachuting accident. Analysis of 122 cases].

    Science.gov (United States)

    Krauss, U; Mischkowsky, T

    1993-06-01

    Based on a population of 122 severely injured patients the causes of paragliding accidents and the patterns of injury are analyzed. A questionnaire is used to establish a sport-specific profile for the paragliding pilot. The lower limbs (55.7%) and the lower parts of the spine (45.9%) are the most frequently injured parts of the body. There is a high risk of multiple injuries after a single accident because of the tremendous axial power. The standard of equipment is good in over 90% of the cases. Insufficient training and failure to take account of geographical and meteorological conditions are the main determinants of accidents sustained by paragliders, most of whom are young. Nevertheless, 80% of our patients want to continue paragliding. Finally some advice is given on how to prevent paragliding accidents and injuries.

  1. Severe Accidents in the Energy Sector

    Energy Technology Data Exchange (ETDEWEB)

    Hirschberg, S; Spiekerman, G; Dones, R

    1998-11-01

    A comprehensive database on severe accidents, with main emphasis on the ones associated with the energy sector, has been established by the Paul Scherrer Institute (PSI). Fossil energy carriers, nuclear power and hydro power are covered in ENSAD (Energy related Severe Accident Database), and the scope of work includes all stages of the analysed energy chains, i.e. exploration, extraction, transports, processing, storage and waste disposal. The database has been developed using a wide variety of sources. As opposed to the previous studies the ambition of the present work has been, whenever feasible, to cover a relatively broad spectrum of damage categories of interest. This includes apart from fatalities also serious injuries, evacuations, land or water contamination, and economic losses. Currently, ENSAD covers 13,914 accidents, of which 4290 are energy related, and 1943 are considered as severe accidents. Significant effort has been directed towards the examination of the relevance of the worldwide accident records to the Swiss specific conditions, particularly in the context of nuclear and hydro power. For example, a detailed investigation of large dam failures and their consequences was carried out. Generally, while Swiss specific aspects are emphasised, the major part of the collected and analysed data, as well as the insights gained, are considered to be of general interest. In particular, three sets of the aggregated results are provided based on world wide occurrence, on OECD countries, and on non OECD countries, respectively. Significant differences exist between the aggregated, normalised damage rates assessed for the various energy carriers: On the world wide basis, the broader picture obtained by coverage of full energy chains leads to aggregated immediate fatality rates being much higher for the fossil fuels than what one would expect if power plants only were considered. The highest rates apply to LPG, followed by hydro, oil, coal, natural gas and

  2. An Asymptomatic Patient with Severe Mitral Regurgitation

    Directory of Open Access Journals (Sweden)

    Blase A. Carabello, MD

    2018-01-01

    Full Text Available In primary mitral regurgitation there are anatomic abnormalities of the mitral valve causing backward flow, placing a hemodynamic burden on the left ventricle. If this burden is severe and prolonged, it leads to left ventricular damage, heart failure, and death. The preferred therapy is restoration of mitral competence through mitral valve repair, which is safer than mitral valve replacement. When repair is performed in a timely fashion, lifespan can be returned to that of a normal individual. Triggers for timely repair include the onset of symptoms and evidence of left ventricular dysfunction as determined by ejection fraction falling toward 60% and/or end-systolic dimension increasing toward 40 mm.

  3. Method for consequence calculations for severe accidents

    International Nuclear Information System (INIS)

    Nielsen, F.; Thykier-Nielsen, S.; Walmod-Larsen, O.

    1986-08-01

    This report was commissioned by the Swedish State Power Board, who wanted a method for calculation of radiation doses in the surroundings of nuclear power plants caused by severe accidents. The PLUCON4 code were used for the calculations. A TC-SV-accident at Ringhals 1 wer chosen as example. A transient without shutdown leads to core meltdown through the reactor vessel. The pressure peak at the moment of vessel failure opens a safety valve in the dry well. Meteorolgical data for two years from the Ringhals meteorological tower were analysed to find representative weather situations. As typical weather were chosen Pasquill D with wind speed 8 m/s, and as extreme weather were chosen Pasquill F with wind speed 4.8 m/s. (author)

  4. Improvement of the severe accident practice tool

    International Nuclear Information System (INIS)

    Kawasaki, Ikuo; Takahashi, Shunsuke

    2016-01-01

    We developed the severe accident (SA) practice tool based on lessons learned in the accident at the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Station. We utilized the developed SA practice tool and carried out the SA training for some employees of Kansai Electric Power Co., Inc. Afterwards, we examined the opinions given by trainees attending the training lecture and improved the SA practice tool to achieve a better educational effect. The main changes we made were improvement of the practice scenario for EAL judgments and addition of functions to the practice tool such as the EAL explanation document indication. As a result of having carried out the SA education using this practice tool, we determined the tool users could make the right EAL judgment and report the communication vote. Finally, we confirmed that the knowledge necessary for SA correspondence could be given satisfactorily by this practice tool. (author)

  5. Big Rock Point severe accident management strategies

    International Nuclear Information System (INIS)

    Brogan, B.A.; Gabor, J.R.

    1996-01-01

    December 1994, the Nuclear Energy Institute (NEI) issued guidance relative to the formal industry position on Severe Accident Management (SAM) approved by the NEI Strategic Issues Advisory Committee on November 4, 1994. This paper summarizes how Big Rock Point (BRP) has and continues to address SAM strategies. The historical accounting portion of this presentation includes a description of how the following projects identified and defined the current Big Rock Point SAM strategies: the 1981 Level 3 Probabilistic Risk Assessment performance; the development of the Plant Specific Technical Guidelines from which the symptom oriented Emergency Operating Procedures (EOPs) were developed; the Control Room Design Review; and, the recent completion of the Individual Plant Evaluation (IPE). In addition to the historical presentation deliberation, this paper the present activities that continue to stress SAM strategies

  6. Ramsay Hunt syndrome with severe dysphagia.

    Science.gov (United States)

    Coleman, Crystal; Fozo, Michael; Rubin, Adam

    2012-01-01

    Ramsay Hunt syndrome, first described by J. Ramsay Hunt in 1907, encompassed the symptoms of otalgia, erythematous vesicular rash on the auricle, and facial paralysis. Although rare, in some cases, the varicella zoster virus responsible for the illness can also be associated with involvement of cranial nerves III-XII, cervical nerves, aseptic meningitis, and the syndrome of inappropriate secretion of antidiuretic hormone. We present a case of a patient with clinical evidence of Ramsay Hunt syndrome involving the cranial nerves V, VII, VIII, X, and, possibly, XII. Pharyngeal wall and vocal fold paralysis, and severely reduced laryngeal elevation, resulted in such significant dysphagia that percutaneous endoscopic gastrostomy tube placement was required. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  7. Thyrotoxicosis associated with severe hypoalbuminemia and hyperbilirubinemia

    Directory of Open Access Journals (Sweden)

    Mert Evlice

    2017-01-01

    Full Text Available Thyrotoxicosis is a known cause of nonspecific abnormalities in liver function tests: most commonly mild elevations in serum bilirubin and liver enzymes, and rarely decreases in serum albumin levels. We report a case of severe hyperbilirubinemia and hypoalbuminemia secondary to thyrotoxicosis in a 64-year-old woman who presented to our emergency department with complaints of jaundice, pruritis, and chronic diarrhea. In our case, the symptoms and signs of various abnormalities in liver function tests such as serum albumin and bilirubin normalized after euthyroid state. We think that these findings are related to thyroid dysfunction. Every hyperbilirubinemia and hypoalbuminemia, which can be seen in many serious diseases, may unexpectedly appear in the long-term progression of thyrotoxicosis. Whether thyrotoxicosis is present in patients with hyperbilirubinemia and hypoalbuminemia should be evaluated.

  8. Saccadic Alterations in Severe Developmental Dyslexia

    Directory of Open Access Journals (Sweden)

    Stefano Pensiero

    2013-01-01

    Full Text Available It is not sure if persons with dyslexia have ocular motor deficits in addition to their deficits in rapid visual information processing. A 15-year-old boy afflicted by severe dyslexia was submitted to saccadic eye movement recording. Neurological and ophthalmic examinations were normal apart from the presence of an esophoria for near and slightly longer latencies of pattern visual evoked potentials. Subclinical saccadic alterations were present, which could be at the basis of the reading pathology: (1 low velocities (and larger durations of the adducting saccades of the left eye with undershooting and long-lasting postsaccadic onward drift, typical of the internuclear ophthalmoplegia; (2 saccades interrupted in mid-flight and fixation instability, which are present in cases of brainstem premotor disturbances.

  9. Simulation of severe accidents in COTELS experiments

    International Nuclear Information System (INIS)

    Vasilev, Yu.S.; Zhdanov, V.S.; Kolodeshnikov, A.A.; Kadyrov, Kh. G.; Turkebaev, T.E.; Tsaj, K.V.; Suslov, E.E.

    1999-01-01

    At present, the issue of atomic reactor operation safety is of a great attention. It is evident that the accident accompanied with a core materials melting is an improbable event. To fully assess a hazard of a reactor use and enhance its safety, it is necessary to predict a possible accident progress and specify possible consequences of severe accidents and eliminating measures. In COTELS experiments, aimed at investigation of interaction of corium with concrete and water, the corium s imulator m elt is discharged on the concrete. The concrete erosion parameters, composition and rate of aerosol and gas escaping are recorded. The solidified melt and concrete fragments structure is studied after the testing, using the X-ray diffractometer DRON-3. This paper gives consideration to possible mechanisms of formation of uranium-containing and other phases of products of interaction of the corium melt with concrete and water

  10. Aerosol transport in severe reactor accidents

    International Nuclear Information System (INIS)

    Fynbo, P.; Haeggblom, H.; Jokiniemi, J.

    1990-01-01

    Aerosol behaviour in the reactor containment was studied in the case of severe reactor accidents. The study was performed in a Nordic group during the years 1985 to 1988. Computer codes with different aerosol models were used for calculation of fission product transport and the results are compared. Experimental results from LACE, DEMONA and Marviken-V are compared with the calculations. The theory of aerosol nucleation and its influence on the fission product transport is discussed. The behaviour of hygroscopic aerosols is studied. The pool scrubbing models in the codes SPARC and SUPRA are reviewed and some knowledge in this field is assessed on the background of an international rewiew. (author) 60 refs

  11. The several faces of the cosmological principle

    Energy Technology Data Exchange (ETDEWEB)

    Beisbart, Claus [TU Dortmund (Germany). Fakultaet 14, Institut fuer Philosophie und Politikwissenschaft

    2010-07-01

    Much work in relativistic cosmology relies upon the cosmological principle. Very roughly, this principle has it hat the universe is spatially homogeneous and isotropic. However, if the principle is to do some work, it has to be rendered more precise. The aim of this talk is to show that such a precification significantly depends on the theoretical framework adopted and on its ontology. Moreover, it is shown that present-day cosmology uses the principle in different versions that do not fit together nicely. Whereas, in theoretical cosmology, the principle is spelt out as a requirement on space-time manifolds, observational cosmology cashes out the principle using the notion of a random process. I point out some philosophical problems that arise in this context. My conclusion is that the cosmological principle is not a very precise hypothesis, but rather a rough idea that has several faces in contemporary cosmology.

  12. Severe Accidents in the Energy Sector

    International Nuclear Information System (INIS)

    Hirschberg, S.; Spiekerman, G.; Dones, R.

    1998-11-01

    A comprehensive database on severe accidents, with main emphasis on the ones associated with the energy sector, has been established by the Paul Scherrer Institute (PSI). Fossil energy carriers, nuclear power and hydro power are covered in ENSAD (Energy related Severe Accident Database), and the scope of work includes all stages of the analysed energy chains, i.e. exploration, extraction, transports, processing, storage and waste disposal. The database has been developed using a wide variety of sources. As opposed to the previous studies the ambition of the present work has been, whenever feasible, to cover a relatively broad spectrum of damage categories of interest. This includes apart from fatalities also serious injuries, evacuations, land or water contamination, and economic losses. Currently, ENSAD covers 13,914 accidents, of which 4290 are energy related, and 1943 are considered as severe accidents. Significant effort has been directed towards the examination of the relevance of the worldwide accident records to the Swiss specific conditions, particularly in the context of nuclear and hydro power. For example, a detailed investigation of large dam failures and their consequences was carried out. Generally, while Swiss specific aspects are emphasised, the major part of the collected and analysed data, as well as the insights gained, are considered to be of general interest. In particular, three sets of the aggregated results are provided based on world wide occurrence, on OECD countries, and on non OECD countries, respectively. Significant differences exist between the aggregated, normalised damage rates assessed for the various energy carriers: On the world wide basis, the broader picture obtained by coverage of full energy chains leads to aggregated immediate fatality rates being much higher for the fossil fuels than what one would expect if power plants only were considered. The highest rates apply to LPG, followed by hydro, oil, coal, natural gas and

  13. Overview of severe accident research at KAERI

    International Nuclear Information System (INIS)

    Kim, H.D.; Kim, S.B.; Hong, S.W.; Kim, D.H.

    2000-01-01

    The severe accident research program at Korea Atomic Energy Research Institute, within the framework of governmental 10 year long-term nuclear R and D program, aims at the development of assessment techniques and accident management strategies for the prevention and mitigation of potential risk. The research program includes experimental efforts, development of phenomena specific models and development of an integrated computer code. The results of research program is intended to be utilized for the design of the advanced light water reactor and development of accident management strategies for the operating reactors. The main focused areas of recent investigation at KAERI are experiments on in-vessel core debris retention (SONATA-IV) and fuel coolant interaction (TROI) along with the development of models and integrated computer code (MIDAS). (author)

  14. Xamoterol in severe congestive heart failure

    DEFF Research Database (Denmark)

    Tangø, M; Lyngborg, K; Mehlsen, J

    1992-01-01

    Twelve patients in severe congestive heart failure were given placebo, 100 mg xamoterol (Corwin) twice daily and 200 mg xamoterol twice daily, respectively, in 3 two-week periods in a double-blind randomised study. At the end of each treatment period the patients were evaluated. No differences were...... found between placebo and xamoterol in the following parameters: New York Heart Association function group index, heart volume, body weight, exercise duration on bicycle and treadmill, heart rate and systolic and diastolic blood pressure at rest. However, during exercise we found significantly lower...... heart rate and rate-pressure product during xamoterol treatment. This reduction is probably indicating occupation of beta-adrenoreceptors with concomitant reduced oxygen consumption during exercise....

  15. Intrathoracic lipoblastoma presenting with severe respiratory distress

    Directory of Open Access Journals (Sweden)

    Joseph Motshedi Sekgololo

    2017-12-01

    Full Text Available Lipoblastoma is a rare benign tumour which originates from an adipose tissue. In this study we report the case of a three year old boy who presented with a large intrathoracic tumour occupying the whole of the left hemithorax. He presented in severe respiratory distress. A chest X-ray showed total opacity of the left hemithorax, and CT-scan showed a low attenuation mass inkeeping with fat in the left hemithorax. A complete resection of a tumour was undertaken, with histopathology report confirming the diagnosis of lipoblastoma. The relevant literature review was done. At three and six months follow up, there was no recurrent tumour on imaging and the child had started thriving well.

  16. Comparative analysis among several cross section sets

    International Nuclear Information System (INIS)

    Caldeira, A.D.

    1983-01-01

    Critical parameters were calculated using the one dimensional multigroup transport theory for several cross section sets. Calculations have been performed for water mixtures of uranium metal, plutonium metal and uranium-thorium oxide, and for metallics systems, to determine the critical dimensions of geometries (sphere and cylinder). For this aim, the following cross section sets were employed: 1) multigroup cross section sets obtained from the GAMTEC-II code; 2) the HANSEN-ROACH cross section sets; 3) cross section sets from the ENDF/B-IV, processed by the NJOY code. Finally, we have also calculated the corresponding critical radius using the one dimensional multigroup transport DTF-IV code. The numerical results agree within a few percent with the critical values obtained in the literature (where the greatest discrepancy occured in the critical dimensions of water mixtures calculated with the values generated by the NJOY code), a very good results in comparison with similar works. (Author) [pt

  17. Therapeutic Challenge in a Severely Atrophic Mandible

    Directory of Open Access Journals (Sweden)

    Edvard Janev

    2018-03-01

    Full Text Available BACKGROUND: After tooth loss, however, severely atrophic residual alveolar ridges are fairly common, especially in patients who have been edentulous for a long period. Anterior area of the mandible is areas where clinicians have greater anatomical limitations. Reduced alveolar bone height very often represents a contraindication to implant therapy, unless a procedure such as a ridge augmentation is performed. CASE REPORT: This study aims to present two separate cases in highly selected edentulous anterior mandibular sites, where one stage, mini implants were used to support total prostheses. Small diameter implants have been used for retention of complete removable mandibular overdentures. This is an excellent option for those who suffer from the inconvenience and embarrassment of loose lower dentures and are tired of having to use sticky pastes and creams to make their dentures stay in place. CONCLUSION: Small diameter implants, when used multiples may offer adequate support for a removable prosthesis and overcome this problem.

  18. Therapeutic Challenge in a Severely Atrophic Mandible

    Science.gov (United States)

    Janev, Edvard; Janeva, Nadica; Peeva–Petreska, Marija; Mitic, Kristina

    2018-01-01

    BACKGROUND: After tooth loss, however, severely atrophic residual alveolar ridges are fairly common, especially in patients who have been edentulous for a long period. Anterior area of the mandible is areas where clinicians have greater anatomical limitations. Reduced alveolar bone height very often represents a contraindication to implant therapy, unless a procedure such as a ridge augmentation is performed. CASE REPORT: This study aims to present two separate cases in highly selected edentulous anterior mandibular sites, where one stage, mini implants were used to support total prostheses. Small diameter implants have been used for retention of complete removable mandibular overdentures. This is an excellent option for those who suffer from the inconvenience and embarrassment of loose lower dentures and are tired of having to use sticky pastes and creams to make their dentures stay in place. CONCLUSION: Small diameter implants, when used multiples may offer adequate support for a removable prosthesis and overcome this problem. PMID:29610621

  19. Brain SPECT in severs traumatic head injury

    International Nuclear Information System (INIS)

    Beaulieu, F.; Eder, V.; Pottier, J.M.; Baulieu, J.L.; Fournier, P.; Legros, B.; Chiaroni, P.; Dalonneau, M.

    2000-01-01

    The aim of this work was to compare the results of the early brain scintigraphy in traumatic brain injury to the long term neuropsychological behavior. Twenty four patients had an ECD-Tc99m SPECT, within one month after the trauma; scintigraphic abnormalities were evaluated according to a semi-quantitative analysis. The neuropsychological clinical investigation was interpreted by a synthetic approach to evaluate abnormalities related to residual motor deficit, frontal behavior, memory and language disorders. Fourteen patients (58%) had sequela symptoms. SPECT revealed 80 abnormalities and CT scan only 31. Statistical analysis of uptake values showed significantly lower uptake in left basal ganglia and brain stem in patients with sequela memory disorders. We conclude that the brain perfusion scintigraphy is able to detect more lesions than CT and that it could really help to predict the neuropsychological behavior after severe head injury. Traumatology could become in the future a widely accepted indication of perfusion SPECT. (authors)

  20. Myocardial Autophagy after Severe Burn in Rats

    Science.gov (United States)

    Zhang, Qiong; Shi, Xiao-hua; Huang, Yue-sheng

    2012-01-01

    Background Autophagy plays a major role in myocardial ischemia and hypoxia injury. The present study investigated the effects of autophagy on cardiac dysfunction in rats after severe burn. Methods Protein expression of the autophagy markers LC3 and Beclin 1 were determined at 0, 1, 3, 6, and 12 h post-burn in Sprague Dawley rats subjected to 30% total body surface area 3rd degree burns. Autophagic, apoptotic, and oncotic cell death were evaluated in the myocardium at each time point by immunofluorescence. Changes of cardiac function were measured in a Langendorff model of isolated heart at 6 h post-burn, and the autophagic response was measured following activation by Rapamycin and inhibition by 3-methyladenine (3-MA). The angiotensin converting enzyme inhibitor enalaprilat, the angiotensin receptor I blocker losartan, and the reactive oxygen species inhibitor diphenylene iodonium (DPI) were also applied to the ex vivo heart model to examine the roles of these factors in post-burn cardiac function. Results Autophagic cell death was first observed in the myocardium at 3 h post-burn, occurring in 0.008 ± 0.001% of total cardiomyocytes, and continued to increase to a level of 0.022 ± 0.005% by 12 h post-burn. No autophagic cell death was observed in control hearts. Compared with apoptosis, autophagic cell death occurred earlier and in larger quantities. Rapamycin enhanced autophagy and decreased cardiac function in isolated hearts 6 h post-burn, while 3-MA exerted the opposite response. Enalaprilat, losartan, and DPI all inhibited autophagy and enhanced heart function. Conclusion Myocardial autophagy is enhanced in severe burns and autophagic cell death occurred early at 3 h post-burn, which may contribute to post-burn cardiac dysfunction. Angiotensin II and reactive oxygen species may play important roles in this process by regulating cell signaling transduction. PMID:22768082